1) A 29-year old Saudi female patient underwent a gastric band adjustment procedure due to not reaching her required weight loss goal of 5 years after gastric band surgery. 2) During the procedure, the access port of the gastric band was located using fluoroscopy and saline was injected to tighten the band. 3) The patient felt some pain with needle insertion but no local anesthesia was used. The tightness was adjusted based on the patient's comfort and imaging findings.

1. Gastric Band Adjustment Case Study 31/10/2009 1 Done by: ShathaJamal Al-Mushayt Presented for: Dr. Abdullah Al-Huwaimel

2. Patient information Gender: Female Age: 29 years old Nationality: Saudi Professional diagnosis: Morbid Obesity Patient history: Gastric band surgery 5 years ago Exam type: Gastric Band Adjustment she could not reach the required weight..(still obese) 2

3. Contrast Media (CM) Type: Barium sulfate -340 g Preparationof CM: mixed with water Poured in a cup To be Swallowed by mouth 3

4. Patient preparation Patient had nothing by mouth for 4 hours before exam No pregnancy the patient was free of any object that may superimpose interested anatomic part under x-ray 4

5. Procedure Equipment Fluoroscopic unit Cotton pads Antiseptic fluid Needle & syringe Saline Pen marker Gastric band existed inside the patient body 5

6. Gastric Band System Gastric band (silicone ring) tube access port 6

7. How was Gastric band inserted by surgeon? The band was inserted around the upper part of the stomach The access port was placed just under the skin The tube connect between them >> See image 7

8. Inserted Gastric Band 8

9. Inserted Gastric Band Inserted band forms a small stomach pouch  less food is stored in the stomach, feel full sooner Band size is controlled by Injection or withdrawn of Saline. 9

10. Inserted Gastric Band The inner surface of the band ring is a balloon-like Injection  to tighten the band Withdrawn  to loose the band 10

11. Procedure’s Steps Patient was lying down on the x-ray table Palin radiograph was taken: AP supine, KV: 96 Table then was tilted up to 44 degrees –fowler's position (to prevent the normal reflux while CM drinking) 11

12. 12 Procedure’s Steps - The radiologist located the access port under x-ray & marked it- he sterilized the place by antiseptic cotton pad and inserted the needle into the port “Plain film of this case patient” The needle

13. Procedure’s Steps the patient was instructed to collect the Barium sulfate in her mouth and swallow it at once 13

14. Procedure’s Steps In this case, Saline was injected by the syringe & needle to tight the band Remember! “she could not reach the required weight..(still obese) “ 14

15. Procedure’s Steps The tight level depends on the patient’s comfort, displayed image and radiologist’s opinion 15 End of the procedure 

16. Result(finding) About 2 ml of saline was infused into the band Re-evaluation after adjustment shows: Passage of contrast to the stomach and Satisfaction of the patient 16 Dictating doctor, DimaJamjoom Signing and approving doctor, Al bagerNaserElbagirNasir

17. After Care Since the patient was satisfied with the band size while swallowing, she could go home. It was recommend to have a smooth meal the day of procedure The following day, must be able to eat normally 17

18. My Comment Patient felt little pain while inserting the needle. So, I wondered why did they not use local anesthesia to numb the skin?! The procedure was interesting. 18

19. Morbid Obesity 19 Obesity is an abnormal accumulation of fat. 20-40% over the ideal weight mild obesity 40-100%moderate obesity 100%  morbid obesity

20. Morbid Obesity Obesity considered morbid when it significantly increases the risk of obesity-related health conditions or serious diseases It is considered serious “chronic” disease: symptoms occur slowly over long period of time 20

21. Obesity In General Is one of the most serious public health issues of the 21st century Is a leading cause of death worldwide with increasing prevalence in adults and kids; 21

22. Causes Most commonly caused by a combination of: excessive dietary calories, lack of physical activity If a person eats more calories than he/she burns ,the person gains weight as the body stores the excess energy as fat Other causes: genetic susceptibility medical reasons. e.g. hypothyroidism psychiatric illness 22

23. Symptoms & Obesity-Related Health Conditions Major symptoms: Excessive weight gain & the large amounts of fatty tissue Obesity-Related Health Conditions: Hypertension Type II Diabetes Hypercholesterolemia Decreased fertility & pregnancy complications Gallstones Sleeping disorders etc. 23

24. Treatment Obesity is difficult to treat & weight may be regained. Diet, exercises are primary treatments Surgeries for sever cases 24

25. Hope You Like It ! Thank You 25

27. http://medicaldictionary.thefreedictionary.com/Obesity%2c+morbid

28. http://en.wikipedia.org/wiki/Obesity#Causes

29. http://www.medicinenet.com/obesity_weight_loss/article.htm26