Lagb 1

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Lap Band Presentation

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  • With the LAP-BAND ® System, weight loss is slow and gentle—not as rapid from the start as with Gastric Bypass. Regular follow-up visits for nutrition and exercise education as well as for adjustments are necessary, however, for optimum results.
  • Although initial weight loss with Gastric Bypass is typically very rapid, at 5 years many LAP-BAND ® System and Gastric Bypass patients achieve comparable weight loss results. 55% of excess weight for the LAP-BAND ® System versus 59% with Gastric Bypass. * O’Brien P, McPhail T, Chaston T, et al. Systematic review of medium-term weight loss after bariatric operations. Obes Surg. 2006: 16; 1032-1040.
  • The LAP-BAND® System procedure is major surgery. As with any surgery there are possible risks and complications with the LAP-BAND® System including but not limited to infection, nausea, vomiting, band slippage and obstruction. all can be corrected with additional laparoscopic surgery. There is also a risk associated with the patients ability to tolerate an foreign object implanted in the body. Not all risks and complications are included in this presentation. For detailed risk information please visit www.lapband.com.
  • Prospective study on lap bariatric procedures with complications categorized using Clavien’s methodology (Clavien P. Proposed classification of complications of surgery with examples of utility in cholecystectomy. Surgery 1992; 111:518-526) for severity scores. Grade 3 and 4 are considered “major.” Grade Definition LAP-BAND® System RYGB BPD 1 Events carrying minor risk IV for hydration, hospitalized for nausea IV for hydration, hospitalized for nausea IV for hydration, hospitalized for nausea 2 Events requiring drug therapy, transfusions, hospital stay > 2x median stay Prolonged LOS for post-op edema Leak managed with TPN, PE Pancreatis, delayed gastric emptying 2b Events requiring endoscopy or reop (not requiring organ resection) Port or band revision Reop for bleeding, exploratory lap Reop for bleeding, exploratory lap 3 Events with lasting disability or requiring organ resection Sigmoid esophagus Revision of anastomosis, bowel resection Revision of anastomosis, bowel resection 4 Death Death Death Death
  • * Need full reference
  • Lagb 1

    1. 1. Laparoscopic Adjustable Gastric Banding Adam Kopelan, MD Acting Chairman of Surgery Newark Beth Israel Medical Center
    2. 2. SIGNIFICANT REDUCTION IN CO-MORBIDITY AT 5 YEARS <ul><li>* p<0.001 </li></ul>* * * * Christou NV, Sampalis JS, Liberman M, et al. Surgery Decreases Long-Term Mortality, Morbidity, and Health Care Use in Morbidly Obese Patients. Annals of Surgery 2004;240(3):416-424.
    3. 3. SIGNIFICANT REDUCTION IN CO-MORBIDITY AT 5 YEARS <ul><li>* p<0.001 </li></ul>* * Christou NV, Sampalis JS, Liberman M, et al. Surgery Decreases Long-Term Mortality, Morbidity, and Health Care Use in Morbidly Obese Patients. Annals of Surgery 2004;240(3):416-424.
    4. 4. FIVE-YEAR MORTALITY REDUCTION <ul><li>89 Percent Reduction in Risk of Death Over Five Years </li></ul>* Includes perioperative (30-day) mortality of 0.4%. p-value 0.001 Christou NV, Sampalis JS, Liberman M, et al. Surgery Decreases Long-Term Mortality, Morbidity, and Health Care Use in Morbidly Obese Patients. Annals of Surgery 2004;240(3):416-424.
