Bariatric Seminar at Riverside Community Hospital


– [Instructor] Welcome to the Center for Surgical Weight Loss at
Riverside Community Hospital. By the end of the
presentation you will be able to define bariatric, state if you are a candidate for surgery, describe the three types
of surgeries offered at Riverside Community Hospital, state two contraindications
to bariatric surgery, describe life after weight loss surgery, describe how to achieve maximum results, and state the next step. The Center for Surgical Weight Loss at Riverside Community
Hospital is committed to providing compassionate
care to patients seeking surgical management to
achieve optimum weight loss. Your bariatric team is
comprised of a Nurse Coordinator to help you navigate the process, a Bariatric Surgeon, Dietician, and dedicated Nurses. Bariatrics is the branch
of medicine that deals with the causes, prevention
and treatment of obesity. Obesity is measured by
a formula called BMI. BMI stands for Body Mass Index, which is an indirect measure of body fat. This number represents your
risk for health conditions identified as comorbidities. Comorbidities are medical
conditions that cause, are caused by, or related
to another condition. Extra weight may lead to these
conditions or comorbidities. Coronary Artery Disease, hypertension, sleep apnea, type two diabetes, dyslipidemia or high cholesterol, and osteoarthritis. To measure your BMI,
we will use a formula. Visit the website CDC.gov. Search for the adult BMI calculator. Take a minute to see what your BMI is. Place your weight and
height into the formula and click Calculate BMI. Take a minute and pause
the presentation here. Calculate your BMI and
come back and push play when you’re ready to resume. This slide shows the
treatment options based on a person’s BMI. Once your BMI reaches 35,
surgery may help you lost weight and keep it off. In 1991, no state had an
obesity rate greater than 20%. In 2010, 38 states had an
obesity rate greater than 25%. Eight states have a rate greater than 30%. Alabama, Arkansas, Kentucky,
Louisiana, Mississippi, Oklahoma, Tennessee and West Virginia. To qualify for surgery there’ll be certain criteria you will need to meet. The criteria is based on
the Indications for Surgery: National Institutes of Health
Guidelines, or the NIH. One, BMI of 40 or greater
without co-morbidities. Two, BMI between 30 and
39.9 with one co-morbidity. Again, co-morbidities are
things like diabetes type two, hypertension, sleep apnea, osteoarthritis, coronary artery disease
or increased cholesterol. Number three, tried and
failed a non-surgical weight reduction program
such as diet pills, nutrition plans and exercise. The goal of surgery is to lose
over half of excess weight to help reduce or prevent
obesity related health problems. Only surgery has proven
effective over the long term for most patients with
clinically severe obesity. There is minimal morbidity, less than 5% and mortality, less than 1%. It is important to remember
that surgery is only a tool. To be successful, you must combine surgery with a lifelong commitment to
diet, activity and support. The Center for Surgical Weight Loss at Riverside Community Hospital offers three surgical options: Laparoscopic Adjustable Gastric Banding, Gastric Bypass and Sleeve Gastrectomy. We also perform revisional
surgery for people who have had bariatric surgery and
may be experiencing problems. The three types of surgeries
offered are either restrictive or malabsorptive procedures. Restrictive procedures
limit the amount of food by reducing the size of
your stomach and therefore you cannot consume regular portions. The two types are Sleeve Gastrectomy and Adjustable Gastric Banding. Combination procedures limit the amount of food and calories absorbed. This combines restrictive
and malabsorptive surgery. The size of your stomach is reduced and the intestines are altered
so calories are not absorbed. The one type of surgery performed is called Roux-en-Y Gastric Bypass. In normal digestion, the
esophagus is a tube that carries solid foods and liquids from
the mouth to the stomach. The stomach is a storage pouch. Food arrives here after
swallowing where it is processed before passing to the small intestines. The small intestines are
about 20 to 30 feet in length and where the majority of nutrients and calories from food are absorbed. The large intestines are the final section of the digestive tract where water is reabsorbed into the body for the leftover liquid
from digested food. We will now go over what is
involved with each procedure, show you a short clip of the surgery, and discuss the benefits of the procedure. First, the Roux-en-Y Gastric Bypass. A small pouch is created
at the top of the stomach. The small bowel is cut and the lower part is connected to the stomach. The small bowel connected
to the detached stomach is reattached to the bowel coming from the newly
developed stomach pouch. – [Narrator] Gastric
Bypass is a restrictive and malabsorptive procedure
that results in fewer nutrients and calories being absorbed. It reduces food intake
by cutting and stapling the stomach to make a small stomach pouch. The small intestine is
cut and the lower section is directly attached to the new pouch. Food then passes directly
into the lower portion of the small intestine,
bypassing most of the stomach and upper intestines. – [Instructor] The benefits
of Gastric Bypass include: long term data is available. No foreign body. More effective weight loss and
Type Two diabetes resolution than with Sleeve
Gastrectomy or a Lap Band. No need for additional
visits for band refills. And can lose 80 to 100 pounds
or 62% of excess weight. The next procedure is
the Sleeve Gastrectomy. A narrow tube is made
with a surgical stapler from the pylorus valve of the stomach to the esophagus along the
inside curve of the stomach. The remainder of the stomach is removed and cannot be reattached at a later date. The normal digestive process
remains since the valve at the bottom of the
stomach was not altered. You will have the normal
