Weight Loss Surgery. Malabsorptive: Your intestines are rearranged to reduce the amount of food absorbed into the system

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1 The Region s Leader Weight Loss Surgery Table of Contents About Weight Loss Surgery 1 Laparoscopic Procedures 2 Adjustable Gastric Band 2 Biliopancreatic Diversion With Duodenal Switch 3 Rou-en-Y (RNY) 4 Sleeve Gastrectomy 5 Quick Comparison 6 What Happens How Will My Life Change 7-8 Am I a Candidate 9 Does My Insurance Cover Free Information Seminar 10 About Weight Loss Surgery Is Weight Loss Surgery For Me? You and your physician should consider weight loss surgery, also known as bariatric surgery, only if other methods of weight loss have not worked. If weight loss surgery is considered for treatment of morbid obesity, you should know what to epect before and after weight loss surgery, understand special considerations of the surgery and know the risks and responsibilities you take on when choosing weight loss surgery. The in Dayton is certified as a Bariatric Surgery Center of Ecellence. This distinction is given by the American Society of Metabolic and Bariatric Surgery and Surgical Review Corporation as the gold standard quality in weight loss surgery. This is a weight loss surgery patient s assurance of quality surgery and treatment. The Miami Valley Hospital (MVH) Weight Loss Surgery Center in Dayton was founded in Procedures and Services At the in Dayton, the surgeon will partner with you to decide which of the procedures will be best for you. Factors such as the amount of weight you need to lose, related medical conditions and your personal preference should all be considered when choosing a weight loss procedure. There are three types of weight loss surgeries, also known as bariatric surgeries: Gastric Restrictive: Your stomach is restricted so less food will fit into it Malabsorptive: Your intestines are rearranged to reduce the amount of food absorbed into the system Combination: Procedures combining aspects of the two types above More than 90% of the cases are completed laparoscopically (through a minimally invasive incision in your skin). Occasionally a procedure is completed with a traditional open procedure. Newer procedures are available that have a single incision. Discuss your preference with the surgeon. It s important to choose your procedure carefully, because all weight loss procedures involve adapting your life to accommodate the changes made to your digestive system. There are different risks associated with each procedure. Spend some time learning the advantages and disadvantages of the various procedures. Then, when you attend one of our free weight loss information sessions, you ll be ready to ask questions.

2 Adjustable Gastric Band The Adjustable Gastric Band is a constricting ring placed around your stomach to reduce the amount of food it will hold at one time. This is purely a gastric restrictive procedure, and it can be adjusted, if necessary, during an office visit. This procedure uses a minimally invasive laparoscope to place the adjustable band around your stomach. Pure gastric restrictive procedures tend to be the simplest weight loss procedures, with a shorter hospital length of stay and few complications. They also require stricter discipline for successful weight loss. It s possible to defeat the Adjustable Gastric Band surgery by gradually stretching the constricted stomach pouch, or by eating so frequently that weight loss eventually stops, or even reverses. Nevertheless, a loss of nearly 40%-60% of ecess weight is common with this procedure. On the plus side, the Adjustable Gastric Band has the fewest complications of any weight loss procedure. Other than tightly restricting the amount of food you eat, it creates few other changes in your eating and digestion. Advantages Fewer cosmetic issues Less risk of incision infections Less risk of hernias Quicker recovery Reversible Band can be adjusted at an office visit The procedure usually leads to a 40-50% loss of ecess weight Disadvantages Takes longer to lose weight Risk of leaks and bowel obstructions Patients need to be disciplined with eating Overeating and under-chewing can cause an obstruction or vomiting 2

