Jacksonville Surgical Specialists bariatric seminar transcript
00:00
[gentle music]
-[Dr. Webb] Our mission is to empower
00:02
patients who are burdened with the disease of morbid obesity,
00:06
to help them overcome that disease process.
00:08
One of the saddest things about morbid obesity
00:11
is that the majority of our patients
00:12
think that it is an infliction that they should be able
00:15
to do something about on their own.
00:17
And they're told by so many authority figures
00:20
that they should just diet and exercise
00:23
and then it would cure it.
00:24
And then that's not true.
00:25
It's a disease process.
00:27
What we're able to do is give them a tool
00:28
with which they can be successful
00:30
at helping to resolve the disease and all the co-morbidities
00:34
all the diseases that go along with it.
00:37
-[Dr.Abbas] So basically, bariatric procedures could be really
00:40
categorized into two categories
00:43
and essentially, they lay on a spectrum.
00:45
So, we have restrictive or purely restrictive procedures.
00:48
And the ideal behind those is that they restrict
00:50
the number of calories that you can eat.
00:52
And thus by restricting your calories, you lose weight.
00:55
These could be things like the Adjustable Gastric Band,
00:58
the Intragastric Balloon,
01:00
which is one side of the spectrum.
01:02
As you move up and essentially the surgery
01:04
becomes more effective at losing weight.
01:06
You have a combination of procedures
01:09
which combines restrictive as well as mal-absorptive.
01:12
So, on that end of the spectrum would be something like
01:14
a Roux-en-Y Gastric Bypass
01:17
or something like a Duodenal Switch.
01:19
As you move from the restrictive procedures,
01:21
to the restrictive and mal-absorptive procedures,
01:24
the weight loss or the effectiveness of these surgeries
01:26
become much better.
01:27
So, the weight loss will obviously be far more enhanced.
01:32
The risks will certainly go up as you move
01:35
from the restrictive procedures
01:39
However, if we were to talk about overall bariatric risks,
01:43
so out of 60,000 patients that were reviewed from the ASMBS,
01:48
which is the American Society of Metabolic
01:50
and Bariatric Surgeons Centers of Excellence.
01:52
Which we are one.
01:53
So, we are a center of excellence for bariatric surgery.
01:57
The mortality risk or the risk of death within 30 days
02:03
is less than one in a thousand.
02:06
[Pictured Text]
Why Choose Memorial Advanced Surgery?
Outstanding Quality
- Memorial Advanced Surgery and Memorial Hospital have partnered together to provide superior support programs, surgical experience and excellent medical facilities to ensure the best possible outcomes.
- Our team of bariatric specialists have helped over 2,000 bariatric patients since 2003
- North Florida's first comprehensive weight loss program
02:07
- [Dr. DePeri] We were the first in town to pursue these procedures laparoscopically.
02:11
Our accreditation we've had for many years
02:13
[Pictured Text]
[MBSAQIP award logo in top left corner of page]
Awards and Accolades:
- Metabolic and Bariatric Surgery Accreditation & Quality Improvement Program Center of Excellence (MBSAQIP)
- Blue Cross & Blue Shield of Florida Blue Distinction Center for Bariatric Surgery
- Aetna Preferred Hospital for Bariatric Surgery
- Cigna 3 Star Quality Bariatric Center
Importance of Accreditation
- A recent study showed that the mortality rates at non-accredited facilities are on average three times greater than the mortality rates at accredited facilities.
- Accreditation is an important life-saving process and we encourage patients and referring physicians to seek out those facilities that meet these rigorous standards.
02:14
through the ASMBS with initially
02:17
a center of excellence designation
02:20
and now what we call MBSAQIP designation.
02:23
Our accreditation says that we're good at what we do.
02:28
We have good outcomes, low complication rates,
02:31
and good patient satisfaction.
02:35
- [Dr. Abbas] The changes are significant.
02:38
And the way I actually get this
02:40
is directly from my patients.
02:42
Direct feedback from the patients.
02:45
Things that are simple to maybe, you know, to you and I,
02:48
like tying your shoes.
