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Docs Forced to Alter Surgery Plans For Obese Girl

Doctors operating on Alexis Shapiro, a Texas girl suffering from rare medically induced obesity, had to switch plans mid-surgery Friday.
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Doctors operating on a Texas girl suffering from rare medically induced obesity had to switch plans mid-surgery Friday because of complications.

Alexis Shapiro, 12, of Cibolo, Texas, had a liver that was far larger and fattier than doctors anticipated, officials at Cincinnati Children’s Hospital Medical Center said in live tweets of the operation. Instead of performing a planned gastric bypass operation and a procedure to snip the vagus nerve, which controls appetite, the team led by Dr. Thomas Inge is performing a different kind of weight-loss surgery, a sleeve gastrectomy.

That procedure typically removes about 25 percent of the stomach, forming a sleeve-like structure that limits the amount of food a person can eat. Patients feel full sooner and wind up consuming less. The operation is irreversible.

Doctors said the surgery would still allow Alexis, who weighs 203 pounds, to lose weight, but it would also reduce the size of her liver, allowing the gastric bypass and the vagus nerve operation at a later date.

Parents Jenny and Ian Shapiro couldn't be reached immediately for comment, but a hospital spokeswoman, Danielle Jones, said they were satisfied with the doctors' decision, but worried about Alexis' reaction to additional surgery.

"The family is fine. They are confident that our doctors know what they are doing," Jones said.

Dr. Jeffrey Schwimmer, a Univeristy of California, San Diego, pediatric obesity expert not involved with Alexis' operation, said that the Cincinnati crew's decision made good sense. He said very large livers are common in kids with conditions like Alexis has, and that they can get in the way of delicate gastric bypass procedures.

"They made a clinical decision that this is the right approach at this time," he said. "That is consisent with the expected standard of care across the nation."

Alexis Shapiro developed a benign brain tumor called a craniopharyngioma more than two years ago. Surgery to remove it was successful, but it left her with hypothalamic obesity, a rare problem in which a patient's metabolism goes haywire. She gained massive amounts of weight and suffered from an insatiable appetite.

Instead of the planned three-hour operation, doctors finished the sleeve gastrectomy in about two hours.