Laparoscopic Adjustable Laparoscopic Adjustable Gastric BandGastric Band

Dr. Isaac Samuel Dr. Isaac Samuel –– Bariatric DirectorBariatric DirectorDr. Mohammad Jamal Dr. Mohammad Jamal –– Bariatric SurgeonBariatric Surgeon

Lynn Gingerich Lynn Gingerich -- Bariatric Physician AssistantBariatric Physician AssistantDebi Heitshusen Debi Heitshusen –– Bariatric Nurse CoordinatorBariatric Nurse Coordinator

Amy Lukas Amy Lukas –– Bariatric DietitianBariatric DietitianChris MelicharChris Melichar-- Program Assistant/InsuranceProgram Assistant/Insurance

UIHC Bariatric Program is a UIHC Bariatric Program is a Center of ExcellenceCenter of Excellence

COE Designations:COE Designations:

American Society for Metabolic & American Society for Metabolic & Bariatric SurgeryBariatric Surgery (ASMBS) (ASMBS) Wellmark BC/BSWellmark BC/BSBCBS BCBS -- Blue DistinctionBlue DistinctionUnited Resource NetworkUnited Resource NetworkAetnaAetna

The designation underscores the The designation underscores the programprogram’’s excellence in patient education s excellence in patient education

and outstanding clinical outcomes.and outstanding clinical outcomes.

The Lap Band is implanted using laparoscopic surgery …

a procedure that involves smaller incisions and less tissue trauma than

open surgery…

resulting in shorter hospital stays, faster recovery, smaller scars, and

less pain than open surgical procedures.

Time OffTime Off

Hospital Stay Hospital Stay –– one nightone nightReturn to WorkReturn to Work-- 11--2 weeks 2 weeks

After one month After one month –– first adjustmentfirst adjustment33--4 adjustments 14 adjustments 1stst yearyear

Effects of gastric banding on Effects of gastric banding on Obesity related conditionsObesity related conditions

Type II Diabetes resolved 47.8%Type II Diabetes resolved 47.8%High Blood Pressure resolved 43.2%High Blood Pressure resolved 43.2%High Cholesterol resolved 78.3%High Cholesterol resolved 78.3%Sleep Apnea resolved 94.6%Sleep Apnea resolved 94.6%Acid reflux/GERD resolved 32.3%Acid reflux/GERD resolved 32.3%

The Lap Band is made of strong, flexible silicone and The Lap Band is made of strong, flexible silicone and has a soft balloon that fits around the stomach.has a soft balloon that fits around the stomach. The The amount of saline in the balloon controls the tightness amount of saline in the balloon controls the tightness around the stomach.around the stomach.

The balloonThe balloon’’s tightness affects how much food you s tightness affects how much food you are able to eat during a meal and the length of time it are able to eat during a meal and the length of time it takes for food to leave your stomach pouch to travel takes for food to leave your stomach pouch to travel through your digestive system. How does this help through your digestive system. How does this help you achieve your weight loss goals and improve your you achieve your weight loss goals and improve your quality of life? Youquality of life? You’’ll feel fuller sooner and stay fuller ll feel fuller sooner and stay fuller longer with the Band. longer with the Band.

The bandThe band’’s tubing is connected to the Port. The port s tubing is connected to the Port. The port is made from an implantis made from an implant--grade medical plastic and grade medical plastic and silicone. It is usually fastened (or sutured) on the left silicone. It is usually fastened (or sutured) on the left or right side, about 2 inches below the rib cage. The or right side, about 2 inches below the rib cage. The exact location will depend upon your body shape and exact location will depend upon your body shape and your surgeonyour surgeon’’s decision. .s decision. .

The band works on three ways:The band works on three ways:

1.) It limits the amount of food that is1.) It limits the amount of food that isconsumedconsumed

2.) It delays the emptying of the new2.) It delays the emptying of the newstomach pouchstomach pouch

3.) It creates the sensation of fullness for a3.) It creates the sensation of fullness for along period of time after eatinglong period of time after eating

Average weight LossAverage weight Loss

Food digestion happens through normal Food digestion happens through normal digestion, and healthy weight loss occurs digestion, and healthy weight loss occurs at a target rate of:at a target rate of:

11--2 pounds per week2 pounds per week

Patients in a 3Patients in a 3--year clinical trial lost an year clinical trial lost an average of 40% of their excess weight at average of 40% of their excess weight at one year and 43% at three years.one year and 43% at three years.

The Lap Band is adjustable so if the rate of The Lap Band is adjustable so if the rate of weight loss is not acceptable, the band can be weight loss is not acceptable, the band can be tightened to make you feel full after eating less tightened to make you feel full after eating less food. food.

