Virtual gastric banding by hypnosis

Neuro Slimmer System

There's a solution to everything and when it comes to losing weight, curing unhealthy food cravings, and getting in the shape you've always wanted, Neuro Slimmer System Gastric Surgery Hypnosis is the real and effective solution. It works by targeting your subconscious mind through hypnosis. The method that has been proven by many types of research around the world. Basically, the idea of the whole system is to plant a belief in your subconscious mind that you've gone through the Gastric Banding Surgery, a surgery that uses a silicon belt to slightly fasten your stomach near the esophagus to create two pouches in which the upper one is always smaller. This apparent drastic reduction in stomach size triggers your mind to fluctuate its limits of the fat reserves your body should have. The resulting effect is always a reduction in these reserves because your mind finally understands that you don't need to eat more or carry out unhealthy eating habits. As we said, the same result is achieved by the Neuro Slimming System Gastric Surgery Hypnosis and that too for a far lesser price, great precision, and no incision. The plus point of this program is that at the same price you get two bonuses in which the first one is preparatory audio sessions that motivates you or prepares you for the main audio course and the second one is a nutrition course aimed at helping you steer clear of all the cravings and settle for a healthy diet. More here...

Neuro Slimmer System Gastric Surgery Hypnosis Summary

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4.9 stars out of 31 votes

Contents: Ebook, Online Program
Author: James Johnson
Official Website: neuroslimmer.com
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My Neuro Slimmer System Gastric Surgery Hypnosis Review

Highly Recommended

The author presents a well detailed summery of the major headings. As a professional in this field, I must say that the points shared in this manual are precise.

As a whole, this e-book contains everything you need to know about this subject. I would recommend it as a guide for beginners as well as experts and everyone in between.

Gastric Band Hypnotherapy

Gastric Band Hypnotherapy Is A Virtual Gastric Band That Results In Quick Weight Loss. The Session Has Been Produced By Clinical Hypnotherapist Jon Rhodes. Gastric Band Hypnotherapy is unique because it convinces your subconscious mind that you have a gastric band fitted. Your mind thinks that your stomach is now much smaller than it really is. This leads to a remarkable change in your behaviour. When eating you now feel full much sooner than before. Often just half your normal portions leaves you feeling satisfied. This causes you to naturally eat much less than you did before, which leads to rapid and sustainable weight loss. You can now effortlessly reduce your eating without feeling hungry all the time. You simply go about your life and the weight falls off you every day. It really is that simple. When you buy the Gastric Band Hypnotherapy pack you will receive a zip file that contains: Gastric Band Hypnotherapy Band Fitting MP3 Run Time: 10.32 m.s. Gastric Band Hypnotherapy Band Inflation MP3 Run Time: 14.45 m.s. Gastric Band Hypnotherapy Band Post-Op MP3 Run Time: 12.42 m.s. Gastric Band Hypnotherapy Reversal MP3 (should you ever wish to remove the mind band) Run Time: 12.10 m.s. Gastric Band Hypnotherapy Pdf eBook Guide 6 Pages More here...

Gastric Band Hypnotherapy Summary

Contents: Audios, Ebook
Author: Jon Rhodes
Official Website: www.gastricbandhypnotherapy.net
Price: $49.00

Laparoscopic Gastric Bypass Clinical Outcomes

In 1993, Wittgrove and Clark performed the first laparoscopic gastric bypass. This was soon followed by a published report in 1994 of their initial five cases outlining the technical feasibility of the operation.1 Since that time variations in operative technique have been described, the majority of which differ in the type of gastrojejunal anastomosis created. Regardless of the laparoscopic technique used during the procedure, the questions that must be answered pertain to outcomes in comparison to open gastric bypass. In this chapter, the world's literature will be reviewed pertaining to outcomes following laparoscopic gastric bypass. As of this printing, the following five papers make up the published experience regarding laparoscopic gastric bypass outcomes and are presented in the order they were published. In 1998, Lonroth and Dalenback published their experience with a variety of laparoscopic bariatric procedures.2 Included in their experiences were 29 patients who underwent...

