baptist physician communication packet june 2014
DESCRIPTION
Update for Baptist physicians on the communications of the previous monthTRANSCRIPT
Physician Communication Packet
June 2014
PHYSICIAN COMMUNICATION PACkeT
What’s Inside:
3 Physician Introduction
Jacksonville Orthopaedic Institute; Scott McGinley, MD
4 – 5 YMCA/Baptist Health
Youth nutrition counseling
6 – 8 Travel and Tropical Medicine Center
9 – 12 Baptist Center for Bariatrics
Baptist CareConnection
Link — June 2014
Baptist Briefs Link — June 2014
Welcome Dr. McGinleyOrthopaedic Surgeon, Jacksonville Orthopaedic Institute
Jacksonville Orthopaedic Institute is pleased to welcome Scott
McGinley, MD, to their Fleming Island/Clay Division.
Scott McGinley, MD, believes in caring for his patients by listening,
engaging, and regarding everyone like family. He enjoys treating
all injuries and orthopaedic conditions and is particularly interested
in knees, hands, the spine and arthritis.
His education and qualifications include:
• Medical Degree from University of Medicine and Dentistry of
New Jersey, Newark, NJ
• Residency in Orthopaedic Surgery, University of Medicine and
Dentistry of New Jersey, Newark, NJ
• Fellowship in Orthopaedic Sports Medicine, University of Florida
College of Medicine, Gainesville, FL
• Board-certified in orthopaedic surgery
To make an appointment with Dr. McGinley, please call 904.276.5776 or visit joi.net.
Jacksonville Orthopaedic Institute
Fleming Island/Clay Division
1845 Town Center Blvd.
Suite 405
Fleming Island, FL 32003
PHYSICIAN INTRODUCTION
June 6, 2014 Dear Health Care Provider, It is shocking to learn that as of today 1 out of every 3 children in America is considered overweight or obese. Based on current trends, by the year 2030, 2 out of every 3 children born today will be obese by the time they graduate high school. Here at the YMCA of Florida’s First Coast, we believe that through knowledge, guidance and encouragement we can help our future leaders develop and realize their highest potential. This is why we invest in the education of our youth through all of the many camps and activities that the Y offers. And now for the first time, the Y is offering Youth Nutrition Consultations with our Registered Dietitians (RDN) who are highly experienced in youth nutrition education. During these consults, the RDN can estimate the child’s nutritional needs, suggest meal plans and discuss physical activity. The consult will be a personalized and interactive conversation between the child, caregiver (i.e. parent) and the RDN. Our goal is to help the child find a balance between home and school life to meet their health goals and set a foundation for future healthy living. For more information please call 904.854.2084 to get in touch with the First Coast YMCA’s Registered Dietitians. Please see the attached flyer for additional details. Sincerely,
Sue Dukes, DTR Director of Healthy Living Innovations: Nutrition & Obesity YMCA of Florida’s First Coast 12735 Gran Bay Parkway West, Suite 250 Jacksonville, FL 32258 [email protected]
Youth Nutrition Counseling
BROOKS YMCA
Private, one-hour individual consultations are available for children ages 2-17. COST Members - $45 Non-Members - $60
All children deserve to grow up carefree, but sometimes that can be difficult when health problems start to develop and get in the way of having fun. Many obesity issues can be curbed with the right diet and exercise, that’s why we’re making nutrition consultations available to our youth to help them start feeling like a kid again.
Visit the Welcome Center for more information or call SUE DUKES, DTR Director of Healthy Living Innovations: Nutrition & Obesity 904.854.2083
A travel medicine and infectious diseases expert, James Allen, MD, PhD, consults with his patients to provide valuable information that is customized to their health needs and travel itinerary.
James Allen, MD, PhD, is board-certified in Infectious Diseases and Internal Medicine, with a PhD in microbiology. He has earned a Certificate of Knowledge in Clinical Tropical Medicine and Travelers’ Health through the American Society of Tropical Medicine and Hygiene and a Certificate in Travel Health from the International Society of Travel Medicine. As an Infectious Diseases and Travel Medicine specialist, he is an active member in the following medical organizations:
International Society of Travel Medicine International Society for Infectious DiseasesInternational Society for Mountain Medicine Infectious Diseases Society of AmericaWilderness Medical Society The American Nepal Medical AssociationAmerican Society of Tropical Medicine and Hygiene
IntroducingBaptist Travel and Tropical Medicine CenterJames Allen, MD, PhD - Medical Director
As a highly sought-after speaker, Dr. Allen has given presentations internationally and domestically to corporations, physicians, nurses, students and travelers on the topics of travel medicine, hepatitis, malaria and other travel health issues. In addition to providing the appropriate immunizations to each traveler, Dr. Allen provides them with valuable information, about the following:
Country specific health informationJet lagCountry specific immunization recommendationsWorld Disease MapsMalaria prevention - medicines and repellentsVaccine Information Statements (VIS)CDC Travel Notices U.S. Dept. of State Travel Warnings and AlertsCountry specific diseases U.S. Consular informationFood and water precautionsImmunocompromised travelerTraveler’s diarrhea - prevention and treatment Deep vein thrombosisHigh altitude illness Health advice for women/child travelers
To schedule a Travel Consultation or to learn more, please contact Dr. Allen’s office at 904.396.3336.
“ I have served as a medical missionary in Peru, Ecuador, Honduras, Costa Rica, Kenya and Nepal. As a result of my experiences, I gained extensive knowledge and a passion for tropical and travel medicine which I enjoy sharing with others.”
- James E. Allen, MD, PhD
Meet Dr. AllenPhysician, Baptist Infectious Diseases
The physicians of Baptist Infectious Diseases are pleased to
welcome James Allen, MD, PhD, to their Baptist Medical Center
Jacksonville practice.
Dr. Allen has extensive experience in all areas of infectious
diseases. He has a special expertise in travel and tropical
medicine and has served as a medical missionary in Peru, Ecuador,
Honduras, Costa Rica, Kenya and Nepal. He is excited to bring his
expertise to the Northeast Florida community.
His education and qualifications include:
• Doctor of Medicine from the University of Miami, Miami,FL
• Residency in Internal Medicine, Loyola University Medical
Center, Maywood, IL
• Fellowship in Infectious Diseases, University of Colorado,
Denver, CO
• Board-certified Internal Medicine
• Board-certified Internal Medicine sub-specialty
Infectious Diseases
• Certificate in Knowledge in Tropical Medicine and
Travelers Health
• Certificate in Travel Medicine
To make an appointment with Dr. Allen, please call 904.396.4886.
Baptist Infectious Diseases
820 Prudential Drive
Suite 515
Jacksonville, FL 32207
PHYSICIAN INTRODUCTION
Treating obesity. Transforming lives. Bariatric surgery is the most effective treatment for morbid obesity and can improve or resolve medical problems related to obesity. — National Institutes of Health
B a p t i s t C e n t e r f o r B a r i at r i C s
M
Quality
• Recognized as an Accredited Bariatric Center of Excellence
• Board-certified, fellowship trained surgeons — more than 530 surgeries performed
• Minimally invasive approaches result in fewer complications, faster recoveries
• Outcomes for BMI reduction two years post surgery exceed the MBSAQIP benchmark
• Creating a new wing of the hospital dedicated to bariatrics
Comprehensive
• Perform the three most common types of bariatric surgery — tailor best option for each patient
• Multi-disciplinary team approach includes the primary care provider, bariatric surgeon, plastic surgeon, bariatric coordinator, clinical dietitians, psychologists, exercise specialists, dedicated nurses and trained hospital staff
• Comprehensive program is structured for sustained weight loss and lifelong success — includes long-term follow up and ongoing free support groups
Affordable
• Unlike other area programs, we do not charge a program fee — informational seminars, insurance assessment and support groups are free
• Low-interest financing options for hospital and surgery fees available for self-pay patients
Referrals and Consultations
Fax: 904.391.5451Phone: 904.202.SLIM (7546)Email: [email protected]: baptistbariatrics.com
Thank you for allowing us to care for your patients’ weight loss and bariatric surgical needs.
