Lap-Band for Weight Loss

1
Lap-Band for Weight Loss

• Marc Bessler, M.D.
• New York Presbyterian Center for Obesity Surgery
• FDA Approved

2
Obesity is a Disease

• 55 of Americans are overweight or obese
• These rates, already among the highest in the
  world, are increasing
• Patients suffer social and economic
  discrimination
• The Institute of Medicine calculated the health
  care cost to be more than 70 billion annually
• Mortality 2-10 fold increase

3
What Causes Obesity ?

• Obesity develops when energy intake consistently
  exceeds energy output
• Complex disease involving- genetics
  - physiology- metabolism - appetite
  regulation - environmental factors -
  psychosocial cultural

4
Why Lose Weight ?

• Feel Better
• Quality of Life
• Look Better
• Be Healthier
• Avoid Discrimination
• Live Longer

5
Medical Problems from Obesity

• Many medical problems are caused by or worsened
  by obesity.
• Most get better or go away with significant
  weight loss.
• These medical problems are called comorbidities.

6
Obesity Comorbidities

• High Blood Pressure
• Diabetes
• High Cholesterol
• High Triglycerides
• Heart Disease
• Joint Pains
• Difficulty Breathing
• Sleep Apnea

• Heartburn
• Urine Incontinence
• Varicose Veins
• Difficulty Exercising
• Fatty Liver
• Increased Cancer Risk
• Frequent Headaches
• Sex Hormone Problems

7
Morbid Obesity

• 100 pounds over Ideal Body Weight
• Body Mass Index of 40 or greater
• 80 pounds over Ideal Body Weight if causing
  significant comorbidity
• Body Mass Index of 35 or greater if causing
  significant comorbidity

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Ideal Body Weight
Metropolitan Life Insurance Height-Weight Table,
1983 Height Women Men Height Women
Men 410 115 58 143 151
411 117 59 146 154 50
119 510 149 157 51 122 511
152 160 52 125 136 60
155 163 53 128 138 61 167 54
131 140 62 171 56
134 142 63 174 57
137 145 64 179
9
Body Mass Index (BMI)

• A number that indicates degree of overweight.
• Eliminates height from consideration
• Calculated as 703 times weight in pounds
• divided by height in inches squared.
• Normal is 20-25

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BMI Table
Height in Inches Height in Inches Height in
Inches Wt 57 59 61 63 65 67 69 71 73 75 Wt
57 59 61 63 65 67 69 71 73 75 Wt 57 59 61 63 65
67 69 71 73 75 154 33 31 29 27 26 24 23 22 20
19 165 36 33 31 29 28 26 24 23 22 21 176 38 36 33
31 29 28 26 25 23 22 187 40 38 35 33 31 29 28 26
25 24 198 43 40 37 35 33 31 29 28 26 25 209 45 42
40 37 35 33 31 29 28 26 220 48 44 42 39 37 35 33
31 29 28 231 50 47 44 41 39 36 34 32 31 29 243 52
49 46 43 40 38 36 34 32 30 254 55 51 48 45 42 40
38 35 34 32 265 57 53 50 47 44 42 39 37 35 33 276
59 56 52 49 46 43 41 39 37 35 287 62 58 54 51 48
45 42 40 38 36 298 64 60 56 53 50 47 44 42 39
37 309 67 62 58 55 51 48 46 43 41 39 320 69 64 60
57 53 50 47 45 42 40 331 71 67 62 59 55 52 49 46
44 42 342 74 69 65 61 57 54 51 48 45 43 353 76 71
67 63 59 55 52 49 47 44 364 78 73 69 64 61 57 54
51 48 46 375 81 76 71 66 62 59 56 52 50 47 386 83
78 73 68 64 61 57 54 51 48 397 86 80 75 70 66 62
59 56 53 50 408 88 82 77 72 68 64 60 57 54 51 419
90 84 79 74 70 66 62 59 56 53 430 93 87 81 76 72
67 64 60 57 54 441 95 89 83 78 73 69 65 62 58
55 452 98 91 85 80 75 71 67 63 60 57 463 99 93
87 82 77 73 69 65 61 58
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Risk of Death and Obesity
D E A T H
BMI
12
Treatment Options