Dilated Pouch Gastric Bypass

Esophageal Dilation Gastric Banding

Esophageal dysmotility and dilation is a newly recognized complication of LASGB. Intuitively, one might expect an inverse correlation between stomal diameter and esophageal dilation, but none was found. The majority of patients in our study developed new or more severe esophageal symptoms after placement of the device. Other studies support an increase in reflux after gastric banding. Ovrebo found in a study of 17 patients with the so-called Swedish LASGB device that acid regurgitation and heartburn increased from approx 15 to 60 after gastric banding. Other authors report complications such as food intolerance unresponsive to band deflation being attributable to pouch dilatation and or stomal stenosis. Kuzmak, although using a previous version of the current band system, showed that early postoperative contrast study document a pouch dilation rate of 6.5 which increased to 50 over a four year follow-up. Doherty et al found that 38 of patients with an adjustable silicone gastric band...

Laparoscopic Instruments for Bariatric Surgery

Laparoscopic Suture Passer

Laparoscopic gastric bypass (LGB) has developed in recent years due to close collaboration between physicians and the technology manufacturers. Close relationships with surgeons have allowed our industry to recognize the emergence of this procedure, and start to develop technologies that help make a LGB a safe, effective option for a challenging patient population.

Laparoscopic Vertical Banded Gastroplasty

Horizontal Gastroplasty

The evolution of morbid obesity surgery has been directed by an effort to minimize complications while improving weight loss and reducing obesity comorbidities. Two different types of procedures have developed, simple and complex. Simple procedures include all restrictive procedures like the horizontal gastroplasty (HG), the vertical banded gastroplasty (VBG), or the adjustable ring gastroplasty. Complex procedures entail those that bypass segments of the gastrointestinal tract like the jejunoileal bypass, biliopancreatic diversion and the gastric bypass procedure (GBP). The complex procedure obtains better weight loss at the cost of more complications. Of all these, the most commonly performed are the GBP and the VBG the current gold standards of bariatric surgery in their respective classes. Vertical Banded Gastroplasty The horizontal gastroplasty (Fig. 8.1) was introduced by Printen in 1973. The initial procedure failed to produce significant weight loss because of a large pouch...

RouxenY Gastric Bypass

Since the advent of laparoscopic Roux-en-Y gastric bypass by Wittgrove et al, in 1993, the operation has generally been accorded high marks as to feasibility, when performed by skilled laparoscopic surgeons, and as to weight loss, when compared with the original operation performed using conventional open surgical techniques. Early series suggest that some improvement in the risk for wound complications (infection and hernia) may be possible on the other hand, there may be a higher risk of gastrojejunal anastomotic leak and stomal stenosis. In addition, the method of gastrojejunal anastomosis continues to undergo revision, based on a widespread dissatisfaction with the original technique, described by Wittgrove et al, in which an EEA (Ethicon Division of Johnson and Johnson, New Brunswich, NJ) 21 mm French-guage anvil must be pulled per orum down the esophagus, using an endo-scopically positioned guide wire. Postoperative care following laparoscopy is similar to that after open...

Laparoscopic Gastric Bypass for Recurrent Reflux

Revision Ethicon

Several studies mention the use of gastric bypass as an alternative and superior technique for morbidly obese patients who present with primary GE reflux disease.44,45 Perez et al.46 identified a higher rate of recurrent reflux in obese patients undergoing laparoscopic Nissen fundoplication compared with their normal-weight cohorts. Applying this theory to patients with recurrent symptoms, Heniford et al.25 described using the Roux-en-Y gastric bypass in obese patients with recurrent reflux symptoms after failed anti-reflux surgery. Patients should meet the National Institutes of Health 1991 Consensus criteria of a body mass index (BMI) > 40 or > 35 when associated with significant comor-bidities. They must have also tried and failed multiple diets. If the recurrent reflux patient meets these criteria, a gastric bypass should be offered rather than simply revising the previous fundoplication. Laparoscopic gastric bypass is performed with the patient in a split-legged position....

