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OBESITY SURGERY PowerPoint Presentation

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OBESITY SURGERY Presentation Transcript

Slide 1 - MORBID OBESITY AMHE 2010 Convention Chateau Montebello Yvan Ducheine MD 310 Central Avenue East Orange NJ 07018
Slide 2 - Obesity & Surgery GOALS & OBJECTIVES: Definition Prevalence Impact Associated Illnesses Treatments (Surgical & Non-Surgical) Eligible Candidates Results of Surgery
Slide 3 - Obesity & Surgery DEFINITION: National Institutes of Health Anyone with a body mass index of 30 or above is considered obese. A body mass index above 40 is considered morbidly obese.
Slide 4 - Obesity & Surgery PREVALENCE: Worldwide: 1.7 Billion 1.5 to 2 times higher in women USA 34% of Americans 6% Morbidly Obese 60% to 80% of African Americans (BET) Children 17%-33%
Slide 5 - Obesity & Surgery It is the 2nd most preventable cause of death after smoking Decrease life expectancy (2.4 years) Increased in co-morbid illnesses
Slide 6 - Obesity & Surgery Hypertension Diabetes Asthma Sleep Apnea Hyperlipidemia Arthritis Infertility Venous Stasis Depression Greater Cancer Risk Breast Cancer Colon Cancer Endometrial Cancer *All cancers except pancreatic cancer & prostate cancer
Slide 7 - Obesity & Surgery TREATMENT OPTIONS Medicine 18% vs Surgery 30% to 80% J Am Coll Surg. 2003 Mar;196(3):379-84.  A comparison of diet and exercise therapy versus laparoscopic Roux-en-Y gastric bypass surgery for morbid obesity: a decision analysis model.Patterson EJ, Urbach DR, Swanstrom LL.Department of Minimally Invasive Surgery, Legacy Health System, Portland, OR, USA.CONCLUSIONS: In a decision analysis model, laparoscopic gastric bypass surgery for morbid obesity was associated with a substantially longer survival than diet and exercise therapy. Copyright 2003 by the American College of Surgeons
Slide 8 - Obesity & Surgery BARIATRIC SURGERY WORLDWIDE Only effective therapy for morbid obesity 2002-2003 146,301Bariatric surgeries 2839 Bariatric Surgeons 103,000 operations done in USA/Canada, increased to 112K (2007-08). 37.15% open, 65.85% laparoscopic
Slide 9 - Obesity & Surgery ELIGIBILITY CRITERIA FOR SURGERY Acceptable Medical Risk for Surgery Failed attempts @ non-surgical weight reductions (Diet & Exercise) BMI>40; BMI> 35 with obesity related comorbidities No Psychiatric Contraindications Realistic Commitment and Expectations
Slide 10 - Obesity & Surgery FOOD ADDICTION Psychological Component Physical Component Group Therapy & Support BEHAVIOR MODIFICATION Eat 3 times per day No Snacking Between Meals (Water Only) No Eating after 7:00 pm LIFESTYLE CHANGES Walk one half hour per day (Continuous)
Slide 11 - Obesity & Surgery GASTRIC BANDING Restrictive 30% to 40% Avoidance of gastrointestinal anastomosis Less Invasive Less Nutritional Px. GASTRIC BYPASS Malabsorptive 70%-80% Greater Weight Loss More Invasive Increased risk of nutritional deficiencies
Slide 12 - Obesity & Surgery                    LAP-BAND System
Slide 13 - Obesity & Surgery GASTRIC BYPASS             Roux-en-Y Gastric Bypass
Slide 14 - Obesity & Surgery SURGICAL COMPLICATIONS Infections Strictures Intestinal Leaks Nausea & Vomiting Hernia Obstruction Death <1% METABOLIC COMPLICATIONS Nutritional Deficiencies Anemia Bone Disease Neuropathy Vit. A Deficiency Vit. D Deficiency
Slide 15 - Obesity & Surgery RESULTS: Hypertension 62-73% Cured Diabetes Mellitus 75-85% Cured Sleep Apnea 90% Cured GERD 90% Cured Dyslipidemia 34% Cured (38% improved) Hypertension & Dyslipidemia = @ 10 yrs.
Slide 16 - Obesity & Surgery RESULTS: Dramatic Reduction in Weight Marked Quality of Life Improvement Depression, Self-esteem, eating pathology,
Slide 17 - Obesity & Surgery RESULTS: (Non-Compliance with Behavior & Exercise) Depression 12% Sexual Concerns 4% Relationship Problems 2% (>90%) Medical Complications due to Surgery 9% Lack of Exercise Being the Most Likely Area of Non-Compliance
Slide 18 - Obesity & Surgery Obesity Prevalence (34% to 50%) Co-morbidities Eligible Candidates (BMI 35+ or BMI >40) Types of Bariatric Surgeries Success Rate in Weight Loss Success in Curing Diabetes, Hypertension Complications Change in Quality of Life and Life Expectancy
Slide 19 - Obesity & Surgery Cameron, JL: Current Therapy in Surgery 8th Edition Seidell JC. Epidemiology of obesity. Mason ME, Jalagani H, Vinik AI Metabolic complications of bariatric surgery: diagnosis and management issues. Gastroenterol Clin North Am. 2005 Mar;34(1):25-33.  Buchwald H, Williams SE Bariatric surgery worldwide 2003. Obes Surg. 2004 Oct;14(9):1157-64.   Elkins G, Whitfield P, Marcus J, Symmonds R, Rodriguez J, Cook T. Noncompliance with behavioral recommendations following bariatric surgery. Dymek MP, le Grange D, Neven K, Alverdy J Quality of life and psychosocial adjustment in patients after Roux-en-Y gastric bypass: a brief report. Obes Surg. 2001 Feb;11(1):32-9. White S, Brooks E, Jurikova L, Stubbs RS Long-term outcomes after gastric bypass. Obes Surg. 2005 Feb;15(2):155-63.  Sjostrom L, Lindroos AK, Peltonen M, Torgerson J, Bouchard C, Carlsson B, Dahlgren S, Larsson B, Narbro K, Sjostrom CD, Sullivan M, Wedel H; Swedish Obese Subjects Study Scientific Group Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2005 Apr 7;352(14):1495-6; author reply 1495-6. Patterson EJ, Urbach DR, Swanstrom LL. comparison of diet and exercise therapy versus laparoscopic Roux-en-Y gastric bypass surgery for morbid obesity: a decision analysis model. J Am Coll Surg. 2003 Mar;196(3):379-84.     Craig BM, Tseng DS. Cost-effectiveness of gastric bypass for severe obesity.Am J Med. 2002 Oct 15;113(6):491-8. Fang J. The cost-effectiveness of bariatric surgery Am J Gastroenterol. 2003 Sep;98(9):2097-8.
 

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