Craig Morgenthal, MD, FACS Office: 904.398.0033
Steven Hodgett, MD, FACSOffice: 904.398.0033
Candidates for Bariatric Surgery
• BMI greater than 40
• BMI greater than 35 with associated medical problems (type 2 diabetes, hyperlipidemia, hypertension)
• Note: FDA approved use of Lap Band in patients with BMI over 30 with co-morbidities
• Patient has attempted weight loss through behavioral modification or medical treatment
• Patient is committed to long-term lifestyle changes
Your Patient’s Journey
M
Free informational seminar
Insurance verification
First consultation with surgeon
Psychologicalevaluation
Support group before surgery
Counseling with registered dietitian
Medical clearances
Second consultation with surgeon
Surgery and recovery
Monthly support groups post-op
Baptist Center for Bariatrics
Procedure LAPAROSCOPIC ADJUSTABLE GASTRIC BANDING
LAPAROSCOPIC SLEEVE GASTRECTOMY
LAPAROSCOPIC ROUX-EN-Y GASTRIC BYPASS
Description An adjustable silicone ring (band) is placed around the top part of the stomach and creates a small pouch
The procedure works by removing 80% of the stomach and reducing the secretion of gastric hormones
The procedure creates a small gastric pouch and also bypasses the stomach and a portion of the small intestine
How does it work?
• Reduces amount of food that can be consumed
• Adjustments (fills) are made through the access port by adding saline solution; average 6 fills in the first year
• No alteration to digestive tract
• Reduces amount of food that can be consumed
• Reduces gastric hormones and sensation of hunger in many patients
• No alteration to digestive tract
• Reduces amount of food that can be consumed
• Reduces amount of calories and nutrients the body absorbs (controlled malabsorption)
Average weight loss
• 50% of excess weight • 1 pound/week in first year
• 50-70% of excess weight • 1-2 pounds/week in first year
• 60-70% of excess weight • 1-2 pounds/week for first year
Long-term nutrition
• Small portions of healthy food • High protein, low carb • No drinking with meals • Zero-calorie liquids only
• Small portions of healthy food • High protein, low carb • No drinking with meals • Zero-calorie liquids only
• Small portions of healthy food • High protein, low carb • No drinking with meals • Zero-calorie liquids only • Avoid sugar and fats to prevent
dumping*
Nutritional supplements
• Multivitamin • No routine labs
• Multivitamin • Vitamin B12 • Need routine labs at 3, 6 and 12
months post-op, then yearly
• Multivitamin • Vitamin B12 • Calcium and iron (higher chance
of nutritional deficiencies if don’t take)
• Need routine labs at 3, 6 and 12 months post-op, then yearly
What are the risks?
• Lowest chance of operative complications
• Possible complications include heart, lung, blood clots and infections
• 25-40% chance for re-operation by 10 years due to band slip, erosion, leak or port problem
• Inadequate weight loss • Easiest procedure to “cheat”
• Low risk of major complications such as bleeding, leakage or stricture
• Possible complications include heart, lung, blood clots and infections
• Possible stomach enlargement and need for re-operation, 10% chance or higher
• Highest chance of operative complications including bleeding, leaking or obstruction, less than 5% need re-operation
• Possible complications include heart, lung, blood clots and infections
• Possible nutritional deficiencies • No aspirin, NSAIDs or smoking
due to risk of marginal ulcer or stricture
Hospital stay Overnight 2 nights 2 nights
Time off work 1-2 weeks 1-2 weeks 2-3 weeks
Operation time 1 hour 1.5 hours 2 hours
Recommendations • Better results if patients enjoy participating in an exercise program and are disciplined in following nutrition guidelines
• Less effective for BMI over 50 • Safe for higher-risk patients • Procedure is reversible
• Good option for patients with type 2 diabetes and patients whose medical conditions preclude other procedures, such as anemia, Crohn’s disease, extensive prior surgery or frequent steroid use
• Safe for higher-risk patients • Procedure is not reversible
• Most effective weight loss for patients with a BMI of 35-55
• Good option for patients with BMI over 50, type 2 diabetes, severe heartburn, joint problems or exercise limitations
• Not recommended for higher-risk and elderly patients
• Procedure is reversible
* Also called rapid gastric emptying, dumping syndrome occurs when the undigested contents of your stomach are transported or “dumped” into your small intestine too rapidly. Common symptoms include abdominal cramps and nausea.
Procedure LAPAROSCOPIC ADJUSTABLE GASTRIC BANDING
LAPAROSCOPIC SLEEVE GASTRECTOMY
LAPAROSCOPIC ROUX-EN-Y GASTRIC BYPASS
DescriptionAn adjustable silicone ring (band) is placed around the top part of the stomach and creates a small pouch
The procedure works by removing 80 percent of the stomach and reducing the secretion of gastric hormones
The procedure creates a small gastric pouch and also bypasses the stomach and a portion of the small intestine
How does it work?
• Reduces amount of food that can be consumed• Adjustments (fills) are made through the access port
by adding saline solution; average 6 fills in the first year
• No alteration to digestive tract
• Reduces amount of food that can be consumed• Reduces gastric hormones and sensation of hunger
in many patients• No alteration to digestive tract
• Reduces amount of food that can be consumed• Reduces the amount of calories and nutrients the body absorbs
(controlled malabsorption)
Average weight loss
• 50% of excess weight• 1 pound/week in first year
• 50‐70% of excess weight• 1‐2 pounds/week in 1st year
• 60‐70% of excess weight• 1‐2 pounds/week for 1st year
Long-term Nutrition
• Small portions of healthy food• High protein, low carb• No drinking with meals• Zero-calorie liquids only
• Small portions of healthy food• High protein, low carb• No drinking with meals• Zero-calorie liquids only
• Small portions of healthy food• High protein, low carb• No drinking with meals• Zero-calorie liquids only• Avoid sugar and fats to prevent dumping*
Nutritional Supplements
• Multivitamin • No routine labs
• Multivitamin• Vitamin B12• Need routine labs at 3, 6 and 12 months post‐op,
then yearly
• Multivitamin• Vitamin B12• Calcium and iron (higher chance of nutritional deficiencies if don’t take)• Need routine labs at 3, 6 and 12 months post‐op, then yearly
What are the risks?
• Lowest chance of operative complications• Possible complications include heart, lung, blood
clots and infections• 10-20% chance for re-operation by 10 years due
to band slip, erosion, leak or port problem• Inadequate weight loss• Easiest procedure to “cheat”
• Moderate chance of operative complications including bleeding or leaking
• Possible complications include heart, lung, blood clots and infections
• Newer procedure with 3‐5 year published outcomes• Possible stomach enlargement and need for
re‐operation, 10% chance or higher
• Highest chance of operative complications including bleeding, leaking or obstruction, less than 5% need re-operation
• Possible complications include heart, lung, blood clots and infections• Possible nutritional deficiencies• No aspirin, NSAIDs or smoking due to risk of marginal ulcer
or stricture
Hospital Stay Overnight (less than 1 day) 2 nights 2 nights
Time off Work 1-2 weeks 1-2 weeks 2-3 weeks
Operation Time 1 hour 1.5 hours 2 hours
Recommendations
• Better results if patients enjoy participating in an exercise program and are disciplined in following nutrition guidelines
• Less effective for BMI over 50• Safe for higher-risk patients• Procedure is reversible • Many insurance companies will authorize
this procedure
• Good option for patients with type 2 diabetes and patients whose medical conditions preclude other procedures, such as anemia, Crohn’s disease, extensive prior surgery or frequent steroid use
• Safe for higher-risk patients• Procedure is not reversible• Several insurance companies will authorize
this procedure
• Most effective weight loss for patients with a BMI of 35‐55• Good option for patients with BMI over 50, type 2 diabetes,
severe heartburn, joint problems or exercise limitations• Not recommended for higher-risk and elderly patients• Procedure is reversible• Many insurance companies will authorize this procedure
ComparisonofBariatricSurgicalProcedures
Procedure
LAPAROSCOPIC
ADJUSTABLEGASTRICBANDING
LAPAROSCOPIC
SLEEVEGASTRECTOMY
LAPAROSCOPIC
ROUX‐EN‐YGASTRICBYPASS
Description
Anadjustablesiliconering(band)isplaced
aroundthetoppartofthestomachand
createsasmallpouch
Theprocedureworksbyremoving80
percentofthestomachandreducingthe
secretionofgastrichormones
Theprocedurecreatesasmallgastric
pouchandalsobypassesthestomachand
aportionofthesmallintestine
Howdoesitwork?
