Bariatric Procedures
Is The Lap-Band Still a Good Surgery?
About two decades ago, a novel bariatric procedure and device was brought to market. The adjustable gastric band, commonly referred to by its trade name, the Lap-Band, hit the market with a splash. And rightly so. This was the first device that offered significant weight loss but could also be adjusted and removed without any significant changes to the gastrointestinal tract. It was seen as an excellent alternative to the gold standard of the time – the gastric bypass.
Why Is the Gastric Band Rarely Placed any Longer?
In the mid 2000s, a novel approach to weight loss surgery was developed in the form of adjustable gastric banding. The first product to market was a band known as the Lap-Band and shortly after the Realize Band came in as competition. The gastric band was both new and very promising because it gave patients and adjustable and removable option that did not require permanent adjustment of the G.I. system. In essence, the band is placed around the upper portion of the stomach and tightened to form two stomach chambers. The smaller, upper chamber was the new receptacle for food and the band slowed the passage of food from the upper to the stomach. Patients would be limited in the amount they could eat, would feel full longer and ultimately lose weight.
Lap Band/Gastric Band
For many decades, the gastric bypass has been the gold standard in resolution of many of the diseases associated with morbid obesity, as well as being the benchmark by which we measure the weight loss potential of any bariatric surgery. However, the nature of the gastric bypass, and to a lesser degree, the gastric sleeve, meant that many patients experienced a number of uncomfortable postoperative realities including dumping syndrome, potential for nutritional deficiencies, and some shorter-term complications such as leaks in the staple line.
Soon after the advent of laparoscopic surgery, the gastric band was developed. The first of these was known as the Lap-Band, and shortly thereafter, the Realize Band was developed as a competitor. Early on, it seemed like an excellent option for those who were not comfortable altering the anatomy of their gastrointestinal tract. Further, the Lap-Band offered the potential for adjustments and was completely reversible if the patient did not tolerate it well. The trade-off for this versatility was that the overall weight loss and disease resolution potential was somewhat lower than that of more-traditional, stapled procedures like the gastric bypass and the gastric sleeve. However, the Lap-Band got an additional boost when the FDA approved it as the only weight loss surgery for patients with a BMI as low as 30, as long as they had co-morbid conditions.
Bariatric Surgery FAQs with Dr. Abbas
Transcript (slightly edited for ease of reading)
Jenny: Just talking about bariatric surgery. Who is a candidate for bariatric surgery?
Dr. Abbas: Generally speaking, anybody that has a BMI greater than 35. And the way you calculate your BMI is… Everybody has a smartphone now – just type in your height and type in your weight in a BMI calculator and you’ll actually get your BMI. So, BMI greater than 35 with a medical condition such as diabetes, hyperlipidemia which is elevated cholesterol or hypertension or if somebody has a BMI of 40. So, again, if you just type in BMI calculator in your Google search, you’ll find it. It is your weight relative to your height. So, BMI stands for the Body Mass Index.
So those are the patients who are actually on our candidates for bariatric surgery.
Can the Gastric Sleeve be Performed on an Outpatient Basis?
Let’s get right to it and say…yes! We are outfitted with the most advanced robotic surgical technology, known as the da Vinci Xi robotic surgical system – specifically created for general surgeries including bariatric surgery.
While we do perform many of our sleeves in the outpatient setting, not all weight loss surgery procedures can be handled at an ambulatory surgery center. Some patients will require an overnight hospital stay. This is especially true for patients that, either due to poor health or other reasons, have a higher risk of complications. For high-risk patients, it is important that they have access to the full breath of hospital services in case of a complication.
Are You at Risk of Diabetes?
Tapping into a great deal of research involving excess blood sugar, we now know more than ever before about diabetes – also known as the silent killer. It is so named because many of the significant follow-on effects of the disease are not readily apparent until they have caused serious and often permanent damage (nerve damage, kidney disease, blood circulation issues and more). Sadly, the CDC expects that over a third of the US population will have diabetes by 2050, representing the single greatest threat to our collective health. Unfortunately, many people simply do not know that they have diabetes, or pre-diabetes — a precursor to the full-blown disease. Further, diabetes is a chronic disease. Meaning, once you have it, it cannot be cured – only managed.
Can Thinning the Waist Help Prevent Thinning in the Brain?
On July 31st, 2019, Dr. Husain Abbas of MASJax appeared in an interview for local station News4Jax to discuss recent study findings tying increased body mass index, a common measure for obesity, to increased risk of dementia.
We know that obesity has many health consequences including cardiovascular problems and diabetes, but a new study in the Journal of Neurology1 also indicates your excess weight may also affect your mental health including your cognitive function and diseases like dementia.
Understanding Your Bariatric Surgery Insurance Coverage
Insurance coverage is one of the most asked about topics when it comes to bariatric surgery. Patients are often surprised to learn that weight loss surgery is a covered benefit under many insurance policies. But coverage does not necessarily mean no cost to the patient or that you can have surgery tomorrow. Many factors come into play when determining what your cost for surgery might be, when all is said and done. Our team will work with you to help you navigate this process, but we always encourage patients to become familiar with their policy, as ultimately, it is the responsibility of the patient. From obesity coverage to your tailored surgery estimate, our team will be with you every step of the way to help you feel comfortable with the financial side of weight loss surgery.
Understanding Dumping Syndrome
Sweaty, shaky, diarrhea? If you find yourself feeling this way after a meal, it could be a condition called Dumping Syndrome. After gastric bypass surgery, and occasionally with other bariatric procedures, patients may experience this unpleasant side effect. But why does Dumping Syndrome occur? And why does it affect gastric bypass patients more than others?
During a gastric bypass, the lower part of the stomach is disconnected. The pylorus, a sphincter that regulates flow of food between the stomach and the small intestine, is separated along with the larger portion of stomach. The new, small stomach pouch which accepts food is reconnected to the small bowel, without a regulating valve. This new connection is farther down the small bowel, meaning food is bypassing the first part of the intestine.
Will I Lose Weight after Bariatric Surgery?
In the forefront of virtually every patient’s mind, when they are about to undergo bariatric surgery, is whether it will be successful and they will lose a significant amount of weight. The short answer is that the vast majority of patients do very well and approximately 80% of patients will meet their long-term weight loss goals. While this success rate is far greater than the 5-or-so percent success rate of diet and exercise alone, many patients are still concerned about whether they will become one of the 20% who do not succeed. But let’s explore what success actually means.
First and foremost, the name “weight loss surgery” is not fully accurate or reflective of success after the procedure. Bariatric surgery is not about weight loss – losing weight is simply a very tangible and wonderful side effect. Our main goal is to improve or eliminate the diseases associated with morbid obesity. These are ultimately the causes of early death, significant lifestyle impairment, and serious emotional problems. And while most patients see and feel some of these downsides, there are many more that silently exist in the background. Type II diabetes, certain forms of cancer, heart disease, an increased risk of stroke, joint degradation, and many, many more may not be readily seen or felt on a day-to-day basis.
