1. BARIATRIC SURGERY UT Health | McGovern Medical School
UT Minimally Invasive Surgeons of Texas

2. University level personalized care in your neighborhood

3. TOPICS TO DISCUSS What is Obesity?
Do I qualify for weight loss surgery?
Which surgery is right for me?
What can I expect during the process?

4. Defining Obesity
Obesity is an excessive accumulation of body fat. Many people believe that obesity is caused by simply overeating and a lack of self-control. But the truth is, it’s a chronic progressive disease that is caused by many factors.

5. Body Mass Index
5'4"
Height
Weight (lbs)
5'2"
5'0"
5'10"
5'8"
5'6"
6'0"
6'2"
120
130
150
160
170
180
190
200
210
220
230
240
250
140
260
270
280
290
300
6'4"
A ratio of weight to height called Body mass index or BMI is generally used to classify the degree of overweight

6. CLASS III, SEVERE OBESITY
NORMAL BMI 18.5 – 24.9
OVERWEIGHT BMI 25 – 29.9
CLASS I, OBESITY BMI 30 – 34.9
CLASS II, SERIOUS OBESITY BMI 35 – 39.9
CLASS III, SEVERE OBESITY
BMI  40

7. Obesity is a multifactorial disease with a strong genetic component
Genetics
Hormonal Factors
Cultural Factors
Psychological Factors
Behavioral Factors
Metabolic Factors

8. Obesity-related Diseases
Diabetes
High blood pressure
Heart disease
Stroke
High cholesterol
Osteoarthritis and other orthopedic problems
Cancer (esophagus, pancreas, colon, breast, endometrium, kidney, thyroid, and gallbladder)
Infertility
Sleep apnea
Liver and gallbladder disease
Etc.
Obesity is associated with over 200 different disease and medical conditions.

9. Obesity is the 2nd leading cause of preventable death, followed behind smoking, in the United States.
Obesity and obesity-related conditions together may lead to a lower quality of life, disability or early death.

10. Obesity is Treatable
Even modest weight loss (5-15% of total body weight) reduces risk factors for certain diseases. Various effective treatments for obesity are available including diet and exercise, pharmaceuticals, endoluminal procedures, and surgery.

11. Bariatric Surgery
Bariatric surgery is the most effective treatment for patients with obesity. Surgery reduces the risk of premature death by 30-40%.

12. Bariatric Surgery
Bariatric surgery is safe. - Risk of mortality is 0.1%, which is lower than surgery to remove the gallbladder or getting a hip replaced Bariatric surgery is durable. - At 5 years after surgery, the majority of patients maintain at least 50% of their excess weight loss

13. Bariatric Surgery Qualifications
BMI ≥ 40, or more than 100 pounds overweight
BMI ≥35 and at least one or more obesity-related co-morbidities
Type II diabetes (T2DM), hypertension, sleep apnea and other respiratory disorders, non- alcoholic fatty liver disease, osteoarthritis, lipid abnormalities, gastrointestinal disorders, or heart disease.

14. Bariatric Surgery Qualifications
Inability to achieve a healthy weight loss sustained for a period of time with prior weight loss efforts. No significant physical, medical, emotional or psychological problems. Full understanding of risks associated with surgery. Participate in permanent lifestyle changes and long-term follow-up.

15. Bariatric Surgery is only a tool to help achieve a healthier lifestyle!

16. Long-term success is predicated on permanent diet, lifestyle, and exercise changes.

17. Surgical Options Types of procedures Restrictive Malabsorptive
Metabolic
Combination
Procedures offered
Adjustable Gastric Band
Sleeve Gastrectomy
Roux-en-Y Gastric Bypass
Duodenal Switch
Revisions & Reversals

18. Minimally Invasive/Laparoscopic Surgery
Benefits are:
Small incisions that heal with minimal scarring
Less pain
Shorter hospital stay
Faster recovery
Earlier return to work