Gastric Bypass Complications

Average percent excess weight loss over three years in patients with intact bands was only 38 , despite the fact that a number of patients were deleted from the follow-up pool because of conversion to gastric bypass or band removal. There was no apparent correlation between stomal diameter and weight loss. Studies from other countries, however, report better results. For example, a study by Lise of 111 patients report a reduction in BMI from 46.4 to 33.1 kg m2 at two years follow up. At the FDA Advisory Panel session23 only 115 patients had been followed for three years following the procedure. Patients lost approximately one-third of excess weight and one-third of patients required either revision or removal of the device. In a series of international patients presented from Europe and Australia, surgical revision or repair of tubing or removal of the device has been necessary in 28 , the most common problem being prolapse. The mean EWL following...

Laparoscopic Adjustable Silicone Gastric Banding

Lap Band Journal

Gastric banding has been promoted as a treatment for obesity by many surgeons over recent decades. Advantages included technical ease of performing the procedure and no intestinal anastomosis with the added risks of anastomotic leak. The most popular banding procedure is the vertical-banded gastroplasty, however this involves creation of a gastric staple line with risks of staple line disruption. Gastric banding involves creating a gastric pouch by encircling the stomach with some type of material such as dacron, silastic, etc. in order to create a narrowed efferent tract. Possible complications of this procedure are erosion of the band material into the stomach lumen and intractable postoperative vomiting, if the patient does not follow dietary recommendations including eating slowly and careful chewing of food before swallowing. Laparoscopic adjustable silicone gastric banding (LASGB) is a relatively new surgical procedure for the treatment of morbid obesity. The LASGB device (Fig....

Laparoscopic RouxenY Gastric Bypass Detailed Technical Issues

Laparoscopic Roux-en-Y gastric bypass is one of the most difficult and challenging laparoscopic procedures routinely performed today. It requires advanced skills and knowledge of both the fields of bariatric surgery and laparoscopy, familiarity with both short and long term follow-up of patients, as well as early postoperative technical and delayed long-term nutritional and metabolic complications. Those issues will be discussed in other chapters. The topic of this chapter is to provide a detailed technical step by step description of the procedure. Abdominal access for laparoscopy is a critical issue in the morbidly obese patient. Techniques for abdominal access are wide and varied however, the most important issue is the careful planning of trocar placement so that the surgeon has the best possible view and can use his surgical instruments optimally to accomplish their objectives. While this principle is very important in all laparoscopic procedures, there is no field in which this...

Lap Band Contrast Studies

Herniated Lap Band

For maximal constriction before concerns arise about damage to the band from overinflation. A logical adjustment strategy is to progressively narrow the band diameter until the patient begins a steady and sustained weight loss. One approach is to inject 1 2 ml of saline into the band at intervals of 2-4 weeks between injections while monitoring the patient's intake of both calories and food groups. Patients must be repeatedly told to avoid sugar and other sweets that provide a high caloric intake in a small volume, since sweets-eating behavior is one of the more common reasons for failure of gastric restriction procedures for obesity. We have routinely excluded patients with identifiable sweets-eating behaviors from undergoing gastric restrictive procedures. Despite this, we have seen many patients develop sweets-eating behavior when faced with the postoperative limitations in quantity of oral consumption imposed by the procedure. Repeated dietary counseling may help avoid, and...

Table of contents

Indications and Patient Selection for Bariatric Surgery 3. Laparoscopic Instruments for Bariatric Surgery 7. Laparoscopic Adjustable Silicone Gastric Banding B. Laparoscopic Vertical Banded Gastroplasty 9. Hand-Assisted Laparoscopic Roux-en-Y Gastric Bypass 10. Laparoscopic Roux-en-Y Gastric Bypass Detailed Technical issues 11. Laparoscopic Gastric Bypass Clinical Outcomes after Laparoscopic Roux-en-Y Gastric Bypass

Age Obesity And Glucose Counterregulation

Both the autonomic nervous system and the hypothalamic-pituitary-adrenal axis are activated in excess in the morbidly obese. Before and after bariatric surgery (average weight loss 40 kg over 12 months), severely obese non-diabetic subjects, underwent a hyperinsulinaemic hypoglycaemic clamp (blood glucose 3.4 mmol l). Before weight reduction, patients demonstrated brisk peak responses in glucagon, epinephrine, pancreatic polypeptide, and norepinephrine. After surgery and during hypoglycaemia, all these responses were attenuated and most markedly so for glucagon, which was totally abolished in association with a marked improvement in insulin sensitivity. In contrast, the growth hormone response was increased after weight reduction (Guldstrand et al., 2003).

