This document summarizes the bariatric surgery program at Singing River Hospital. It began in 2000 and has performed over 2200 cases, including 629 gastric bypasses, 615 sleeve gastrectomies, and 712 adjustable gastric bands. The program has two bariatric surgeons, several patient advocates, and offers three surgical options - gastric banding, sleeve gastrectomy, and gastric bypass. It details the procedures, risks, benefits, criteria, considerations and follow-up process for each surgery. The goal is to achieve significant and long-term weight loss and improve obesity-related health conditions through lifestyle changes and support.
4 things to keep in mind about gastric sleeve surgeryambisurgery
For further information about Gastric Sleeve Surgery, visit AMBI Surgery, A leading provider of Vertical Sleeve Gastrectomy, and other weight loss procedures at http://www.ambisurgery.com/procedures-gastric_sleeve.php today.
Ms Susan Moug's keynote speech 'The Promotion of Physical Activity - Everyone's Responsibility' at the SCPN's 'Be Active Against Cancer' conference, Tuesday 4th February 2014.
BARIATRIC SURGERY IN TREATMENT OF MORBIDLY OBESE PATIENTSweightlossindia
Only surgery has proven effective over the long term
for most patients with clinically severe obesity.”
- NIH Consensus Conference Statement, 1991
Surgery for the treatment of clinically severe obesity
is endorsed by:
The National Institutes of Health
The American Medical Association
The National Institute of Diabetes and Digestive
and Kidney Diseases
American Association of Family Practitioners
Weight Loss Solutions at Nova helps many lose weight safely and successfully.
Reduces blood pressure, diabetic and coronary conditions while improving mobility.
4 things to keep in mind about gastric sleeve surgeryambisurgery
For further information about Gastric Sleeve Surgery, visit AMBI Surgery, A leading provider of Vertical Sleeve Gastrectomy, and other weight loss procedures at http://www.ambisurgery.com/procedures-gastric_sleeve.php today.
Ms Susan Moug's keynote speech 'The Promotion of Physical Activity - Everyone's Responsibility' at the SCPN's 'Be Active Against Cancer' conference, Tuesday 4th February 2014.
BARIATRIC SURGERY IN TREATMENT OF MORBIDLY OBESE PATIENTSweightlossindia
Only surgery has proven effective over the long term
for most patients with clinically severe obesity.”
- NIH Consensus Conference Statement, 1991
Surgery for the treatment of clinically severe obesity
is endorsed by:
The National Institutes of Health
The American Medical Association
The National Institute of Diabetes and Digestive
and Kidney Diseases
American Association of Family Practitioners
Weight Loss Solutions at Nova helps many lose weight safely and successfully.
Reduces blood pressure, diabetic and coronary conditions while improving mobility.
Studies show that Gastric Bypass weight-loss surgery can provide long term health benefits for obese patients. To learn more about the pros and cons of weight-loss surgery visit ncweightloss.org. FirstHealth provides weight-loss options to patients in the Pinehurst, Raeford, Sanford, Lumberton, Laurinburg, Rockingham, and Troy regions of North Carolina and beyond.
From Fat to Fit - How to Jump - Start Your Metabolism and Get Amazing Weight ...MontanaDevis
Weight loss is one of the hottest topics ever. Everyone seems to be trying to lose weight nowadays. Most diet programs are about weight loss and body weight is often used as an indicator of fitness progress. But, this is an incorrect approach.
Your ultimate goal should always be to lose fat and reducing excess body fat is what you should be concerned about. Weight loss and Fat loss is NOT the same thing! Many people confuse the two terms, often believing that they mean the same, when in fact weight loss and fat loss are very different from one another.
Intermittent bolus feeding versus continuous enteral feedingDr. Prashant Kumar
Early enteral nutrition is recommended in critically ill adult patients. The optimal method of administering enteral nutrition remains unknown. Continuous enteral nutrition administration in critically ill patients remains the most common practice worldwide; however, its practice has recently been called into question in favour of intermittent enteral nutrition administration, where volume is infused multiple times per day.
This presentation will outline the key differences between continuous and intermittent enteral nutrition, describe the metabolic responses to continuous and intermittent enteral nutrition administration and outline recent studies comparing continuous with intermittent enteral nutrition administration on outcomes in critically ill adults.
PREVENTION OF ACUTE GI DISTURBANCES WITH A FUNCTIONAL FOOD FORMULATION DESIGNED TO SUPPORT AND MAINTAIN INTESTINAL BARRIER FUNCTION DURING SPORTS PERFORMANCE
Salamone Maurizio, Sponsiello Nicola, Daniele Carandini, Roberto Conte, Stefano Belgeri
this presentation is about what is enteral feeding and how it is being carried out etc., it also gives information about classification based on duration of feeding. there is an information about infusion techniques and the time required for it.
Early Enteral Nutrition in Critically Ill Patients is the best for helping early recovery, decreasing hospital stay and decreasing malnutrition in ICU
How? When? Formulas used? Access forms?
Studies show that Gastric Bypass weight-loss surgery can provide long term health benefits for obese patients. To learn more about the pros and cons of weight-loss surgery visit ncweightloss.org. FirstHealth provides weight-loss options to patients in the Pinehurst, Raeford, Sanford, Lumberton, Laurinburg, Rockingham, and Troy regions of North Carolina and beyond.
From Fat to Fit - How to Jump - Start Your Metabolism and Get Amazing Weight ...MontanaDevis
Weight loss is one of the hottest topics ever. Everyone seems to be trying to lose weight nowadays. Most diet programs are about weight loss and body weight is often used as an indicator of fitness progress. But, this is an incorrect approach.
