endoscopic sleeve gastroplasty - dr. marvin › wp-content › uploads › 2018 › 11 ›...

2019

Endoscopic Sleeve Gastroplasty

Dr.RobertMarvin

6330WestLoopSouthSuite230

Bellaire,TX 77041

Office:713-993-7124Fax:713-963-0476

[email protected]

For Out-of-Town Patients

Dr.RobertMarvin6330WestLoopSouthSte.610

Bellaire,TX77401Office:713-993-7124Fax:713-963-0476

VISIONSTATEMENTHoustonSurgicalSpecialistsisamulti-physicianpractice,headedbyanexperiencedsurgeonwithatrackrecordofconsistentlyexcellentresults.Westrivetoprovideaglobalapproachtothecomplexproblemofmorbidobesitywithawiderangeoftreatmentplans,frommedicallysuperviseddiets,nutritionandvitaminplans,toalltheproveneffectivesurgicalprocedures.Ourgoalsaretoidentifypatientswhowillbenefitfrombariatricsurgery,provideconsistenterrorfreeapplicationofsurgicaltechnique,andeffectivepostoperativecarewithsubsequentclinicaloutcomesthatfarexceedrecognizedstandards.Byfulfillingthesegoals,weanticipatethatHoustonSurgicalSpecialistswillprovideconsistent,qualitycaretotheobesepatient,continuetoberecognizedbythepre-eminentsocietyofobesitysurgeonsintheUnitedStatesandbecomethepremierepracticeforthecareofobesityinourregion.

WithhelpfromDr.Marvinyoucanbefreefromtheburdenofobesity.

HSSEndoscopicGastroplastyDisclaimer1. Dr.Marvin doesNOT guarantee specific weight loss for any weight loss procedure to anyspecific patient. Too many factors are involved to make accurate predictions. Weight lossestimates are based on data reported in the medical literature and/or Dr. Marvin’s practiceexperience.2. Dr.MarvincanmakeNOguaranteeofthelongevityforendoscopicgastroplasty.Longtermdataisnotavailableforthisprocedure.Itispossiblethattheweightlosseffectmaydecreaseorbelostovertime.3. TheremaybeafailurerateassociatedwithEndoscopicGastroplasty.Failureisdefinedaslossoftheweightlosseffectwithinthefirst90daysaftertheprocedure.Datafromalargeinternationalcentersuggestthefailurerateforthisproceduremaybe5-7%.



PRE-OPINFORMATION&INSTRUCTIONS

Dr. Robert Marvin 6330 West Loop South Ste. 610

Bellaire, TX 77401

Office: 713-993-7124 Fax: 713-963-0476

www.doctormarvin.com

DAYOFSURGERY

YourSurgeryDateis:

Location:FirstStreetSurgicalHospital4801Bissonnet,Bellaire,TX77401

Pleasecallthefacilityfordirectionsoranyadditionalinformation713-275-1111

ArrivalTime:

**THEABOVETIMEISALWAYSSUBJECTTOCHANGE**

**Ifyouarerunninglate,getcaughtintrafficoranyotherunforeseendelay,pleasethehospitalknowthatyouarescheduledforsurgeryatthetimelistedaboveandwhattimeyouwillbearriving.



TRAVELINSTRUCTIONSFORNON-LOCALPATIENTSNomatterwhereyoulive,theESGweightlossprocedureisavailablewithDr.Marvin.PatientstraveltoHoustonfortheESGfromacrossthenationininternationally.LocatedinprestigiousBellaire,weareminutesfrommostattractionsintown.ThefacilitiesusedfortheESGarewithin5milesofDr.Marvin’sclinic.Houstonistheperfectlocationforstartingyourweightlossjourney.

Schedule

ConsultationsarescheduledwiththepatientandDr.Marvinoverthetelephone.Fortheprocedure;tominimizethelengthoftimeofffromworkandregularlife,thescheduleisa5day/4nightsstayinHouston.ThisisoneofthehighlyappreciatedperksoftheESG,veryquickrecovery!

o ThursdaymorningarriveinHoustonwithenoughtimeforyourPre-opappointwithDr.Marvin.

