1. The Lap-Band The Facts

2. Why the fuss Obesity is increasing at an alarming rate Co – existing conditions including NIDDM are posing significant problems

3. Criteria for Surgery BMI > 35 with co-morbidity BMI >40 Exceptions

4. How does it work?

5. How is it done

6. FACTS Low morbidity operation Requires MDT input Adjunct to weight loss – NOT a guarantee Failures – 15-20% of people Average of 50% EWL Loss is slow and steady – 0.5 – 1kg/week Follow up is for life

7. Roux En Y Gastric Bypass Diabetes 70-80% EWL Higher morbidity

8. Sleeve gastrecomy

9. Case study Mrs X Type 2 diabetes and BMI of 46 Long history of diets The Yo-Yo dieter Insulin recently commenced ? Band ? More diets ? Drugs

10. What next Under went extensive pre-op counselling regarding the lap band Information session GP specialist – close liaison with LMO if abnormal results Dietition Psychologist Surgeon

11. What Happened Lap Banding Lost 28 kg over 12 months HbA1c – 7.8 pre op to 6.3 and insulin has now stopped Part of a banding support group and she is happy

12. Diabetes and Lap-Band Recent research (dixon et al.2002) has shown that 64% of people with type 2 diabetes have remission of diabetes after Lap-Band Remission defined as Normal fasting BSL/Insulin level and normal HbA1c Average HbA1c drop from 7.8 -6.2 over 12 months

13. MIOS Multidisciplinary clinic in Boronia Local service Achieving excellent results 85 Lap Bands No major complications Audit Offer alternatives to lap band if appropriate