• Reducesamountoffoodthatcanbe
consumed
• Adjustments(fills)aremadethroughthe
accessportbyaddingsalinesolution,
average6fillsinthe1styear
• Noalterationtodigestivetract
• Reducesamountoffoodthatcanbe
consumed
• Reducesgastrichormonesandsensation
ofhungerinmanypatients
• Noalterationtodigestivetract
• Reducesamountoffoodthatcanbe
consumed
• Reducestheamountofcaloriesand
nutrientsthebodyabsorbs(controlled
malabsorption)
Averageweightloss• 50%ofexcessweight
• 1pound/weekin1styear
• 50‐70%ofexcessweight
• 1‐2pounds/weekin1styear
• 60‐70%ofexcessweight
• 1‐2pounds/weekfor1styear
Long‐termNutrition
• Smallportionsofhealthyfood
• Highprotein,lowcarb
• Nodrinkingwithmeals
• Zerocalorieliquidsonly
• Smallportionsofhealthyfood
• Highprotein,lowcarb
• Nodrinkingwithmeals
• Zerocalorieliquidsonly
• Smallportionsofhealthyfood
• Highprotein,lowcarb
• Nodrinkingwithmeals
• Zerocalorieliquidsonly
• Avoidsugarandfatstoprevent
dumping*
Nutritional
Supplements
• Multivitamin
• Noroutinelabs
• Multivitamin
• VitaminB12
• Needroutinelabsat3,6and12months
post‐op,thenyearlythereafter
• Multivitamin
• VitaminB12
• Calciumandiron(higherchanceof
nutritionaldeficienciesifdon’ttake)
• Needroutinelabsat3,6and12months
post‐op,thenyearlythereafter
Whataretherisks?
• Lowestchanceofoperative
complications
• Possiblecomplicationsincludeheart,
lung,bloodclotsandinfections
• 10‐20%chanceforreoperationby10
yearsduetobandslip,erosion,leakor
portproblem
• Inadequateweightloss
• Easiestprocedureto“cheat”
• Moderatechanceofoperative
complicationsincludingbleedorleak
• Possiblecomplicationsincludeheart,
lung,bloodclotsandinfections
• Newerprocedurewith3‐5year
publishedoutcomes
• Possiblestomachenlargementandneed
forre‐operation,10%chanceorhigher
• Highestchanceofoperative
complicationsincludingbleed,leakor
obstruction,lessthan5%need
reoperation
• Possiblecomplicationsincludeheart,
lung,bloodclotsandinfections
• Possiblenutritionaldeficiencies
• Noaspirin,NSAIDs,orsmokingdueto
riskofmarginalulcerorstricture
• Stomachpouchmaystretchandleadto
weightregain
HospitalStay Overnight(lessthan1day) 2nights 2nights
TimeoffWork 1‐2weeks 1‐2weeks 2‐3weeks
OperationTime 1hour 1.5hours 2hours
Recommendations
• Betterresultsifpatientsenjoy
participatinginanexerciseprogramand
aredisciplinedinfollowingnutrition
guidelines
• LesseffectiveforBMIover50
• Safeforhigherriskpatients
• Procedureisreversible
• Manyinsurancecompanieswill
authorizethisprocedure
• Goodoptionforpatientswithtype2
diabetesandpatientswhosemedical
conditionsprecludeotherprocedures
suchasanemia,Crohn'sdisease,
extensivepriorsurgeryorfrequent
steroiduse
• Safeforhigherriskpatients
• Procedureisnotreversible
• Severalinsurancecompanieswill
authorizethisprocedure
• Mosteffectiveweightlossforpatients
withaBMIof35‐55
• GoodoptionforpatientswithBMIover
50,type2diabetes,severeheartburn,
jointproblemsorexerciselimitations
• Notrecommendedforhigherriskand
elderlypatients
• Procedureisreversible
• Manyinsurancecompanieswill
authorizethisprocedure
* Alsocalledrapidgastricemptying,dumpingsyndromeoccurswhentheundigestedcontentsofyourstomacharetransportedor"dumped"intoyoursmall
intestinetoorapidly.Commonsymptomsincludeabdominalcrampsandnausea.
ComparisonofBariatricSurgicalProcedures
Procedure
LAPAROSCOPIC
ADJUSTABLEGASTRICBANDING
LAPAROSCOPIC
SLEEVEGASTRECTOMY
LAPAROSCOPIC
ROUX‐EN‐YGASTRICBYPASS
Description
Anadjustablesiliconering(band)isplaced
aroundthetoppartofthestomachand
createsasmallpouch
Theprocedureworksbyremoving80
percentofthestomachandreducingthe
secretionofgastrichormones
Theprocedurecreatesasmallgastric
pouchandalsobypassesthestomachand
aportionofthesmallintestine
Howdoesitwork?
• Reducesamountoffoodthatcanbe
consumed
• Adjustments(fills)aremadethroughthe
accessportbyaddingsalinesolution,
average6fillsinthe1styear
• Noalterationtodigestivetract
• Reducesamountoffoodthatcanbe
consumed
• Reducesgastrichormonesandsensation
ofhungerinmanypatients
• Noalterationtodigestivetract
• Reducesamountoffoodthatcanbe
consumed
• Reducestheamountofcaloriesand
nutrientsthebodyabsorbs(controlled
malabsorption)
Averageweightloss• 50%ofexcessweight
• 1pound/weekin1styear
• 50‐70%ofexcessweight
• 1‐2pounds/weekin1styear
• 60‐70%ofexcessweight
• 1‐2pounds/weekfor1styear
Long‐termNutrition
• Smallportionsofhealthyfood
• Highprotein,lowcarb
• Nodrinkingwithmeals
• Zerocalorieliquidsonly
• Smallportionsofhealthyfood
• Highprotein,lowcarb
• Nodrinkingwithmeals
• Zerocalorieliquidsonly
• Smallportionsofhealthyfood
• Highprotein,lowcarb
• Nodrinkingwithmeals
• Zerocalorieliquidsonly
• Avoidsugarandfatstoprevent
dumping*
Nutritional
Supplements
• Multivitamin
• Noroutinelabs
• Multivitamin
• VitaminB12
• Needroutinelabsat3,6and12months
post‐op,thenyearlythereafter
• Multivitamin
• VitaminB12
• Calciumandiron(higherchanceof
nutritionaldeficienciesifdon’ttake)
• Needroutinelabsat3,6and12months
post‐op,thenyearlythereafter
Whataretherisks?
• Lowestchanceofoperative
complications
• Possiblecomplicationsincludeheart,
lung,bloodclotsandinfections
• 10‐20%chanceforreoperationby10
yearsduetobandslip,erosion,leakor
portproblem
• Inadequateweightloss
• Easiestprocedureto“cheat”
• Moderatechanceofoperative
complicationsincludingbleedorleak
• Possiblecomplicationsincludeheart,
lung,bloodclotsandinfections
• Newerprocedurewith3‐5year
publishedoutcomes
• Possiblestomachenlargementandneed
forre‐operation,10%chanceorhigher
• Highestchanceofoperative
complicationsincludingbleed,leakor
obstruction,lessthan5%need
reoperation
• Possiblecomplicationsincludeheart,
lung,bloodclotsandinfections
• Possiblenutritionaldeficiencies
• Noaspirin,NSAIDs,orsmokingdueto
riskofmarginalulcerorstricture
• Stomachpouchmaystretchandleadto
weightregain
HospitalStay Overnight(lessthan1day) 2nights 2nights
TimeoffWork 1‐2weeks 1‐2weeks 2‐3weeks
OperationTime 1hour 1.5hours 2hours
Recommendations
• Betterresultsifpatientsenjoy
participatinginanexerciseprogramand
aredisciplinedinfollowingnutrition
guidelines
• LesseffectiveforBMIover50
• Safeforhigherriskpatients
• Procedureisreversible
• Manyinsurancecompanieswill
authorizethisprocedure
• Goodoptionforpatientswithtype2
diabetesandpatientswhosemedical
conditionsprecludeotherprocedures
suchasanemia,Crohn'sdisease,
extensivepriorsurgeryorfrequent
steroiduse
• Safeforhigherriskpatients
• Procedureisnotreversible
• Severalinsurancecompanieswill
authorizethisprocedure
• Mosteffectiveweightlossforpatients
withaBMIof35‐55
• GoodoptionforpatientswithBMIover
50,type2diabetes,severeheartburn,
jointproblemsorexerciselimitations
• Notrecommendedforhigherriskand
elderlypatients
• Procedureisreversible
• Manyinsurancecompanieswill
authorizethisprocedure
* Alsocalledrapidgastricemptying,dumpingsyndromeoccurswhentheundigestedcontentsofyourstomacharetransportedor"dumped"intoyoursmall
intestinetoorapidly.Commonsymptomsincludeabdominalcrampsandnausea.
