Lose the Weight, Find your Life

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1 Bariatric Surgery: University of Iowa Lose the Weight, Find your Life Isaac Samuel, MD, FRCS, FACS Professor of Surgery Director, Bariatric Surgery 1 Present UI Bariatric Surgeons Jessica Smith, MD Peter Nau, MD Isaac Samuel, MD 2 U Iowa: The Birthplace of Bariatric Surgery 1966: Birthplace of Obesity Surgery under Edward E. Mason, MD, PhD the Father of bariatric surgery Dedicated his whole life to helping the severely obese patient. Founding President of the American Society for Bariatric Surgery (ASBS). 3 1

2 First Laparoscopic Gastric Bypass in Iowa 2000: UI the FIRST to introduce the laparoscopic approach to gastric bypass in the state of Iowa Dr. James Maher (Director ) Dr. Isaac Samuel (Director 2004 present) Dr. Cornelius Doherty (Past-President ASBS 1989) Dr. James Maher 1981, Iowa City 4 NIH 1991: Obesity is a Disease (AMA 2013) 1991: NIH Consensus Development Conference Gastric restrictive or bypass procedures could be considered for well-informed and motivated patients with acceptable risks. 5 NIH Criteria for Bariatric Surgery Low probability of success with non-surgical means Body Mass Index (BMI) > 40 (normal is 19-25), BMI > 35 with complications of obesity, or 100 lbs. over Ideal Body Weight (or Twice IBW) 6 2

3 UIHC Current Treatments of Choice Laparoscopic Roux-en-Y gastric bypass (LRYGB) Laparoscopic sleeve gastrectomy (LSG) 7 Roux-en-Y Gastric Bypass 8 Gastric Sleeve Laparoscopic Sleeve Gastrectomy 9 3

4 Problems of Open Weight Loss Surgery Incisional fluid collections Horrendous wound infections Incisional hernia repair 1/3 4-5 nights hospital stay 6-8 weeks off work Occasionally used for patients with previous open surgeries 10 Laparoscopic Gastric Bypass Surgery 11 Advantages of Laparoscopic Approach 5 to 6 key hole incisions Incisional hernia extremely rare (we ve had zero) Infection rate very low Less pain Quick recovery, return to activity Fewer Adhesions 12 4

5 UIHC Current Treatments of Choice LRYGB = Restrictive component (small pouch)» + Malabsorption component (bowel bypass) LSG = Restrictive component (narrow sleeve)» + Resective component (80% stomach removed) 13 Gastric Bypass Versus Gastric Sleeve Bypass Vs Sleeve: Too early to tell Bypass - 50 yrs, sleeve few yrs Complication rates are coming down Choice of surgery should be individually tailored for each patient based on the patient s individual circumstances and the surgeons experience/outcomes 14 Lap Band: Band on the run Band erosion into stomach Band slippage with dangerous acute gastric obstruction Band leak Tube-related complications (disconnection, kinks, leaks) Port-site infection Flipped port Esophageal spasm and dilatation Gastroesophageal reflux disease (GERD) Repeated adjustments of band High removal rate and conversion LRYGB/LSG 15 5

6 Benefits of Gastric Bypass: Treatment for Diabetes Mellitus II Headline News, February 2007: NIH issues an official statement that gastric bypass surgery is better than insulin in the treatment of Diabetes Mellitus II in the morbidly obese. Gastric bypass is the international gold standard. 16 Benefits: Reduces Related Problems Sleep apnea High blood pressure Diabetes Asthma Joint pain/arthritis Stress incontinence High cholesterol and triglyceride levels Heartburn Migraine, infertility, hyperlipidemia Will resolve close to 80% with Gastric Bypass Surgery. 17 Risks of LRYGB: Depends on where you go UI Program Achieves EXEMPLARY outcomes nationally 18 6

7 Recommended Plan for Obesity Surgery See a dietitian Start an exercise program Stop bad habits (pop, snacking, smoking) 19 Recommended Plan for Obesity Surgery See a dietitian Start an exercise program Stop bad habits (pop, snacking, smoking) Come to the University of Iowa Hospital Excellent patient education 100% laparoscopic rate Extremely low complication rates Long-term or life-long follow-up 20 Success Story # 1 Lost 120 lbs! Gained a husband! 250 lbs, BMI 43 Worked full time as an Accounts Manager Borderline HTN Heartburn Stress Incontinence Irregular Menses Infertile & divorced One year: 131 lbs, BMI 22, 100% EBWL Follows diet and exercise everyday All Co-morbidities resolved 3 y post-op had a healthy 7lbs baby boy 21 7

8 Bariatric surgery will only work if you work with it. It is not a cure - only a tool to help you reach your goals. 22 Center of Excellence Designations: Metabolic & Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) in conjunction with the American College of Surgeons Wellmark Blue Cross/Blue Shield Blue Cross Blue Shield - Blue Distinction United Resource Network Optum Health Aetna These designations underscore the program s excellence in patient education and outstanding clinical outcomes. 23 Bariatric Surgery is Metabolic Surgery 24 8

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