Additionally, if weight loss is occurring too Additionally, if weight loss is occurring too quickly, the band can be loosened so that more quickly, the band can be loosened so that more food is needed to feel full. food is needed to feel full.

nerve endings in the nerve endings in the pouch signal fullnesspouch signal fullness

our bodies only need our bodies only need 500 calories a day 500 calories a day to survive to survive (with supplements)(with supplements)

How can a person eat soHow can a person eat solittle and survive?little and survive?

Recommended Plan Recommended Plan in Preparation in Preparation

for Obesity Surgeryfor Obesity Surgery

Start working on your Start working on your diet and behavior diet and behavior

modifications today!modifications today!

See dietitian for a low fat, low calorie diet.See dietitian for a low fat, low calorie diet.

Keep a daily food & exercise JournalKeep a daily food & exercise Journal..

Write down what you eat & how much of it you Write down what you eat & how much of it you eat. Try to stay within what the dietitian has eat. Try to stay within what the dietitian has

given you per day. Please be truthful.given you per day. Please be truthful.

Please, bring your food diary back Please, bring your food diary back to every visit until surgery so we can to every visit until surgery so we can

review it with youreview it with you..

Drink 6Drink 6--88-- glasses glasses of water every dayof water every day

Water is the key to the surgery !!Water is the key to the surgery !!

It helps you lose the weight It helps you lose the weight and and

it helps you keep it offit helps you keep it off

Never compromise your water intake Never compromise your water intake

Beverage RestrictionsBeverage Restrictions

No PopNo Pop (diet or regular) N0 Juice(diet or regular) N0 Juice((calories, phosphate, carbonation)calories, phosphate, carbonation)

1 can of regular pop or 8 oz. juice per day is equal to 1 can of regular pop or 8 oz. juice per day is equal to 17# wt gain per year17# wt gain per year..

PhosphatePhosphate binds with calcium binds with calcium ––which may lead to which may lead to osteoporosisosteoporosis

CarbonationCarbonation stretches out your pouchstretches out your pouch –– eat more eat more ––weight loss stopsweight loss stops

No AlcoholNo Alcohol –– it will cause gastritis and it will cause gastritis and eventual ulcers in your poucheventual ulcers in your pouch

You must start an exercise planYou must start an exercise plan

We would like you to do We would like you to do 30 minutes of exercise every day.30 minutes of exercise every day.

For those of you who suffer from a lot of joint For those of you who suffer from a lot of joint pain, we suggest that you start water aerobics. pain, we suggest that you start water aerobics. 2020--30 minutes of swimming is a wonderful 30 minutes of swimming is a wonderful workout and will not put any stress on your workout and will not put any stress on your joints.joints.

Whatever you do (swimming, walking, biking,Whatever you do (swimming, walking, biking,treadmill, gym) treadmill, gym) –– increase your heart rateincrease your heart rate

STOP SMOKINGSTOP SMOKING

For those of you who smoke, we encourage For those of you who smoke, we encourage you you STOP smokingSTOP smoking as soon as possible.as soon as possible.

We want your lung function in the best We want your lung function in the best possible shape going into surgery. possible shape going into surgery.

You have to be smoke free for 3 months You have to be smoke free for 3 months prior to surgery.prior to surgery.

ALWAYS chew your food ALWAYS chew your food to mush before you swallowto mush before you swallow. .

It is very important after the surgery that It is very important after the surgery that all of your food be chewed to mush before all of your food be chewed to mush before you swallow or you will vomit.you swallow or you will vomit.

The band is non forgiving The band is non forgiving and you will pay the price.and you will pay the price.

““DO NOT DO NOT ““ drink with your mealsdrink with your meals

STOPSTOP drinking 30 minutes before you eatdrinking 30 minutes before you eat

DO NOTDO NOT drink while you eatdrink while you eat

WAITWAIT to resume drinking for 30 min. to resume drinking for 30 min. after you are done eating and you after you are done eating and you have the have the ““fullfull”” feelingfeeling

Band AdjustmentsBand Adjustments

Because your doctor wants to Because your doctor wants to make sure that your stomach heals make sure that your stomach heals completely from the surgery, your completely from the surgery, your first band adjustment wonfirst band adjustment won’’t usually t usually

occur until 4occur until 4--6 weeks after your 6 weeks after your surgery.surgery.

