Bariatric Surgery 101

Transcription

1 Bariatric Surgery 101

2 Dr. Brent Bell, MD Bariatric / General Surgeon

3 Medical Conditions Caused By Morbid Obesity Type 2 DM Hypertension Cholesterol Sleep Apnea Fatty Liver Asthma Osteoarthritis Reduced Fertility Cancer GERD

4 Mainstream Surgical Options Gastric Bypass Sleeve Gastrectomy Adjustable Band

5 Comparison of Treatments Method Weight Follow-Up Loss Period Commercial Weight Loss 3% TBW 2 years Sibutramine (Meridia) 9 lbs. 1 year Orlistat (Alli, Xenical) 6 lbs. 1 year Physician Supervised Diet 10 lbs. 2 years Lap Gastric Bypass 60 % EBW 5 years Lap Gastric Sleeve 50% EBW 4 years Lap Adjustable Band 33 % EBW 3 years

6 New FDA approved drugs Qsymia Phentermine+topiramate 6-9% TBW Belviq Serotonin-related appetite suppressant 3% TBW

7 Surgical Results Procedure Weight Loss Resolution Diabetes Resolution HTN Improve Lipid Panel Resolution Sleep Apnea Mortality Rate Lap Bypass 60% * 84% 75% 94% 85%.3% Lap Sleeve 50% * 68% 73% 81% 77%.3% Lap Adjust Band 33% * 48% 38% 71% 95%.3%

8 5 foot, 7 inches BMI 47.6

9 Procedure Lap Gastric Bypass Lap Gastric Sleeve Lap Adjustable Band Bleeding 5% 5% - Leak 1% 1% 1% Blood clot/dvt 0.3% 0.3% 0.3% Stricture 5% Less than 1% - Gallbladder 10% 10% 10% Attack Marginal Ulcer 5% - - Internal Hernia Less than 1% - - Erosion - - 1% Slip % Port or Tubing Problem %

10 Who Qualifies for Surgery? Body Mass Index 35+ Co-Morbidities Prior Failed Weight Loss Attempts Psychologically Stable Otherwise fit for anesthesia and surgery

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12 Surgery Facts Procedure Lap Gastric Bypass Lap Gastric Sleeve Lap Adjustable Band Operative Time Hospital Stay Recovery Time 2 hours 2 nights 2 weeks 1 hour 2 nights 2 weeks 1 hour Outpatient 2 weeks

13 Surgical Incisions

14 Pre-operative Evaluation Dietary visits REQUIRED Certified trainer visits - REQUIRED Psychological screening REQUIRED 2-5 year weight history Other medical tests as needed

15 Post-operative Expectations Transition diet from liquids back to regular diet over 2-3 months Lifelong monitoring of protein and vitamin levels every 3 12 months Monthly band adjustments BAND ONLY At least grams protein per day Procedure -specific vitamin regimen Individualized exercise regimen

16 Follow Up Schedule Physician: 2 week, 3 month, 6 month, 12 month then yearly Dietician: 1 month, 3 month, every 6 months Certified Trainer: 1 month, 3 month, every 6 months

17 OVERVIEW Steps to Surgery Patient recruitment Verify Insurance Coverage FOR BARIATRICS Office visit with surgeon Complete insurance requirements Submit packet to insurance Receive approval number or denial Schedule surgery

18 Nutrition Counseling for Bariatric Surgery Lori Naber, RD, LD Registered Dietitian, Licensed Dietitian Advanced Training in Weight Management Nutrition Services , extension 6094

19 The RD s Vital Role in your Care Assist you with lifestyle changes to initiate before and after surgery Educate you on your hospital diet and post-surgery diet progressions from liquids to regular Help you minimize post-surgery complications (dehydration, vomiting, diarrhea, gas, etc.) Teach you label reading to navigate the maze of bariatric shakes and life-long vitamin/minerals supplements to prevent nutritional deficiencies Monitor your labs, weight, food intake, etc. to optimize your nutrient intake and maximize your weight loss

20 My Stomach Shrunk helping you to feel full to limit portion size! Current Stomach: 48 fluid ounce capacity or 1 ½ quarts Variable, highly individualized New stomach: Initially ~1 fluid ounce, stretching to 2-3 oz 70-90% less volume (varies with procedure) Perspective: 48 fl oz = 96 level tablespoons = 6 cups 1 fl oz = 2 level tablespoons = 1/8 cup

21 Diet Progression Post Surgery (times vary) Stage I, 1-2 days. Proper Hydration Only Clear Liquids (sugar free) Small sips using 1 oz medicine cup NO STRAWS Stage II, 2 weeks. Proper Hydration & Protein Bariatric Clear & Bariatric Full Liquids High Protein Bariatric Shakes (Low Fat, Sugar free) Stage III, 1-2+ months. Introduce Texture Sugar free, Low Fat: Puree to Mechanical Soft Foods Chew foods to toothpaste consistency ¼ -½ cup portions Fluids between meals Stage IV, Lifetime. Solid Foods Healthy Eating, 3 Meals per day, Limited Portions.

22 QUESTIONS FOR THE DIETITIAN?

23 Social Services Case Management Services Linda M. Jones, LCSW, ACSW Director of Social Services Golden Valley Memorial Hospital

24 Case Management Point of Contact Advocate Keeping Appointments Meeting Goals

25 Social Work Services Planning for behavioral and lifestyle changes Developing realistic goals and steps Keeping your weight reduction in perspective Assist to decrease obstacles Explore new image of self and how others respond to you Assist in obtaining SUCCESS!

26 Support Group Social workers will be leading monthly support groups with various topics related to the psycho/social issues related to weight loss and developing a new lifestyle of wellness This group will assist you and provide a forum for learning more with others

27 Bariatric Services Questions??