Presentation on theme: "Prime Care Surgical Weight Loss Program"— Presentation transcript:
1 Prime Care Surgical Weight Loss Program “A comprehensive program integrating body, mind & spirit”Gaylord Kavlie, M.D., F.A.C.S.Brandon Helbling, M.D.Jean Ellefson, RN Jessica Miller, RN, BSN, CPANClinical Coordinator Clinical CoordinatorMid Dakota Clinic St. Alexius Medical CenterBernie Kraft, LRD CDE Laura Russell, LRD CDEAffiliated With:
2 Mission StatementTo provide support to those committed to a healthier lifestyle and improved quality of life through medical and surgical treatment of obesity.
3 What Is Morbid Obesity?Clinically severe obesity at which point serious medical conditions occur as a direct result of the obesityDefined as >200% of ideal weight, >100 lb overweight, or a body mass index of 40
6 Obesity Related Co-Morbidities (Health Risks) Infertility ProblemsFatigueAdult Onset Type II DiabetesFatty LiverGallbladder DiseaseVenous InsufficiencyHerniaPremature DeathsCancerDiabetesHypertensionHyperlipidemiaCardiac diseaseRespiratory diseasesleep apneaArthritisDepressionStress IncontinenceMenstrual irregularityThese are just a few. There are over 30!
7 Surgical Weight Loss “Not a Miracle” At present surgery is our most effective option in achievingSUSTAINEDweight loss in themorbidly obese patient.“Not a Miracle”
8 Medical Benefits of SWL Type II Diabetes 76.8% remission rate, significantly improved in 86%High Blood Pressure eliminated in 61.7%, significantly improved in 78.5%High Cholesterol reduced in more than 70% of patientsSleep Apnea eliminated in 85.7% of patientsJoint Disease, Asthma, and Infertility dramatically improved or resolvedPlus many other important medical benefitsJAMA 2004
12 Laparoscopic Adjustable Gastric Banding A silicone band is placed around the upper part of the stomachThe band is attached to a portA small pouch is createdStomach holds less foodInduces feeling of satietyOR time = minutesGenerally outpatient procedureReturn to work in 3-5 daysFrequent evaluations and adjustments needed to meet individual needs
13 Possible Complications of Lap Banding ErosionProlapseSlippageInfectionObstructionStomach PerforationDevice MalfunctionEsophageal Dilation
14 The LAP-BAND System Advantages Disadvantages Adjustable – customized per patientNo stomach stapling, cutting or intestinal reroutingRemovable and reversibleLow malnutrition riskOR time = 1 hour or lessGenerally outpatient procedureMortality rate %DisadvantagesSlower initial weight loss than gastric bypassSoft calories such as ice cream, milk shakes, etc can be absorbed and may slow weight loss.Regular follow-up is critical for optimal resultsOnly trained practitioners can do adjustmentsLess long-term information is available because it hasn’t been done as longForeign body
15 Roux-en-Y Gastric Bypass Combination procedureFirst done in 1967, done laparoscopically since 1993Gastric pouch is approximately size of your thumbConsidered the “Gold Standard”ASMBS
16 SUCCESS OF GASTRIC BYPASS SURGICAL TREATMENTIn a 5 Year Study of 500 Roux En Y Surgical Weight Loss Patients:77% Of Excess Body Weight Was Lost in 1 Year & Maintained For 60 Months96% Of Severe Co-Morbidities Were Eliminated Within 1 Year98% Of Type II Diabetes Was Clinically ReversedDr.’s Wittgrove & Clark,
17 POSSIBLE SURGICAL COMPLICATIONS OF GASTRIC BYPASSAbscessDeep Vein ThrombosisPulmonary EmboliGastric LeaksBleedingDevelopment of a FistulaObstructionPulmonary ComplicationsInfectionHerniasStricturesStomal UlcersVentral HerniaAnemiaVitamin & MineralDeficienciesPerforation
18 Bariatric Surgery Has Become More Safe Mortality rate related to bariatric surgery dropped 78.7% from 0.89% in 1998 to 0.19% in 2004.Additionally, morbidly obese patients have a longer life expectancy after bariatric surgery due to resolution of comorbidities.