02:49
My patients tell me they were not able to do that.
02:52
- [Ruth] I struggled with my weight all of my life.
02:55
I have other family members who have had bariatric surgery
02:59
and wasn't sure if that would be an option for myself.
03:04
I had tried a few times in the past unsuccessfully.
03:08
And when I was referred to Memorial,
03:13
they were incredibly helpful
03:15
and they actually were able to make it happen for me.
03:17
And I didn't think it could.
03:19
When I got the phone call and they let me know that
03:23
you know, that it could be an option for me,
03:26
I felt hope for the first time in a while.
03:30
I felt like there were possibilities for me
03:33
that I had written off for myself for a long time.
03:37
I had the Gastric Sleeve.
03:39
When I walked into the bariatric center here
03:41
I weighted 535 pounds.
03:44
I did follow the pre-op diet pretty closely.
03:48
My Surgery date when I walked in that morning,
03:51
I weighed 481.
03:53
So, I had lost about 50 pounds in about three months.
03:58
As of today I'm at 209.
04:01
And so I would say it was very successful.
04:06
and a big part of that for me,
04:09
has just been having really good support
04:13
but it really, I mean, it's completely changed my life.
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I had spent years avoiding a lot of things
04:19
because I knew I couldn't fit.
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I can exercise and do things that I enjoy now
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that before weren't even an option for me.
04:27
I, you know, we went to a theme park recently
04:30
and I rode every single roller coaster just because I could.
04:34
And I didn't think that I would have that in my life.
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I honestly had written that off, you know
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even down to sitting in a booth at a restaurant,
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I knew I couldn't do that.
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And within, I think two months of surgery,
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I sat in a booth and I remember I sat down and cried
04:56
just tears of joy, because I mean,
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it's just little things like that,
04:59
that you get so used to navigating around
05:04
because it just, isn't a possibility.
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And suddenly those little things are happening
05:09
and it just gives you, it gave me a feeling
05:11
of freedom, for sure.
05:14
And I'm still at a place in my journey
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where my size is continuing to go down.
05:19
- [Jamila] For me it was a mental thing.
05:22
I did not realize until after the surgery
05:27
how much I disrespected food.
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I had surgery February 18th, 2015.
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My husband had his bariatric surgery, February 25th, 2015.
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He's down 115 pounds.
05:43
Everybody was more than willing to be helpful.
05:47
Everybody was more than willing
05:48
to make sure that I was comfortable.
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And it was the same for my husband.
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It was the same for my daughter.
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Everybody had the same great experience.
05:58
She had the Sleeve, she lost her 80 pounds
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and she's 135 pounds.
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And even outside of the people here,
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we have this, you know, Glorian has this set of people
06:10
who meet every month, you know,
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every month they pick a restaurant.
06:15
Those people really don't know you
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but they still support you all the same.
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You know, like some faces are familiar, some people are new,
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but it's still a support system.
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And honestly, when we come here for appointments
06:28
I can go to my appointment upstairs and leave, but I don't.
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I come in every time and I speak to everybody in the office
06:34
because whenever I need them they always pick up the phone.
06:38
And if I can't get 'em on the phone and I email 'em,
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they email me back.
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- [ Dr. Webb] We have a comprehensive program here.
06:44
We were the first comprehensive bariatric surgical program
06:47
in this part of Florida.
06:50
And so it involves our bariatric surgery center
06:54
at Memorial Hospital with our bariatric dieticians.
06:57
We offer support group meetings.
06:59
We help prepare patients before surgery for the procedure.
07:02
And then of course I'm more involved
07:04
with the surgical aspect, which is the surgery itself.
07:07
But then afterwards, we have a dedicated program
07:10
to helping folks be successful with their surgery.
07:12
When I first started doing this in 2003
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I used to get excited about folks when they come in
07:17
would dwell on their weight loss.
07:19
And then what we realized with time is the weight loss
07:21
is not what's important.
07:23
It's the quality of life.
07:24
It's the fact that they're healthy,
07:25
that their blood pressure is better.