3 Laparoscopic Procedures Laparoscopic procedures are operations performed with special tools through small holes in your skin. Instead of the large incision used in traditional surgery, the physician makes a few small holes and inserts tools and a small video camera. This method allows the physician to see eactly what they re doing and work with great precision. The primary advantage of laparoscopic procedures is that, with smaller incisions, you heal faster and can get back to your life faster. Laparoscopic surgery also offers significantly smaller scars. Occasionally, physicians encounter open complications of various sorts while operating laparoscopically. They may elect at that point to cut a traditional incision to complete the procedure. This change is usually unavoidable due to the comple nature of surgery and of weight loss surgery in particular. Your surgical team will do everything possible to make your surgery safe and effective, and sometimes this means converting a laparoscopic procedure to an open one. Duodenal Switch (DS) The Duodenal Switch (DS) procedure combines a reduction in your stomach size with a bypass of some of your small intestine. The effect is that you can eat less, and absorb less from the food you do eat. It s a combination gastric restrictive and malabsorptive procedure, and is highly effective in causing significant weight loss. This usually results In the largest loss: 70-09% of ecess weight of all procedures. This is the most comple of the weight loss procedures. Part of your stomach is removed and food is routed around most of the intestines. This usually results in the largest loss: 70-90% of ecess weight. All malabsorptive procedures including DS procedures cause significant permanent changes in your digestion. You ll need to monitor your vitamin and protein intakes carefully, and there will be changes in your elimination of waste. You can learn about these changes in detail at one of our free Weight Loss Information Sessions. On the plus side, the DS procedure is perhaps the most effective form of weight loss (bariatric) surgery. The majority of people who have this surgery lose between 70% and 90% of their ecess weight within two years. These people often report great satisfaction with the result of their surgeries. Typically, they feel the digestive complications the DS procedure causes are minor compared to the active life their new weight provides. Advantages Greater weight loss Allows more normal eating habits Less hunger Ulcers less likely No Dumping Syndrome (undigested contents of your stomach are dumped into your rapidly commonly causing abdominal cramps and nausea) Least chance of weight regain Functionally reversible small intestine too Disadvantages Highest risk of complications from surgery Nutritional supplements must be taken More frequent stools Foul-smelling stools & diarrhea Longest recovery Life long follow-up 3

4 Gastric Bypass The Gastic Bypass procedure is a combination gastric restrictive and malabsorptive procedure. It differs from the Biliopancreatic Diversion with Duodenal Switch (DS) in that it creates an even smaller stomach pouch and routes your intestines differently. Its effectiveness is between that of the Adjustable Gastric Band and the BPD/DS, but with fewer complications. Like the DS, the Gastric Bypass procedure causes permanent changes in your digestion. You must commit to lifelong vitamin supplements and careful monitoring of your protein intake. There are also changes in waste elimination, but the fact that this is the most popular weight loss procedure in the US indicates that many, many people find these changes acceptable. The Gastric Bypass procedure typically results in about 50-70% loss of ecess weight after two years. Laparoscopic Rou-en-Y The Laparoscopic Rou-en-Y is the most popular method of gastric bypass surgery due to the minimal scarring and fast recovery. A smaller pouch is stapled off in your stomach and part of the intestines is routed from this pouch. The pouch holds less food, giving you a full feeling. Advantages Dumping Syndrome (undigested contents of your stomach are dumped into your small intestine too rapidly, commonly causing abdominal cramps and nausea) forces you to control intake of sweets. This is seen as a benefit by those who want to stop eating sweets. Reversible in some cases Cures reflu Disadvantages Overeating and under-chewing can cause vomiting Longer recovery than the adjustable gastric band 4

5 Sleeve Gastrectomy This new procedure shows much promise, especially if you have a higher BMI and are at higher risk of surgery as a result of other co-morbidities( Such as diabetes, heart disease, sleep Apria).The physician removes a portion of the stomach, leaving a pouch or sleeve about the size and shape of a banana. The procedure is relatively simple and doesn t involve rerouting the intestines. Because your stomach still functions normally, there are usually few dietary restrictions. There is less chance of malnutrition than there is with the gastric bypass or duodenal switch. There is no long-term weight loss data to compare since this procedure is so new. Initial data shows that patients are losing 50-70% or more of their ecess weight. Advantages Fewer food restrictions Less hunger Does not involve any bypass of the intestinal tract Suitable form of surgery for high-risk patients No Dumping Syndrome Can be performed laparoscopically in patients who are etremely overweight Disadvantages Does not always produce the desired weight reduction Risk of leakage and of other complications directly related to stapling No long-term scientific studies on patient outcome Procedure cannot be reversed 5