Labsarerequiredandonlybillablethroughinsuranceinhouse.*

o FridaymorningwillbetheESGprocedure,recovery2-4hours,thenreleasedonlywhenitis

cleartherearenoadversereactionstoanesthesia.Thesurgerycenterdeterminestheircost.

o SaturdayandSundayarefreedaystorelax.Dr.Marvinison-callshouldtheneedarise.

o Mondaymorningisthepost-opvisitwithDr.Marvinandthenreleasedtoflyhome.Dr.Marvindoes

reservetherighttokeepthepatientshouldaconcernbedetected.

Post-Opvisitscanbemanagedbyalocalphysician.Thefollowingpageisalistoflabsneededthroughouttheprocess.

* SELFPAYONLYPATIENTLABS

Ifyouarechoosingnottobillinsuranceforincliniclabwork,youwillberequiredtovisitalocallabnear

youforthepre-optesting.Theseneedtobecompletedbeforeyourpost-opappointmentwithDr.

MarvinonThursday.DuringthephoneconsultDr.MarvinmayaskforaCBC,BMPand/oranEKGpriorto

schedulingtheprocedure.Thesemaybecompletedbyaphysiciannearyou.

HospitalDischargeWhenTravelingAlone–Requires24hourcaretoacompanionover18yearsold.

Fortheout-of-townpatientswhoaretravelingwithoutacompaniontherearetwooptions:Planononenightinthehospitalorhirethenursecompaniontostaywithyoufromdischargeuntil9amthefollowingmorning.Thefacilitywillnotreleaseyouunlessyouhave24hourcare.BrightStaroffersCertifiedNursesAidforhire.ThisCNAwillactattheaccompanimentrequiredbythehospitalorsurgerycenter.Youwillscheduleandmakepaymentdirectly.832-730-1255



ThisisalistoftherequiredlabworkbyDr.Marvin.Thiswillbediscussedduringyourphone

consultationandrelayedtoyoubytheclinicstaff.Pleasehavethispageavailableorapenandpapertomakenote.

Faxto(713)963-0476 Attn:ClinicCoordinatorLabordersareprovideduponrequest.Theselabswillsenddirect:QuestDiagnosticsAccount#27746LabCorpAccount#42214405

PRE AND POST PROCEDURE TESTING ORDERS

Patient Name: DOB: / / Diagnosis: Surgery Date: / /

PRE-OPLABS

CBCPT,PTTBMPLFTSHgA1CLIPIDPANELTSHT3FREET4FREEIONIZEDCALCIUMPTHFE(IRON)FESATTIBCFERRITINFOLICACIDVITAMINAVITAMINB1VITAMINB12VITAMINDTESTOSTERONE(MALE)ESTROGEN(FEMALEFSH/LH(FEMALE)PROGESTERONE(FEMALE)

OTHER:

POST-OPLABS

CBCBMPLFTSw/ALBUMINHgA1CLIPIDPANELTSHT4FREEIONIZEDCALCIUMPTHFE(IRON)FESATTIBCFOLICACIDVITAMINAVITAMINB1VITAMINEB12VITAMIND

OTHER:



PRE-OPNUTRITIONCONSULT&DIET

AllESGpatientsarerequiredtocompleteanutritionconsultprovidedbyPSYMED.Thisistoprovideeducationonlifestylechangesafterthesurgery.Yourweightlosssuccessisdefinedbyyourpost-opeffortsondietmodificationandincreasedexercise.Areferralwillbesentonyourbehalfandpricingisaseparatefee.Seehandout.Toensurethecompleteemptyingofthestomachoffooditems,pleasebegintheStageOneClearLiquidonlydietthemorningbeforetheESGprocedure.Thismeansdonoteatbreakfast,youmayhavecoffee.RefertotheStageOneDietpage.ThesurgerycenterwillremindyouofNOeatingordrinkingaftermidnighttheeveningbeforeyourESG.

PRESCRIPTIONS

• Youwillbegivenaprescriptionforpainmedication,nauseaandB12,thatyoucanfillatanyPharmacy.• TheB12sprayisthemosteffectivedeliveryformyetmaynotbefullycoveredbyyourinsurance.Thesub-

lingual(underthetongue)maybesubstitutedandsoldatourclinic.Thisisforuseafterthesurgery.• AntibioticsaregiventoyouthroughyourIVpriortosurgery.

YouwillNOTneedtotakeanyfurtherdosesofantibioticsafterthedosesareadministered.