Preoperative Evaluation

The goal of this chapter is to identify the appropriate operation for the individual patient with failed prior anti-reflux surgery and describe the different operative techniques used for such patients. Reoperative choices include an open laparotomy, laparoscopy, or a thoracic approach partial or total fundoplication gastric bypass pyloroplasty gastropexy antrectomy and vagotomy Roux-en-Y biliary diversion and esophageal resection.5,11 Some of these techniques are addressed in other Chapters 2, 5, 11-14. This chapter will focus on laparoscopic, open, and transthoracic approaches with partial or total fundoplication.

Treatment Of Sleep Apnoea And Snoring

A number of studies have demonstrated a reduction in sleep apnoea severity after weight loss, either through caloric restriction or bariatric surgery. However, it is important to reassess patients after weight loss and ensure there is little residual disordered breathing. Most published reports indicate that, although there is a reduction in apnoea index, a significant degree of apnoea persists, which in most cases warrants further treatment (86-88). Weight loss associated with apparently successful bariatric surgery may have limited efficacy in reducing sleep apnoea as many patients also have maxi-llo-facial abnormalities predisposing them to OSA (80). Recent data from the SOS Study show a marked reduction in sleep apnoea symptomatology in obese subjects 2 years after surgically induced weight loss compared with controls.

Treatment of the Short Esophagus by Minimally Invasive Surgery

The first attempt at creating a lengthening gastroplasty by thoracoscopy was by Demos et al.66 Swanstrom et al.67 developed a technique in which the lengthening gastroplasty was created through a right transhiatal thoracoscopy simultaneously to laparoscopic dissection of the proximal stomach. Johnson et al.68 used the Ste-ichen gastroplasty technique with a transgastric circular stapler to join the anterior and posterior walls of the stomach together around an inlaying bougie held along the smaller curvature (see Chapters 8 and 11). The gastroplasty is then completed with an EndoGIA and the fun-doplication created around the gastroplasty. Most authors confirm the feasibility of the technique and satisfactory early results. Few long-term reports are available. Jobe et al.69 reported on 14 patients treated by a Collis gastroplasty with a fundoplication. With a 14-month follow-up, all patients showed an intact repair. Thirty-six percent of the patients were diagnosed with active...

Surgical Complications

Over 4 years 12 of the 1164 patients were re-operated, usually due to poor weight loss, but in some cases due to vomiting or other side ef-fects.Usually banding and VBG were converted to gastric bypass but in some cases the original operation was repaired. Figure 35.4 Weight loss (a) and energy intake (b) over 2 years in SOS patients who underwent gastropalsty or gastric bypass ( ). The gastroplasty operations were banding and VBG pooled. Mean + SD. Values in parentheses indicate number of patients at each examination. Energy intake, estimated with validated technique (6,7), did not differ between groups at any time point. Body weights were significantly lower in gastric bypass patients at all time points after surgery P < 0.0001), whereas body weight before surgery did not differ significantly between groups. From Lindroos et al. (8) with permission Figure 35.4 Weight loss (a) and energy intake (b) over 2 years in SOS patients who underwent gastropalsty or gastric bypass ( ). The...

Other Studies Comparing Nonsurgical And Surgical Treatment

Randomized to horizontal gastroplasty or very low calorie diet (VLCD) followed by traditional dieting. A 2-year (42) and 5-year (43) report appeared in the mid-1980s. Unfortunately, less than 50 of the patients had in fact been followed for 2 and 5 years, respectively, when the reports were written. At 2 years the weight loss was 30.6 kg in the gastroplasty group and 8.2 kg in the VLCD diet group. Weight losses are not reported at 5 years. Instead, a 'cumulated success rate' defined as more than 10 kg maintained weight loss was given. This success rate was 16 in the patients operated with horizontal gastroplasty and 3 in the VLCD diet group. Horizontal gastroplasties are no longer in use due to poor long-term results (1,44,45). Gastric Bypass vs. VLCD and Diet In a prospective, non-randomized, non-matched study Martin et al. compared gastric bypass (GBP)