ComparisonofBariatricSurgicalProcedures
Procedure
LAPAROSCOPIC
ADJUSTABLEGASTRICBANDING
LAPAROSCOPIC
SLEEVEGASTRECTOMY
LAPAROSCOPIC
ROUX‐EN‐YGASTRICBYPASS
Description
Anadjustablesiliconering(band)isplaced
aroundthetoppartofthestomachand
createsasmallpouch
Theprocedureworksbyremoving80
percentofthestomachandreducingthe
secretionofgastrichormones
Theprocedurecreatesasmallgastric
pouchandalsobypassesthestomachand
aportionofthesmallintestine
Howdoesitwork?
• Reducesamountoffoodthatcanbe
consumed
• Adjustments(fills)aremadethroughthe
accessportbyaddingsalinesolution,
average6fillsinthe1styear
• Noalterationtodigestivetract
• Reducesamountoffoodthatcanbe
consumed
• Reducesgastrichormonesandsensation
ofhungerinmanypatients
• Noalterationtodigestivetract
• Reducesamountoffoodthatcanbe
consumed
• Reducestheamountofcaloriesand
nutrientsthebodyabsorbs(controlled
malabsorption)
Averageweightloss• 50%ofexcessweight
• 1pound/weekin1styear
• 50‐70%ofexcessweight
• 1‐2pounds/weekin1styear
• 60‐70%ofexcessweight
• 1‐2pounds/weekfor1styear
Long‐termNutrition
• Smallportionsofhealthyfood
• Highprotein,lowcarb
• Nodrinkingwithmeals
• Zerocalorieliquidsonly
• Smallportionsofhealthyfood
• Highprotein,lowcarb
• Nodrinkingwithmeals
• Zerocalorieliquidsonly
• Smallportionsofhealthyfood
• Highprotein,lowcarb
• Nodrinkingwithmeals
• Zerocalorieliquidsonly
• Avoidsugarandfatstoprevent
dumping*
Nutritional
Supplements
• Multivitamin
• Noroutinelabs
• Multivitamin
• VitaminB12
• Needroutinelabsat3,6and12months
post‐op,thenyearlythereafter
• Multivitamin
• VitaminB12
• Calciumandiron(higherchanceof
nutritionaldeficienciesifdon’ttake)
• Needroutinelabsat3,6and12months
post‐op,thenyearlythereafter
Whataretherisks?
• Lowestchanceofoperative
complications
• Possiblecomplicationsincludeheart,
lung,bloodclotsandinfections
• 10‐20%chanceforreoperationby10
yearsduetobandslip,erosion,leakor
portproblem
• Inadequateweightloss
• Easiestprocedureto“cheat”
• Moderatechanceofoperative
complicationsincludingbleedorleak
• Possiblecomplicationsincludeheart,
lung,bloodclotsandinfections
• Newerprocedurewith3‐5year
publishedoutcomes
• Possiblestomachenlargementandneed
forre‐operation,10%chanceorhigher
• Highestchanceofoperative
complicationsincludingbleed,leakor
obstruction,lessthan5%need
reoperation
• Possiblecomplicationsincludeheart,
lung,bloodclotsandinfections
• Possiblenutritionaldeficiencies
• Noaspirin,NSAIDs,orsmokingdueto
riskofmarginalulcerorstricture
• Stomachpouchmaystretchandleadto
weightregain
HospitalStay Overnight(lessthan1day) 2nights 2nights
TimeoffWork 1‐2weeks 1‐2weeks 2‐3weeks
OperationTime 1hour 1.5hours 2hours
Recommendations
• Betterresultsifpatientsenjoy
participatinginanexerciseprogramand
aredisciplinedinfollowingnutrition
guidelines
• LesseffectiveforBMIover50
• Safeforhigherriskpatients
• Procedureisreversible
• Manyinsurancecompanieswill
authorizethisprocedure
• Goodoptionforpatientswithtype2
diabetesandpatientswhosemedical
conditionsprecludeotherprocedures
suchasanemia,Crohn'sdisease,
extensivepriorsurgeryorfrequent
steroiduse
• Safeforhigherriskpatients
• Procedureisnotreversible
• Severalinsurancecompanieswill
authorizethisprocedure
• Mosteffectiveweightlossforpatients
withaBMIof35‐55
• GoodoptionforpatientswithBMIover
50,type2diabetes,severeheartburn,
jointproblemsorexerciselimitations
• Notrecommendedforhigherriskand
elderlypatients
• Procedureisreversible
• Manyinsurancecompanieswill
authorizethisprocedure
* Alsocalledrapidgastricemptying,dumpingsyndromeoccurswhentheundigestedcontentsofyourstomacharetransportedor"dumped"intoyoursmall
intestinetoorapidly.Commonsymptomsincludeabdominalcrampsandnausea.
Baptist Center for BariatricsC o m p a r i s o n C h a r t
To learn more about the Baptist Center for Bariatrics, visit e-baptisthealth.com/bariatrics or call 904.202.SLIM (7546).
* Also called rapid gastric emptying, dumping syndrome occurs when the undigested contents of your stomach are transported or “dumped” into your small intestine too rapidly. Common symptoms include abdominal cramps and nausea.
Procedure LAPAROSCOPIC ADJUSTABLE GASTRIC BANDING
LAPAROSCOPIC SLEEVE GASTRECTOMY
LAPAROSCOPIC ROUX-EN-Y GASTRIC BYPASS
DescriptionAn adjustable silicone ring (band) is placed around the top part of the stomach and creates a small pouch
The procedure works by removing 80 percent of the stomach and reducing the secretion of gastric hormones
The procedure creates a small gastric pouch and also bypasses the stomach and a portion of the small intestine
How does it work?
• Reduces amount of food that can be consumed• Adjustments (fills) are made through the access port
by adding saline solution; average 6 fills in the first year
• No alteration to digestive tract
• Reduces amount of food that can be consumed• Reduces gastric hormones and sensation of hunger
in many patients• No alteration to digestive tract
• Reduces amount of food that can be consumed• Reduces the amount of calories and nutrients the body absorbs
(controlled malabsorption)
Average weight loss
• 50% of excess weight• 1 pound/week in first year
• 50‐70% of excess weight• 1‐2 pounds/week in 1st year
• 60‐70% of excess weight• 1‐2 pounds/week for 1st year
Long-term Nutrition
• Small portions of healthy food• High protein, low carb• No drinking with meals• Zero-calorie liquids only
• Small portions of healthy food• High protein, low carb• No drinking with meals• Zero-calorie liquids only
• Small portions of healthy food• High protein, low carb• No drinking with meals• Zero-calorie liquids only• Avoid sugar and fats to prevent dumping*
Nutritional Supplements
• Multivitamin • No routine labs
• Multivitamin• Vitamin B12• Need routine labs at 3, 6 and 12 months post‐op,
then yearly
• Multivitamin• Vitamin B12• Calcium and iron (higher chance of nutritional deficiencies if don’t take)• Need routine labs at 3, 6 and 12 months post‐op, then yearly
What are the risks?
• Lowest chance of operative complications• Possible complications include heart, lung, blood
clots and infections• 10-20% chance for re-operation by 10 years due
to band slip, erosion, leak or port problem• Inadequate weight loss• Easiest procedure to “cheat”
• Moderate chance of operative complications including bleeding or leaking
• Possible complications include heart, lung, blood clots and infections
• Newer procedure with 3‐5 year published outcomes• Possible stomach enlargement and need for
re‐operation, 10% chance or higher
• Highest chance of operative complications including bleeding, leaking or obstruction, less than 5% need re-operation
• Possible complications include heart, lung, blood clots and infections• Possible nutritional deficiencies• No aspirin, NSAIDs or smoking due to risk of marginal ulcer
or stricture
Hospital Stay Overnight (less than 1 day) 2 nights 2 nights
Time off Work 1-2 weeks 1-2 weeks 2-3 weeks
Operation Time 1 hour 1.5 hours 2 hours
Recommendations
• Better results if patients enjoy participating in an exercise program and are disciplined in following nutrition guidelines
• Less effective for BMI over 50• Safe for higher-risk patients• Procedure is reversible • Many insurance companies will authorize
this procedure
• Good option for patients with type 2 diabetes and patients whose medical conditions preclude other procedures, such as anemia, Crohn’s disease, extensive prior surgery or frequent steroid use
• Safe for higher-risk patients• Procedure is not reversible• Several insurance companies will authorize
this procedure
• Most effective weight loss for patients with a BMI of 35‐55• Good option for patients with BMI over 50, type 2 diabetes,
severe heartburn, joint problems or exercise limitations• Not recommended for higher-risk and elderly patients• Procedure is reversible• Many insurance companies will authorize this procedure
ComparisonofBariatricSurgicalProcedures
Procedure
LAPAROSCOPIC
ADJUSTABLEGASTRICBANDING
LAPAROSCOPIC
SLEEVEGASTRECTOMY
LAPAROSCOPIC
ROUX‐EN‐YGASTRICBYPASS
Description
Anadjustablesiliconering(band)isplaced
aroundthetoppartofthestomachand
createsasmallpouch
Theprocedureworksbyremoving80
percentofthestomachandreducingthe
secretionofgastrichormones
Theprocedurecreatesasmallgastric
pouchandalsobypassesthestomachand
aportionofthesmallintestine
Howdoesitwork?
