ADVANCE AT YOUR OWN PACE

AGENDA

• Welcome and Introductions

• Obesity and Its Impact on Health

• Surgeon Introduction

• Surgical Weight Loss Options

OSVALDO ANEZ, MD

• 28 years of experience

• Performed approximately 5,000 bariatric surgeries

• Medical degree: National University of La Plata, Argentina

• Residency: Washington Hospital Center – chief resident in general surgery

• Board Certified and Fellow of American College of Surgeons

• Member of the American Society for Metabolic & Bariatric Surgery

• Ideal Body Weight (IBW)

• Body Mass Index (BMI)

• Obesity

• Morbid Obesity

• Co-morbidities

• Indications for Surgery

WE WILL DISCUSS

IBW - WOMEN

Height

Feet Inches

Small

Frame

Medium

Frame

Large

Frame

4' 10" 102-111 109-121 118-131

4' 11" 103-113 111-123 120-134

5' 0" 104-115 113-126 122-137

5' 1" 106-118 115-129 125-140

5' 2" 108-121 118-132 128-143

5' 3" 111-124 121-135 131-147

5' 4" 114-127 124-138 134-151

5' 5" 117-130 127-141 137-155

5' 6" 120-133 130-144 140-159

5' 7" 123-136 133-147 143-163

5' 8" 126-139 136-150 146-167

5' 9" 129-142 139-153 149-170

5' 10" 132-145 142-156 152-173

5' 11" 135-148 145-159 155-176

6' 0" 138-151 148-162 158-179

IBW - MEN

Height

Feet Inches

Small

Frame

Medium

Frame

Large

Frame

5' 2" 128-134 131-141 138-150

5' 3" 130-136 133-143 140-153

5'' 4" 132-138 135-145 142-156

5' 5" 134-140 137-148 144-160

5' 6" 136-142 139-151 146-164

5' 7" 138-145 142-154 149-168

5' 8" 140-148 145-157 152-172

5' 9" 142-151 148-160 155-176

5' 10" 144-154 151-163 158-180

5' 11" 146-157 154-166 161-184

6' 0" 149-160 157-170 164-188

6' 1" 152-164 160-174 168-192

6' 2" 155-168 164-178 172-197

6' 3" 158-172 167-182 176-202

6' 4" 162-176 171-187 181-207

BODY MASS INDEX (BMI) Base on weight and height

BMI RANGES

• Normal 18.5-24.9

• Overweight 25.0-29.9

• Obese 30.0-34.9

• Severe Obesity* 35.0-39.9* (with 1 or more co-morbidities)

• Morbid Obesity 40.0-49.9

• Super-Morbid Obesity >50

BMI ranges indicated for surgery

NHLBI 2000 (NIH), Practical Guide: Identification, Evaluation and Treatment of Overweight and Obesity in Adults

OBESITY: DISEASE OF EXCESS FAT STORAGE

• Multi-factorial

• Genetic

• Environmental

• Behavioral

• Costly

• Lifelong and progressive

• Causes multiple co-morbidities

• Life threatening

Genetic

Environmental

Behavioral

OBESITY: PROGRESSIVE

• Weight that increases the risk of developing medical conditions, such as: Type II Diabetes, Sleep Apnea, Hypertension, etc.

• >200% of ideal weight or >100lbs over weight

• BMI > 40

• BMI > 35 with one or more severe co-morbidity

• Life threatening

MORBID OBESITYThe most extreme form of obesity

• Type 2 Diabetes

• Hypertension

• Hyperlipidemia

• Respiratory Disease

• Sleep Apnea

• Depression

• Menstrual Irregularity

• Amenorrhea

• Dysmenorrhea

• Urinary Stress Incontinence

• Asthma/Pulmonary Disorder

• Gastroesophageal Reflux Disease (GERD)

• Degenerative Joint Disease (DJD)

• Heart Disease

• Gallstones

• Fatty Liver Disease

• Coronary Artery Disease

• Stroke

• Osteoarthritis

• Infertility

• Cancer

OBESITY: ASSOCIATED CONDITIONS

“Only surgery has proven effective over the long term for most patients with clinically severe obesity”

