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Bariatric Surgery

Bariatric Surgery. Dr. Jay Woodland St. Mary’s Weight Management Center Evansville Surgical Associates. Why is this relevant?. The most recent NHANES data show that 66.3% of Americans are overweight or obese . (2012) 31.4% are overweight 34.9% are obese. Obesity Rates. Weight (Kg)

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Bariatric Surgery

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  1. Bariatric Surgery Dr. Jay Woodland St. Mary’s Weight Management Center Evansville Surgical Associates

  2. Why is this relevant? • The most recent NHANES data show that 66.3% of Americans are overweight or obese.(2012) • 31.4% are overweight • 34.9% are obese

  3. Obesity Rates

  4. Weight (Kg) Height (m ) BMI = 2

  5. Definitions • Although BMI can be used for most men and women, it does have some limits. It may overestimate body fat in athletes and others who have a muscular build. BMI also may underestimate body fat in older people and others who have lost muscle.

  6. Indiana: 31.4% Kentucky: 31.3% Illinois 28.1%

  7. “Fattest place in America” • Evansville, IN • 37.8% obese • 66.7% overweight 2011 Gallup poll

  8. Body Mass Index vs. Mortality 400 350 High risk Mediumrisk 300 Lowrisk 250 Relative Mortality Rate 200 150 100 50 0 16 19 22 25 28 31 34 37 40 45 BMI(kg/m2) Source: NIH, NEJM, 1995

  9. Medical Complications of Obesity Pulmonary disease abnormal function obstructive sleep apnea hypoventilation syndrome Stroke Idiopathic intracranial hypertension Cataracts Nonalcoholic fatty liver disease steatosis steatohepatitis cirrhosis Coronary heart disease Diabetes Dyslipidemia Hypertension Severe pancreatitis Gall bladder disease Cancer breast, uterus, cervix colon, esophagus, pancreas kidney, prostate Gynecologic abnormalities abnormal menses infertility polycystic ovarian syndrome Phlebitis venous stasis Osteoarthritis Skin Gout

  10. Obesity is a Multifactorial Disease Behavior Environmental Genetics

  11. Obesity Treatment Pyramid Surgery Pharmacotherapy Lifestyle Modification Diet Physical Activity

  12. Benefits of weight loss • Improvement/resolution of related medical conditions • Being obese increases your risk of diabetes, heart disease, stroke, arthritis, and some cancers. If you are obese, losing even 5 to 10 percent of your weight can delay or prevent some of these diseases • Reduction of mortality risk (death) • Improved quality of life 95% of patients reported significant improvement in quality of life after bariatric surgery. • Improved self esteem

  13. Bariatric surgery • 10-fold increase over past decade • 200,000 in US each year • Most effective treatment for sustained weight loss

  14. Criteria to qualify for WLS • Ages 18 – 65 • BMI > 40 • BMI > 35 with Comorbidities • DM, HTN, OSA, hyperlipidemia, NASH, asthma, venous stasis… • Failed medically supervised wt loss attempts • Supportive family/social environment • Approved by insurance company or self-pay • Approved by St. Mary’s Bariatric Team

  15. Contraindications • Untreated major depression or psychosis (controlled or treated depression/anxiety does not rule you out as a candidate) • Current drug or alcohol abuse • Current smoker • Prohibitive anesthetic risk

  16. Contraindications • Women who want to become pregnant soon (must wait 18 months after surgery) • Individuals who continue to smoke cigarettes (eligible candidate must not have smoked for 8 weeks prior to first meeting with surgeon)

  17. The Multidisiplinary Team Physicians • Dr. Stephen Braun MD • Dr. Jay Woodland MD, FACS – Board certified surgeon • Dr. Erik Throop MD, FACS – Board certified surgeon Supportive Staff • Kathleen Ford ACSW, LCSW – behavioral counselor • Corey Filbert RD – nutrition coordinator • Sue Gries LPN • Lana Holman – lab and x-ray technician • Shellie Broshears – patient services • Debbie Fink – Insurance Specialist

  18. Pre-op Assessment • PFT • EGD • Cardiac • Labs

  19. Surgical Options • Roux-en-Y gastric bypass • Sleeve gastrectomy • Lap Band • Duodenal switch

  20. Roux-en-Y gastric bypass • Gold standard • Most common bariatric surgery in US • 65%in 2003, 47% 2011 • Restrictive, malabsorptive, and hormonal • 68% excess weight loss at 3 yrs • Laparoscopic • 2 nights in hospital

  21. Roux en Y Gastric Bypass

  22. Roux-en-Y Gastric Bypass • Advantages • Rapid initial weight loss • Higher total average weight loss • Hormone changes that satiety and appetite • Higher resolution of chronic illnesses • Longer experience in U.S. • Reversible

  23. Roux-en-Y Gastric Bypass • Disadvantages • Intestinal cutting/stapling required • Potential for nutritional deficiencies • Change in UGI anatomy for biliary tree

  24. Gastric Sleeve • Rapidly gaining popularity • Restrictive and hormonal • 62% excess weight loss at 3 yrs • Laparoscopic • 2 nights in hospital

  25. Sleeve Gastrectomy

  26. Gastric Sleeve • Advantages • Excess weight loss can be similar to gastric bypass • Not a malabsorptive procedure • Hormone changes that satiety and appetite • Digestive tract intact

  27. Gastric Sleeve • Disadvantages • Removal of portion of stomach • NOT reversible • Not as high resolution of diabetes as compared to gastric bypass • Can worsen reflux

  28. Lap Band • Falling out of favor • Restrictive • 41% excess weight loss at 3 yrs • Laparoscopic • Outpatient or 1 night stay

  29. Lap Band

  30. Lap Band • http://www.lapband.com/Compare-Lapband

  31. Lap Band • Advantages • Not malabsorptiveprocedure • Digestive tract intact • No stapling or rerouting • Reversible • Adjustable

  32. Lap Band • Disadvantages • Band adjustments • Erosion/Slipping • Port malfunction • Lowest resolution of comorbidities and long term weight loss

  33. Potential Early Complications • Bleeding 4% • anastomotic/intra-abdominal • Leak 1-3% • Infection <5% • Blood clot • DVT 1.3% • PE 1.1%

  34. Potential Late Complications • Marginal Ulcers 4% • Stricture 6% • Internal hernia 3% • Band erosion 2% • Band slip 6%

  35. Potential Late Complications • Nutritional Deficiencies • Iron, Calcium, vit D, vit B12, Folate • if non-compliant with long term follow up and vitamin protocol Prevention and Treatment = Nutritional Education, eating proper foods, vitamin and mineral supplementation for life, exercise, post op follow up

  36. Endoscopy • Pre operative • Ulcer, polyps, h pylori • Marginal Ulcer • Stricture • Stent for leak/stricture • Band erosion/slip

  37. St. Mary’s is committed to your long term success! Weight Loss Surgery is a “TOOL” • Long term commitment and follow up is necessary for success • Good nutrition • Exercise • Ensure adequate hydration • Take vitamins daily • Address social, emotional, and psychological connections with eating

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