Detroit councilwoman's death after weight-reduction surgery focuses attention on such operations

Tuesday, September 10th 2002, 12:00 am

By: News On 6

DETROIT (AP) _ The death of a city councilwoman after weight-reduction surgery has focused attention on a newly available technique in which a noose is tightened around the stomach.

Councilwoman Brenda Scott, who weighed more than 300 pounds, died Sept. 2 from an infection caused by a stomach perforation, three days after surgery at Port Huron Hospital. The medical examiner ruled the death an accident.

Scott, 47, underwent a procedure called Lap-Band Adjustable Gastric Banding, which won approval from the Food and Drug Administration in June 2001. The procedure has been done on nearly 90,000 people in other countries, mostly in Europe, over the past nine years.

The procedure involves placing an adjustable silicone band around the upper part of the stomach, creating a small gastric pouch that limits food consumption and creates an earlier feeling of fullness.

Once in place, the device is inflated with saline and can be tightened or loosened. It is intended to remain in place permanently but can be removed if necessary. Surgeons use keyhole surgery to put it in place.

Other surgical treatments for obesity _ such as stomach stapling and gastric bypass _ are more invasive.

The FDA has said Lap-Banding is intended only for severely obese people _ those who are at least 100 pounds overweight or twice their ideal body weight and have failed to lose weight by diet, exercise and other means.

Doug Trigg, spokesman for INAMED Corp. in Santa Barbara, Calif. _ makers of the Lap-Band device _ said the death rate worldwide has been extremely low _ about 0.005 percent.

Port Huron Hospital, which has performed the procedure more than 80 times since March, had had no major complications before Scott's death, medical director Dr. Kevin Sullivan said Thursday. Sullivan would not comment on Scott's case but said the hospital continues to offer the operation.

The American Society for Bariatric Surgery in Gainesville, Fla., estimates that 63,100 Americans will have stomach-reduction surgery this year. That is up from 23,100 in 1997.

``It used to be considered on the fringes of medicine, and now it's pretty mainstream,'' said Georgeann Mallory, the association's executive director. ``More people know about it. More people have confidence in it.''

Mallory said she had no statistics on complications related to Lap-Banding because the procedure is so new in the United States. She said the death rate for gastric bypass is three in every 1,000 patients.

``There's risk associated with any surgery,'' she said. She added: ``Keep in mind that morbid obesity also carries risks.''

In clinical trials of Lap-Band, most of the 299 patients _ who also were required to diet and exercise _ steadily lost weight over three years.

Lap-Band patients typically leave the hospital within 24 hours. Scott left Port Huron Hospital on Aug. 31. By the next night, she was complaining of abdominal pain and was taken to Detroit Receiving Hospital. She died of peritonitis, an infection of the abdominal lining often caused by a surgical mistake.

Her family has retained attorney Geoffrey Fieger, whose clients have included assisted-suicide advocate Jack Kevorkian.

Fieger said two autopsies revealed perforations in Scott's stomach. He said there was no other way the holes could have occurred except in surgery.

``It's a no-brainer,'' Fieger said.

Jackie Viteri, spokeswoman for the Washington-based American Obesity Association, said she hopes the Scott death does not become an indictment of all weight-reduction operations.

``Each individual case is so different,'' Viteri said. ``There are a lot of options for treatment _ surgery being the most severe. But this shouldn't hinder someone from discussing that option with their surgeon.''