6 Quick Comparison of Weight Loss Surgery Techniques Find the weight loss surgery technique that might be right for you with our Comparison Chart. Adjustable Gastric Band Gastric Bypass Duodenal Switch Sleeve Gastrectomy (Gastric Sleeve) Minimally Invasive Moderate Risk Factor Greatest Risk Factor Adjustable in Office Stomach Staple Partial Removal of the Stomach Required Partial Intestinal Bypass Eat Normal Amounts of Food Restricts Food Amounts Carb Restrictive Dumping Syndrome Changes Desire for Sugar Usually Cures Reflu Quickest Loss Slowest Loss 40-60% Ecess Loss 50-70% Ecess Loss 70-90% Ecess Loss 1-2 Year Loss Period 6

7 What Happens Before Weight Loss Surgery? It s important to understand that weight loss surgery, also known as bariatric surgery, does require certain preparation like any other surgery. Your physician and their staff will provide you with everything you need to know to be comfortable and prepared for the weight loss surgery you choose. You can epect meetings where you ll talk with medical professionals about your weight loss surgery preparation and your commitment to follow up and maintain a healthy weight. And as always, you should check with your medical insurance company to find out what s covered for your surgery and follow-up visits. Other things to epect include blood tests, -rays and physical eaminations to make sure weight loss surgery is right for you. The day before the procedure, your physician may request that you get a PICC line. This is a simple, nearly painless insertion of a thin tube into your arm. Unlike the traditional IV, the PICC line provides fluids and medication and can be used for drawing blood. This tube will be removed shortly after surgery. Weight loss surgery has many other unique preparations. You ll confer with a dietician about dietary changes you ll need to make after surgery. These include drinking fluids to keep hydrated, eating adequate protein and taking vitamin and mineral supplements to make sure your body receives what it needs. You ll also need to omit high-calorie foods and junk food. How Will My Life Change After Weight Loss Surgery? After weight loss surgery, also known as bariatric surgery, you ll start the actual process of losing weight. This process depends on many factors, and takes up to one to two years for most people. Depending on the type of weight loss surgery you have, you can return to work within a timeframe of a few weeks to a few months. Less Weight, More Life You should be up and walking right away. Moving around and following your diet will help you feel better quickly. It s important that you attend your weight loss support group and stay focused in the weeks before you return to work, so you can establish good habits to rely on for the months ahead. Your weight loss support group will be invaluable when it comes to helping you to stay disciplined and committed to losing the weight. As the weight comes off, you ll have more energy. Some of your health problems may start to lessen or even disappear completely. You ll find that old clothes no longer fit. Eventually, you ll be able to get about in public and enjoy life in ways that once seemed impossible. These positive changes are the beginning of the new life you ve been waiting for. With discipline and the help of your weight loss support group, you should be able to settle into your active new life. Things You Need to Know About Bariatric Surgery Weight loss surgery changes how your body operates, and there are a few things you ll have to get used to. They may put you off a bit as you read them here, but you can be sure that many, many people have had this surgery, and most feel these problems are a small price to pay for a new life. 7

8 Each Type of Weight Loss Surgery Has Its Own Issues Adjustable Gastric Band: Adjustable Gastric Band is the most popular and least invasive procedure. After a band has been placed around your stomach, you must be careful what you eat. Sweets and high-carb drinks should be reduced or completely eliminated. These old habits can slow down your weight loss process following a Adjustable Gastric Band. Too much food, especially food that hasn t been well chewed, can cause vomiting. Gastric Bypass: Following a gastric bypass, you may become lactose intolerant and will need to take supplements to compensate for nutrients your body doesn t absorb well. A gastric bypass will change your eating habits, too. Each weight loss procedure varies, but these are some general guidelines: No sweets, carbonated drinks, milk shakes, high-calorie supplements, high-fiber foods, alcohol, or between-meal snacks Don t drink fluids while eating. These fill your stomach before you get enough food Chew your food completely Don t eat until you feel stuffed You ve probably noticed that these changes in eating habits are the same common sense diet advice you ve heard all along. One of the great psychological benefits of weight loss surgery is that you feel a renewed sense of commitment and self-esteem after losing a few pounds. You may want to be more active and lead a full life again. And of course, this movement will lead to better health and faster weight loss. Weight Loss Surgery Concerns Sometimes there are issues with weight loss surgery (bariatric surgery). A small number of people are unhappy with the overall outcome of their surgery, or feel the surgery needs to be adjusted. In very rare cases, there is a medical complication that requires a revision or a reversal of a weight loss procedure. These surgeries are nearly always unique cases requiring a unique surgical strategy. Some surgeries are open and some are laparoscopic. If you re concerned about the possibility of such a special surgery, you are encouraged to bring that up when you come to one of our Information Seminars. Such concerns are normal and legitimate. Our physicians will be happy to answer your questions and help you uncover the root of your concern. The physicians and their support team at the in Dayton firmly believe that successful weight loss surgery depends on your motivation and commitment. So please bring up any doubts or fears you have and let us help you by clarifying whatever aspect of our weight loss programs concerns you. 8

