Weight loss Surgery at St. Agnes Hospital

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Weight loss Surgery at St. Agnes Hospital

• Kuldeep Singh, M.D., F.A.C.S.

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Spectrum of the obesity

• Terms Used to Describe Various Levels of Body Fat

Normal Weight (BMI 18.5 to 24.9)
Overweight(BMI 25 to 29.9)
Obese(BMI 30 to 34.9)
Severely Obese(BMI 35 to 39.9 )
Morbidly Obese(BMI 40 or more)
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Sizing Up Your Level of Body Fat

• Using the Body Mass Index (BMI)

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Health Risks
Related Diseases and Health Problems

• Obese people have more risk for
• Diabetes (type 2)
• Joint problems (e.g., arthritis)
• High blood pressure
• Heart disease coronary artery disease
• Gallbladder problems

Source The Surgeon Generals Call to Action to
Prevent Overweight and Obesity.
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Health Risks (cont.)

• Related Diseases and Health Problems
• In addition, obese people have more risk for
• Certain types of cancer (breast, uterine, colon)
• Digestive disorders (e.g. gastro-esophageal
  reflux disease, or GERD)
• Breathing difficulties (e.g. sleep apnea,
  asthma).
• Psychological problems such as depression.
• Problems with fertility and pregnancy.
• Stress Incontinence.

Source The Surgeon Generals Call to Action to
Prevent Overweight and Obesity.
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Using Surgery to Treat Obesity

• Types of weight-loss surgeries
• Malabsorptive procedures shorten the digestive
  tract
• Restrictive procedures reduce how much the
  stomach can hold
• Combined procedures shorten the digestive tract
  and reduce how much the stomach can hold

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Using Surgery to Treat Obesity- Restrictive
Techniques
Gastric Bypass (GBP)
LAP-BAND System
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Using Surgery to Treat Obesity- Malabsorptive
Techniques
Bilio-Pancreatic Diversion (BPD)
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Expected Outcomes from the Surgery

• Improvement in health problems, including
• Diabetes (type 2) 80 cure possible.
• High blood pressure 40 cure
• Asthma marked improvement
• GERD (gastro-esophageal reflux disease)
• Sleep apnea close to 100 cure
• Problems with fertility and pregnancy
• Depression.

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Laparoscopic Gastric Bypass

• Disadvantages
• Bigger operation and slower recovery.
• Practically irreversible
• Higher chances of nutritional problems such as
  Iron deficiency anemia and vitamin B 12
  deficiency.
• Higher chances of ulcers at the junction of the
  stomach and the jejunum.

• Advantages
• Rapid initial weight loss
• Higher total average weight loss .
• Over 40 years of surgical experience in USA

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How the LAP-BAND System Works

• A silicone band is placed around the upper part
  of the stomach
• A small pouch is created
• Your stomach holds less food
• You feel full faster and longer

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The LAP-BAND System Procedure

• Adjustable Band
• Can be adjusted in office or operating room
• No anesthesia needed.
• On average 4-5 fills in first year
• 1 or 2 fills second year if needed.

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The LAP-BAND System

• Advantages
• Lowest mortality rate
• No stomach stapling or cutting, or intestinal
  re-routing
• Adjustable
• Smaller operation , Reversible
• Lowest operative complication rate
• Low malnutrition risk

• Disadvantages
• Slower weight loss.
• Regular follow-up critical for optimal results
• Requires more commitment from the patient.
• Slippage or erosion and injury to the esophagus
  or stomach as possible complications.

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Who qualifies for the Bariatric Surgery?

• NIH criteria
• Weight BMI more than 40 or 35 with two serious
  illnesses.
• Free from untreated mental illnesses such as
  Bulimia and schizophrenia.
• Documented evidence of weight loss attempts. In
  Maryland 6 months over the past two years.
• Understanding by the patient that the surgery is
  only a tool to lose weight and need to have life
  style changes and exercise/ eating habits.
• Age 18-60 years of age

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Who does not qualify for Bariatric Surgery? Both
Lap Band and Gastric Bypass

• Those who cannot walk.
• Those who have severe heart disease.
• Heart failure.
• Angina and coronary artery disease.
• With severe lung disease.
• In whom surgery is not possible
• Extreme obesity. Absolute weight matters to an
  extent. I will not operate patients over 500 lbs.
• Limited exercise tolerance. You should be able to
  walk with me to the parking lot (2 blocks) and
  back without severe shortness of breath.
• Schizophrenia and Bulimia.

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Bypass or Band?? How to choose?some guidelines

• Bypass
• Bigger operation, higher risk, more weight loss
  and rapid weight loss.
• More nutritional problems anemia and ulcers.
• My preference severe obesity with lot of
  illnesses.
• Lap Band
• Smaller and safer surgery, quick recovery.
• Less nutritional problems, less anemia or ulcers.
• Unique problems such as Slippage and Erosions.
• Reversible.
• My preference BMI small with not so many
  diseases, women.

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The process for the surgery

• Make sure you meet the criteria for the surgery.
• Call your insurance company to check coverage.
• Make sure that we participate with your insurance
  or be willing to pay more out of Pocket expense.
• See the dietician and the psychologist.
• Fill all the forms and organize your folder into
  weight loss attempts, cardiac consult , Sleep
  Study and History and physical note form your
  doctor (whatever applies).
• Call the office and make appointment to see the
  Doctor.
• If you have questions whether you will qualify-
  Call the office to clarify.

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Best Outcomes are seen when

• When surgery is not the starting point but an
  event in the patients attempt to lose weight.
• When you leave all the excuses and get the job
  done. i.e. change eating habits and exercise.
• You are proactively involved in your care i.e.
  when you do not say nobody told me that!
  Empower yourself with the knowledge needed.
• When you are frustrated, desperate and angry with
  your weight. You can then channel your energies
  to achieve goals.

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When surgery does not work out well

• When you are first waiting for weight loss to
  occur after the surgery to start exercising.
• When your mother, wife or husband brings you for
  the surgical consult.
• When you have an excuse why you are not
  exercising or eating well.
• When you rely on surgery for weight loss. Surgery
  only reduces the amount you take in. You have to
  burn the fat by exercising. There is no other
  way.
• When you show up late in doctors office and
  start filling the forms there!!!!

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The Surgery_ Lap Band
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Lap Gastric Bypass