• Diets
• Exercise
• Behavior Modification
• Medication
• Surgery

13
Diets Dont Work !

• Almost anyone can lose weight dieting
• Almost no one can maintain long term weight loss
• 97 of patients 100 pounds or more overweight
  regain lost weight within 2 years
• Often gain more than was lost

14
Exercise

• Very important as part of any weight loss program
• Regular exercise causes more weight loss and
  keeps it off longer
• Length of time is more important than intensity
• Rarely enough as treatment alone

15
Medications

• Cause only modest weight loss 10-15
• Need to be taken indefinitely
• Often cause side effects
• Expensive and often not covered by insurance
• Only work well in combination with diet and
  exercise

16
Surgery

• There are 2 safe and effective procedures
  commonly used in the US
• Vertical Banded Gastroplasty
• Gastric Bypass
• 20 year history and follow up
• Only proven long term effective treatment
• Patients should have failed other treatments

17
Vertical Banded Gastroplasty

• VBG commonly known as Stomach Stapling
• Small stomach pouch
• Staples partition stomach
• Plastic band controls outlet to rest of stomach

18
Vertical Banded Gastroplasty

• Advantages
• Simple to perform
• Bottom of stomach and duodenum can be easily
  examined
• Low incidence of leaks
• Normal absorption of nutrients
• ? lower risk of bowel obstruction

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Problems with VBG

• Staple line can pull through (break)
• Band too tight for some causes vomiting
• Not adjustable
• Infection or erosion of band
• Can lead to poor dietary habits
• Failure in 25-50 of patients
• Has fallen out of favor in US

20
Gastric Bypass

• Small stomach pouch made from top of stomach
• Pouch empties directly to intestine
• Food and enzymes meet lower down in the intestine
• No plastic ring

21
Gastric Bypass Advantages

• No plastic ring
• Greater weight loss
• Causes avoidance of sweets and fats
• Most foods well tolerated
• Low failure rate
• Little weight regain

22
Problems with Gastric Bypass

• Higher rate of complications
• 1/2 - 1 death rate
• Vitamins and minerals poorly absorbed
• Laparoscopy may increase complications
• Difficult to reverse

23
Lap-Band System
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Lap-Band System

• System Components
• Silastic band
• Integrated bladder
• Self locking buckle
• Tubing
• Port

25
Lap-Band
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Lap-Band Port
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Lap-Band the Operation
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Lap Band Around the World

• Most common operation for obesity in Europe,
  Australia and South America.
• Over 50,000 implanted worldwide in past 9 years
• Extremely safe with good weight loss
• Recently FDA approval in the US

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Lap-Band Placement
30
Lap Band Closure
31
Lap-Band Placement
32
Lap Band Placement
33
Lap-Band Fixation
34
Diet after Operation

• Fluids
• Pureed foods
• Soft food
• Regular food
• Meats, fresh breads and white rice come last and
  may not be well tolerated except in small amounts
  and well chewed

35
Office Visits

• 2 weeks after surgery
• 6 weeks after surgery
• may have first band adjustment
• Monthly for first year
• band adjustments as indicated
• Quarterly in second year
• Yearly for life

36
Band Adjustment
37
Lap-Band Inflation
38
Over Inflation
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Components for Success

• Education
• Nurse
• understand procedure
• care after operation
• Nutritionist
• diet changes
• healthy balanced food choices

• Surgery
• Commitment
• follow up
• follow the rules

40
Weight Loss

• More Gradual than other operations
• Continues longer up to 2 years
• 1/3-2/3 of excess weight
• Depends on following rules
• No Sweets
• No Snacking
• No liquids with calories
• A Tool not a Miracle

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Complications

• Band Slippage 3-5
• Band Erosion 1-3
• Tubing Leak 2-3
• Port Infection 1-2
• Stomach Perforation lt1
• Esophageal Dilation ?
• Death lt0.1 (less than 1/1000)

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Summary

• Obesity is a significant health problem
• Non-surgical treatment is ineffective long term
• Gastric Bypass is currently most common in US
• Lap-Band most common in rest of World
• Lap-Band is safer than Gastric Bypass but may
  offer less weight loss on average
• Commitment to long term dietary change is key to
  success with Lap-Band

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Thank You