WHATTOBRINGTOTHEHOSPITAL

o Wearcomfortableclothes–Elasticwaistpantsarebestsothatyourabdomenisnotpinchedorcompressedbytighterclothing.YogaPants.

o Ifyouuseawalker,caneorotherwalkingassistancedevicepleasebringthiswithyoutothe

hospital.Wewantyouupwalkingwithinafewhoursaftersurgery.

o DoNOTbringanythingvaluabletothehospital–leaveallyourjewelry,cellphone,laptop,iPod,etc.withfamilyorATHOME.

o YouDONOTneedtobringanyofyourhomemedicationstothehospitalwithyou.Thehospitalwilldispenseallmedications.

o Somepatientsprefertobringsomeoftheirfavoriteclearliquidbeverageswiththemtothehospital.Youwillhaveadiettraysuppliedtoyou,however,youarewelcometobringanyofthesugarfreeclearliquiditems.



MEDICATIONAFTERSURGERYForthefirstweekaftersurgeryyouwillneedtoCRUSHallpillstoswallowthem,tomakethisaseasyaspossible.Someofyourmedicationsmaybeavoidedduringthefirstweek.Followtheguidelinesbelowtohelpwithyourhomemedicationsandifyouhaveanyquestionsmakesuretocalltheoffice!

Medicationsforhighbloodpressure:

• Resumethesemedsthemorningafteryouaredischarged • Makesuretocrushallmedication • Ifthemedicationcontainstheterms“XR,CR,SRorXL”youwillneedtohaveanalternatedoseof

thesemedicationsasthesearetimereleasepillsandcannotbecrushed Medicationsfordiabetes:

• Resumeyourhomemedsathalfthenormaldoseforthefirst7days. • Besuretocheckyourbloodsugaroftenandcallifyoustarttonoticeeitherextremehighlevels

(>250)orextremelowlevels(<60) • Ifyouareoninsulin,resumehalfthenormaldoseforthefirst7days–makesuretokeepalog

ofyourbloodsugarreadings,thetimeofday,andhowmuchinsulinyouadministered Medicationsforhighcholesterol:

• Youmaywaituntilweek2ofyourdiet(softsolids)toresumethesemeds • Ifyoudecidedtocontinuethesemedicationsathomeduringthefirstweekaftersurgery,theywill

needtobecrushed Bloodthinnersandaspirincontainingproducts:

• IfyouaretakingCoumadin,Plavixorotherbloodthinningmedicationsoraregularbasisyoushouldhavereceivedspecificinstructionsregardingresumingthesemeds.DONOTRESUMETHESEMEDICATIONSUNLESTHEMD/PAHASINSTRUCTEDYOUTODOSO

• Adailyaspirinfor“hearthealth”maybere-startedathome48hoursaftersurgery(81mg,crushed) Supplements:

• Supplementsarenotmandatoryduringthefirstweekaftersurgeryandmaybehelduntilweek2 Thyroidmedication:

• Resumeyournormaldoseofthyroidmedicationthemorningafterleavingthehospital,crushed Heartburn/refluxmedication:

• Thesemedicationsshouldnotbeneededaftersurgery,ifyoubegintohavesymptoms,calltheofficeforfurtherdirection



STAGEONEDIET:LOWSUGAR,CLEARLIQUIDS

• Yourclearliquiddietwilllastforoneweek.IfyouhavesurgeryonFriday,youwillbeon • clearliquidsthroughthefollowingFriday.• Allclearliquidsshouldbesugarfree.Labeled“nosugaradded”doesNOTmeansugar

free.Thereshouldnotbemorethan10caloriesperservingofliquid. • Aclear liquid isdefinedasasubstancethatyoushouldbeabletoseelightthrough.The

coloroftheliquidisnotimportant.Blackcoffeeisallowed. • Avoidstraws,sportstopbottlesorchewingoniceasthiscausesexcessiveintakeofair

andcanworsengasbubblesandgaspains.Carbonatedbeveragesmayresumeafter1month.

