ADVANCE AT YOUR OWN PACE

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Scarlett Terry
5 years ago
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1 ADVANCE AT YOUR OWN PACE

2 Welcome and Introductions Obesity and Its Impact on Health Surgeon Introduction Surgical Weight Loss Options AGENDA

Washington Hospital Center chief resident in general surgery Board Certified and

3 OSVALDO ANEZ, MD 28 years of experience Performed approximately 5,000 bariatric surgeries Medical degree: National University of La Plata, Argentina Residency: Washington Hospital Center chief resident in general surgery Board Certified and Fellow of American College of Surgeons Member of the American Society for Metabolic & Bariatric Surgery

4 WE WILL DISCUSS Ideal Body Weight (IBW) Body Mass Index (BMI) Obesity Morbid Obesity Co-morbidities Indications for Surgery

5 IBW - WOMEN IBW - MEN Height Feet Inches Small Frame Medium Frame Large Frame Height Feet Inches Small Frame Medium Frame Large Frame 4' 10" ' 11" ' 0" ' 1" ' 2" ' 3" ' 4" ' 5" ' 6" ' 7" ' 8" ' 9" ' 10" ' 11" ' 0" ' 2" ' 3" '' 4" ' 5" ' 6" ' 7" ' 8" ' 9" ' 10" ' 11" ' 0" ' 1" ' 2" ' 3" ' 4"

6 BODY MASS INDEX (BMI) Base on weight and height

7 BMI RANGES Normal Overweight Obese Severe Obesity* * (with 1 or more co-morbidities) Morbid Obesity Super-Morbid Obesity >50 BMI ranges indicated for surgery NHLBI 2000 (NIH), Practical Guide: Identification, Evaluation and Treatment of Overweight and Obesity in Adults

8 OBESITY: DISEASE OF EXCESS FAT STORAGE Multi-factorial Genetic Environmental Behavioral Costly Lifelong and progressive Causes multiple co-morbidities Life threatening

9 Genetic Environmental Behavioral

10 OBESITY: PROGRESSIVE

11 MORBID OBESITY The most extreme form of obesity Weight that increases the risk of developing medical conditions, such as: Type II Diabetes, Sleep Apnea, Hypertension, etc. >200% of ideal weight or >100lbs over weight BMI > 40 BMI > 35 with one or more severe co-morbidity Life threatening

12 OBESITY: ASSOCIATED CONDITIONS Type 2 Diabetes Hypertension Hyperlipidemia Respiratory Disease Sleep Apnea Depression Menstrual Irregularity Amenorrhea Dysmenorrhea Urinary Stress Incontinence Asthma/Pulmonary Disorder Gastroesophageal Reflux Disease (GERD) Degenerative Joint Disease (DJD) Heart Disease Gallstones Fatty Liver Disease Coronary Artery Disease Stroke Osteoarthritis Infertility Cancer

13 WHY SURGERY Only surgery has proven effective over the long term for most patients with clinically severe obesity NIH Consensus Conference Statement, 1991

14 INDICATIONS FOR SURGERY BMI >40 Or BMI one severe co-morbidity Obstructive sleep apnea Type 2 diabetes Uncontrolled hypertension (high blood pressure) Failed previous weight loss attempts Morbidly obese for at least 5 years At least 18 years of age 12% of the U.S. Adult Population (more than 20 million people) meet this criteria

15 The Digestive System Surgical Weight Loss Options

NORMAL DIGESTIVE SYSTEM - The first 200cm of small bowel is the jejunum ESOPHAGUS LOWER ESOPHAGEAL SPHINCTER (LES) STOMACH Capacity: average 1000 ml FUNDUS - Last

16 NORMAL DIGESTIVE SYSTEM - The first 200cm of small bowel is the jejunum ESOPHAGUS LOWER ESOPHAGEAL SPHINCTER (LES) STOMACH Capacity: average 1000 ml FUNDUS - Last 300cm of small bowel is the ileum - Jejunum + Ileum = 500 cm total small bowel length BODY THE DUODENUM The duodenum absorbs most: Calcium Iron Vitamins Micronutrients

17 RESTRICTIVE PROCEDURES Adjustable Gastric Banding Sleeve Gastrectomy

risk procedure Stomach remains intact Low malnutrition or vitamin deficiency

18 RESTRICTIVE Adjustable Gastric Banding Pure restriction Progressive slow compression to prevent hunger No stomach stapling Reversible Simple, lower risk procedure Stomach remains intact Low malnutrition or vitamin deficiency (<1%) Expect about 50% EWL at 3 yrs & only 30% at 1 yr Small cc pouch Port Site

RISKS Migration of implant (band erosion)

Esophageal spasm Gastroesophageal reflux

19 RISKS Migration of implant (band erosion) Band slippage Pouch dilation Tubing-related complications (port disconnection, tubing kinks) Port-site infection/displacement Esophageal spasm Gastroesophageal reflux disease (GERD) Inflammation of the esophagus or stomach

20 RESTRICTIVE Sleeve Gastrectomy Stomach reduced to 20-25% of original size Surgical removal of large portion of stomach Dramatically decreases ghrelin levels Average weight loss greater than gastric band, less than gastric bypass Not reversible

21 COMBINATION (RYGBP) Produced better weight loss, faster and more consistent long term Level of risk similar with any other general surgical procedure Higher resolution of diabetes Best control or cure of acid reflux Studied extensively and effectiveness and safety proven

22 Makes the stomach smaller (restriction) Causes food to bypass part of the small intestine decreasing absorption of food Dumping syndrome Done by mini incision or laparoscopy GASTRIC BYPASS (RYGBP)

23 DUMPING SYNDROME Dumping Syndrome appears to be due largely to rapid entrance of ingested food into the small bowel. Water flows in from the bowel wall, producing both intestinal distention and a reduction in plasma volume. Generalized vasodilation may be a factor.

24 About 4 incision About 35 TO 45 minutes, requiring less anesthesia 1-3 days hospital stay Reversible MINI INCISION RYGBP

25 LAPAROSCOPIC RYGBP 4-5 small incisions 1.5 to 3 hour 1 to 3 nights hospital stay Irreversible most of the time

26 MINI INCISION RYGBP LAPAROSCOPIC RYGBP

27 Mean co-morbidity resolution post RYGBP (

28 POTENTIAL COMPLICATIONS Mortality 0.5% (0.3 to 2.3%) Pneumonias 0.1% Blood Clots (in veins or lungs) % Bleeding 1.4% Wound Infection 5% Hernias 3.3% (Internal 0.5%) Staple line breakdown, stretched pouch and/or outlet, 5-10% Gallstones 30% Obstruction of the intestines or pouch Protein Vitamins and mineral deficiencies if the supplements are not taken

29 QUESTIONS This is your journey and you are in charge of your success. We are here to assist you along the way! To schedule an appointment, call

SURGICAL MANAGEMENT OF OBESITY. Anne Lidor, MD, MPH Professor of Surgery Chief, Division of Minimally Invasive and Bariatric Surgery

SURGICAL MANAGEMENT OF OBESITY Anne Lidor, MD, MPH Professor of Surgery Chief, Division of Minimally Invasive and Bariatric Surgery Multi-Factorial Causes of Morbid Obesity include: Genetic Environmental