19. Adjustable Gastric Band
A silicone band is placed around the upper part of the stomach and induces a feeling of fullness
Purely restrictive procedure, no metabolic effect
Outpatient procedure with quick return to work
Requires needle sticks to adjust band for gradual tightening every 6-8 weeks
40-50% excess weight loss at 2 years on average

20. Adjustable Gastric Band
Advantages
No stomach stapling or cutting, or intestinal rerouting
Lowest operative complication, mortality rate, and malnutrition risk
Adjustable and reversible
Disadvantages
Slippage or erosion causing injury to the esophagus or stomach
Device malfunction and port site infection
Slower weight loss
Requires regular follow-up and several band adjustments a year for optimal results

21. 50-70% excess weight loss at 18 months on average
Sleeve Gastrectomy
Performed since early 2000s
70-80% of stomach is removed completely leaving a long, tubular stomach
Improved gut hormone regulation
50-70% excess weight loss at 18 months on average

22. Sleeve Gastrectomy Advantages No intestinal rerouting
Can be changed to almost any other weight loss procedure if needed in the future
Disadvantages
Leaks, bleeding or stenosis related to staple line
15-20% experience heartburn
Because the stomach is removed, it is not reversible

23. Roux-en-Y Gastric Bypass
First done in 1967
Stomach is stapled to make a small pouch and rerouting the intestines reduce the amount you absorb
Reflux, heartburn, and diabetes are profoundly improved
Rapid weight loss: majority of weight loss occurs in first 6-8 months after surgery
60-80% excess weight loss at months on average

24. Roux-en-Y Gastric Bypass
Advantages
Viewed as the gold standard in weight loss surgery
Stomach not removed
Rapid weight loss
More rapid and predictable improvement in most co- morbidities, especially Type 2 diabetes
Disadvantages
Stomach and intestines divided and re-routed
Risks for leak, bleeding, stricture, and internal hernia
Dumping Syndrome is a possibility (inability to tolerate certain foods)
High risk for ulcers in smokers and frequent NSAID use
NO NSAIDs (Aspirin, ibuprofen or Motrin) and NO SMOKING!

25. Dumping Syndrome
Up to 85% of patients will experience dumping syndrome
Rapid heart rate, nausea, vomiting, abdominal pain, and diarrhea
Occurs when eating foods high in sugar

26. 80-90 % excess weight loss at 12 months on average
Duodenal Switch
Combines mechanisms of sleeve gastrectomy and gastric bypass
Typically reserved for pts with BMI >50 and DM
Good options for patients who have weight regain after sleeve
80-90 % excess weight loss at 12 months on average

27. Duodenal Switch Advantages Highest rate of weight loss Disadvantages
Stomach and intestines divided and re-routed
Risks for leak, bleeding, stricture, and internal hernia
Dumping Syndrome is a possibility
Frequent bowel movements (2- 6x/day)
Significant malnutrition
Must also take fat-soluble vitamins A,D,E,K
NO NSAIDs (Aspirin, ibuprofen or Motrin) and NO SMOKING!

28. UT MIST offers comprehensive care through all stages of weight loss - from pre-operative treatment to post-surgical strategies for maintaining health.

29. Large Clinical Support Team
All MIST surgeons are fellowship trained
Perform all accepted procedures
Experienced surgeons
Large team of Nurses, Fellows, Residents
Multiple people focused on your care
Large Clinical Support Team
Full team of personnel for pre- and post-op support
Education, Nutrition, Psychology, Support Groups
Comprehensive program
Robotics, Flexible Endoscopy, New Product Releases and Research
Cutting edge surgeries with published results
State-of-the art technology

30. Insurance Coverage
There are many different levels of coverage for weight-loss surgery. We have dedicated staff to help you navigate your insurance policy and determine what your specific policy covers. Medically supervised weight loss (MSWL) prior to surgery is common.

31. We are committed to providing comprehensive, compassionate care and want to help you achieve a healthier and happier life.

32. Minimally Invasive Surgeons of Texas
UTMIST
Minimally Invasive Surgeons of Texas
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