07:28
Their diabetes is gone, that they can bike,
07:32
they can run marathons, they can just do
07:34
what normal, healthy people do.
07:36
- [Dr. DePeri] It's just seeing the patient happy
07:38
and happy to have lost weight,
07:41
happy to get rid of some of the medications they were taking
07:44
and happy to be able to play with their grandchildren
07:46
and tie their shoes, and sit in a normal chair.
07:50
It's just, it encompasses everything
07:55
and it happens relatively quickly.
07:57
And so it's very satisfying to see patients go through that.
08:01
[Pictured text]
What Causes Obesity?
-
Genetic predisposition
- Twin Studies
- Adopted Children
- "Obesity" gene
-
Physiologic
- Ghrelin
- Leptin
- Decreased stretch receptors
- Loss of satiety mechanism (hypothalamus)
- Evolutionary
-
Behavioral
- Family tradition
- Food to comfort child
- Addiction
-
Gender (80% women)
- Higher Fat Component
-
Socio-Economic
- High/Low income classes
- Cultural Views
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Psycho-Social
- Coping Mechanism (i.e. stress, abuse)
-
Societal
- Technology has decreased energy expenditure
- Elevators, power windows, food delivery, remote controls, computers, video games, TV, cars
BMI - weight (KG) divided by the height (in meters) squared.
BMI corresponds to the % of body fat
08:02
Morbidly obese is, morbid is the Latin term for deadly.
08:05
So, it's deadly obesity.
08:06
And from a number standpoint, it would be a body mass index
08:10
of over 35 with certain co-morbidities,
08:13
which are diseases that are exacerbated
08:16
or made worse by obesity or a BMI over 40.
08:19
- [Dr. Webb] A majority of our patients have BMI
08:21
of greater than 40.
08:23
So this is not just being overweight or being obese.
08:27
This is more of an obesity.
08:28
This is an accumulation of excess weight,
08:32
so much so that's going to cause a whole host
08:34
of co-morbid conditions, disease processes.
08:37
They're gonna diminish the quality of life,
08:40
but also they're gonna shorten the life.
08:41
- [Dr. DePeri] Extremely common in the obese patient
08:42
[Pictured text]
Medical Implications (Co-Morbidities)
- Diabetes type 2
- Hypertension
- Lipid disorders
- Heart Disease
- Asthma
- Sleep apnea
- Gallstones
- NASH (non-alcoholic steatohepatitis)
- Urinary incontinence
- Gastroesophageal reflux
- Osteoarthritis and gout
- Infertility and Menstrual Problems
- Obstetric Complications
- Low Back Pain
- Deep Venous Thrombosis
- Depression
- Immobility
- Cancer (Breast, colorectal, prostate, endometrial, etc.)
- Venus/stasis ulcers
- Skin Infections
- Accident Proneness
08:45
with heart disease, high cholesterol,
08:48
type two diabetes, sleep apnea.
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All of these we would consider the co-morbidities
08:54
that I spoke about and all are impacted by weight loss.
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- [Dr. Webb] The realistic expectations for the surgery are
09:00
[Pictured text]
What are realistic expectations?
-
An optimal and continuous program which uses
- Diet
- Tablets
- Behavior modification
- Exercise
09:03
to have the morbid obesity resolved, to reach a healthy BMI.
09:08
And with that weight loss to resolve the majority
09:13
of their co-morbid conditions,
09:15
if not to resolve those co-morbid conditions,
09:17
then to help make them a lot easier to control.
09:19
- [Dr. DePeri] The procedures we offer all laparoscopic.
09:20
[Pictured text]
Comparison of Surgical and Non-Surgical Treatment Options (% of weight loss)
[table, two columns]
- Lifestyle, Pharmacologic Treatments (diet, tablets, behavior modification, exercise) less than 10%
- Gastric Band 41%
- Sleeve 66%
- Bypass 62%
- BPD-DS 85%
09:24
There's the Adjustable Gastric Band, the Sleeve Gastrectomy,
09:28
the Gastric Bypass, and the Duodenal Switch.