NIH Consensus Conference Statement, 1991

WHY SURGERY

INDICATIONS FOR SURGERY

• BMI >40

• Or BMI 35-39 + one severe co-morbidity

• Obstructive sleep apnea

• Type 2 diabetes

• Uncontrolled hypertension (high blood pressure)

• Failed previous weight loss attempts

• Morbidly obese for at least 5 years

• At least 18 years of age

12% of the U.S. Adult Population (more than 20 million people) meet this criteria

• The Digestive System

• Surgical Weight Loss Options

NORMAL DIGESTIVE SYSTEM

ESOPHAGUS

FUNDUS

BODY

THE DUODENUM

- The first 200cm of small bowel is the jejunum

- Last 300cm of small bowel is the ileum

- Jejunum + Ileum = 500 cm total small bowel length

The duodenum absorbs most:

CalciumIronVitamins Micronutrients

LOWER ESOPHAGEAL SPHINCTER (LES) STOMACH

Capacity: average 1000 ml

RESTRICTIVE PROCEDURES

• Adjustable Gastric Banding

• Sleeve Gastrectomy

RESTRICTIVE

Adjustable Gastric Banding• Pure restriction

• Progressive slow compression to prevent hunger

• No stomach stapling

• “Reversible”

• Simple, lower risk procedure

• Stomach remains intact

• Low malnutrition or vitamin deficiency (<1%)

• Expect about 50% EWL at 3 yrs & only 30% at 1 yr

Port Site

Small 15-30 cc pouch

RISKS

• Migration of implant (band erosion)

• Band slippage

• Pouch dilation

• Tubing-related complications (port disconnection, tubing kinks)

• Port-site infection/displacement

• Esophageal spasm

• Gastroesophageal reflux disease (GERD)

• Inflammation of the esophagus or stomach

RESTRICTIVE

Sleeve Gastrectomy

• Stomach reduced to 20-25% of original size

• Surgical removal of large portion of stomach

• Dramatically decreases ghrelin levels

• Average weight loss greater than gastric band, less than gastric bypass

• Not reversible

COMBINATION (RYGBP)

• Produced better weight loss, faster and more consistent long term

• Level of risk similar with any other general surgical procedure

• Higher resolution of diabetes

• Best control or cure of acid reflux

• Studied extensively and effectiveness and safety proven

GASTRIC BYPASS (RYGBP)

• Makes the stomach smaller (restriction)

• Causes food to bypass part of the small intestine decreasing absorption of food

• Dumping syndrome

• Done by mini incision or laparoscopy

DUMPING SYNDROME

• Dumping Syndrome appears to be due largely to rapid entrance of ingested food into the small bowel. Water flows in from the bowel wall, producing both intestinal distention and a reduction in plasma volume. Generalized vasodilation may be a factor.

MINI INCISION RYGBP

• About 4” incision

• About 35 TO 45 minutes, requiring less anesthesia

• 1-3 days hospital stay

• Reversible

• 4-5 small incisions

• 1.5 to 3 hour

• 1 to 3 nights hospital stay

• Irreversible most of the time

LAPAROSCOPIC RYGBP

LAPAROSCOPIC RYGBP

MINI INCISION RYGBP

Mean co-morbidity resolution post RYGBP (www.ethicon.com)

• Mortality 0.5% (0.3 to 2.3%)

• Pneumonias 0.1%

• Blood Clots (in veins or lungs) 0.03-0.5%

• Bleeding 1.4%

• Wound Infection 5%

• Hernias 3.3% (Internal 0.5%)

• Staple line breakdown, stretched pouch and/or outlet, 5-10%

• Gallstones 30%

• Obstruction of the intestines or pouch

• Protein Vitamins and mineral deficiencies if the supplements are not taken

POTENTIAL COMPLICATIONS

QUESTIONS

This is your journey and you are in charge of your success. We are here to assist you along the way!

To schedule an appointment, call 703 956-6743.