Surgical Methods Of Choice

GBP results in larger weight loss than vertical banded gastroplasty (VBG) and gastric banding. The two latter techniques give similar weight reductions. Banding is associated with more reoperations than GBP and VBG. GBP is technically more de Randomized studies comparing gastric bypass, biliopancreatic diversion and biliopancreatic diversion with duodenal switch are urgently needed. While randomized studies were fairly common in the early days of bariatric surgery no such studies seem to have been published since 1993 (1).

Lengthening Gastroplasties

Collis Gastroplasty Hernia Repair

In 1957, Collis,8 dissatisfied with the problems generated by the short esophagus, including the frequent periesophagitis present in these patients, introduced the concept of esophageal lengthening using the proximal lesser gastric curvature to create a neoesophagus. The lengthening gastroplasty was seen as an alternative to esophagectomy and reconstruction, a solution which was used more liberally at that time. The repositioning of the esophagogastric junction with the recreation of the angle of His was initially thought to be sufficient to prevent gastroesophageal reflux.8 No anti-reflux mechanism was then added to the gastroplasty, leading to poor reflux control. Subsequently, the initial Collis gastroplasty was combined to a Belsey-type of fundoplication by Pearson whereas Orringer and Henderson advocated the use of a total fundoplication to wrap the neoesopha-gus.43 The indications for using a lengthening gastroplasty with either a partial or a total antireflux fundoplication...

Fundoplication Herniation

In these patients, the indication for the primary operation was more frequently a giant hiatal (paraesophageal) hernia, esophageal stricture, or Barrett's esophagus. In these patients, the herniation likely occurred because of esophageal shortening that was not detected and adequately treated with an esophageal lengthening procedure at the first operation. Elective reoperation should include an esophageal lengthening procedure such as a Collis gastroplasty along with a reinforcement and closure of the esophageal hiatus. In summary, patients with acute postoperative herniation require an emergency operation, those with event induced recurrence should undergo elective reoperation, those with a recurrent secondary to esophageal shortening should undergo Collis gastroplasty and repeat fundoplication, and those with asymptomatic recurrence need not undergo reoperation at all.

Slipped Nissen Fundoplication

Above the gastroesophageal junction, was never mobilized during the first procedure and there is very adequate esophageal length to place the fundoplication higher up in the correct position. Alternatively, if the fundoplication is truly slipped onto the stomach, especially in patients with advanced esophageal disease, this may indicate a shortened esophagus which will need to be addressed with a gastroplasty. The operative principles will be discussed in another chapter.

Open Laparotomy for Reoperative Fundoplication

Laparoscopic Nissen Signs

Before creating the fundoplication, it is imperative that the GE junction is well within the abdomen. At least 5 cm of esophagus above the GE junction is mobilized. After releasing tension on the stomach, the GE junction must remain below the diaphragm without retracting into the mediastinum. If this is not possible with esophageal mobilization, an esophageal lengthening procedure such as the Collis gastroplasty is performed.2,11 Additionally, as Hunter et al.15 detail, a Collis gastroplasty may be indicated in patients who appear to have adequate esophageal length, but have herniated their wrap more than once. A Collis gastroplasty is performed by placing a GIA stapler at the angle of His and creating a longitudinal staple line that effectively recreates the GE junction further distally on the stomach (Figure 11.1). The wrap is then performed at the new GE junction while ensuring adequate intraabdominal length. Figure 11.1. Collis gastroplasty.A,An area for the initial gastro-tomy is...

Testosterone Shbg And Obesity

Determine whether visceral fat is more closely linked to low testosterone than is total body fat, but results have been conflicting (26). Glass et al. (25) also first noted that low testosterone levels in obese men could be partly explained by a decrease in SHBG, but whether SHBG is more highly correlated with abdominal obesity or with body mass index remains controversial. A summary of several studies reporting cross-sectional correlations between SHBG and body mass index and waist-to-hip ratio (WHR) is found in Table 2. In massively obese men, weight loss after bariatric surgery can reverse the SHBG abnormalities when near-normal body weight is achieved (27).