• Reducesamountoffoodthatcanbe
consumed
• Adjustments(fills)aremadethroughthe
accessportbyaddingsalinesolution,
average6fillsinthe1styear
• Noalterationtodigestivetract
• Reducesamountoffoodthatcanbe
consumed
• Reducesgastrichormonesandsensation
ofhungerinmanypatients
• Noalterationtodigestivetract
• Reducesamountoffoodthatcanbe
consumed
• Reducestheamountofcaloriesand
nutrientsthebodyabsorbs(controlled
malabsorption)
Averageweightloss• 50%ofexcessweight
• 1pound/weekin1styear
• 50‐70%ofexcessweight
• 1‐2pounds/weekin1styear
• 60‐70%ofexcessweight
• 1‐2pounds/weekfor1styear
Long‐termNutrition
• Smallportionsofhealthyfood
• Highprotein,lowcarb
• Nodrinkingwithmeals
• Zerocalorieliquidsonly
• Smallportionsofhealthyfood
• Highprotein,lowcarb
• Nodrinkingwithmeals
• Zerocalorieliquidsonly
• Smallportionsofhealthyfood
• Highprotein,lowcarb
• Nodrinkingwithmeals
• Zerocalorieliquidsonly
• Avoidsugarandfatstoprevent
dumping*
Nutritional
Supplements
• Multivitamin
• Noroutinelabs
• Multivitamin
• VitaminB12
• Needroutinelabsat3,6and12months
post‐op,thenyearlythereafter
• Multivitamin
• VitaminB12
• Calciumandiron(higherchanceof
nutritionaldeficienciesifdon’ttake)
• Needroutinelabsat3,6and12months
post‐op,thenyearlythereafter
Whataretherisks?
• Lowestchanceofoperative
complications
• Possiblecomplicationsincludeheart,
lung,bloodclotsandinfections
• 10‐20%chanceforreoperationby10
yearsduetobandslip,erosion,leakor
portproblem
• Inadequateweightloss
• Easiestprocedureto“cheat”
• Moderatechanceofoperative
complicationsincludingbleedorleak
• Possiblecomplicationsincludeheart,
lung,bloodclotsandinfections
• Newerprocedurewith3‐5year
publishedoutcomes
• Possiblestomachenlargementandneed
forre‐operation,10%chanceorhigher
• Highestchanceofoperative
complicationsincludingbleed,leakor
obstruction,lessthan5%need
reoperation
• Possiblecomplicationsincludeheart,
lung,bloodclotsandinfections
• Possiblenutritionaldeficiencies
• Noaspirin,NSAIDs,orsmokingdueto
riskofmarginalulcerorstricture
• Stomachpouchmaystretchandleadto
weightregain
HospitalStay Overnight(lessthan1day) 2nights 2nights
TimeoffWork 1‐2weeks 1‐2weeks 2‐3weeks
OperationTime 1hour 1.5hours 2hours
Recommendations
• Betterresultsifpatientsenjoy
participatinginanexerciseprogramand
aredisciplinedinfollowingnutrition
guidelines
• LesseffectiveforBMIover50
• Safeforhigherriskpatients
• Procedureisreversible
• Manyinsurancecompanieswill
authorizethisprocedure
• Goodoptionforpatientswithtype2
diabetesandpatientswhosemedical
conditionsprecludeotherprocedures
suchasanemia,Crohn'sdisease,
extensivepriorsurgeryorfrequent
steroiduse
• Safeforhigherriskpatients
• Procedureisnotreversible
• Severalinsurancecompanieswill
authorizethisprocedure
• Mosteffectiveweightlossforpatients
withaBMIof35‐55
• GoodoptionforpatientswithBMIover
50,type2diabetes,severeheartburn,
jointproblemsorexerciselimitations
• Notrecommendedforhigherriskand
elderlypatients
• Procedureisreversible
• Manyinsurancecompanieswill
authorizethisprocedure
* Alsocalledrapidgastricemptying,dumpingsyndromeoccurswhentheundigestedcontentsofyourstomacharetransportedor"dumped"intoyoursmall
intestinetoorapidly.Commonsymptomsincludeabdominalcrampsandnausea.
ComparisonofBariatricSurgicalProcedures
Procedure
LAPAROSCOPIC
ADJUSTABLEGASTRICBANDING
LAPAROSCOPIC
SLEEVEGASTRECTOMY
LAPAROSCOPIC
ROUX‐EN‐YGASTRICBYPASS
Description
Anadjustablesiliconering(band)isplaced
aroundthetoppartofthestomachand
createsasmallpouch
Theprocedureworksbyremoving80
percentofthestomachandreducingthe
secretionofgastrichormones
Theprocedurecreatesasmallgastric
pouchandalsobypassesthestomachand
aportionofthesmallintestine
Howdoesitwork?
• Reducesamountoffoodthatcanbe
consumed
• Adjustments(fills)aremadethroughthe
accessportbyaddingsalinesolution,
average6fillsinthe1styear
• Noalterationtodigestivetract
• Reducesamountoffoodthatcanbe
consumed
• Reducesgastrichormonesandsensation
ofhungerinmanypatients
• Noalterationtodigestivetract
• Reducesamountoffoodthatcanbe
consumed
• Reducestheamountofcaloriesand
nutrientsthebodyabsorbs(controlled
malabsorption)
Averageweightloss• 50%ofexcessweight
• 1pound/weekin1styear
• 50‐70%ofexcessweight
• 1‐2pounds/weekin1styear
• 60‐70%ofexcessweight
• 1‐2pounds/weekfor1styear
Long‐termNutrition
• Smallportionsofhealthyfood
• Highprotein,lowcarb
• Nodrinkingwithmeals
• Zerocalorieliquidsonly
• Smallportionsofhealthyfood
• Highprotein,lowcarb
• Nodrinkingwithmeals
• Zerocalorieliquidsonly
• Smallportionsofhealthyfood
• Highprotein,lowcarb
• Nodrinkingwithmeals
• Zerocalorieliquidsonly
• Avoidsugarandfatstoprevent
dumping*
Nutritional
Supplements
• Multivitamin
• Noroutinelabs
• Multivitamin
• VitaminB12
• Needroutinelabsat3,6and12months
post‐op,thenyearlythereafter
• Multivitamin
• VitaminB12
• Calciumandiron(higherchanceof
nutritionaldeficienciesifdon’ttake)
• Needroutinelabsat3,6and12months
post‐op,thenyearlythereafter
Whataretherisks?
• Lowestchanceofoperative
complications
• Possiblecomplicationsincludeheart,
lung,bloodclotsandinfections
• 10‐20%chanceforreoperationby10
yearsduetobandslip,erosion,leakor
portproblem
• Inadequateweightloss
• Easiestprocedureto“cheat”
• Moderatechanceofoperative
complicationsincludingbleedorleak
• Possiblecomplicationsincludeheart,
lung,bloodclotsandinfections
• Newerprocedurewith3‐5year
publishedoutcomes
• Possiblestomachenlargementandneed
forre‐operation,10%chanceorhigher
• Highestchanceofoperative
complicationsincludingbleed,leakor
obstruction,lessthan5%need
reoperation
• Possiblecomplicationsincludeheart,
lung,bloodclotsandinfections
• Possiblenutritionaldeficiencies
• Noaspirin,NSAIDs,orsmokingdueto
riskofmarginalulcerorstricture
• Stomachpouchmaystretchandleadto
weightregain
HospitalStay Overnight(lessthan1day) 2nights 2nights
TimeoffWork 1‐2weeks 1‐2weeks 2‐3weeks
OperationTime 1hour 1.5hours 2hours
Recommendations
• Betterresultsifpatientsenjoy
participatinginanexerciseprogramand
aredisciplinedinfollowingnutrition
guidelines
• LesseffectiveforBMIover50
• Safeforhigherriskpatients
• Procedureisreversible
• Manyinsurancecompanieswill
authorizethisprocedure
• Goodoptionforpatientswithtype2
diabetesandpatientswhosemedical
conditionsprecludeotherprocedures
suchasanemia,Crohn'sdisease,
extensivepriorsurgeryorfrequent
steroiduse
• Safeforhigherriskpatients
• Procedureisnotreversible
• Severalinsurancecompanieswill
authorizethisprocedure
• Mosteffectiveweightlossforpatients
withaBMIof35‐55
• GoodoptionforpatientswithBMIover
50,type2diabetes,severeheartburn,
jointproblemsorexerciselimitations
• Notrecommendedforhigherriskand
elderlypatients
• Procedureisreversible
• Manyinsurancecompanieswill
authorizethisprocedure
* Alsocalledrapidgastricemptying,dumpingsyndromeoccurswhentheundigestedcontentsofyourstomacharetransportedor"dumped"intoyoursmall
intestinetoorapidly.Commonsymptomsincludeabdominalcrampsandnausea.