09:31
(gentle music)
[Pictured text - Adjustable Gastric Band]
09:36
[Pictured text]
[Medical illustration of an adjustable gastric band forming a small stomach pouch]
Adjustable Gastric Band
- Works by restricting food intake
- Requires fills (adjustments) to maintain weight loss
- Extremely dependent upon long-term patient compliance and follow-up
- If slip or erosion, may have to be replaced or removed (explanted)
- Has greatest re-operative rate at 5-10 years of any bariatric procedure
09:36
The Adjustable Gastric Band
09:37
is the procedure we do the least of.
09:40
It tends to have the most difficult time
09:43
for patients in losing weight after surgery.
09:46
Cons would be a slow weight loss.
09:48
It can take upwards of three to four years
09:51
to lose all of your weight
09:52
and requires a little more discipline
09:55
than the other procedures in terms of your diet
09:57
and dietary habits after surgery.
09:59
[Pictured text]
Adjustable Gastric Band
- 23% of success rate at resolving morbid obesity at 10 years
- 50% of Bands have been removed within 10 years; of remaining Bands, fewer than half are successful
- More Bands are removed now annually than are replaced
- Essentially, if you get a Band, you are signing up for two surgeries: one to place the band and one to remove it!
- If you have had a Gastric Band in the past, we are happy to take care of you and discuss revision options.
09:59
- [Dr. Webb] The reason why we don't do the Lap Band
10:02
is because at 10 years, there's overall a 23% success rate.
10:07
Which means conversely, there's a 77% failure rate.
10:10
The most common procedure that we do
10:12
is the Sleeve Gastrectomy.
10:13
The second most common procedure we do
10:15
is removing the failed Band and converting it to a Sleeve.
10:20
What we tell our patients in our seminars,
10:22
if in 2017 you should be aware of the fact
10:25
that if you are signing up for a Band,
10:27
you're signing up for two procedures
10:29
And that's one to put it in and one to take it out.
10:31
But none of us in our practice do the Band.
10:33
(gentle music)
[Pictured text - Vertical Sleeve Gastrectomy]
10:37
- [Dr. Abbas] A Vertical Sleeve Gastrectomy is a restrictive procedure.
10:41
However, it also has hormonal effect.
10:44
By the way, we actually manipulate the anatomy of the body.
10:48
Anytime we perform a stapling procedure,
10:50
which is what a Sleeve Gastrectomy would be,
10:53
then we have some immediate complications
10:56
and we have also some long-term complications.
10:58
So, some of the immediate complications would be things
11:01
like bleeding because anytime we suture,
11:03
we, what we call resect or we cut an organ,
11:06
we risk obviously bleeding.
11:08
There's also a risk that anytime that we staple any organ
11:12
the staple line may actually fail.
11:14
And so you may actually have a leak,
11:16
which is probably what people have heard of.
11:19
We have become very good at actually dealing
11:21
with all of these complications.
11:23
And our supportive treatment
11:26
has made this procedure very safe.
11:29
- [Dr. DePeri] The Vertical Sleeve is similar in nature to a Band
11:30
[Pictured text]
[Medical illustration of how food would move through a small portion of a stomach after a Vertical Sleeve Gastrectomy]
Vertical Sleeve Advantages
- Safe and effective for higher risk, higher BMI patients.
- Not an ulcerogenic procedure (best procedure for patients who require NSAIDS or corticosteroids).
- No dumping
- Not mal-absorptive - does not cause anemia or vitamin deficiency (need supplemental B12)
- Does not re-route or change GI tract
11:33
in that it's a restrictive procedure.
11:34
It relies on the Pylorus,
11:36
which is a little muscle at the end of your stomach,
11:38
to empty the stomach.
11:40
Whereas the Band is a sort of converting your stomach
11:44
into an hourglass where there's no activity within the band.
11:48
Your Pylorus tends to close up and keep that food
11:51
in the stomach until it's churned up enough
11:53
to be able to be absorbed.
11:55
And then it will relax and let the food go on by.
11:58
[Medical video description]
Medical illustration graphic showing a patients' chest and stomach area with small incisions for inserting the operating tools necessary for the procedure.