ClearLiquidShoppingList–TheStaples

• ProteinWater–Isopure(canbemadeintopopsicles) • CrystalLight–allflavors • DietSnappleproducts • FruitH2flavoredwater • PowerAidZERO • SugarFreepopsicles • SugarFreeJell-O • Icedtea–unsweetened • Beef,Chicken,Vegetablebroth • MisoSoup(strainoffanysolids,Miso&Easysoupbase) • SugarFreeTang,Kool-AideorHawaiianPunch • Hottea

UseartificialsweetenersuchasSplenda,Equal,Truvia,SweetnLow,NutraSweet

Youcanusefreshlemonandlimestoflavorplainwater

Plantoconstantlykeepandsipwateroratalltimesbetweentheliquid“meals”.Therecommendedamountis60oz,butyoumayneedmoreorless.Inahydratedstateyoushouldnotfeeladrymouthandyoururineverylightcolored.Importanttonote:Proteindeficienciesareveryrareinthisstage.



STAGETWODIET:LOWSUGAR,SOFTFOODS

• Asoftsoliddietlastfromweek2-4;foodthatcanmashedeasilywithafork.• Asoftsolidmeanssoftandmushybeforechewingandswallowing.• Yoursoftsolidsshouldallbelowfatandlowsugarwithagoalofnutrientdense.• Duringthisstageofyourdiet,youneedtoremembertoNOTDRINKliquidwhileeating

yoursolidmeals.• Youstillneedtoconcentrateonadequatehydrationsoremembertodrinkbetweenyour

mealstoridanycrymouthandkeepurinelightlycolored.

SoftSolidShoppingList:TheStaples

• Eggs–scrambled,hardboiled,eggsalad(lowfatMayoorMiracleWhip)• CreamofWheat,Malt-o-Meal,oatmeal;avoidhighsugar“flavored”varieties• Mashedsweetpotatoes• LowFatCottagecheese,LaughingCowSoftCheese• Lowsugar,lowfatyogurt• Sugarfree,fatfreepudding• Beans–blackbeans,pintobeans,refriedbeans• FlakeyFish,Tofu• Bakedfish–alltypes,butremember,NOTbreadedorfried• Bananas,Avocado• CookedCarrots,cookedpeas• Soups-Lowfatcreambasedsoups,(ButternutSquash,TomatoBasilBisque)andCampbell’sHealthyChoice(madewithskimmilk).NoBeef,ChickenorPork.

Howtoeat*Takeverysmallbitesthesizeofanickel*Chewveryslowly*Stopwhenyoustarttofeelfull*

*Portionsizeisnotrelevantateachmealtime.Youmayfeelfullat3-4bites,thisisokay.

*Youwillfeelhungryasyourbodylearntore-adjustitselftoalowercaloriediet.

Youmayusespices,oliveoilorcoconutoil.

Focusoneatinghighproteinfoods,avoidingsimplecarbs(turnsintosugar)andovereatingisdiscouraged.

READYOURNUTRITIONLABELS–gettoknowwhichfoodsarelowinfatandsugars.



VITAMINSUPPLEMENTS

Thefollowingvitamins/supplementsareMANDATORYforallpost-oppatientsstartingweek2:

**TwiceadayBariatricAdvantageMultivitamin

**1500mgofCalciumCitratedailywithVitaminD

Manygreatproductsaresoldintheclinicforyourinitialpurchase.

ReplacementscanbefoundonourBariatricAdvantagewebsite,customizedspecificallyforDr.Marvin’spatients.

https://www1.bariatricadvantage.com/catalog

ValidationCodeMARVIN

Theproductsrangefromvitaminchews,proteinshakemix,snackbarsandsomuchmore.

Youcansampleorpurchasemanyoftheseproductsinourclinic.Thenorderonlineatyourconvenience.

Thestaffwillprovideorderinginstructions

Dr.RobertMarvin4120SouthwestFreewaySte.230

Houston,TX77027Office:713-993-7124Fax:713-963-0476

POST-OPERATIVEENDOSCOPICSLEEVEGASTROPLASTY

ImmediatePost-OperativePeriod

RecoveryRoom:Patientswillfirstgototherecoveryroomaftertheoperationisover.Therehe/shewillbecloselymonitoredwhilewakingupfromanesthesia.FamilymembersareusuallynotallowedbecauseofGovernmentrulesconcerningprivacyofotherpatients.

2HoursPost-op:Withassistancefromanursethepatients’needstowalkoutsidetheroom,inthehallway,atleast20steps.Afterwalking,thepatientwillbeallowedtotakezerosugarliquidsbymouth.Initiallythisisusuallyicechipsandsipsofwater.However,broth,sugarfreepopsiclesandnocalorie-noncarbonateddrinksareencouraged.Oncethepatientinambulatoryandabletodrinkwater,thenursewilldischargethepatienttoadesignatedcaregiver.Thehospitalorsurgerycenterwillnotreleasethepatientwithoutaccompaniment.