9 Am I a Candidate for Weight Loss Surgery? Determining if you meet the guidelines for weight loss (bariatric) surgery is one of the first steps in your decisionmaking process. Our surgeons use the guidelines established by the National Institutes of Health (NIH) when considering treatment options for patients. NIH Guidelines for Recommending Bariatric Surgery Candidates for weight loss surgery should: Have a Body Mass Inde (BMI) of 40 or greater Have a BMI of 35 or greater with one or more co morbidities (associated illnesses or conditions such as diabetes) Individual with a BMI less than 35 may qualify for Lap Band surgery based on record FDA approved. Patients should also: Understand the risks and rewards of weight loss surgery Have a history of failed, non-surgical efforts at weight loss Commit to dietary, eercise, and other healthy lifestyle changes If you meet these guidelines, you may be a candidate for weight loss surgery. You and your surgeon will work together to make the final decision. Is Weight Loss Surgery for Me? The following questions will help you determine if weight loss surgery is right for you. 1. Are you 100 pounds or more overweight? 2. Is your body mass inde (BMI) 40 or greater? 3. Do you have a weight-related health problem such as diabetes or high blood pressure? 4. Have you tried to lose weight through conventional methods (eercise, diet programs, calorie counting, group sessions, one-on-one counseling) but been unsuccessful? Net Steps The qualification process includes a series of common medical tests. Also, you will meet with your surgeon, a nutritionist, a psychologist, an eercise therapist, and other support staff members prior to surgery. If you are interested in taking the net step in our Weight Loss Program, contact us at (937) 208-4YOU (4968). 9

10 Does My Insurance Cover Weight Loss Surgery Costs? You ll need to work closely with your physician to find out if your medical insurance covers all or part of your weight loss surgery costs. Weight loss surgery is also known as bariatric surgery. You will be responsible for costs not covered by your insurance. When your physician s office checks with your insurance company ask them to find out: If weight loss surgery insurance is ecluded What it does cover for weight loss surgery What your deductible is What your maimum out-of-pocket costs are If your insurance ecludes the procedure, then there s usually no appeal process to cover weight loss surgery costs. You ll need to pay for the surgery yourself. If they do cover the surgery, your physician s office will get a predetermination from your insurance company and let you know how much insurance will pay in your specific case and how much you will be responsible for. If approved, then your physician s office will pre-certify the surgery. Free Weight Loss Surgery Information Seminar To help you determine if weight loss surgery is right for you, we invite you to attend our free weight loss surgery seminar that provides the details about weight loss surgery and gives you an opportunity to ask questions directly to our surgeons. Please go here (link to registration) to register for the net seminar. Also, you may request a one-on-one consultation with one of our surgeons by calling our office at (937) 208-4YOU (4968). We look forward to providing you with the guidance and support that you need. Sincerely, Miami Valley Hospital Department of Bariatrics mvh.org/weightloss One Wyoming St. Dayton, Ohio mvh.org/weightloss The MVH Weight Loss Surgery Center is designated as a Bariatric Surgery Center of Ecellence. This distinction is given by the American Society of Metabolic and Bariatric Surgery/Surgical Review Corporation as the gold standard quality in weight loss surgery. It is a weight loss surgery patient s assurance of quality surgery and treatment. M-WLS /11 10