CRMC Bariatric Seminar by Dr. Schwartz

CRMC Bariatric Seminar by Dr. Schwartz


(inspiring music) – Hi there I’m Dr. Roy Schwartz. General and bariatric surgery with Capital Regional Medical Center. I’ve been here about 29
years performing surgery. Today we’re here to talk about our bariatric surgical options. We’ve had the need to call upon them because there is an increasing
epidemic of overweight individuals that are suffering
from the other diseases that come along with being overweight. There is a certain point where your BMI which is a height/weight index reaches a point that other conditions such as diabetes, heart
disease, arthritis, start to increase because
of the increase in weight. We know that dieting and exercise is not an easy task for many and that often doesn’t do the trick. And so these bariatric
options have now been realized by the entire medical
community as necessary to maintain health. The goal is so that
the comorbid conditions improve with weight loss. It’s not considered a cosmetic operation. And basically there are two kinds along with lifestyle change, diet and exercise. Calorie counting etcetera. That I offer. Because of their risk safety profile, the first being the lap-band which I consider the least invasive and least altering. It’s adjustable. It’s a belt basically that goes around the top of the stomach and makes you feel full quicker and longer and helps with restrictions. So you can’t eat too much too fast. That has good success with little risk and a short recovery. The goal is to lose about two
thirds of your excess weight at about five years. 40% at one and 50% at two. And keeping those realistic goals with reinforcement and follow
up and adjusting the band along with the diet and exercise helps you lose the wight and undo your diseases and get rid of a lot of your oral medications. Once the band’s let down or removed there’s no alteration. There is no change in physiology. So there is very few nutritional problems, side effects, etcetera. The sleeve is where we remove
about 2/3 of your stomach and create a thinner stomach. More like a banana shape. And having this thin
banana-like shape stomach allows for the restriction and the early satiety. Meaning you get full faster
and stay full longer. This surgery is a little
bit more complicated and a little bit more
altering, less reversible and has a little bit more success though, especially with diabetes. One of its drawbacks is that reflex may be a problem afterwards. The band actually takes care of reflex in the majority of patients. The sleeve we usually keep you in a
couple nights in the hospital. And the recovery is a
little bit longer because you do have a harder adjustment needing to learn how to eat and get the appropriate calories in and avoid dehydration. It’s success is a little
bit greater than 2/3 or at least 2/3 maybe 5%
or 10% a plus of success. It does have a few side
effects for nutrition. And so that needs to be watched a little bit more diligently. The third surgery which I
don’t particularly offer is the gastric bypass surgery. Thought and felt and still do that that surgery is a
little bit more radical and comes with a lot more
side effect and problems. And it’s really the last step. It’s hard to rebound or recoup or have a exit strategy should that fail. And that still has about
a 25% to 30% failure rate. That has more nutritional problems. Problems with leaks
and valve obstructions, because not only it doesn’t
remove most of the stomach leaving a little pouch, but it also bypasses a good
portion of the small intestine so you don’t digest well. You don’t absorb well. The goal is to help
with diet and exercise. To lose the weight, to a point where your
comorbidities start to improve. Quality of life comes along with that. And as you begin to feel better do more and look better that’s all gravy sort of speak. The weight itself, watching
the numbers drop, does happen. But what’s more importantly a sign of success is the
other diseases improving quality of life. Realistic goals therefore in
the follow up and discussions with our team and the
bariatric center personnel is important to keep the
behavior modification that goes along with the change
in the lifestyle and eating to help you adjust and
adapt with these changes, which are many. That’s why we feel that our
bariatric center is successful and most of our patients
feel that way as well. We have dieticians, support groups, a lot of personnel to refer to for educational advice. And they can refer you
on to various websites, help with insurance questions, which we are also very
astute in dealing with. The way this process usually begins in referrals made by either your primary or you’ve investigated it
and you may want to come to a seminar or call directly
for an office appointment. Once in the system we can advocate and look at your insurance plan. Figure out what the
requirements are in that regard. See you as a patient
and decide if you need certain consultations prior to the surgeries. The surgery is being different, have different requirements going in, regarding clearance from
other physicians especially if you have significant comorbidities. Then after we look at your
insurance requirements we begin the educational process and then you can decide on the procedure and move ahead. Our staff will help you
with the steps necessary. There is periprocedural dieting outside of the usual calorie counting. And the carbohydrate
addiction model to follow meaning low carbs high protein. That’s gonna be the basic mantra for life but periprocedurally before the surgeries there is a liver shrinking diet. And we’ll review that with you. After the surgery there is a progression
of liquids to solids, over a few weeks. Adjustment’s done for
lap-bands in the office, when we make those tighter
or looser as need be, also has a three day progression
of liquids to solids, if the band is snugged up. Recovery is a little different
for the two procedures as I touched on before. We usually can send lapband
patients home the same day. They feel pretty good in a week. It’s equivalent to surgery such as a laparoscopic
cholecystectomy, gallbladder removal. And they feel pretty good at the outset and have to get up and go. The sleeve procedure
is a little bit longer in the hospital stay, one to two days. They usually feel good in a week to two. But to get up and go may be a three to four week process regarding adapting to the
food and liquid requirements in order to maintain hydration. Well thank you very
much for taking the time to inquire and I hope that you’ll be successful
in your endeavors. Please reach us over the website or at various phone numbers
to get the process started. We’ll be glad to help you. Thanks for listening. And see you soon. (inspiring music)

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