process of stomach emptying, but will get a feeling
of fullness sooner.. A hormone called Ghrelin
is in the two thirds of the stomach that was removed. The hormone stimulates your appetite, so if it is removed, you’ll
get a feeling of fullness quicker and take in fewer calories. – [Narrator] Sleeve Gastrectomy
is a restrictive procedure that limits food intake
by cutting and stapling a thin vertical section of the stomach to make a narrower stomach pouch. The remaining larger
portion of the stomach is then permanently removed. Unlike Gastric Bypass, there is no rerouting of the intestines. However, the Sleeve Gastrectomy
involves permanently removing a large portion of the stomach. – [Instructor] Some of the benefits of Sleeve Gastrectomy are: no foreign body. No additional visits for band refills. Less or absent nutritional deficiencies. Greater appetite suppression. Can be performed laparoscopically on people with a high BMI. Can lose up to 55% of excess weight. The final procedure is the
Adjustable Gastric Band, also known as the Lap Band. A band is placed around the
top section of the stomach. It creates a small pouch
which limits food intake. A small port is placed on
the left side of the abdomen under the skin, which is used later to make the pouch smaller or larger. This port is used for
the adjustable fills. – [Narrator] During a
minimally invasive procedure, an adjustable band is
placed around the upper part of the stomach creating a small pouch. The band is connected by thin tubing to an access port below the skin. Through this port your
surgeon adjusts the lap band by inflating or deflating
the inner lining with saline. As the band inflates, the
stomach outlet becomes smaller. This helps reduce or restrict
the amount of food you eat, and slows the emptying
into the lower stomach, helping you feel full
sooner and stay full longer. – [Instructor] Benefits
of the Lap Band include: lowest rate of complications when compared to bypass and sleeve. No re-routing of the anatomy, no stapling of stomach, no anastomosis, or the joining of or opening
between two organs or spaces that normally are not connected. And you can lose up to
43% of excess weight. The advantages of the
laparaoscopic approach are: less invasive, less pain postoperatively, fewer wound complications, shorter stay in the hospital and a quicker return to work. The two approaches to
performing bariatric surgery are open and laparoscopic approaches. Today, most approaches are
performed laparascopically, where a small incision is made
in the abdomen for a surgeon to insert a camera to
view internal spaces. They offer small incisions and are made to insert instruments. Possible side effects of
bariatric surgery may include: nausea and vomiting, gas and bloating, dumping syndrome, lactose intolerance, temporary hair thinning, depression and psychological distress, changes in bowel habits. Your surgeon will discuss
these further with you during your consultation. Possible complications
after surgery may include: infection, bleeding or
leaking at suture lines, blockage of the intestines
or stomach pouch, dehydration, blood clots in legs or lungs, vitamin and mineral deficiency, protein malnutrition, incisional hernia, irreversibility or difficulty
reversing some procedures, revision procedures are
sometimes required, and death. Who is not a candidate
for bariatric surgery? Non-adult patients under the age of 18. Conditions that may render
you a poor surgical candidate or increase the risk of poor results. Unwilling or unable to comply
with dietary restrictions. And currently pregnant or may be pregnant. The Center for Surgical Weight Loss at Riverside Community
Hospital uses Colleen Cook’s Success Habits Principles to help patients stay on track. These include items like
personal accountability, or taking responsibility, portion control, eating less, Nutrition, decreasing
sugar and fat in the diet, fluid intake, staying hydrated
and not drinking until 30 minutes after eating, regular exercise and
vitamins and minerals. Colleen, a weight loss
surgery patient herself, says we feel deprived when we
are forced to follow rules. Therefore, she calls her
success habits principles because we feel guided and
directed by our own best choices. These principles work no matter which weight loss surgery
procedure you have. Additional postoperative
results can be best achieved by attending a support group. This is another part
of the healing process. All patients are encouraged
to attend a support group monthly after surgery. Patients will be able
to interact with people who know what they are dealing with. Lifelong commitment. Your emotional and physical
well being is dependent on your commitment. Be sure to ask your surgeon
what is expected of you and make the commitment to
maintain your well being. Most patients return to work
within two to four weeks, however, everyone is
different; go at your own pace. Taking the next step. Part one: insurance verification. Your Nurse Navigator will
work with you to find out what is covered and covered expenses when it comes to your bariatric procedure. Only if it’s deemed medically
necessary do insurances usually cover expenses. Remember, list your past
weight loss attempts. No cutting corners. Be as thorough as you can. Overdeliver on your information. Part two: schedule an appointment
with a Bariatric Surgeon. Go to www.riversidecommunityhospital.com and see our list of bariatric surgeons. Typical patient pathway for the Center for Surgical Weight Loss is shown here. Pause the presentation and
take a moment to review. When you’re ready push play. So to summarize, surgical
weight loss is a tool. Long term success depends on you. Success depends on lifestyle modification. Many co-morbid conditions are eliminated with bariatric surgery. You’ll be learning about
lifestyle modifications and that will help you
keep the weight off. We look forward to providing
you with personalized and quality care on your journey as you pursue your weight loss goal with Riverside Community Hospital. (upbeat music)

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