AtHotel/Home–

Medications:FollowtheMedicationGuideonresumingprescribedmedications.Tabletswillneedtobecrushedandcapsulesopenedforthefirstweek.Usuallythesearetakenwithwater.Anymedicationthatcanbeskippedshouldwaituntil1weekpost-op.Examplesare:cholesterolmedications,previouspainmedications,musclerelaxants,specialvitamins,etc.Absolutelynecessarybloodthinnerssuchasaspirin,PlavixorCoumadinshouldberestarted48hoursaftersurgery.Ifanysignsofbleedingoccurtheyshouldbediscontinuedandthepatientshouldcalltheofficeimmediately.Diabetes medications should be reduced to ½ dose for the first week, and blood sugar levels should bemonitored every 6 hours if the patient is on any insulin. If you are on diabetes medication, make anappointmenttoseetheprescribingphysicianwithin2-3weeks.

Activities:Patientscandotheiractivitiesofdailyliving(ADL)suchasgoingupsteps,ortakingcareofthemselvesinthebathroomorshower.Thepatientdoesnotneedspecialassistancefromsomeoneelseafter1-2days,ifthen.He/sheshouldnotstayinbed;movingaboutandevenlightexerciseareencouraged.Thepatient’sactivitylevelshouldincreasewithin48hours.Allexerciseisallowedassoonaspossible,includingstrenuousactivityandliftingcan.Normalsexualactivitycanoccurassoonasthepatientfeelscomfortableenough.

Driving:Atypicalpatientwillbeabletodrivehis/hercarapproximately1-2dayspost-operatively.Drivingshouldonlybeattemptedifthepatientfeelsthathe/shecanturnthewheelorapplythebrakesinanemergency.Ifnot,thepatientshouldnotattempttodrive.

ReturntoWork:Patientsareabletoreturntoworkbydaythreepost-oporsooner.



Diet:AftertheESGprocedurepatientwillbeonaclearliquid,lowsugardietfor7days.Startingweek2throughweek4asoftdietisprescribed.Pleaseseethedietsectionforadescriptionofthediet.After30days/4weeksthepatientmayresumearegulardiet,onlyamuchhealthierchoicesthanbefore.Continuetotakesmallbites,chewslowlyandstopwhenyoufeelfull.Also,avoidcarbonatedbeveragesuntil1monthaftersurgery.Caffeineisallowed(withsugarsubstitutesandnon-dairy,lowfatcreamer).Concentratedfruitjuiceandprocessedsugarsshouldbeavoidedtoavoidcramping,flushinganddiarrheawhicharethesymptomsofthedumpingsyndrome.Week2-4Medications:Allpreviousmedicationsshouldberesumedandcanbetakennormally(i.e.aswholepillsorcapsules.Diabetesmedicationsshouldremainat½thepreviousdosage,andthepatientshouldmakeanappointmenttoseetheprescribingphysiciantoalterthedose.Continuewithprescribedbariatricspecificsupplementsandmultivitamin.DietWarning:itisABSOLUTELYESSENTIALNOTTOOVEREATaftertheESGprocedure.Thelengthofthesuturelinewillbevulnerabletoinhibitingtheexpectedsuccess.Arevisionmayberequiredtotightenthestomachormovetothemoreinvasivelaparoscopicsleevegastrectomy.After1monththepatientcanfollowtheregularprescribeddietprovided.FOLLOWUPonMondayaftertheprocedurewithDr.MarvinYourfollowupvisitswillbewithalocalPCPorbariatricsurgeoninyourarea.Itwillbenecessarytohavebloodtestsdoneattheseappointment.Thiswillincludebloodcounts,electrolytes,proteinlevels,calcium,iron,vitaminB1,vitaminB12andfolicacidlevels.Providethephysicianwiththelabspageandpleaseforwardtheresultstoourofficeasnotated.APPOINTMENTS:Youwillreceiveafollowupquestionnaireandaremindertocheckinwithyourlocalphysicianforlabs.1Month3Months6Months12Monthsandyearlythereafter.