Considerations for Esophageal Lengthening Procedures

Collis Transthoracic

The Collis gastroplasty is the most widely used technique to lengthen the esophagus. First described in conjunction with transthoracic hiatal hernia repairs, the Collis gastroplasty can also be performed with minimally invasive approaches. Although some have reported outstanding long-term results with the Collis gastroplasty,17 the neoesophagus may contain acid-secreting mucosa causing concern that patients with Barrett's esophagus may continue to be exposed to acidic irritation. In the current era wherein most reoperations follow failed laparoscopic Nissen fundoplication, the proximal end of the Collis gastroplasty may become ischemic because the short gastric vessels have been previously divided. This may result in a stricture that is very difficult to treat by dilation. In 1996, Swanstrom et al.18 described a minimally invasive transthoracic Collis gastroplasty technique (see Chapter 13). For this approach, a 12-mm trocar is placed in the right anterior axillary line in the third...

FDA surveillance systems

The data elements per event include the manufacturer, model-specific device, event and receipt dates, and patient and device problem codes. The FDA uses the information reported through these programs to assist in the early identification and characterization of emerging medical device problems and related public health issues. The reports are used for health hazard evaluations, product assessments, trend analysis, regulatory actions, or for developing effective education programs and timely feedback to healthcare practitioners and medical device manufacturers. Case series studies conducted using MAUDE data looked at the adverse events associated with various devices, including breast implants 13-15 , gastric band device 16 , pulmonary artery catheterization 17 , gloves 18 , surgical staplers 19, breast pumps 20 , and infusion pumps 21 .

Stricturoplasty and Intrathoracic Fundoplication

Collis Fundoplasty

Transverse closure of the fundus for the modified Collis-Nissen fundoplasty provides substantial additional fundic tissue, enabling creation of a total or partial wrap around the extended esophageal tube without tension. (Reprinted from Ferraro P, Duranceau A. Elongation gastroplasty with total fundoplication. Operative Techniques in General Surgery 200 2 24-37, Copyright 2000, with permission from Elsevier.) Figure 13.7. Transverse closure of the fundus for the modified Collis-Nissen fundoplasty provides substantial additional fundic tissue, enabling creation of a total or partial wrap around the extended esophageal tube without tension. (Reprinted from Ferraro P, Duranceau A. Elongation gastroplasty with total fundoplication. Operative Techniques in General Surgery 200 2 24-37, Copyright 2000, with permission from Elsevier.)

Esophagectomy Indications Techniques and Outcomes

Esophageal lengthening (gastroplasty) operations for esophageal shortening (see Chapter 13). In some patients, Barrett's esophagus, a complication of reflux, has progressed to highgrade dysplasia or superficial cancer. In such situations, endoscopic mucosal resection or ablative procedures utilizing cautery or laser energy can be used to reduce the risk of invasive cancer while preserving the esophagus. When these procedures are not appropriate for a patient with severe complications of reflux or prior anti-reflux surgery, esophagectomy may be the only therapeutic option remaining.

Evolution of Hiatal Hernia and Anti Reflux Surgery

Esophagitis, a reflux recurrence rate of 9.5 was observed. When esophagitis without stricture was identified before the operation, 10.3 of these patients had recurrent reflux. If a stricture was present, the operation failed in 45 of the operated population.7 The repair difficulties and imperfect results obtained when an esophagus is shortened or strictured then led Leigh Collis to propose a lengthening gastroplasty in order to provide good, healthy tissue for the repair while removing tension for its positioning under the diaphragm.8

Pulmonary Function and Mechanics

Dyspnoea than those without OSA (22). Weight loss following bariatric surgery results in significant relief of these symptoms (23), with an independent association between the reduction in sleep-disordered breathing and relief of breathlessness and chest pain. This suggests that OSA is implicated in the genesis of these symptoms in subjects with obesity, possibly through effects on respiratory control with relative daytime hypoventilation and resulting mild hypoxaemia. In the absence of weight loss, continuous positive airway pressure (CPAP) therapy can improve daytime gas exchange and respiratory control (24,25) in patients with OSA and so may also reduce the incidence of daytime respiratory symptoms in obese subjects with OSA. There have been a number of recent studies describing an epidemiological association between obesity and asthma (26,27). However, the diagnosis of asthma in these studies was not confirmed with tests of bronchial hyperresponsiveness (BHR). A more recent study...