11:58
- [Dr. Webb] The Sleeve Gastrectomy is the most
12:01
frequently performed procedure that we do by far.
12:04
We've had great success with it in our practice.
12:07
The excess body weight loss in one year is over 70%.
12:12
The nice thing about it is, it's very easily reproducible.
12:15
[Medical video description]
Medical illustration graphic showing how food moves through a stomach and into the digestive tract before and after the Vertical Sleeve Gastrectomy procedure, which, removes a portion of the patient's stomach, limiting the amount of food that can fit into the stomach.
12:15
It is done safely, reproducibly,
12:19
it has a very good dependable success rate
12:24
for the majority of our patients.
12:26
It also has sustained weight loss.
12:27
There's a very low rate of recidivism or weight regain.
12:31
It is good at helping resolve the co-morbidities.
12:37
It has a very, um if it's done as all of our procedures,
12:41
we're able to do this laparoscopically.
12:43
Most of our patients are out of the hospital
12:45
in 30 to 48 hours after surgery.
12:48
Like all laparoscopic procedures is a very rapid recovery.
12:51
For the most part folks are able to drive
12:54
after they leave the hospital
12:55
as long as they're not taking narcotic pain meds.
12:57
They can get in the shower,
12:58
they can walk and walk up and down stairs.
13:00
And after about a week or week and a half
13:02
they can pretty much get back to their normal activities.
13:05
[Pictured text]
Vertical Sleeve Risks
- Risk of leaks (less than 1%); leaks seldom occur, but may be difficult to heal and may require further surgery.
- May develop stricture (narrowing of sleeve which causes obstructive symptoms).
- May increase GERD symptoms initially until swelling resolved and weight is lost.
13:05
One of the most common disadvantages that we run into
13:07
is that patients who have GERD
13:09
or Gastroesophageal Reflux Disease,
13:11
may have that exacerbated.
13:14
If patients come to us already experiencing severe GERD,
13:17
then it is probably not as good an option.
13:21
It has a very low instance of severe complications.
13:24
The risk of having a staple line leak
12:28
is less than 1% in our hands.
13:31
On the whole, let's see, a very good procedure
13:34
that has very predictable, as we said, reproducible results.
13:40
(gentle music)
[Pictured text - Biliopancreatic Diversion]
13:45
- [Dr. DePeri] Biliopancreatic Diversion with Duodenal Switch
13:46
[Medical video description]
Medical illustration graphic showing how food moves through a stomach and into the digestive tract before and after the Biliopancreatic Diversion procedure, which removes a portion of the patients stomach and repositions a portion of the small intestine within the digestive tract so digestive enzymes are rerouted to a later portion of the digestive tract, limiting the amount of absorption that can happen.
13:47
is the most complex operation we do.
13:50
And it relies on mal-absorption,
13:54
or lack of absorption of what you're eating
13:58
for your weight loss.
14:00
It has the greatest long-term success rate
14:03
in terms of losing weight and keeping it off, especially
14:07
for the group of patients, we would call the super obese
14:09
or those with a body mass index over 50.
14:12
The rate of weight regain with that procedure
14:14
is only about one of a half percent.
14:18
But with complexity comes a little bit more work
14:22
and dedication in terms of adherence to a proper diet
14:27
and a vitamin protocol afterwards.
14:28
- [Dr. Abbas] So the Biliopancreatic Diversion
14:29
[Medical illustration of a complete Biliopancreatic Diversion procedure]
14:31
really lays on the other end of the spectrum.
14:33
It's a very powerful tool with regards to weight loss.
14:37
[Pictured text]
Biliopancreatic Diversion: Advantages and Disadvantages
Advantages:
- Combination of Sleeve and added mal-absorptive component
- Greatest long-term weight loss (85%) in super-obese patients (BMI greater than 50)
- Lower ulceration risk
- Excellent resolution of co-morbid diseases especially diabetes.
Disadvantages:
- Significant nutritional problems in noncompliant patients.
