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South Mississippi Surgical Weight Loss Center Info Session
- 3. Our Program Began in 2000 2200 Total cases 629 Gastric Bypasses 615 Sleeve Gastrectomies 712 Adjustable Gastric Bands Data from 2000 to Date
- 4. Our Surgeons Dr. Pete Avara Bariatric Surgeon Medical Director Dr. David Jenkins Bariatric Surgeon
- 5. Our Patient Advocates Kim Fortier, MHS, PA-C Physician Assistant Dena Trusler, RN, CBN Clinical Nurse Robyn Roberts, RMA Medical Assistant Valorie Barnes, MA Insurance Coordinator Tanya Delacruz, MA Billing Coordinator Allison Lewis Patient Outreach
- 6. Our Hospital Singing River Hospital Pascagoula, MS
- 7. Obesity is a Disease Psychological Emotional Genetic Behavioral Physical Hormonal Dietary “It’s Not Your Fault, But It’s Your RESPONSIBILI TY” -Dr. Pete Avara
- 8. Medical Weight Loss Full Meal Replacement Program utilizing OPTIFast® products Utilizes ‘Stimuli Narrowing’ to Help in Weight Control Weekly Behavior Modification For Patients with a BMI of 30-35 or Who Aren’t Candidates for Surgery Need to Lose a lot of Weight Before Surgery is a Safe Option Have Severe Medical Conditions that Prevent Surgery as a Safe Option Patients Can Lose an Average of 50 lbs in a 6 Month Period* *Per the Nestle Corporation’s studies, utilizing a 800 cal/day meal replacement option
- 9. Why Surgery? “Bariatric Surgery is the only proven method that results in durable weight loss.” 2 76.8% of Patients Show Remission to Type 2 Diabetes 3 Hypertension is Eliminated in 61.7% of Patients 3 High Cholesterol is Reduced in 70% of Patients 3 85.7% of Patients Show Improvement in Sleep Apnea 3 Joint Disease, Asthma, and Infertility Either Significantly Improved or Resolved 3 Information gathered from JAMA 2004
- 10. Criteria for Weight Loss Surgery BMI of 40 or Greater BMI between 35-40 with significant obesity related conditions: Diabetes Hypertension Severe sleep apnea
- 11. Important Considerations Be aware of risks and benefits of surgery Long Term Success Depends on a Lifelong Commitment to Your Health Involve Family and Friends in Your Decision, Success Improves with Support
- 13. Surgical Options Adjustable Gastric Banding Restrictive Sleeve Gastrectomy Restrictive Roux en Y Gastric Bypass Restrictive and Malabsorptive
- 14. Laparoscopic Adjustable Gastric Banding
- 15. Laparoscopic Adjustable Gastric Band Outpatient Procedure Return to Work in 4 Days to 1 Week Band Adjustments are Done Every 6 to 8 Weeks Once Band is at an Acceptable Fill Level Follow Up in Clinic Yearly with Labs Follow up is Lifelong
- 16. Band Adjustment
- 17. Adjustable Gastric Band Advantages Average of 40% Excess Body Weight Loss4 It is completely reversible Digestion and Absorption is Not Changed and Anatomy is Not Altered Slow and Gradual Weight Loss Resolution of Co-Morbid Conditions with Weight Loss
- 18. Adjustable Gastric Band Disadvantages Potential Injury to the stomach, liver or spleen Frequent Follow up Consisting of an Injection every 6 to 8 Weeks Potential of Infection or Leaking Around Port or Tubing Potential of Erosion of Band into Stomach Potential Stretching of Pouch or Slippage of Band Potential Intolerance to the Band
- 19. Band Slippage
- 21. Overnight Hospital Stay Return to Work in 1 to 2 Weeks Return to Clinic: 3 Weeks, 6 Months, and 1 Year, and Yearly Thereafter Lab Work done at 6 Months, and 1 Year, then Yearly Thereafter Follow up is Lifelong Laparoscopic Sleeve Gastrectomy
- 22. Laparoscopic Sleeve Gastrectomy Advantages Average of 65% Excess Body Weight Loss 4 No Dumping Syndrome Significant Improvement of Co Morbid Conditions
- 23. Potential for Leaks or Bleeding Along Staple Line Potential for the Sleeve to Enlarge Over Time if Lifelong Lifestyle Changes are not Made Potential for Stricture or Narrowing Not Reversible Laparoscopic Sleeve Gastrectomy Disadvantages
