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OBESITY

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OBESITY Powered By Docstoc
					An holistic, multi-disciplinary approach to
            surgical weight loss

               Mr. Justin Bessell
                    MBBS MD FRACS
      General & Upper Gastrointestinal Surgeon

              Dr. Helen Patroney
                        BMBS
                 Bariatric Physician
           What is obesity?


• Imbalance between calorie intake & expenditure

• Genetic, behavioral & environmental factors

• BMI (body mass index) = weight/height2
                  BMI

• BMI > 25 = overweight    (>50% adults)
• BMI > 30 = obese         (20% adults)
• BMI > 35 = severe obesity (8% adults)
   The most common chronic illness in the
              Western world!
Health risks of obesity


 1. Premature death
 2. Physical limitations
 3. Psychological effects
         1. Premature death

• 12 x increased death rate for 25-34 yr old men

• 6 x increased death rate for 35-44 yr old men

• Increased death rate for both men & women
BMI & death
        2. Physical limitations

• Osteo-arthritis
   – hip & knee replacements
   – chronic back pain

• Difficulties with activities of normal living
   – sporting & outdoor activities
   – buying clothes
   – personal hygiene
   – travel
3. Psychological effects

 •   Depression
 •   Low self-esteem
 •   Low self-confidence
 •   Reduced employability
 •   Decreased sex drive
 •   Social isolation
Surgical procedures

  Gastric bypass
Surgical procedures

  The LAP-BAND
   How the LAP-BAND works

• The band is placed
  around the upper part of
  the stomach
   – A small pouch is
     created
   – The stomach holds less
     food
   – Patients feel full faster
     and longer
 The LAP-BAND is adjustable

• The plastic band around the
  stomach is hollow
• It is filled with a saline solution
• By adding or removing the
  saline, the surgeon can make
  the band tighter or looser
• Adjustments are made to meet
  individual weight loss needs
Do I qualify for a LAP-BAND?

 1. BMI > 35
 2. Age 16 - 65 yrs
 3. Serious efforts to lose weight
 4. Understand risks & responsibilities
Risks
• Die – 1:2000
• Complication – 2%
• Re-operation – 10%
• Gap $1700, not re-imbursed by health fund
  – majority costs covered by health fund
  – within 48 hrs before surgery
Responsibilities

         1. Eating
         2. Exercise
         3. Follow-up
          Surgical work-up
• Lifestyle approach
   – Dietician
   – Exercise Physio/Personal trainer
   – Psychologist
   – Internal Medicine Physician

• Investigations
   – Blood tests
   – Endoscopy

• See again in 4 - 6 weeks
• 2 weeks of Optifast just before surgery
Before the operation

• Admitted to Wakefield Hospital
• Temp, BP, heart rate, weight recorded
• DVT prophylaxis
• Nursing care mapped out
• Surgery usually lasts 1 - 1.5 hours
• Recovery ~ 30-60 minutes
   After the operation
• Return to ward
   – IV drip & painkillers

• First day
   – Barium swallow
   – start fluids (water, tea, coffee, apple juice, etc)
   – if tolerated, drip stopped & painkiller tablets orally
   – have a shower, go for a walk, breathing exercises
   – see dietitian for revision

• Day 2
   – restrictions and wound care discussed
   – discharged home!
Subsequent follow-up

• 1st band inflation 6 wks later
• Review every 6 wks ± band adjustments
• Consultations alternate with Dr. Helen
  Patroney
• 4 - 6 adjustments may be req in 1st yr
• Minimum frequency twice a year for life
Results
• Weight control
   – Slow, gradual weight loss (1/2 kg per week)
   – 60% wt loss over 5 yrs

• Risk of death
   – 73% reduction

• Diabetes
   – 65% cured, further 25% improved (total = 90%)

• High blood pressure
   – 2/3 cured, further 1/3 improved

• High cholesterol
   – may return to normal values
Results
• Reflux/heartburn
  – 90% cured, further 5% improved

• Asthma
  – 1/3 cured, further 1/3 improved

• Depression
  – 75% cured
Results
Results

				
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