    5. 5. LAPAROSCOPIC ADJUSTABLE GASTRIC BANDING <ul><li>Restrictive </li></ul><ul><li>Good results in Europe and Australia </li></ul><ul><li>LAP-BAND ® </li></ul><ul><li>REALIZE ® </li></ul><ul><li>FDA approved 6/01 </li></ul>
    6. 6. The LAP-BAND ® System
    7. 7. REALIZE ® Band
    8. 8. Adjustable Gastric Banding <ul><li>Advantages </li></ul><ul><li>No stomach stapling, cutting, or intestinal rerouting </li></ul><ul><li>Low perioperative complication rates </li></ul><ul><li>Low malnutrition risk </li></ul><ul><li>Free of “dumping syndrome” </li></ul><ul><li>Adjustable–customized per patient </li></ul><ul><li>Reversible </li></ul><ul><li>One-tenth the short-term mortality rates of open Roux-en-Y gastric bypass </li></ul><ul><li>Minimally invasive </li></ul><ul><li>Satiety-inducing procedure </li></ul><ul><li>Average patient does not need an overnight stay </li></ul><ul><li>Disadvantages </li></ul><ul><li>Slower initial weight loss than gastric bypass </li></ul><ul><li>Regular follow-up critical for optimal results </li></ul><ul><li>Requires implanted medical device </li></ul><ul><li>Less experience in the United States </li></ul>
    9. 9. Comparing Weight Loss Results Reference: 1. O’Brien P, McPhail T, Chaston T, et al. Systematic review of medium-term weight loss after bariatric operations. Obes Surg . 2006:16;1032-40. Laparoscopic adjustable gastric banding (LAGB) provides effective weight loss after 3 years, comparable to that seen with standard gastric bypass 1 *LAGB using the LAP-BAND ® System and another adjustable gastric band. Comparison is based on pooled data from 43 peer-reviewed reports involving at least 100 patients at entry and providing at least 3 years postoperative data.
    10. 10. Significant Excess Weight Loss Observed Over Time With the LAP-BAND ® System <ul><li>In a recent study, 62.0% ± 20.9% mean excess weight loss with the LAP-BAND ® System at 36 months (n=68)* 1 </li></ul>Reference: 1. Ponce J, Paynter S, Fromm R. Laparoscopic Adjustable Gastric Banding: 1,014 Consecutive Cases. J Am Coll Surg . 2005;201(4):529-35. <ul><li>Based on a chart review of 1,014 consecutive cases of patients undergoing LAP-BAND ® System surgery at a single center. Follow-up data were available for relatively few patients at 36 months (68 of 77) and 48 months (12 of 14). These data were collected prior to the development and launch of the LAP-BAND AP™ System. </li></ul>
    11. 11. Possible Risks and Complications <ul><li>Risks associated with any surgery, including death </li></ul><ul><ul><li>0.05% short-term mortality 1 </li></ul></ul><ul><li>Infection </li></ul><ul><li>Nausea and vomiting </li></ul><ul><li>Band Slippage </li></ul><ul><li>Erosion </li></ul><ul><li>Obstruction </li></ul><ul><li>Reoperation </li></ul>Data on File, Allergan, Inc. Reference: 1. Chapman A, Game P, O’Brien P. Laparoscopic adjustable gastric banding for the treatment of obesity: update and re-appraisal. ASERNIP-S Report No. 31, Second Edition. Adelaide, South Australia. ASERNIP-S, June 2002.
