Bariatric surgery

A bariatric boost for (diaphragm) hernia repair

These days, Joan Calhoun prefers to bike wherever she can—to the gym, to the golf course— simply because she can. She exercises every day. And she calls herself the “Energizer Bunny.”

Joan Calhoun after her surgery: “I feel
like I got a second chance at life,” she
says. “I embraced it and I ran with it.”

Rewind two years, and the Joan Calhoun you’d find would be a shadow of the woman you’d meet today.

Back then, however, weight and exercise were the least of her troubles. After a hard battle with breast cancer in 1998, Calhoun developed severe anemia—a problem her physicians attributed to her bouts with radiation and chemotherapy. As the problem worsened, she endured multiple endoscopies and colonoscopies that never yielded any results. Meanwhile, she began struggling to breathe, developed a near-crippling case of acid reflux and seemed to be bleeding internally.

All the while, physicians kept telling her, “Joan, you need to lose weight.” The observation wasn’t news to Calhoun. She knew she needed to shed some pounds, and she wanted to. But how could she? “I could barely get out of my chair,” she says.

Finally in 2004, the New Jersey native found her way to The Johns Hopkins Hospital Division of Gastroenterology.

From there, it took some time, some more tests, and a trial run of Nexium, which only proved temporarily successful, before gastroenterologist David Hutcheon realized what her problem was. Calhoun had developed a paraesophageal hernia through her diaphragm—in other words, a hole—and her stomach was protruding through it into her chest cavity, eventually resulting in bleeding ulcers, reflux, iron deficiency and the myriad other symptoms that, by then, she’d been struggling with for eight years. Then, in November 2008, Hutcheon sent Calhoun to Johns Hopkins gastrointestinal surgeon Anne Lidor to fix the problem.

“She was in pretty bad shape,” Lidor recalls.

Meanwhile, Calhoun’s situation was growing more critical: After months of receiving iron infusions, she was running out of viable veins, and her medical team was struggling to keep up with her iron deficiency. And so, Lidor agreed to operate. But there was a catch.

“When you try to fix hernias in overweight patients, the outcomes usually aren’t that good,” Lidor says. “You can have a hernia anywhere; it just means you have a hole somewhere you have muscle. The likelihood of recurrence is high.”

Consequently, Lidor recommended two procedures: One to repair the hernia and then a bariatric procedure in hopes that the subsequent weight loss would lessen the possibility of a recurrence.

Calhoun was stunned. “I didn’t come to Hopkins for weight loss,” she says. “I came because I couldn’t breathe. I felt like I was dying.”

The idea of bariatric surgery scared her. But if that was what it would take to get better, then that was what Calhoun would do. Once she agreed, Lidor set a date—Dec. 8, 2008—and booked an operating room at Johns Hopkins Bayview Medical Center.

Shortly after the six-hour laparoscopic operation was completed, Calhoun woke up in her recovery room. Within hours, she says, she was on the move. Six weeks later she was playing golf. A full year later and she’s shed 78 pounds, has no further bleeding or reflux, has more energy than ever, and hasn’t seen a hint that her hernia could make a comeback. Now retired and living in Marco Island, Florida, she spends her days bicycling, exercising and reveling in her newfound energy.

“It’s amazing,” says Calhoun.“I’m back to how I was 10 years ago.”

The surgeon speaks: A resounding success

By the time I met Joan Calhoun, she’d been struggling for years, all while her condition grew worse.

Joan Calhoun's
GI Surgeon, Anne Lidor

Unfortunately, even in very thin patients, fixing a paraesophageal hernia is a very challenging operation because usually the stomach has moved so high into the chest that it can take four or five hours to repair. There are a lot of important structures in the surgical field—the aorta, for instance—in addition to the vena cava, the lungs, the esophagus. Being overweight only complicates the condition and the surgery, not to mention increases the possibility of a recurrence.

And yet, because their health and energy suffer so much, it’s not uncommon for patients in Joan’s condition to struggle with their weight.

This is why I recommended to Joan that, in addition to the hernia repair, she also undergo a bariatric procedure called a sleeve gastrectomy. In all probability, the resulting weight loss would give her exactly the advantage she needed to prevent the hernia from returning and, as a bonus, would provide her with the energy and good health she so desperately wanted and deserved.

Of course, bariatric surgery is a huge decision and requires a significant commitment and lifestyle change. Joan, fortunately, was not only a candidate for the surgery, but she also proved to be a very cooperative and willing patient.

Not only did she agree to the procedure, but she has since embraced the new way of life it entails. She’s done everything she needed to guarantee her own success with a healthy diet and exercise, commitment and dedication. Today, she’s thrilled with her quality of life and is a resounding success story. As a surgeon, I find it incredibly gratifying to see a patient emerge from a medical ordeal like she faced not only healthier, but happier.

--Anne Lidor

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