19 Gastric Bypass Advantages Disadvantages Rapid initial weight loss More effective, rapid co-morbidity improvementsFood restriction with the added weight loss benefit of minor food malabsorptionBetter long term weight loss results than restrictive only proceduresAssists those who consume too many calories by making them ill – “dumping”Has been done the longestIs the “Gold Standard” and remains the most researched obesity surgery to dateDisadvantagesCutting and stapling of stomach and bowel is requiredMore operative & post-op complicationsPortion of digestive tract is bypassed, reducing absorption of essential nutrientsNonadjustable, difficult to reverseTechnically more complex
21 POSSIBLE SURGICAL COMPLICATIONS OF SLEEVE GASTRECTOMYDeep vein thrombosisPulmonary embolusPneumoniaAcute respiratory distress syndromeAccidental perforation of internal organsGastric leakPostoperative bleedingSmall bowel obstruction
22 Sleeve Gastrectomy Advantages Stomach is reduced in volume but tends to function normally. Most food items can be consumed in small amounts.Eliminates the portion of the stomach that produces the hormones that stimulate hunger (Ghrelin).No dumping syndrome because the pylorus is preserved.By avoiding the intestinal bypass, protein deficiency and vitamin deficiency are almost eliminated.Very effective for high BMI patientsAppealing option for people with existing anemia, Crohn's disease and numerous other conditions that make them too high risk for intestinal bypass procedures.It can be converted to almost any other weight loss procedure.DisadvantagesSoft calories such as ice cream, milk shakes, etc can be absorbed and may slow weight loss.Potential for leaks related to long staple line on the stomach.Because the stomach is removed, it is not reversible.
23 Frequently Asked Questions About Bariatric Surgery.... Q: Is Weight Loss Surgery Reversible?A: Lap Band- Yes, Gastric Bypass- No,Sleeve Gastrectomy- No.Q: Is There Guaranteed Success?A: No. These surgeries can be defeated if healthy lifestyle changes are not maintained.
24 More Frequently Asked Questions Q: Will you take my gallbladder out when you do my surgery?A: No. We do not remove healthy gallbladders. If you have evidence of stones or disease it may be removed.Q: What are the age limits for these surgery?A: 18 is the youngest. Patients up to age 65 have had these surgeries, however, all patients are individually considered.
25 More Frequently Asked Questions Q: When can I go back to work?A: Depends- based on the procedure done and the type of work you do.Q: When can I drive?A: When off of narcotic pain medication.Q: When can I exercise?A: Walking is recommended in moderation immediately after surgery. 6 weeks for more intense exercise.
26 More Frequently Asked Questions Q: Can I drink alcohol?A: No beer because of carbonation. Wine and other alcoholic beverages are fine but contain many empty calories.Q: Am I going to have loose skin after I lose weight? A: Probably. Reconstructive surgery to correct this is usually covered by insurance if you lose 100 pounds or more.
28 Pre-Operative Expectations Goals of optimum weight loss during thepre-op period:Reduce liver sizeIncrease the odds that surgery can be completed laparoscopicallyDemonstrate commitment to the nutritional program that has been prescribed for youDemonstrate your commitment to making lifestyle changes.
29 Lifetime Rules for Eating Eat slowly and chew wellAvoid overeatingMoisture rich foodsLimit sugar and high fat foodsTotal of 64 oz. fluid daily, taken between mealsAvoid carbonated beverages- includes beerTake your prescribed supplements
30 Insurance Requirements for Pre-Authorization Surgical EvaluationPsychological EvaluationPre and Post-Op Nutrition with LRDDocumented weight loss attemptsMedical Records with documented weights
31 Jean Ellefson, RN MDC Clinical Coordinator Surgical Weight Loss Program Call with questions or to enroll in our program: (701) , ext Fax: (701)