- Average 2 BM/Day
- More extensive vitamin replacement regimen
- More complex WLS procedure
14:37
Again, the immediate complications are the same
14:40
because it's a stapled procedure
14:43
and it's also a mal-absorptive procedure
14:45
because we re-route the small intestine.
14:47
So, there is a risk of bleeding.
14:49
There is a risk of infection and at the same time
14:52
there's a risk of staple line failure.
14:55
Again, those are the immediate risks.
14:57
And for most of those risks
14:59
we will control them in the operating room.
15:01
As in, we will never leave the operating room
15:03
without having a perfect operation essentially.
15:07
Should these complications occur again?
15:09
We have actually really developed a huge arsenal
15:13
of interventions that we can control
15:15
all of these complications, should they occur.
15:18
The other risk of Biliopancreatic Procedure
15:21
and is specific to it, is actually malnutrition.
15:24
Because we are causing mal-absorption
15:26
of the gastrointestinal tract,
15:28
then the risk of having low proteins
15:31
and also not being able to absorb enough calories, is there.
15:35
Which means you really have to be very compliant.
15:39
You must keep all your appointments with your clinician,
15:41
particularly your surgeon and your dietician,
15:44
so that we can monitor the level of your vitamins,
15:48
as well as seeing your overall physical ability
15:51
and making sure that you're meeting your micro
15:54
and macro nutrient requirements.
15:56
- [Dr. DePeri] All of our patients that we operate on
15:58
get put on a vitamin regimen.
15:59
And so they all take vitamins, calcium, B12 supplements,
16:03
and we depend on them to do that.
16:06
So in terms of dedication,
16:09
they come to the program knowing that's gonna be part of
16:11
what they're post-op care is.
16:12
(gentle music)
[Pictured text - Gastric Bypass]
16:17
- [Dr. Webb] The Gastric Bypass is the procedure that we have done
16:20
for the longest period of time.
16:21
We began doing that in 2003.
16:24
It's still considered by the SMBS
16:26
to be the gold standard for bariatric surgery
16:28
because it's what has been being performed the longest
16:30
with great success.
16:32
We do not do as many Gastric Bypasses as we once did,
16:36
primarily because the Sleeve
16:38
is such a straightforward, simple procedure.
16:40
And then the Duodenal Switch is such a robust procedure.
16:44
The Bypass is extremely useful for patients
16:47
with severe GERD who need weight loss surgery.
16:50
It also has a very good percentage
16:53
of resolution of diabetes and co-morbidities,
16:55
which is why we do this procedure,
16:57
With the Bypass, we're not going to remove
16:59
any part of the stomach.
17:02
We just bypass the stomach.
17:03
[Medical video description]
Medical illustration graphic showing how food moves through the digestive tract after a Gastric Bypass procedure is performed.
17:03
We divide the upper part fo the stomach
17:06
and leave a gastric pouch
17:08
that's about the size of a golf ball.
17:10
We then go downstream and divide the Jejunum
17:13
and we make a Roux-en-Y Anastomosis very similar to that
17:18
that we do with the Duodenal Switch
17:20
We then bring the one end of the Jejunum
17:22
up to the gastric pouch and we make a connection
17:26
or anastomosis between those two,
17:28
what's called the Gastrojejunal Anastomosis.
17:31
So, patients will eat a small amount.
17:32
They fill that pouch with about
17:36
a golf ball sized amount of food.
17:38
The opening between the stomach pouch or gastric pouch
17:41
and the Jejunum is approximately a half inch.
17:44
So once they eat that small amount of food
17:46
it's emptied slowly into the Jejunum.
17:48
There is an area between the gastric pouch
17:52
and the anastomosis where there's only food,
17:55
much like the Duodenal Switch.
17:57
There's just food, there are no digestive enzymes.
18:01
And then downstream of the digestive enzymes come into play.
18:04
We then have a fairly long common limb
18:07
where all the absorption takes place.
18:10
With the Gastric Bypass, we have restriction
18:13
as well as an element of mal-absorption,
18:16
very similar to what we see with the Duodenal Switch.
18:19
- [Dr. Abbas] The Gastric Bypass lies between the Sleeve
18:22
and the Laparoscopic Duodenal Switch.