HSSEndoscopicGastroplastyDisclaimer1.Dr.MarvindoesNOTguaranteespecificweightlossforanyweightlossproceduretoanyspecificpatient.Toomanyfactorsareinvolvedtomakeaccuratepredictions.Weightlossestimatesarebasedondatareportedinthemedicalliteratureand/orDr.Marvin’spracticeexperience.2.Dr.MarvincanmakeNOguaranteeofthelongevityforendoscopicgastroplasty.Longtermdataisnotavailableforthisprocedure.Itispossiblethattheweightlosseffectmaydecreaseorbelostovertime.3.TheremaybeafailurerateassociatedwithEndoscopicGastroplasty.Failureisdefinedasalossoftheweightreductioneffectwithinthefirst90daysaftertheprocedure.Datafromalargeinternationalcentersuggestthefailurerateforthisproceduremaybe5-7%.



CONCERNSANDRISKWITHTHEENDOSCOPICSLEEVEGASTRECTOMY

WARNING:UnpleasantsymptomsoccurringafterObesitySurgerycanindicateaprogressingand/orlifethreateningproblemthatcouldrequireimmediatehospitalizationorsurgerytocontrol.Failuretonotifythedoctorimmediately

couldresultinpreventableinjuryordeath.Call713-993-7124IMMEDIATELYifuntowardsymptomsoccur.

In general, the first fewweeks after aprocedure is an importantperiod tomonitor forproblems, as themajorityofcomplicationswilloccurduringthistime.Bleedingandabdominalinfection,whicharethemostserious problems, tend to occur just after surgery and are less likely later in this period. The completedetailedcopyoftheriskswillbemadeavailabletoyouinpersonandasignaturerequiredontheconsentform.

Bleeding

ThisisthemostcommoncomplicationduringandafteranESG.Becausethestomachhasarichbloodsupply,andthesuturesareplaceddeepintothegastricwall,significantbleedingcanbeseenduringtheprocedure.Usually this is well controlled by applying the synching device to tighten the suture. Rarely, an additionalendoscopictechnique(orevensurgery)couldberequiredtocontrolbleeding.

It is possible that a patient could also later develop symptoms and signs of bleeding. Symptoms include,dizziness, appearing pale, shortness of breath, rapid heart-beat, and low or absent urine output, vomitingblood or “coffee grounds”, or passing blood or black stools by rectum. Any of these symptoms should becommunicatedtotheEndoscopist/SurgeonIMMEDIATELY.

Significantbleeding could requireblood transfusionorextendedhospitalmonitoring.Persistentor clinicallysignificantbleeding could require repeatendoscopyand/or surgery to treat. The riskof significantbleedingrequiringtransfusionappearstobelessthan1%withESG1.

StomachLeak

This is potentially a life-threatening complication. Theoretically, a stomach leak after ESG is from bacteriatrackingoutalongafullthicknesssutureandcausinganinfectionintheabdominalspace.Thisisdescribedasaperi-gastricinflammation,asseenonCTscan.Because,theleakafterESGappearstobemorelimitedthanaftersurgery,thisprocesscanbetermeda“micro-leak.”

Symptoms of stomach leak include: rapid heart rate, dizziness, shortness of breath, fever, worseningabdominal pain, left chest or shoulder pain, abdominal distention, the appearance of illness and a generalfeelingthatsomethingisverywrong.Diagnosisisdependentuponavarietyofinformationsources,suchas:clinical assessment, vital signmeasurement, laboratory tests (whiteblood cell count) and radiologic studies(CTscan).

TheriskofaninfectionoutsideofthestomachafterESGappearstobelessthan1%1.Interventionisbasedonclinicalfactors,but,ingeneral,thetreatmentforamicro-leakafterESGislessinvasivethanthetreatmentofaleak after a surgical sleeve operation1. However, unusual or extreme cases could require an operation tomanage.

BloodClots



Thisisarareproblemwhichoccursinlessthan1%ofpatients.Obesepatientsaremorepronetodevelopingbloodclotsintheveinsofthelegsthanarenormalweightpatients.Theclotisdangerousbecauseifitweretobreakoffitmighttravelupthebloodstreamtothelungwhereiscouldsuddenlydecreasebloodflow.Thisisknownasapulmonaryembolismandcanbefatal.

