The Deepest Cut

All over Kansas City one fall evening, dieters tuned in to KMBC Channel 9 for a Healthwatch report that promised information on a weight-loss miracle. Thanksgiving was approaching, and those extra holiday pounds couldn't be far behind. Channel 9 reporter Kelly Eckerman said just what overweight people wanted to hear:

Imagine that you could eat whatever you want and still lose 20 to 50 pounds a month. Believe it or not, it's happening to people who are not on diets or an exercise routine. Instead, they are trying a different approach.

That approach was an innovative operation so effective that some experts predicted it would replace all other types of weight-loss surgery, Eckerman said.

In that November 2000 broadcast, Eckerman told viewers that physician Timothy Sifers was the only surgeon in the metro area performing the duodenal switch, a procedure touted as the most advanced of the obesity surgeries that had evolved since the crude stomach-stapling operations of the 1980s. Over the years, doctors had discovered flaws in some procedures: The Roux-en-Y technique caused patients to vomit if they ate too quickly or didn't chew thoroughly enough; adjustable gastric banding sometimes failed to result in weight loss; and biliopancreatic diversion could be accompanied by ulcers, chronic diarrhea, gas and major nutrient deficiencies. After the duodenal switch, though, patients lost at least as much weight as with the other procedures but didn't suffer as many complications.

"These people tend to be able to eat pretty much all they want to, but they still lose the weight," Sifers told Channel 9. Eckerman interviewed one of Sifers' patients, a 400-pound woman who said she'd just had the duodenal switch and was excited about her projected weight loss. Eckerman emphasized that the new type of surgery had no "annoying" side effects.

Watching in his south Kansas City home, Marion Bonura thought he had found the answer to his lifelong struggle with fat. In his early fifties, Bonura was so big that he couldn't zip his fly or trim his own toenails. His profession didn't make it any easier -- a fourth-generation restaurateur, Bonura, with his wife, ran Luigi's Restaurant on Holmes Road in south Kansas City, and they had helped their youngest son, Luigi, open the elegant new Trattoria Luigi's in a renovated design studio on the Plaza. (That restaurant closed in the spring of 2001.)

Bonura wanted to escape the constant culinary temptation. After the segment ended, he went to his computer and started researching the duodenal switch operation. A few weeks later, he called Sifers' office in Mission and set up an appointment for a consultation.

"He wanted that surgery really, really bad. It was all he could talk about after he'd seen it on TV," recalls his wife, Marian Bonura.

Marian went to her husband's consultation with him in January. They did everything together. At their restaurant six days a week, she cooked pasta while he chatted up customers and handled the business. Construction workers were building their dream house, and before it was finished they'd sneak in, put on old records and dance on the marble floors. Even their first names, Marion and Marian, were almost indistinguishable.

As they sat together in Sifers' waiting room, Marian Bonura had misgivings. She thought the operation was too risky. A nurse led the couple into a consultation room, and soon Sifers walked in. Marian remembers that he looked as if he'd just arrived from a beach vacation. His hair was bleached blond, and he wore multicolored floral surgical scrubs. Sifers pulled out a marker and some paper, Marian recalls, and drew diagrams of different types of surgical procedures.

"There were three of them Sifers told us about. He said the third one was the best surgery of all: the duodenal switch. I'll never forget the name," she says.

Bonura was ready to sign the consent forms and write a check for $15,000 -- $9,000 for Sifers and $6,000 for Overland Park Regional Hospital -- because his insurance would not cover the surgery. But his wife expressed doubts. She says she told Sifers that her husband had a history of blood clots and was taking the blood thinner cumidin. Other health problems had been brought on by obesity: He had inflamed veins in one leg, he suffered from kidney stones and he couldn't walk up a flight of stairs without getting winded.

"Sifers said no problem, it would be a walk in the park," Marian Bonura recalls.

Sifers' receptionist scheduled Bonura for surgery almost immediately, and Bonura handed over the cash, Marian Bonura says. On the day her husband went into the hospital, he told her he was scared. "Then don't do it," she told him. "We can go home right now." But at that moment, nurses arrived and wheeled him off to the operating room.

While she waited, Marian Bonura says she wondered whether she should have stopped him.

He'd been in her life since the 1960s, when she was 25 and answered a help-wanted ad for a waitress at his family's restaurant. Back then, Luigi's Restaurant and Cocktail Lounge was downtown, across from Katz's drugstore at 10th Street and Main. Six days a week, she went to work there. One day the young waitress walked into the kitchen, and there was Bonura, stirring a pot of spaghetti sauce. He looked at her and professed his love. "He had big old tears rolling down his cheeks," she recalls.