ComparisonofBariatricSurgicalProcedures
Procedure
LAPAROSCOPIC
ADJUSTABLEGASTRICBANDING
LAPAROSCOPIC
SLEEVEGASTRECTOMY
LAPAROSCOPIC
ROUX‐EN‐YGASTRICBYPASS
Description
Anadjustablesiliconering(band)isplaced
aroundthetoppartofthestomachand
createsasmallpouch
Theprocedureworksbyremoving80
percentofthestomachandreducingthe
secretionofgastrichormones
Theprocedurecreatesasmallgastric
pouchandalsobypassesthestomachand
aportionofthesmallintestine
Howdoesitwork?
• Reducesamountoffoodthatcanbe
consumed
• Adjustments(fills)aremadethroughthe
accessportbyaddingsalinesolution,
average6fillsinthe1styear
• Noalterationtodigestivetract
• Reducesamountoffoodthatcanbe
consumed
• Reducesgastrichormonesandsensation
ofhungerinmanypatients
• Noalterationtodigestivetract
• Reducesamountoffoodthatcanbe
consumed
• Reducestheamountofcaloriesand
nutrientsthebodyabsorbs(controlled
malabsorption)
Averageweightloss• 50%ofexcessweight
• 1pound/weekin1styear
• 50‐70%ofexcessweight
• 1‐2pounds/weekin1styear
• 60‐70%ofexcessweight
• 1‐2pounds/weekfor1styear
Long‐termNutrition
• Smallportionsofhealthyfood
• Highprotein,lowcarb
• Nodrinkingwithmeals
• Zerocalorieliquidsonly
• Smallportionsofhealthyfood
• Highprotein,lowcarb
• Nodrinkingwithmeals
• Zerocalorieliquidsonly
• Smallportionsofhealthyfood
• Highprotein,lowcarb
• Nodrinkingwithmeals
• Zerocalorieliquidsonly
• Avoidsugarandfatstoprevent
dumping*
Nutritional
Supplements
• Multivitamin
• Noroutinelabs
• Multivitamin
• VitaminB12
• Needroutinelabsat3,6and12months
post‐op,thenyearlythereafter
• Multivitamin
• VitaminB12
• Calciumandiron(higherchanceof
nutritionaldeficienciesifdon’ttake)
• Needroutinelabsat3,6and12months
post‐op,thenyearlythereafter
Whataretherisks?
• Lowestchanceofoperative
complications
• Possiblecomplicationsincludeheart,
lung,bloodclotsandinfections
• 10‐20%chanceforreoperationby10
yearsduetobandslip,erosion,leakor
portproblem
• Inadequateweightloss
• Easiestprocedureto“cheat”
• Moderatechanceofoperative
complicationsincludingbleedorleak
• Possiblecomplicationsincludeheart,
lung,bloodclotsandinfections
• Newerprocedurewith3‐5year
publishedoutcomes
• Possiblestomachenlargementandneed
forre‐operation,10%chanceorhigher
• Highestchanceofoperative
complicationsincludingbleed,leakor
obstruction,lessthan5%need
reoperation
• Possiblecomplicationsincludeheart,
lung,bloodclotsandinfections
• Possiblenutritionaldeficiencies
• Noaspirin,NSAIDs,orsmokingdueto
riskofmarginalulcerorstricture
• Stomachpouchmaystretchandleadto
weightregain
HospitalStay Overnight(lessthan1day) 2nights 2nights
TimeoffWork 1‐2weeks 1‐2weeks 2‐3weeks
OperationTime 1hour 1.5hours 2hours
Recommendations
• Betterresultsifpatientsenjoy
participatinginanexerciseprogramand
aredisciplinedinfollowingnutrition
guidelines
• LesseffectiveforBMIover50
• Safeforhigherriskpatients
• Procedureisreversible
• Manyinsurancecompanieswill
authorizethisprocedure
• Goodoptionforpatientswithtype2
diabetesandpatientswhosemedical
conditionsprecludeotherprocedures
suchasanemia,Crohn'sdisease,
extensivepriorsurgeryorfrequent
steroiduse
• Safeforhigherriskpatients
• Procedureisnotreversible
• Severalinsurancecompanieswill
authorizethisprocedure
• Mosteffectiveweightlossforpatients
withaBMIof35‐55
• GoodoptionforpatientswithBMIover
50,type2diabetes,severeheartburn,
jointproblemsorexerciselimitations
• Notrecommendedforhigherriskand
elderlypatients
• Procedureisreversible
• Manyinsurancecompanieswill
authorizethisprocedure
* Alsocalledrapidgastricemptying,dumpingsyndromeoccurswhentheundigestedcontentsofyourstomacharetransportedor"dumped"intoyoursmall
intestinetoorapidly.Commonsymptomsincludeabdominalcrampsandnausea.
Baptist Center for BariatricsC o m p a r i s o n C h a r t
To learn more about the Baptist Center for Bariatrics, visit e-baptisthealth.com/bariatrics or call 904.202.SLIM (7546).
* Also called rapid gastric emptying, dumping syndrome occurs when the undigested contents of your stomach are transported or “dumped” into your small intestine too rapidly. Common symptoms include abdominal cramps and nausea.
Procedure LAPAROSCOPIC ADJUSTABLE GASTRIC BANDING
LAPAROSCOPIC SLEEVE GASTRECTOMY
LAPAROSCOPIC ROUX-EN-Y GASTRIC BYPASS
DescriptionAn adjustable silicone ring (band) is placed around the top part of the stomach and creates a small pouch
The procedure works by removing 80 percent of the stomach and reducing the secretion of gastric hormones
The procedure creates a small gastric pouch and also bypasses the stomach and a portion of the small intestine
How does it work?
• Reduces amount of food that can be consumed• Adjustments (fills) are made through the access port
by adding saline solution; average 6 fills in the first year
• No alteration to digestive tract
• Reduces amount of food that can be consumed• Reduces gastric hormones and sensation of hunger
in many patients• No alteration to digestive tract
• Reduces amount of food that can be consumed• Reduces the amount of calories and nutrients the body absorbs
(controlled malabsorption)
Average weight loss
• 50% of excess weight• 1 pound/week in first year
• 50‐70% of excess weight• 1‐2 pounds/week in 1st year
• 60‐70% of excess weight• 1‐2 pounds/week for 1st year
Long-term Nutrition
• Small portions of healthy food• High protein, low carb• No drinking with meals• Zero-calorie liquids only
• Small portions of healthy food• High protein, low carb• No drinking with meals• Zero-calorie liquids only
• Small portions of healthy food• High protein, low carb• No drinking with meals• Zero-calorie liquids only• Avoid sugar and fats to prevent dumping*
Nutritional Supplements
• Multivitamin • No routine labs
• Multivitamin• Vitamin B12• Need routine labs at 3, 6 and 12 months post‐op,
then yearly
• Multivitamin• Vitamin B12• Calcium and iron (higher chance of nutritional deficiencies if don’t take)• Need routine labs at 3, 6 and 12 months post‐op, then yearly
What are the risks?