Prevention And Treatment Of Gallstones

A double-blind study of effectiveness of UDCA in preventing gallstone development after vertical band gastroplasty in 29 morbidly obese patients is reported by Worobetz et al. (35). Three months after surgery patients had lost a mean of 17 of pre operative weight. Six of 14 placebo patients versus none of 10 UDCA treated patients developed gallstones, suggesting that gallstone formation following gastroplasty can be prevented by UDCA therapy. Sugerman et al. (31) investigated a 6-month regimen of prophylactic ursodiol to prevent development of gallstones after gastric bypass in patients with BMI of 40 or above before surgery. The study used three dose levels placebo, and 300, 600 and 1200 mg daily. At 6 months, gallstone formation was noted in 32 , 13 , 2 and 6 respectively. The 600 and 1200 doses were significantly different from placebo. The authors conclude that a dose of 600 mg is an effective prophylactic in these patients.

Methods

Operations systematically performed to achieve weight loss first appeared in the early 1950s, initially as removal of long segments of small bowel, subsequently as bypass of even longer intestinal segments excluded from the nutrient stream but available for reattachment should the need arise (intestinal bypass jejuno-ileal bypass). Stomach operations, pioneered by Edward E. Mason of Iowa in the 1960s, similarly evolved from gastric resection into gastric bypass, excluding a large portion of the stomach, attaching the remnant to a loop of small bowel (Figure 34.1). Mason was convinced that the mechanism of weight loss was mechanical restriction of intake through the small gastric remnant ('pouch'). Thus, he went on to develop a purely restrictive operation, gastroplasty, consisting of a stapled pouch with an externally banded conduit into the stomach proper. The small size of the pouch ( < 15 ml) and the small diameter of the outlet (9 mm) physically limit the amount of food that can...

Results

The simplest outcome measure, weight reduction, can be expressed in absolute or relative terms, with the latter based on percentage of preoperative body weight or reduction of 'excess' body weight determined from life insurance tables of desirable weight for height. As a 'rule of thumb' weight loss is approximately one-third of initial (maximum) weight after gastric bypass compared to 20-25 after gastric restriction and 40 after biliopancreatic diversion or duodenal switch. In terms of reduction of excess weight ( excess weight loss, EWL), gastric restriction achieves 50-55 , gastric bypass 60-65 and BPD around 75 . Variations in these weight losses are related to initial body weight and to differences in setting, location and patient selection between different series.

Study Design

In the registry study 6000-7000 obese men (BMI > 34) and women (BMI > 38) in the age range 37-60 years are examined by GPs at 480 of the 700 existing primary health care centres in Sweden. From the registry, patients are recruited into the intervention study consisting of one surgically treated group (goal n 2000, February 2000, n 1870) and one matched control group (same numbers) treated conventionally at the 480 primary health care centres. The surgically treated patients obtain (variable) banding, vertical banded gastrop-lasty (VBG) or gastric bypass (3) (Figures 35.1-35.3). Figure 35.1 Gastric banding as originally described by Bo (59) and Solhaug (60). Later adjustable gastric banding was introduced (61-63). Copyright Sofia Karlsson and Lars Sjostrom Figure 35.1 Gastric banding as originally described by Bo (59) and Solhaug (60). Later adjustable gastric banding was introduced (61-63). Copyright Sofia Karlsson and Lars Sjostrom Figure 35.2 Vertical banded gastroplasty as...