- 25. 2 to 3 Day Hospital Stay Return to Work in 1 to 3 Weeks Return to Clinic: 3 Weeks, 6 Months, and 1 Year, and Yearly Thereafter Labs Checked at 6 Months, and 1 Year, then Yearly Thereafter Follow up is Lifelong Laparoscopic Gastric Bypass
- 26. Gastric Bypass Advantages Average of 70% Excess Body Weight Loss 4 Significant Improvement of Co Morbid Conditions Especially Diabetes and Cholesterol Most Well Studied
- 27. Potential for Leaks or Bleeding Along Staple Line Potential for Malnutrition Potential for Strictures and/or Ulceration at the Connection Between the Pouch and Intestine Potential for Dumping syndrome Potential for Internal Herniation Potential for Enlargement of the Pouch Over Time with if Lifelong Lifestyle Changes are not Made Gastric Bypass Disadvantages
- 28. Other Surgical Options Vertical Banded Gastroplasty Duodenal Switch
- 29. Any person having surgery is at risk for certain complications: Pneumonia Blood clots Heart Attack Stroke Wound infections General Risks for Bariatric Surgery
- 30. Obesity is a Disease “It’s Not Your Fault, But It’s Your RESPONSIBILITY ” -Dr. Pete Avara
- 31. Insurance Benefits will be Verified An Assessment Visit will be Scheduled with the Surgeon or Physician Assistant The Next Steps
- 32. Preparation for Surgery Weight Management Perioperative Nutrition Class (PET) Psychological Evaluation
- 33. We WantYou to be Successful! Follow up is Key
- 34. 1. http://www.surgerylaparoscopic.co.uk/website/wp- content/uploads/2011/10/band-adjustment-3.jpg 2. Story of Obesity Surgery. ASMBS. http://asmbs.org/story-of-obesity-surgery- introduction/ 3. Benefits of Bariatric Surgery. ASMBS. http://asmbs.org/benefits-of-bariatric- surgery/ 4. Rationale for Surgical Treatment. ASMBS. http://asmbs.org/rationale-for- surgical-treatment/ References
- 35. Thank You For Coming! www.smsurgicalweightloss.com “Like” us on FACEBOOK
Editor's Notes
- SMSWLC is the ONLY center of excellence on the MS gulf coast extending to Mobile to the east, Slidell to the west, and Jackson to the north. That means our program and our hospital goes through yearly accreditation and inspections to make sure we are keeping the highest of quality standards as well as offering all aspects of support to our patients
- Read off slide…I usually note that Dr. Avara has been a part of our practice since it began in 2000.
- Dr Avara is our medical director. He took over as medical director in 2003. He is a board certified general surgeon who did his training at UMC in Jackson and is residency at University hospital in Jacksonville fl. He has special training in advanced laparoscopy, which is how we do all of our surgeries, and has done a mini fellowship in bariatrics. He is a resident of Pascagoula, MS and has been practicing in this area for 25 years. Dr. Jenkins is a board certified general surgeon. He did his training at UMC in jackson and his residency in the Air Force. He is career military having retired from the Air Force as a Colonel in 2008. He joined our practice at that time. Although he has not been doing surgery within our program for as long, Dr. Jenkins helped Keesler start their bariatric program in 2000.
- Give a little bio of each person. Make note that we also have a registered dietician on staff as well who is available at all times, however, our permanent dietician has recently left and we are working on hiring a new one.
- Explain this is where we do most of surgeries. This is where are site visits take place and that we have a dedicated OR team as well as specialized nursing staff to take care of our patients at this hospital.
- Obesity is a disease and its not as simple as calories in and calories out. It is our job to help the patient learn about their disease process and how to combat it for the rest of their life. We are not going to cure their disease, only put it in remission and its going to be a daily decision to wake up and make healthy choices.