18:24
So, the risks are, again, the same.
18:26
[Pictured text]
Gastric Bypass Advantages
Advantages:
- Excellent resolution of co-morbid conditions, especially diabetes
- Long-term results: proven sustainable results
- Minimal nutritional problems
- Dumping physiology to prevent sweets
Disadvantages:
- Cutting and stapling of stomach and bowel is required
- "Dumping syndrome" can occur
- Portion of digestive tract is bypassed, reducing absorption of essential nutrients
- Complications due to mal-absorption reported.
18:26
Your bleeding, infection, staple line leak,
18:31
and the interventions are essentially the same
18:33
for either, you know, just as we did for the Sleeve
18:36
and the Duodenal Switch.
18:38
The mal-absorption deficiencies
18:41
is less than the Duodenal Switch.
18:44
So it lays, if you look at the spectrum
18:46
where we have a Sleeve on one end
18:48
and the Duodenal Switch on the other end,
18:49
the Gastric Bypass is in the middle.
18:51
And as we go from the Sleeve to the Duodenal Switch,
18:53
the weight loss is gonna be greater.
18:55
So that's why you get an increased risk
18:58
of having nutritional deficiencies.
19:01
Again, the steps, the way we control this,
19:03
is by keeping a close eye on our patients
19:06
and making sure that they see us,
19:07
and they see our dietician,
19:09
to make sure that they're actually meeting
19:11
their micro and macro nutrient requirements.
19:14
- [Dr. DePeri] Once our patients reach out to us,
19:17
either by coming to a seminar or taking the online seminar,
19:20
we will see them in the office and examine them,
19:23
discuss their treatment options with them.
19:26
Preparation for the surgery is important.
19:28
We wanna make sure that, that they are seen
19:30
by at least their primary care physician
19:32
and any specialist that might be required based
19:36
on their personal medical history.
19:38
A lot of times folks are seen pre-operatory
19:40
by the Cardiologist, Pulmonologist, Endocrinologist,
19:43
or Gastroenterologist most commonly,
19:46
in addition to the primary care physician
19:48
to make sure they're medically prepared
19:49
to have what is a needed surgery,
19:52
but it's still done electively.
19:54
So we wanna make sure that when they come to surgery
19:56
that they're in tip top shape to have that procedure done.
19:59
Everybody would like to have a magic pill.
20:00
We don't have that.
20:02
This requires a commitment.
20:04
What we say is we have a commitment to our patients.
20:06
We require a similar commitment from our patients
20:10
for us to have that same goal of helping them
20:13
to resolve their disease,
20:15
to help them be cured of this disease.
20:19
I like to tell folks, it's not a sprint, it's a marathon.
20:23
And so it is a prolonged period of losing weight
20:27
and then of helping to maintain that weight loss.
20:29
It requires a dedication to following the dietary regimen
20:33
and the dietary regimen is not on us.
20:35
It's basically just making sure
20:36
that you get your protein in.
20:38
And if you get an a adequate amount of protein
20:39
there's not gonna be a lot of room
20:41
for the things that you shouldn't eat.
20:42
Make sure that you take your vitamins
20:44
as recommended and prescribed,
20:46
keep regular follow-up's with us.
20:48
And we also recommend attending the support group meetings,
20:51
if folks are able to.
20:53
And basically, getting enough exercise,
20:57
living an appropriate lifestyle.
20:59
It's a lot easier after that weight comes off.
21:00
And, of course, the people that we see
21:02
are people that have already made a commitment
21:05
to living healthier, and to living better.
21:07
We're just gonna help 'em do that.
21:08
We're gonna help augment that process.
21:10
- [Dr. DePeri] Oftentimes patients think that surgery
21:12
is the be all, end all.
21:13
And although surgery is a huge, big deal,
21:16
it's only part of the process.
21:18
There's education that goes on,
21:22
psychiatric care that goes on,
21:26
support group, all in an effort to help the patient
21:30
through the process so they can have a successful outcome.
21:43
(gentle music)
[Pictured text - For more information, visit HCAFloridaPhysicians.com]