The treatment is PREVENTION of the formation of blood clots. Our patients are given a short-acting bloodthinner before their procedure and sequential leg squeezing devices are fitted over the legs during theoperation.Although,bothofthesearesomewhateffective,neitherisanywherenearaseffectiveasthemaintreatment,whichisgettingoutofbedandwalkingsoonaftertheprocedureisover.EARLYMOBILIZATIONisthekeytopreventingbloodclots.Itisthemostimportantthingthepatientcandoforhim/herselfaroundthetimeofthesurgery.

EsophagealInjury

PerforminganESGrequiresplacementofinstrumentsandtubesthroughtheesophagustoreachthestomach.These include, inorder, a small caliberdiagnostic endoscope, a large caliberover-tube, andadual channeloperatingendoscopewith themounted suturingdevice.Theesophagus is thinnerwalled than the stomachandmoreeasily injuredbyinstrumentation.Conversely,theseinstrumentsareplacedunderdirectvision,oroveradevicealreadyinposition(over-tube).So,injuryshouldbeveryuncommon.

Apartialthicknessinjurytotheesophaguscanprobablybemanagedconservatively.However,afullthicknessinjurymightrequiresurgerytorepairandtreat.FullthicknessinjurywithESGhasnotbeenreported.

FailuretoLoseWeightAswithanyweightlossprogramprocedureorsurgerythepatientschoicesafterareofthegreatestimpact.Weprovidedetailednutritionalinformationandexerciserecommendations.Althoughthedataprovidesweightlossstatistics,thereisnoguaranteeofhowmuchorforhowlongitcanbemaintained.Thefactis,thereonlyexisttwoyearsaresearchdataontheEndoscopicSleeveGastroplasty.Reminder:AnutritionconsultwithaRegisteredDietitianisrequired.

IMPORTANT:Theproblemsaboveareapartiallistofallpossiblecomplicationsthatcanoccurafterthis

procedure.Somecomplicationsarerareandmaybebeyondtheexperienceofthesurgeonoreventhe

surgicalliterature.Complicationsareusuallynotforeseeable.

Reference

Lopez-NavaG,etal.EndoscopicSleeveGastroplastyforObesity:aMulticenterStudyof248Patientswith24MonthsFollow-up.ObesSurg.April27,2017(online).



PleaseCompleteandReturntotheofficewithin10dayspriortoprocedure

WeareexcitedtogreetyouinHouston!Toassistyouintravelplansandensureasmoothprocessthefollowinginformationisrequired.

MyPhoneconsultwithDr.Marvinwason:___/___/______

Requiredofmetocomplete10daysprior(withdatesofcompletionandsubmitted):

Failuretocompletemayresultinacancellationofmyprocedure

CBC___ Completed__________SenttoDr.Marvin__________

BPM___ Completed__________SenttoDr.Marvin__________

EKG___ Completed__________SenttoDr.Marvin__________

Other___________Completed__________SenttoDr.Marvin__________

NutritionConsultwithaRegisteredDietitian___Completed__________ R.D.Name____________

MyProcedureDate____/____/________ HermannDriveSurgical713-285-5500

2001HermannDr.Houston,TX77004

MyPre-Opappointment:____/____/________ Dr.MarvinHoustonSurgicalSpecialist713-993-7124

MyPost-OpAppointment____/____/________ 4120SouthwestFrwy.Ste230Houston,TX77027

MyFlightison____/____/________Arrival_______am/pmORIamdriving_______

Airport:BushIntercontinental(IAH)_____ orWilliamP.Hobby(HOU)_____

MymodeofTransportationwillinclude(Checkallthatapply):

RentalAuto___ AirportShuttle____ HotelShuttle____ Uber/Lyft/Taxi____

Myaccommodationsduringthetrip: Privateresidence____

Hotel(NameandAddress)_________________________________________________________

MyTravelCompanion(orresponsiblepartyupondischarge)

Friend/Familyovertheageof18____ Name________________________Cell________________

PulseStaffingPrivateDutyTransport____ Bookingcompleted____/____/________

AnyotherinformationIwouldliketoadd(suchasbringingpetsorspecialneeds):_______________

______________________________________________________________________________________

Remindertopreparefortheclearliquiddietthedaypriortotheprocedureasthiswillbeatravelday

Werecommendprintingacopyforyourselftokeepontrackandavoidanyunnecessarydelays

Signature__________________Date_______________ SubmittedtoDr.Marvin____

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