Your ultimate goal should always be to lose fat and reducing excess body fat is what you should be concerned about. Weight loss and Fat loss is NOT the same thing! Many people confuse the two terms, often believing that they mean the same, when in fact weight loss and fat loss are very different from one another.
Intermittent bolus feeding versus continuous enteral feedingDr. Prashant Kumar
Early enteral nutrition is recommended in critically ill adult patients. The optimal method of administering enteral nutrition remains unknown. Continuous enteral nutrition administration in critically ill patients remains the most common practice worldwide; however, its practice has recently been called into question in favour of intermittent enteral nutrition administration, where volume is infused multiple times per day.
This presentation will outline the key differences between continuous and intermittent enteral nutrition, describe the metabolic responses to continuous and intermittent enteral nutrition administration and outline recent studies comparing continuous with intermittent enteral nutrition administration on outcomes in critically ill adults.
PREVENTION OF ACUTE GI DISTURBANCES WITH A FUNCTIONAL FOOD FORMULATION DESIGNED TO SUPPORT AND MAINTAIN INTESTINAL BARRIER FUNCTION DURING SPORTS PERFORMANCE
Salamone Maurizio, Sponsiello Nicola, Daniele Carandini, Roberto Conte, Stefano Belgeri
this presentation is about what is enteral feeding and how it is being carried out etc., it also gives information about classification based on duration of feeding. there is an information about infusion techniques and the time required for it.
Early Enteral Nutrition in Critically Ill Patients is the best for helping early recovery, decreasing hospital stay and decreasing malnutrition in ICU
How? When? Formulas used? Access forms?
Obesity is a life-long progressive, life threatening condition marked by the excess accumulation of body fat, which can significantly reduce life expectancy. When weight reaches extreme levels, it is called MORBID OBESITY and is a chronic condition with numerous medical, psychological and social consequences.
For more information visit - https://www.radiancehospitals.org/medical-treatment/bariatric-surgery
Nutritional Trends and Implications for Weight Loss Surgerymilfamln
Learning Objectives:
1. Describe and list the types of bariatric surgeries.
2. Identify current practice guidelines for MNT in bariatrics.
3. Identify key factors in pre-op assessments for long-term success.
Best Cardiology Hospitals in Vijayawadapriyareddy999
If you are looking for the best cardiology hospital in Vijayawada, look no further than Anu Hospitals. We have a team of experienced and qualified cardiologists who can diagnose and treat various heart conditions, such as coronary artery disease, heart failure, arrhythmia, and more. We also offer advanced cardiac procedures, such as angioplasty, bypass surgery, pacemaker implantation, and more. At Anu Hospitals, we care for your heart with compassion and excellence. Visit our website to learn more about our cardiology services and book an appointment today.
LGBTQ+ Adults: Unique Opportunities and Inclusive Approaches to CareVITASAuthor
This webinar helps clinicians understand the unique healthcare needs of the LGBTQ+ community, primarily in relation to end-of-life care. Topics include social and cultural background and challenges, healthcare disparities, advanced care planning, and strategies for reaching the community and improving quality of care.
Health Education on prevention of hypertensionRadhika kulvi
Hypertension is a chronic condition of concern due to its role in the causation of coronary heart diseases. Hypertension is a worldwide epidemic and important risk factor for coronary artery disease, stroke and renal diseases. Blood pressure is the force exerted by the blood against the walls of the blood vessels and is sufficient to maintain tissue perfusion during activity and rest. Hypertension is sustained elevation of BP. In adults, HTN exists when systolic blood pressure is equal to or greater than 140mmHg or diastolic BP is equal to or greater than 90mmHg. The
International Cancer Survivors Day is celebrated during June, placing the spotlight not only on cancer survivors, but also their caregivers.
CANSA has compiled a list of tips and guidelines of support:
https://cansa.org.za/who-cares-for-cancer-patients-caregivers/
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
Deep Leg Vein Thrombosis (DVT): Meaning, Causes, Symptoms, Treatment, and Mor...The Lifesciences Magazine
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This document is designed as an introductory to medical students,nursing students,midwives or other healthcare trainees to improve their understanding about how health system in Sri Lanka cares children health.
KEY Points of Leicester travel clinic In London doc.docxNX Healthcare
In order to protect visitors' safety and wellbeing, Travel Clinic Leicester offers a wide range of travel-related health treatments, including individualized counseling and vaccines. Our team of medical experts specializes in getting people ready for international travel, with a particular emphasis on vaccines and health consultations to prevent travel-related illnesses. We provide a range of travel-related services, such as health concerns unique to a trip, prevention of malaria, and travel-related medical supplies. Our clinic is dedicated to providing top-notch care, keeping abreast of the most recent recommendations for vaccinations and travel health precautions. The goal of Travel Clinic Leicester is to keep you safe and well-rested no matter what kind of travel you choose—business, pleasure, or adventure.
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Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
This conference will delve into the intricate intersections between mental health, legal frameworks, and the prison system in Bolivia. It aims to provide a comprehensive overview of the current challenges faced by mental health professionals working within the legislative and correctional landscapes. Topics of discussion will include the prevalence and impact of mental health issues among the incarcerated population, the effectiveness of existing mental health policies and legislation, and potential reforms to enhance the mental health support system within prisons.
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
Empowering ACOs: Leveraging Quality Management Tools for MIPS and BeyondHealth Catalyst
Join us as we delve into the crucial realm of quality reporting for MSSP (Medicare Shared Savings Program) Accountable Care Organizations (ACOs).
In this session, we will explore how a robust quality management solution can empower your organization to meet regulatory requirements and improve processes for MIPS reporting and internal quality programs. Learn how our MeasureAble application enables compliance and fosters continuous improvement.
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
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
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
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
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
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
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!