• Lowest chance of operative complications• Possible complications include heart, lung, blood
clots and infections• 10-20% chance for re-operation by 10 years due
to band slip, erosion, leak or port problem• Inadequate weight loss• Easiest procedure to “cheat”
• Moderate chance of operative complications including bleeding or leaking
• Possible complications include heart, lung, blood clots and infections
• Newer procedure with 3‐5 year published outcomes• Possible stomach enlargement and need for
re‐operation, 10% chance or higher
• Highest chance of operative complications including bleeding, leaking or obstruction, less than 5% need re-operation
• Possible complications include heart, lung, blood clots and infections• Possible nutritional deficiencies• No aspirin, NSAIDs or smoking due to risk of marginal ulcer
or stricture
Hospital Stay Overnight (less than 1 day) 2 nights 2 nights
Time off Work 1-2 weeks 1-2 weeks 2-3 weeks
Operation Time 1 hour 1.5 hours 2 hours
Recommendations
• Better results if patients enjoy participating in an exercise program and are disciplined in following nutrition guidelines
• Less effective for BMI over 50• Safe for higher-risk patients• Procedure is reversible • Many insurance companies will authorize
this procedure
• Good option for patients with type 2 diabetes and patients whose medical conditions preclude other procedures, such as anemia, Crohn’s disease, extensive prior surgery or frequent steroid use
• Safe for higher-risk patients• Procedure is not reversible• Several insurance companies will authorize
this procedure
• Most effective weight loss for patients with a BMI of 35‐55• Good option for patients with BMI over 50, type 2 diabetes,
severe heartburn, joint problems or exercise limitations• Not recommended for higher-risk and elderly patients• Procedure is reversible• Many insurance companies will authorize this procedure
ComparisonofBariatricSurgicalProcedures
Procedure
LAPAROSCOPIC
ADJUSTABLEGASTRICBANDING
LAPAROSCOPIC
SLEEVEGASTRECTOMY
LAPAROSCOPIC
ROUX‐EN‐YGASTRICBYPASS
Description
Anadjustablesiliconering(band)isplaced
aroundthetoppartofthestomachand
createsasmallpouch
Theprocedureworksbyremoving80
percentofthestomachandreducingthe
secretionofgastrichormones
Theprocedurecreatesasmallgastric
pouchandalsobypassesthestomachand
aportionofthesmallintestine
Howdoesitwork?
• Reducesamountoffoodthatcanbe
consumed
• Adjustments(fills)aremadethroughthe
accessportbyaddingsalinesolution,
average6fillsinthe1styear
• Noalterationtodigestivetract
• Reducesamountoffoodthatcanbe
consumed
• Reducesgastrichormonesandsensation
ofhungerinmanypatients
• Noalterationtodigestivetract
• Reducesamountoffoodthatcanbe
consumed
• Reducestheamountofcaloriesand
nutrientsthebodyabsorbs(controlled
malabsorption)
Averageweightloss• 50%ofexcessweight
• 1pound/weekin1styear
• 50‐70%ofexcessweight
• 1‐2pounds/weekin1styear
• 60‐70%ofexcessweight
• 1‐2pounds/weekfor1styear
Long‐termNutrition
• Smallportionsofhealthyfood
• Highprotein,lowcarb
• Nodrinkingwithmeals
• Zerocalorieliquidsonly
• Smallportionsofhealthyfood
• Highprotein,lowcarb
• Nodrinkingwithmeals
• Zerocalorieliquidsonly
• Smallportionsofhealthyfood
• Highprotein,lowcarb
• Nodrinkingwithmeals
• Zerocalorieliquidsonly
• Avoidsugarandfatstoprevent
dumping*
Nutritional
Supplements
• Multivitamin
• Noroutinelabs
• Multivitamin
• VitaminB12
• Needroutinelabsat3,6and12months
post‐op,thenyearlythereafter
• Multivitamin
• VitaminB12
• Calciumandiron(higherchanceof
nutritionaldeficienciesifdon’ttake)
• Needroutinelabsat3,6and12months
post‐op,thenyearlythereafter
Whataretherisks?
• Lowestchanceofoperative
complications
• Possiblecomplicationsincludeheart,
lung,bloodclotsandinfections
• 10‐20%chanceforreoperationby10
yearsduetobandslip,erosion,leakor
portproblem
• Inadequateweightloss
• Easiestprocedureto“cheat”
• Moderatechanceofoperative
complicationsincludingbleedorleak
• Possiblecomplicationsincludeheart,
lung,bloodclotsandinfections
• Newerprocedurewith3‐5year
publishedoutcomes
• Possiblestomachenlargementandneed
forre‐operation,10%chanceorhigher
• Highestchanceofoperative
complicationsincludingbleed,leakor
obstruction,lessthan5%need
reoperation
• Possiblecomplicationsincludeheart,
lung,bloodclotsandinfections
• Possiblenutritionaldeficiencies
• Noaspirin,NSAIDs,orsmokingdueto
riskofmarginalulcerorstricture
• Stomachpouchmaystretchandleadto
weightregain
HospitalStay Overnight(lessthan1day) 2nights 2nights
TimeoffWork 1‐2weeks 1‐2weeks 2‐3weeks
OperationTime 1hour 1.5hours 2hours
Recommendations
• Betterresultsifpatientsenjoy
participatinginanexerciseprogramand
aredisciplinedinfollowingnutrition
guidelines
• LesseffectiveforBMIover50
• Safeforhigherriskpatients
• Procedureisreversible
• Manyinsurancecompanieswill
authorizethisprocedure
• Goodoptionforpatientswithtype2
diabetesandpatientswhosemedical
conditionsprecludeotherprocedures
suchasanemia,Crohn'sdisease,
extensivepriorsurgeryorfrequent
steroiduse
• Safeforhigherriskpatients
• Procedureisnotreversible
• Severalinsurancecompanieswill
authorizethisprocedure
• Mosteffectiveweightlossforpatients
withaBMIof35‐55
• GoodoptionforpatientswithBMIover
50,type2diabetes,severeheartburn,
jointproblemsorexerciselimitations
• Notrecommendedforhigherriskand
elderlypatients
• Procedureisreversible
• Manyinsurancecompanieswill
authorizethisprocedure
* Alsocalledrapidgastricemptying,dumpingsyndromeoccurswhentheundigestedcontentsofyourstomacharetransportedor"dumped"intoyoursmall
intestinetoorapidly.Commonsymptomsincludeabdominalcrampsandnausea.
ComparisonofBariatricSurgicalProcedures
Procedure
LAPAROSCOPIC
ADJUSTABLEGASTRICBANDING
LAPAROSCOPIC
SLEEVEGASTRECTOMY
LAPAROSCOPIC
ROUX‐EN‐YGASTRICBYPASS
Description
Anadjustablesiliconering(band)isplaced
aroundthetoppartofthestomachand
createsasmallpouch
Theprocedureworksbyremoving80
percentofthestomachandreducingthe
secretionofgastrichormones
Theprocedurecreatesasmallgastric
pouchandalsobypassesthestomachand
aportionofthesmallintestine
Howdoesitwork?
• Reducesamountoffoodthatcanbe
consumed
• Adjustments(fills)aremadethroughthe
accessportbyaddingsalinesolution,
average6fillsinthe1styear
• Noalterationtodigestivetract
• Reducesamountoffoodthatcanbe
consumed
• Reducesgastrichormonesandsensation
ofhungerinmanypatients
• Noalterationtodigestivetract
• Reducesamountoffoodthatcanbe
consumed
• Reducestheamountofcaloriesand
nutrientsthebodyabsorbs(controlled
malabsorption)
Averageweightloss• 50%ofexcessweight
• 1pound/weekin1styear
• 50‐70%ofexcessweight
• 1‐2pounds/weekin1styear
• 60‐70%ofexcessweight
• 1‐2pounds/weekfor1styear
Long‐termNutrition
• Smallportionsofhealthyfood
• Highprotein,lowcarb
• Nodrinkingwithmeals
• Zerocalorieliquidsonly
• Smallportionsofhealthyfood
• Highprotein,lowcarb
• Nodrinkingwithmeals
• Zerocalorieliquidsonly
• Smallportionsofhealthyfood
• Highprotein,lowcarb
• Nodrinkingwithmeals
• Zerocalorieliquidsonly
• Avoidsugarandfatstoprevent
dumping*
Nutritional
Supplements
• Multivitamin
• Noroutinelabs
• Multivitamin
• VitaminB12
• Needroutinelabsat3,6and12months
post‐op,thenyearlythereafter
• Multivitamin
• VitaminB12
• Calciumandiron(higherchanceof
nutritionaldeficienciesifdon’ttake)
• Needroutinelabsat3,6and12months
post‐op,thenyearlythereafter
Whataretherisks?
