Source: The Surgeon General’s Call to Action to Prevent Overweight and Obesity.
Using Surgery to Treat Obesity
Types of weight-loss surgeries
Malabsorptive procedures shorten the digestive tract: BPD & BPD-DS
Restrictive procedures reduce how much the stomach can hold: Lap Band & Sleeve Gastrectomy
Combined procedures shorten the digestive tract and reduce how much the stomach can hold: Gastric Bypass
Using Surgery to Treat Obesity- Restrictive Techniques Sleeve Gastrectomy LAP-BAND System wo-pub2.med.cornell.edu/.../PublicA.woa/4/wa
Using Surgery to Treat Obesity- Malabsorptive Techniques Bilio-Pancreatic Diversion (BPD) We do not perform BPD, however we can refer you to surgeons in the area who perform this surgery
Mixed Techniques Roux-en-Y Gastric Bypass
Risk Benefit Ratio RISK Lap Band Sleeve Gastrectomy Roux –en-Y Gastric Bypass Bilio-Pancreatic Diversion HIGH LOW BENEFIT HIGH LOW Lap Band Sleeve Gastrectomy Roux –en-Y Gastric Bypass Bilio-Pancreatic Diversion Riskier the operation, the more effective it is
Expected Outcomes from the Surgery
Improvement in health problems, including:
Diabetes (type 2): 80% cure possible.
High blood pressure: 40% cure
Asthma: marked improvement
GERD (gastro-esophageal reflux disease):
Sleep apnea: close to 100% cure
Problems with fertility and pregnancy
Laparoscopic Gastric Bypass
Rapid initial weight loss
Higher total average weight loss .
Over 40 years of surgical experience in USA
Bigger operation and slower recovery.
Higher chances of nutritional problems such as Iron deficiency anemia and vitamin B 12 deficiency.
Higher chances of ulcers at the junction of the stomach and the jejunum.
How the LAP-BAND System Works
A silicone band is placed around the upper part of the stomach
A small pouch is created
Your stomach holds less food
You feel full faster and longer
The LAP-BAND System Procedure
Can be adjusted in office or operating room
No anesthesia needed.
On average 4-5 fills in first year
1 or 2 fills second year if needed.
The LAP-BAND System
Lowest mortality rate
No stomach stapling or cutting, or intestinal re-routing
Smaller operation , Reversible
Lowest operative complication rate
Low malnutrition risk
Slower weight loss.
Regular follow-up critical for optimal results
Requires more commitment from the patient.
Slippage or erosion and injury to the esophagus or stomach as possible complications.
Arose from need to perform a safer yet effective operation in patients with high BMI (>50) and multiple co-morbidities.
It is first stage of BPD-DS (Bilio-pancreatic diversion with Duodenal switch).
Designed as an separate staged procedure by Johnson in 1993.
Sleeve Gastrectomy (SG)
Complications and outcomes are somewhere between Adjustable Laparoscopic gastric Banding and Gastric Bypass.
Advantage of absence of Iron deficiency anemia, Marginal Ulcers, ability to perform upper endoscopic procedures and decrease the weight and co-morbidities to lead to any second staged procedure such as band, bypass or BPD.
Who qualifies for the Bariatric Surgery?
Weight: BMI more than 40 or 35 with two serious illnesses.
Free from untreated mental illnesses such as Bulimia and schizophrenia.
Documented evidence of weight loss attempts. In Maryland 6 months over the past two years.
Understanding by the patient that the surgery is only a tool to lose weight and need to have life style changes and exercise/ eating habits.
Age: 18-60 years of age
Those who cannot walk.
Those who have severe heart disease.
Angina and coronary artery disease.
With severe lung disease.
In whom surgery is not possible
Extreme obesity. Absolute weight matters to an extent. I will not operate patients over 500 lbs.
Limited exercise tolerance. You should be able to walk with me to the parking lot (2 blocks) and back without severe shortness of breath.
Schizophrenia and Bulimia.
Who does not qualifies for the Bariatric Surgery? These are our contraindications
Bypass or Band?? How to choose? some guidelines
Bigger operation, higher risk, more weight loss and rapid weight loss.
More nutritional problems: anemia and ulcers.
My preference: severe obesity with lot of illnesses .
Smaller and safer surgery, quick recovery.
Less nutritional problems, less anemia or ulcers.
Unique problems such as Slippage and Erosions.
My preference: BMI small with not so many diseases, women.
The process for the surgery
Make sure you meet the criteria for the surgery.
Call your insurance company to check coverage.
Make sure that we participate with your insurance or be willing to pay more out of Pocket expense.
See the dietician and the psychologist.
Fill all the forms and organize your folder into weight loss attempts, cardiac consult , Sleep Study and History and physical note form your doctor (whatever applies).
Call the office and make appointment to see the Doctor.
If you have questions whether you will qualify- Call the office to clarify.
Centers of Excellence
Awarded COE by most of the Insurers in Maryland (Blue cross, Atena, United Healthcare and Cigna).
Awarded COE by SRC (Surgical review Committee in June 2006 for full three years.
Morbidity and Mortality of Gastric Bypass surgery at St. Agnes Hospital 2001-2007 NA 65% 65% EBWL % 1 year NA 0.99% 5 % Marginal ulcer NA 0.95% 2.5% Bowel obstruction NA 4.5% 4.5% Re-admission NA 2% 2.5% Re-operations NA 8.5% 10% Morbidity 1.9% 0.23% 0.3% Mortality 3328 1300 55 000 Number of patients Washington State Data St. Agnes Program Average for Centers of Excellence (SRC) Variable
Comparison of % EBWL of Gastric bypass and Lap. Band patients Chapman et al.; Surgery 135:326-351: 2004
Resolution of co-morbidities after 1 year in Gastric bypass patients with Insurance mandated diet Jamal et al., SOARD 2:122-127; 2006 NS 79% 82% Joint pain NS 91% 84% GERD NA NA NA Sleep apnea NS 83% 100% Venous stasis NS 79% 93% Diabetes NS 71% 58% HTN P value No diet Preoperative diet Variable