Kristina Lukowski & Jessaca York April 29, 2013 BIOL 1120 Lap-band SYSTEM Kristina Lukowski & Jessaca York April 29, 2013 BIOL 1120

Obesity More than 1/3 of U.S. adults (35.7%) are obese. An adult who has a BMI between 25 and 29.9 is considered overweight. An adult who has a BMI of 30 or higher is considered obese.

Obesity Major cultural influences contribute to weight gain and obesity Obesity-related conditions include: Heart disease Stroke Type 2 diabetes Certain types of cancer Some leading causes of preventable death

Ways to Combat Obesity Exercise Personal Professional (Physical training, Gym, Fitness videos) Surgery Sleeve Gastrectomy Gastric Bypass Dieting Weight Watchers Jenny Craig

Lap-band system – The way to go! Performed laparoscopically There is no stomach amputation or cutting of your intestines during this procedure. Designed for long-term use. Can be removed and reversed if desired. Can be adjusted over time to fit the needs of the patient. Sleeve Gastrectomy G A S T R I C B Y P A S S Performed laparoscopically, more than 80% of the stomach is amputated to create a sleeve. A more radical procedure than a gastric band that is permanent and irreversible. Cannot be adjusted. Performed either open or laparoscopically, the stomach is cut and the intestines rerouted to bypass significant digestion. Extremely difficult to reverse. Cannot be adjusted.

Cost On average, a severely obese person of average height spends $1,566 more a year on healthcare costs, compared with people in a normal weight range. A morbidly obese person of average height spends $2,845 more when compared to people in a normal weight range. Using the LAP-BAND® System to significantly reduce your weight may therefore also reduce your weight-related costs. Cost: ~$30,000 total on average Follow-up care necessary! ~$35.00 to $200.00 per visit

Insurance Coverage Today many health plans cover the LAP BAND procedure, which means most, if not all, the costs will be paid for. Each health plan will have certain criteria that need to be met before you can actually have the surgery. Over 90% of the LAP-BAND® System cases performed in 2012 were reimbursed in full or in part by insurance

Surgical Procedure 1.During a minimally-invasive procedure, an adjustable band is placed around the upper part of the stomach, creating a small pouch. 2. The band is connected by thin tubing to an access port below the skin. 3. Through this port, surgeon adjusts LAP-BAND by inflating or deflating the inner balloon with saline. 4. As the band inflates, the stomach outlet becomes smaller This helps reduce the amount of food you eat and slows the emptying into the lower stomach, helping you feel full sooner, stay full longer, and reduce hunger urges This procedure does not require any rerouting of the anatomy

Lap-band procedure: walk-through https://www.lapband.com/Compare-Lapband

Materials Components of the LAP-BAND® System Fabricated primarily from silicone elastomers and polymers. Silicone elastomers, polysulfone, titanium and stainless steel. These materials have also been used in other medical device applications. Biocompatibility test results have demonstrated that sterilized finished devices meet the acceptance criteria for each of the tests.

Post-Implant Care Follow a nutrition plan as prescribed by the surgeon and nutritionist, including vitamin supplements and soft foods Adhere to a specific exercise program Seek behavioral modification therapy to ensure that a complete life change is made Maintain attendance to frequent follow-up visits designed to adjust the band and check on the patient's overall health

Indications BMI ≥40 kg/m2 - OR - BMI ≥30 kg/m2 with one or more obesity-related comorbid conditions. Adult patients who have failed more conservative weight reduction alternatives Commitment to accept significant changes in eating habits for the rest of life Long-term implant

Complications Explant and replacement surgery may be required. Patients who become pregnant or severely ill, or who require more extensive nutrition may require deflation of their bands. Anti-inflammatory agents, such as aspirin, should be used with caution and may contribute to increased risk of band erosion. Placement of the LAP-BAND® System is major surgery and, as with any surgery, death can occur. Risks associated with the medications and methods used during surgery, the risks associated with any surgical procedure, and the patient's ability to tolerate a foreign object implanted in the body. Band slippage, erosion and deflation, reflux, obstruction of the stomach, dilation of the esophagus, infection, or nausea and vomiting may occur. Reoperation may be required.

Improvements Significant weight loss Ability to keep weight off Decreased obesity-associated morbidity Better lifestyle habits Smaller portion sizes Decreased calorie intake Decreased sugar intake Increased Energy Increased Exercise Activity

Success Stories Frank lost 135 lbs Tammy lost 104 lbs Brooke lost 160 lbs Dan lost 170 lbs “I got my life back!”

Questions

References Overweight and Obesity. (August 13, 2012) http://www.cdc.gov/obesity/data/adult.html retrieved 4.26.13 Lapband AP System. (2013) https://www.lapband.com/learn-about-lapband/ retrieved 4.20.13 Needleman Bradley, Happel Lynn. Bariatric Surgery: Choosing the Optimal Procedure. Surgical Clinics of North America. 2008. The LAP-BAND® System Surgical Aid in the Treatment of Obesity (PSI). Allergan, Inc. Irvine, CA. 02/11. Hutter Matthew, et al. First Report from the American College of Surgeons Bariatric Surgery Center Network: Laparoscopic Sleeve Gastrectomy has Morbidity and Effectiveness Positioned Between the Band and the Bypass. September 2001. DeMaria et al. Baseline data from American Society for Metabolic and Bariatric Surgery-designated Bariatric Surgery Centers of Excellence using the Bariatric Outcomes Longitudinal Database. Surgery for Obesity and Related Diseases 6. 2010. The Longitudinal Assessment of Bariatric Surgery (LABS) Consortium. Perioperative Safety in the Longitudinal Assessment of Bariatric Surgery. The New England Journal of Medicine Vol. 361 No. 5. July 30, 2009.