Band AdjustmentsBand Adjustments

Most patients have their first adjustment Most patients have their first adjustment after eating solid food for one week. The after eating solid food for one week. The exact timing will depend upon your exact timing will depend upon your progress. Remember, the Lap Band progress. Remember, the Lap Band provides some restriction even when it is provides some restriction even when it is empty. If you are losing 1 to 2 pounds a empty. If you are losing 1 to 2 pounds a week and feeling satisfied with an week and feeling satisfied with an appropriate portion of food, you may not appropriate portion of food, you may not need an adjustment at this time. need an adjustment at this time.

The purpose of an adjustment is to ensure that you The purpose of an adjustment is to ensure that you feel satisfied when you eat and that you are losing feel satisfied when you eat and that you are losing weight gradually, about 1weight gradually, about 1--2 pounds per week. 2 pounds per week.

The adjustments are done by your doctor or another The adjustments are done by your doctor or another healthcare professional by adding sterile saline to the healthcare professional by adding sterile saline to the band through the port. Adjustments can also involve band through the port. Adjustments can also involve removing saline from the band through the port. removing saline from the band through the port.

When filling the band, saline travels from the port When filling the band, saline travels from the port through the tube and into the band, making the band through the tube and into the band, making the band fit more snugly around your stomach. fit more snugly around your stomach.

REMEMBERREMEMBERAvoid: Avoid:

raw vegetables, raw vegetables, fruits with skin, fruits with skin, nuts, nuts, popcorn, popcorn, tough meats, tough meats, stringy foods, and stringy foods, and crusty bread (bagels and pretzels)crusty bread (bagels and pretzels)

These may block your These may block your Stomach outlet Stomach outlet

Eat approximately 4 ounces (1/2 cup) of food at Eat approximately 4 ounces (1/2 cup) of food at each meal and note that protein will stay in your each meal and note that protein will stay in your upper stomach longer than other foods.upper stomach longer than other foods.

Do not snack between meals. Do not snack between meals. Drink fat free skim milk.Drink fat free skim milk.

Eat slowly, take small bites and chew your food Eat slowly, take small bites and chew your food wellwell

Do not drink with your mealsDo not drink with your meals

No nonsteroidal medicationNo nonsteroidal medication(Advil, Motrin, Ibuprofen, Aleve, Aspirin, Arthritis (Advil, Motrin, Ibuprofen, Aleve, Aspirin, Arthritis

medication) medication) for the rest of your life.for the rest of your life.

No continual use of steroidsNo continual use of steroids(Prednisone, Cortisone, Medrol) (Prednisone, Cortisone, Medrol)

Daily use of either of these medications Daily use of either of these medications can cause ulcers in can cause ulcers in

your pouchyour pouch..

Tylenol products only Tylenol products only

SupplementsSupplements

Chewable Multivitamin with ironChewable Multivitamin with ironDailyDaily

RISKS RISKS associated with gastric bandingassociated with gastric banding

Band erosion, band slippageBand erosion, band slippageTubingTubing--related complications related complications (port disconnection, tubing kinking) (port disconnection, tubing kinking) Band leak Band leak Esophageal spasm Esophageal spasm Gastroesophageal reflux disease (GERD) Gastroesophageal reflux disease (GERD) Inflammation of the esophagus or stomach Inflammation of the esophagus or stomach PortPort--site infection or port displacementsite infection or port displacement

Realize Band Realize Band –– U.S. Clinical TrialU.S. Clinical Trial N=276N=276

Key Serious Adverse EventsKey Serious Adverse EventsBand slippage Band slippage 9 (3.3%)9 (3.3%)Band erosion Band erosion 1 (0.4%) 1 (0.4%)

Port displacement Port displacement 7 (2.5%)7 (2.5%)

Low Low reoperationreoperation rate due to few rate due to few complicationscomplications

Band replacements Band replacements 2 2 Band revisions Band revisions 1010

Band explantations Band explantations 44Port revisions/replacements Port revisions/replacements 2727

Average % excess weight loss (EWL) Average % excess weight loss (EWL) at 2 and 3 years postat 2 and 3 years post--surgery surgery

45% and 43 % respectively45% and 43 % respectively

Ensuring your success with the Lap Band Ensuring your success with the Lap Band requires hard work, dedication to your new requires hard work, dedication to your new lifestyle, and support from your loved ones.lifestyle, and support from your loved ones.

To help you along the way, the REALIZE To help you along the way, the REALIZE Personalized Banding Solution includes Personalized Banding Solution includes Realize Realize mySuccessmySuccess™™ –– an online tool that will help an online tool that will help you and your doctor set goals and you and your doctor set goals and continuoslycontinuoslywatch your progress together watch your progress together -- for up to 3 for up to 3 years years

Review TestReview Test

Click on the ICON link below and answer the Click on the ICON link below and answer the question to record your participationquestion to record your participation

ICON