Unbuckling the Band Recycling the Band and Rehabilitating the Patient Terry Simpson MD, FACS – Virginia Mason 1991.

Slides:



Advertisements
Similar presentations
Bariatric Surgery By Sue Gabriel, ARNP, CCRN, MSN Nursing made Incredibly Easy! January/February ANCC/AACN contact hours Online:
Advertisements

You Can Get Your Weight Under Control SMR124 Rev. 2 10/26/10.
Revision of failed restriction to RYGB
Welcome to Utah. Laparoscopic Banding with or without Gastric Imbrication The pros and cons of this evolving technique Covidian Trainer First Health.
GI Complications of Gastric Bypass Caroline R. Tadros, MD May 15 th 2013.
Gastric Obstruction post “Sleeve gastrectomy”
Management of Patients With Gastric and Duodenal Disorders
ERCP in patient with altered Upper GI anatomy. Bariatric surgery 75 million Americans are obese, BMI > million are morbidly obese, BMI >40 Total.
LGCP  Restrictive bariatric procedure similar to vertical sleeve gastrectomy without the need for gastric resection  Reducing risks of complications.
Peptic ulcer disease.
Long Term Use of Feeding Jejunostomy Following Oesophagectomy FMS Macharg, Y Soon, S Singh and SR Preston Regional Oesophago-Gastric Unit Royal Surrey.
Weight Loss Surgical Procedures Help You Overcome Obesity.
Combination Surgical Therapy Banding the Bypass Bypassing the Band Matthew Kroh,MD Assistant Professor of Surgery Cleveland Clinic Center for Surgical.
Lap-Band for Weight Loss Marc Bessler, M.D. New York Presbyterian Center for Obesity Surgery FDA Approved.
Lap-Band Surgery for Adolescents NYU Medical Center Program for Surgical Weight Loss George Fielding, MD Associate Professor of Surgery Evan P. Nadler,
Dietetic Support for Bariatric Surgery
Gastrointestinal Surgery for Severe Obesity Prepared By: Dr. Fahad Al-Jindan Dr. Fahad Al-Jindan.
Carly Pabon NTR 573 Spring  The different types of bariatric surgery, their prevalence, and effectiveness.  Qualifications for bariatric surgery.
Gastric Surgery for Severe Obesity David L. Gee, PhD Professor of Food Science and Nutrition Central Washington University.
Unearned White Privilege What Does it mean?. Society in the view of Women In the Cleaver’s yearsOur times now.
© 2003 By Default! A Free sample background from Slide 1 Complications of Bariatric Surgery Presented by: Robyn Ache, D.O. Fellowship.
Bariatric surgery: an effective ‘psychotherapy’ for food addiction David Schroeder Surgical Obesity Service Hamilton/Wellington.
Complications Associated with Laparoscopic Adjustable Gastric Banding for Morbid Obesity Dr. Mojtaba Hashemzadeh Dr. Leila Zahedi-Shoolami Dr. Mahmoud.
Bariatric Surgery Mr B.M.Axisa Consultant Laparoscopic and Upper GI Surgeon.
L Genser (2), A Soprani(1,2), Tabbara M (2), J Cady (1) 1- Clinique Geoffroy Saint Hilaire (Paris), 2- Service de Chirurgie Digestive et Hépato-Bilio-Pancréatique,
Bariatric Weight Loss Surgery November 2012 Diet Host In-service Jen Hey, Dietetic Intern Clinical Nutrition.
Chichester J P Mulier1 Risks Costs Benefits When to say No J P Mulier MD PhD Sint Jan Brugge-Oostende
Surgical treatment for morbid obesity
Esophageal Problems after Gastric Banding
RATIONALE FOR BARIATRIC SURGERY IN ADOLESCENTS. SCOPE OF THE OBESITY PROBLEM 26% of children and adolescents aged 2 to 17 years were overweight (18%)
Metabolic Surgery Chandra Hassan MD Director of Bariatric Surgery St. Vincent’s Charity Medical Center Cleveland, OH Chandra Hassan MD Director of Bariatric.
1 Jaime Ponce, MD FACS FASMBS Director of Bariatric Surgery Hamilton Medical Center Dalton GA Outpatient Bariatric Surgery: Is it Here? MISS Morbid Obesity.
Sleeve En Y Does Changing the Name Change the Perception? Mitchell Roslin, MD FACS Chief of Bariatric Surgery Lenox Hill Hospital Northern Westchester.
BY: HILLARY SULLIVAN MEDICAL NUTRITION THERAPY BASIC EXPLANATION OF BARIATRIC SURGERY TYPES.
Dr Maryam Ali AlQaydi,MBBS R5 – otolaryngology head & neck surgery In Saudi board From UAE, Ministry of Health 19/3/2015.
1 B-Band Gastric Bypass Band enforcing the restrictive effect of gastric bypass surgery.
Self-Adjusting Gastric Banding System Erin Crosby Andrew Dickerman Josh Mabasa Brian Reis.
Coding Options for Reoperative Procedures ASMBS Reoperative Surgery Insurance Toolkit.
Jeff W. Allen MD, FACS Norton Surgical Specialists Louisville, KY.
Self-Adjusting Gastric Banding System Erin Crosby Andrew Dickerman Joshua Mabasa Brian Reis.
Experience with 458 cases of Gastric Plication Surgery Dr Ariel Ortíz Lagardere,FACS. Obesity Control Center hospital, México.
Adolescent Obesity - A Pediatric Surgeon’s Perspective Allen F. Browne, M.D. Adolescent Adjustable Gastric Band Interest Group AAGBIG.
“Complicaties na bariatrische ingrepen”
Carle Bariatrics Weight Loss Surgery Seminar. Major public health problem worldwide Affects 30% of industrialized world American statistics: – 60% of.
Understanding Your Gastroesophageal Reflux Disease (GERD)
Call Us :
Dr Ramen Goel, Bombay Hospital Mumbai : Fixing fat problem with Best Weight Loss Surgeon in India
Assessment and treatment of abdominal pain in the bariatric patient
Dr. Mojtaba Hashemzadeh Dr. Leila Zahedi-Shoolami
Laparoscopic One Anastomosis Gastric Bypass (LOAGB/BAGUA)
STOMACH & DUODENUM-3 Bariatric surgery.
Jerome DARGENT, Lyon (France)
BYPASS GASTRICO DE UNA ANASTOMOSIS (OAGB-BAGUA): RESULTADOS EN UNA
In the name of GOD.
Why do you think you regained your weight?
Adolfo Leyva-Alvizo MD FACS1, Eduardo Gonzalez MD FACS1, Francisco X
Gastric Prolapse following Laparoscopic Adjustable Gastric Banding is a Complication that Every Clinician Must be Aware of! Case Report O Jalil, Rhodri.
“Losing it is only the beginning…” Complications of Bariatric Surgery
Acute Management of Patients with a Prior History of Bariatric Surgery
Evaluation of Minimally Invasive Approaches to Achalasia in Children
ERAS Sandra J. Beck, MD, FACS, FASCRS
Cancer oesophagus.
(OAGB) “How do I do it” Laparoscopic One Anastomosis Gastric ByPass
BARIATRIC SURGERY UT Health | McGovern Medical School
Know the 4 Things About Gastric Bypass Surgery
מפגש מומחים: השמנה - טיפולים בריאטריים פרופ' זמיר הלפרן
Self-Adjusting Gastric Banding System
Background Bariatric interventions offer a more efficacious and durable weight loss than non-surgical approaches Surgical weight loss procedures are limited.
By Dr Khaled Ahmad, MD, FACS, FASMBS
Presentation transcript:

Unbuckling the Band Recycling the Band and Rehabilitating the Patient Terry Simpson MD, FACS – Virginia Mason 1991

Classic Band Slip 2 yrs post Lap Band with Complete Obstruction

The Lap Band 500,000 bands placed in US since introduction in 2001 Most weight loss surgeons placed bands in their practice Direct to Consumer Marketing made it the most asked for weight loss operation Responsible for the Rise in Gastric Sleeve Operations Difficulty with instructions and follow up had increased rate of band failure compared to band dedicated practices

What Won’t Work Instructing patients that the band will make them “feel full” or “feel satisfied” leads to poor results This leads to eating fast, loading the stomach pouch above the band and leads to slips The patient presented chronically ate fast and noticed reflux and heartburn for the previous two months. GI placed on Nexium

Increased pressure in upper pouch leads to pouch dilation as well as a slip of stomach coming up through the band. Either from people eating too fast, or stuffing the upper pouch with food to feel “full.” This leads to reflux, heartburn and what is called an “early” band slip.

Classic Band Slip

Most patient can be treated by removing fluid from the band and placing them on a liquid diet. About 85% improve with this regimen. However, some present with complete obstruction

Problems with Traditional Repair Standard revision leaves thinned out pouch that can later perforate Removal of band solves the issue but leads to weight regain Conversion to other bariatric procedures has a high rate of complications

Lap Band Slip 3876 patients banded, 411 (11%) had band revised for pouch related problems. 2% had band removed. 3% converted to another procedure Most often treated by removing fluid from the band and placing patients on a liquid diet If not satisfactory then patient will require surgery

Surgical Treatment Morbidity and Mortality of conversion to gastric sleeve includes 5.5% rate of “leak” Conversion to RNY has leak rate of 3% Removal of band solves issue but loss of weight loss tool leads to increased weight gain The plan is removing the pressure from the stomach- hence, why not unbuckle – a new procedure

Classic Band Slip

Unbuckling the band there was a large amount of scar tissue beneath that would not even admit a 32 French (10 mm) gastric tube. After lysis easily admits 90 French balloon (30 mm). Immediate relief in the post operative recovery room, able to drink fluids without reflux or heartburn

Two Months Later 2 months later- band buckled – op time 12 minutes Patient able to eat and drink without difficulty now 4 years out

Unbuckling the Band 63 cases of unbuckling and re-buckling the band done since 2010 Most re-buckled in two months- some re-buckled as long as two years later No mortality 5 cases needed to be repositioned after two months or more of unbuckling 3 patients had recurrence of slips- all from maladaptive eating behavior Allowed patients to “keep” their band Done acutely and allowed patients to be discharged that day or done as an outpatient procedure

Re-buckling the Band It is a second procedure Takes less than 20 minutes of operating room time Allows patient to keep their tool and to be rehabilitated in their eating behavior Less morbidity and mortality than conversion to other procedures In two cases new bands were placed as the bands were damaged in the revision

New Procedure Unbuckling and re-buckling the band is a new procedure that has promise It involves careful dissection with the scar around the stomach – hence that procedure is called the “Ryan” procedure