• Lowestchanceofoperative
complications
• Possiblecomplicationsincludeheart,
lung,bloodclotsandinfections
• 10‐20%chanceforreoperationby10
yearsduetobandslip,erosion,leakor
portproblem
• Inadequateweightloss
• Easiestprocedureto“cheat”
• Moderatechanceofoperative
complicationsincludingbleedorleak
• Possiblecomplicationsincludeheart,
lung,bloodclotsandinfections
• Newerprocedurewith3‐5year
publishedoutcomes
• Possiblestomachenlargementandneed
forre‐operation,10%chanceorhigher
• Highestchanceofoperative
complicationsincludingbleed,leakor
obstruction,lessthan5%need
reoperation
• Possiblecomplicationsincludeheart,
lung,bloodclotsandinfections
• Possiblenutritionaldeficiencies
• Noaspirin,NSAIDs,orsmokingdueto
riskofmarginalulcerorstricture
• Stomachpouchmaystretchandleadto
weightregain
HospitalStay Overnight(lessthan1day) 2nights 2nights
TimeoffWork 1‐2weeks 1‐2weeks 2‐3weeks
OperationTime 1hour 1.5hours 2hours
Recommendations
• Betterresultsifpatientsenjoy
participatinginanexerciseprogramand
aredisciplinedinfollowingnutrition
guidelines
• LesseffectiveforBMIover50
• Safeforhigherriskpatients
• Procedureisreversible
• Manyinsurancecompanieswill
authorizethisprocedure
• Goodoptionforpatientswithtype2
diabetesandpatientswhosemedical
conditionsprecludeotherprocedures
suchasanemia,Crohn'sdisease,
extensivepriorsurgeryorfrequent
steroiduse
• Safeforhigherriskpatients
• Procedureisnotreversible
• Severalinsurancecompanieswill
authorizethisprocedure
• Mosteffectiveweightlossforpatients
withaBMIof35‐55
• GoodoptionforpatientswithBMIover
50,type2diabetes,severeheartburn,
jointproblemsorexerciselimitations
• Notrecommendedforhigherriskand
elderlypatients
• Procedureisreversible
• Manyinsurancecompanieswill
authorizethisprocedure
* Alsocalledrapidgastricemptying,dumpingsyndromeoccurswhentheundigestedcontentsofyourstomacharetransportedor"dumped"intoyoursmall
intestinetoorapidly.Commonsymptomsincludeabdominalcrampsandnausea.
ComparisonofBariatricSurgicalProcedures
Procedure
LAPAROSCOPIC
ADJUSTABLEGASTRICBANDING
LAPAROSCOPIC
SLEEVEGASTRECTOMY
LAPAROSCOPIC
ROUX‐EN‐YGASTRICBYPASS
Description
Anadjustablesiliconering(band)isplaced
aroundthetoppartofthestomachand
createsasmallpouch
Theprocedureworksbyremoving80
percentofthestomachandreducingthe
secretionofgastrichormones
Theprocedurecreatesasmallgastric
pouchandalsobypassesthestomachand
aportionofthesmallintestine
Howdoesitwork?
• Reducesamountoffoodthatcanbe
consumed
• Adjustments(fills)aremadethroughthe
accessportbyaddingsalinesolution,
average6fillsinthe1styear
• Noalterationtodigestivetract
• Reducesamountoffoodthatcanbe
consumed
• Reducesgastrichormonesandsensation
ofhungerinmanypatients
• Noalterationtodigestivetract
• Reducesamountoffoodthatcanbe
consumed
• Reducestheamountofcaloriesand
nutrientsthebodyabsorbs(controlled
malabsorption)
Averageweightloss• 50%ofexcessweight
• 1pound/weekin1styear
• 50‐70%ofexcessweight
• 1‐2pounds/weekin1styear
• 60‐70%ofexcessweight
• 1‐2pounds/weekfor1styear
Long‐termNutrition
• Smallportionsofhealthyfood
• Highprotein,lowcarb
• Nodrinkingwithmeals
• Zerocalorieliquidsonly
• Smallportionsofhealthyfood
• Highprotein,lowcarb
• Nodrinkingwithmeals
• Zerocalorieliquidsonly
• Smallportionsofhealthyfood
• Highprotein,lowcarb
• Nodrinkingwithmeals
• Zerocalorieliquidsonly
• Avoidsugarandfatstoprevent
dumping*
Nutritional
Supplements
• Multivitamin
• Noroutinelabs
• Multivitamin
• VitaminB12
• Needroutinelabsat3,6and12months
post‐op,thenyearlythereafter
• Multivitamin
• VitaminB12
• Calciumandiron(higherchanceof
nutritionaldeficienciesifdon’ttake)
• Needroutinelabsat3,6and12months
post‐op,thenyearlythereafter
Whataretherisks?
• Lowestchanceofoperative
complications
• Possiblecomplicationsincludeheart,
lung,bloodclotsandinfections
• 10‐20%chanceforreoperationby10
yearsduetobandslip,erosion,leakor
portproblem
• Inadequateweightloss
• Easiestprocedureto“cheat”
• Moderatechanceofoperative
complicationsincludingbleedorleak
• Possiblecomplicationsincludeheart,
lung,bloodclotsandinfections
• Newerprocedurewith3‐5year
publishedoutcomes
• Possiblestomachenlargementandneed
forre‐operation,10%chanceorhigher
• Highestchanceofoperative
complicationsincludingbleed,leakor
obstruction,lessthan5%need
reoperation
• Possiblecomplicationsincludeheart,
lung,bloodclotsandinfections
• Possiblenutritionaldeficiencies
• Noaspirin,NSAIDs,orsmokingdueto
riskofmarginalulcerorstricture
• Stomachpouchmaystretchandleadto
weightregain
HospitalStay Overnight(lessthan1day) 2nights 2nights
TimeoffWork 1‐2weeks 1‐2weeks 2‐3weeks
OperationTime 1hour 1.5hours 2hours
Recommendations
• Betterresultsifpatientsenjoy
participatinginanexerciseprogramand
aredisciplinedinfollowingnutrition
guidelines
• LesseffectiveforBMIover50
• Safeforhigherriskpatients
• Procedureisreversible
• Manyinsurancecompanieswill
authorizethisprocedure
• Goodoptionforpatientswithtype2
diabetesandpatientswhosemedical
conditionsprecludeotherprocedures
suchasanemia,Crohn'sdisease,
extensivepriorsurgeryorfrequent
steroiduse
• Safeforhigherriskpatients
• Procedureisnotreversible
• Severalinsurancecompanieswill
authorizethisprocedure
• Mosteffectiveweightlossforpatients
withaBMIof35‐55
• GoodoptionforpatientswithBMIover
50,type2diabetes,severeheartburn,
jointproblemsorexerciselimitations
• Notrecommendedforhigherriskand
elderlypatients
• Procedureisreversible
• Manyinsurancecompanieswill
authorizethisprocedure
* Alsocalledrapidgastricemptying,dumpingsyndromeoccurswhentheundigestedcontentsofyourstomacharetransportedor"dumped"intoyoursmall
intestinetoorapidly.Commonsymptomsincludeabdominalcrampsandnausea.
Baptist Center for BariatricsC o m p a r i s o n C h a r t
To learn more about the Baptist Center for Bariatrics, visit e-baptisthealth.com/bariatrics or call 904.202.SLIM (7546).
* Also called rapid gastric emptying, dumping syndrome occurs when the undigested contents of your stomach are transported or “dumped” into your small intestine too rapidly. Common symptoms include abdominal cramps and nausea.
baptistbariatrics.com904.202.SLIM (7546)
Meet our bariatric surgeons Our goal is to provide your patients with safe, consistent, quality care that helps enhance and extend their lives.
B a p t i s t C e n t e r f o r B a r i at r i C s
Craig Morgenthal, MD, FACS
“ We guide our patients by encouraging a healthy lifestyle, providing a proven bariatric surgery tool and supporting them with a comprehensive program. Together, this is the framework for long-term success.”
• Medical director of Baptist Center for Bariatrics
• Board-certified general surgeon and fellow of the American College of Surgeons
• Attended medical school at Tel Aviv University, completed his general surgery residency at the State University of New York at Brooklyn, and did a research and clinical fellowship in minimally invasive and bariatric surgery at Emory University School of Medicine
• Office: 904.398.0033
Steven Hodgett, MD, FACS
“ What I appreciate most about being a bariatric physician is developing personal relationships with each patient.”
• Board-certified bariatric surgeon with advanced training in weight loss surgery and laparoscopic surgery
• Attended medical school at the Medical College of Wisconsin in Milwaukee, completed his residency in general surgery at the University of South Florida School of Medicine and completed a clinical fellowship in minimally invasive surgery at Washington University School of Medicine in St. Louis, Missouri
• Office: 904.398.0033
Referrals and Consultations
Fax: 904.391.5451Phone: 904.202.SLIM (7546)Email: [email protected]: baptistbariatrics.com
Thank you for allowing us to care for your patients’ weight loss and bariatric surgical needs.