- We use the OPTIFast MWL program. It has been around since the early 1980s. It utilizes a ‘stimuli narrowing’ technique that takes away your food choices and puts you on a structured low calorie regimen fortified with all of you dietary nutrients. This active weight loss phase is 12 weeks long. During this time you are coming in for weekly behavioral modification lessons to teach you about your eating style an approach to food. At the end of 12 weeks you enter a 6 week transition phase where you slowly reintroduce solid food back into the diet with a new perspective on how you eat and why to aid in your weight maintenance. Patients lose an average of 50lbs in a 6 month period and we recommend this for patients in that 30-35 BMI range who may not be a candidate for surgery. We will verify insurance benefits on this program and when we contact you we will let you know if this is an option under your insurance policy.
- Read from slide
- Read from slide…insurance determines comorbid conditions and Val will let them know what their insurance specifically requires if they fall in this category.
- Read from slide
- Talk about pre op weight loss and show where the liver lies over the top of the stomach. Losing weight before surgery reduces the fatty infiltration of the liver and allows us to gently lift the liver up and out of the way so we can do your surgery more safely.
- Read from slide
- We do all of our procedures laparoscopically with the use of very small incision and the use of trocars (show trocar) We will insert the trocar into your abdomen which gives us access to your abdominal cavity. We will do a general inspection of your abdominal cavity and gently clear a space behind the back of the stomach. We will insert one of two banding options, the Lap Band or the Realize band (show bands and explain which is which…the Lap band has the ridged balloon…and pass around). We will slip the band around the back of the stomach and buckle it like a belt buckle around the stomach. We will bring the tubing outside of the abdomen and attach it to a port. This port will be attached to your abdominal muscle under the skin so it can’t been seen, just felt. It is through this port that we will insert sterile water or saline into the port, which travels down the tubing and fills the balloon on the inside of the band. As the balloon fills it creates a small stomach pouch above the band which allows you to feel full for a longer period of time with a smaller amount of food.
- Read from slide
- Explain band adjustment and how the port is fastened to the abdominal muscle under the skin
- Read slide
- Read slide and explain what an erosion is and how a pouch can be stretched or slip and emphasize the need for long term behavioral changes to make this work.
- Explain picture…this can be diagnosed by upper GI series
- The sleeve is again done using laparosocopy with the use of small incision, trocars and a small camera. We will divide the blood supply around the outer edge of the stomach so we remove all of the arteries and veins supplying the outside of the stomach. We will use a laparoscopic stapler which will fire 6 rows of staples and divide in between them…leaving 3 rows of staples on one side and 3 rows of staples on the other side and divide the stomach all the way to the top. The light pink side of the stomach is removed from the abdomen, leaving you with a sleeve of a stomach. I would then explain how the pylorus remains in tact so the normal transit of food through their system remains the same.
- Read slide
- Read slide
- Read slide
- The RNY gastric bypass is also done laparoscopically. We will divide the top of the stomach to make a small stomach pouch roughly the size of a shot glass. We will then come down to the small intestine and divide it bringing one end up to meet the new stomach pouch then reconnecting the lower end (I usually have to explain that there is an opening at the lower anastamosis because the pic does not show that well). I explain then that food will come down the esophagus, fill the small stomach pouch and then enter the small intestine. The remaining stomach and small intestine is not altered and still functions normally. They will produce digestive enzymes that will meet your food at a different level. However, we do bypass the pylorus so food transits through your system faster than it did originally.
- Read slide
- Read slide. Give example of Jeffrey Brune for improvement of triglycerides (were 1800 before surgery normal is less than 150 with a BMI of 36, were 118 at three months after surgery)
- Read from slide. Explain in detail the malabsorption and what can happen if you don’t take vitamins. Explain that if you smoke you increase your risk of ulcer that won’t heal.
- Briefly explain other procedures they may read about but we don’t perform.
- Read slide
- Touch on obesity as a disease again.
- Let them know Val will contact them about insurance benefits and at that time they may schedule an appointment with the surgeon. They will have one on one time with the surgeon to discuss options and decide where they want to go. If you choose MWL you will meet with Kim and she will let you know what meal plan may work best for and give you options about how your plan structure will go including price estimates on product.
- If insurance requires they will then be scheduled for WM. If not, they will have to do a PET class (explain what that is). We will check pre op weight loss before surgery and we offer support group (tell when and where)
- Explain each number…we want them to be successful! Come to us if your struggling we want to help you!