Thoracotomy

The patient should have cardiac and pulmonary clearance before surgery. Once in the operating room, DVT prophylaxis and perioperative antibiotics are given. A thoracic epidural is placed for postoperative pain management. The patient is intubated with a double lumen tube to allow left lung collapse during the procedure. The patient is then placed in the semilateral position to allow for a thora-coabdominal incision, if needed. A left thoraco-tomy is performed in the 7th or 8th intercostal space and the left lung is excluded. The pulmonary ligament is divided and the esophagus is mobilized to the level of the aortic arch. The esophagus is encircled with a Penrose drain above the level of the inferior pulmonary vein. The middle esophageal artery is divided. The vagus nerves are identified and spared. The hiatal adhesions are lysed and the hernia sac, if present, is excised. Both crura are clearly defined and the previous fundoplication is taken down. The...

John G Kral

Surgical treatment of obesity ('bariatric surgery' anti-obesity surgery) passes the pragmatic test it works, most of the time. It is also cost-effective and on a cost per-kg-lost basis is superior to any other method of weight loss for class II and III obesity. Most important the results are durable, defined as providing maintenance of medical significant weight loss for more than 5 years.

Peptic Stricture

Mation culminating in intractable peptic esophageal stricture and esophageal shortening. This results in ongoing severe reflux symptoms accompanied by dysphagia and weight loss. The incidence of peptic stricture in the era of effective acid suppression medications is estimated to be 1-5 of patients with esophagitis.20 Initial management of early peptic stricture consists of a careful clinical evaluation including endoscopy with biopsy to rule out cancer, determine whether Barrett's esophagus exists, and obtain a histologic diagnosis. Standard therapy includes intensive acid suppression and dilation, and is successful in about 75 of patients. However, long-term follow-up of such patients is often inadequate, and the true outcomes of medical therapy are not known.21 Patients with recurrent stricture or ongoing symptoms of reflux in the setting of optimal medical therapy are candidates for anti-reflux surgery. Surgical options include standard partial or total fundoplication, or...

Critique

Most surgeons performing bariatric surgery, whether newcomers to the field or seasoned veterans, are committed to one type of procedure gastric restriction for the newcomers and gastrointestinal bypass for the veterans. The arguments over 'gold standard', procedure-of-choice or even standard of care embody an anti-intellectual and hazardous failure to recognize the complexity of the disease of obesity and the need to individualize. The complexity goes beyond the advances in molecular genetics and cell biology, which as yet have not translated into clinical practice or improved patient satisfaction. Unfortunately many surgeons engaged in treating obesity do not seem to have realized that

Coloni

Roux-en-Y gastric bypass for patients with morbid obesity and gastroesophageal reflux disease. Courtesy of Ethicon Endo-Surgery, Inc., a Johnson & Johnson company. All rights reserved. The report by Heniford et al.29 of 55 patients undergoing reoperative anti-reflux surgery included two patients who met the National Institutes of Health criteria for morbid obesity and subsequently underwent gastric bypass. They both reported good resolution of symptoms. As of 2004 there were no other published reports describing gastric bypass for revisional anti-reflux surgery.

History

Even into the 1930s there was considerable debate over what constituted optimal methods of esophageal replacement. In 1934, Ochsner and Owens14 summarized the extant literature regarding extrathoracic esophageal reconstruction. Skin tubes (dermatoplasty), jejunoplasty, coloplasty, gastroplasty, and hybrid procedures combining two of these techniques all offered mortality rates from 20 to > 50 . The procedures were completed in only about half of the patients, and overall good results were reported in only 30-40 of patients. The development of intrathoracic reconstruction techniques using the stomach in the 1930s was enthusiastically adopted, and reports of large series of patients who had undergone successful esophagectomy and reconstruction during the 1940s and 1950s began to appear.15-19

Virtual Gastric Banding

Virtual Gastric Banding

Virtual Gastric Band Hypnosis Audio Programm that teaches your mind to use only the right amount of food to keep you slim. The Virtual Gastric Band is applied using mind management techniques, giving you the experience of undergoing surgery to install a virtual gastric band or virtual lap-band, creating a small pouch at the top of the stomach which limits how much food can be eaten. Once installed, the Virtual Gastric Band creates the sensation of having a smaller stomach that is easily filled and satisfied with smaller amounts of food.

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