    12. 12. Possible Risks and Complications <ul><li>Remember: There are risks associated with any surgery </li></ul>*Published complication rates vary depending upon the institution and how the surgeon diagnoses and defines a particular complication. 1. Parikh MS, Laker S, Weiner M, et al. Objective comparison of complications resulting from laparoscopic bariatric procedures. J Am Coll Surg . 2006;202(2):252-61. 2. Chapman A, Game P, O’Brien P. Laparoscopic adjustable gastric banding for the treatment of obesity: update and re-appraisal. ASERNIP-S Report No. 31, Second Edition. Adelaide, South Australia. ASERNIP-S, June 2002. Categories LAP-BAND ® System Gastric Bypass Total Complications* 9% 1 23% 1 Major ( Grade III/IV ) Complications * 0.2% 1 2% 1 Short-term Mortality Rate 0.05% 2 0.5% 2 Grade I Events carrying minor risks Grade II Events requiring intervention, eg, drug therapy, TPN, blood transfusions, therapeutic imaging, or reoperation Grade III Events with residual and lasting disability and/or requiring organ resection Grade IV Death as a result of any complication
    13. 13. Comparison of Average Recovery Time 1 Reference: 1. Fisher BL. Comparison of recovery time after open and laparoscopic gastric bypass and laparoscopic adjustable banding. Obesity Surgery. 2004;14;67-72. The LAP-BAND ® System n=21 Open Bypass n=20 Lap. Bypass n=19 Length of Hospital Stay (Days) 1.3 3.5 2.5 Days to Normal Activity 7.2 17.6 18.2 Recovery (Days) 15.8 29.1 21.7
    14. 14. Lap-Band Versus RNYGP <ul><li>The LAP-BAND ® System </li></ul><ul><li>Minimally invasive 1 </li></ul><ul><li>55% average excess weight loss 5 years after LAGB surgery 2*+ </li></ul><ul><li>Lower short-term mortality (up to 10 times) and perioperative complication rates 3,4 </li></ul><ul><li>Adjustable long-term satiety 1 </li></ul><ul><li>Reversible 1 </li></ul><ul><li>Requires implanted medical device </li></ul><ul><li>Shorter hospital stay and recovery 5 </li></ul><ul><li>Long track record worldwide, 6 years experience in United States 1 </li></ul><ul><li>Regular follow-up required </li></ul><ul><li>Gastric Bypass </li></ul><ul><li>More invasive 1 </li></ul><ul><li>58% average excess weight loss 5 years after surgery 2* </li></ul><ul><li>Higher short-term mortality and perioperative complication rates 3,4 </li></ul><ul><li>Nonadjustable 1 </li></ul><ul><li>Difficult to reverse 1 </li></ul><ul><li>Does not require implanted medical device </li></ul><ul><li>Longer hospital stay and recovery 5 </li></ul><ul><li>Longer track record in the United States </li></ul><ul><li>Less frequent follow-up required </li></ul>1. Data on File, Allergan, Inc. 2. O’Brien PE, McPhail T, Chaston TB, Dixon JB. Systematic review of medium-term weight loss after bariatric operations. Obes Surg. 2006;16:1032-1040. 3. O’Brien PE, Dixon JB. Lap-Band®: Outcomes and Results. J Lap Adv Surg Tech . 2003;13(4):265-70. 4. Parikh MS, Laker S, Weiner M, et al. Objective comparison of complications resulting from laparoscopic bariatric procedures. J Am Coll Surg . 2006;202:252-261. 5. Chapman AE, Kiroff G, Game P, et al. Laparoscopic adjustable gastric banding in the treatment of obesity: A systematic literature review. Surgery . 2004;135(3):326-51. <ul><li>LAGB using the LAP-BAND ® System and another adjustable gastric band. Comparison is based on pooled data from 43 peer-reviewed reports involving at least 100 patients at entry and providing at least 3 years postoperative data. </li></ul>
    15. 15. SELECTION <ul><li>Choice of patient </li></ul><ul><li>Motivation of patient </li></ul><ul><li>Exercise </li></ul><ul><li>Sweet tooth? </li></ul>
    16. 16. EXPANDED CRITERIA J.B. Dixon et al. JAMA (2008) 299(3):316-323
    17. 17. EXPANDED CRITERIA J.B. Dixon et al. JAMA (2008) 299(3):316-323
    18. 18. EXPANDED CRITERIA MONTHS S. Sultan et al. Surg Endosc (2009) 23:1569-1573
    19. 19. EXPANDED CRITERIA MONTHS S. Sultan et al. Surg Endosc (2009) 23:1569-1573
    20. 20. EXPANDED CRITERIA S. Sultan et al. Surg Endosc (2009) 23:1569-1573
    21. 21. SUMMARY <ul><li>LAGB IS SAFE </li></ul><ul><li>SELECTION IS KEY </li></ul><ul><li>CO-MORBID CONDITIONS ARE IMPROVED </li></ul><ul><li>EXPANDED CRITERIA </li></ul>

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