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Patients repeatedly tell us that the single most important thing that they have done in the process of undergoing weight loss surgery was to come to a seminar. At the informational seminars we do not just provide you with basic information about weight loss surgery, we also go into great depth explaining how these operations work and what you the patient need to know about it to make it successful. At present there is no cure for obesity, and there is no weight loss plan – surgical or non-surgical that works without permanent eating habit and lifestyle changes. The operations simply offer very good tools that help you accomplish these changes a lot easier then it has ever been for you before. Please take advantage of these seminars to help you decide if weight loss surgery is the right choice for you. The informational seminars are offered several times a month. Our surgeons lead the seminars and are also available afterwards for questions. We also try to have patients who have already undergone weight loss surgery available for a question and answer session.<< Back to Top >> EsophagoGastroDuodenoscopy (EGD) Upper Endoscopy (or EGD) stands for EsophagoGastroDuodenoscopy. It is a procedure very commonly performed by a gastroenterologist for reflux disease, gastric ulcer disease, and for persistent abdominal pain of unknown etiology. Most bariatric surgeons continue to perform upper endoscopy in order to provide more comprehensive care for their patients. A slipped band, an anastamotic stricture or other problems related to weight loss surgery are often best diagnosed and treated by your bariatric surgeon. An EGD is a procedure for which you will require sedation, but not general anesthesia. The procedure allows the surgeon to examine the lining of the esophagus (swallowing tube), stomach and duodenum (small bowel). By directly visualizing the inside of your GI tract, many conditions can be diagnosed, abnormal anatomy can be identified, and with some detective work we can determine what previous weight loss surgery operations were performed or why they might have failed. Once you are sedated, the endoscope (a long thin scope attached to a camera) is advanced into the mouth, down the throat and into the stomach and duodenum. The Anesthesiologist will keep you comfortable during the procedure, and monitor you during and after the procedure. Most patients have little recall about the procedure because of the sedation. Potential risks
<< Back to Top >> X-Ray Adjustments / Fills under Fluoroscopy X-ray adjustments are most frequently performed when the port cannot be palpated or located thru the skin. A fluoroscopy x-ray machine is then used to locate the port and to guide the needle into the port while observing it on a monitor. Routine band adjustments performed under X-Ray are being performed more frequently. Many patients prefer x-ray adjustments because they get to watch the adjustment performed and actually see the tightening of the band and the effect it has on the passage of liquids thru the band. Also x-ray adjusting can reduce the number of required fills because the adjustments can be performed more aggressively and the correct adjustment reached faster. Several studies have shown that blind adjustments can lead to an increased risk for band slippage. This is because adjustments done blindly are just that, and they can lead to too tight of an adjustment for the esophagus to handle. This can occur without the knowledge of the patient or the doctor for quite some time, unless a UGI is done to ensure the band adjustment is correct. Often we start adjusting our patients in the office but eventually they are taken to x-ray for the last few adjustments to avoid that problem. << Back to Top >> Our office cares for patients that had a Lap-Band operation performed by another surgeon, or performed in Mexico. Mexico or other surgeon patients first must meet with the surgeon for an evaluation and then all their adjustments are performed under X-Ray as described above. Once you become our patient, routine follow-up and access to the services offered by our weight loss surgery program are also available for your use. Please read about our Weight Loss Surgery Program. << Back to Top >> Plastic surgery after weight loss surgery is not recommended until the active weight loss period has stopped. This will vary from patient to patient and vary from procedure to procedure. A patient that underwent a bypass can expect it to be between 1 to 2 years, and a patient that underwent a lap-band anywhere between 1 to 5 years. With significant weight loss over a relatively short period of time (usually 15-18 months), the remaining skin often does not retain the elastic qualities necessary to "shrink back down" to your new underlying shape. This often leaves patients with excessive amounts of hanging skin that creates a multitude of problems such as daily hygiene and finding clothes that fit properly. Skin elasticity and genetics determine skin tone and skin type. Unfortunately not much can be done to influence these factors. But it is no secret that exercise and muscle toning, which we do have control over, play an important role in getting back into shape and helping skin tone. It can be difficult at times to predict who will require plastic surgery and who will not. In some patients this can be predicted in advance or early in the weight loss period, while in others time will only tell. In the bariatric patient seeking plastic surgery, the dominant problem isn't so much the weight-related problem areas as much as it is the redundant or excess skin left behind after weight loss. In some cases it can present hygiene and skin care problems. In others fitting into clothes can be an issue. In more severe cases it can shift the center of gravity causing back pain and difficulty in maintaining balance. If documentation of these issues can be maintained, insurance companies usually will cover the "tummy tuck" operation to remove the excess skin to improve a medical problem. Most of the time the insurance companies perceive the operation as "cosmetic", and will not provide coverage. The bariatric patient considering plastic surgery faces a different problem than usual. The surgeon is not removing a problem area as much as he/she is removing large amounts of excess skin. Every patient is different with different needs. One of the most important considerations for a patient is to realize that a bariatric patient must be treated differently from non-bariatric body contouring patients. What has worked well for many years on other patients simply does not provide adequate shaping and contouring for the bariatric patient. Patients who have undergone gastric bypass surgery and the subsequent significant weight loss may have numerous but similar areas of concern. These areas include:
Obviously all of these concerns cannot be addressed simultaneously during one operation. However, two procedures usually can be safely combined. During your consultation, your surgeon will assess your anatomy as well as your own priorities to help you develop a comprehensive plan, or blueprint, for your body contouring. It is not uncommon to combine a tummy tuck with a breast lift (with or without the addition of breast implants), or a thigh lift with an arm lift, as well as other combinations of procedures. The cornerstone of a successful approach to body contouring is to individualize treatment to your specific circumstances and goals and to ensure that you have an adequate understanding of the issues involved so that you are able to make a fully informed decision. This will help you achieve the appearance you desire with the least invasive procedure available, thus creating a mutually rewarding experience. Body Contouring Some important elements you should understand regarding skin removal include the following: How is Body Contouring Performed? What Are the Risks and Limitations of Body Shaping? Questions Body Shaping Patients Should Ask Their Surgeon
This site provides information about plastic/cosmetic surgery and is designed to help users make decisions regarding their own treatment options. But medical information is not the same as medical advice – the application of medical treatment to a person's specific circumstances. Although we go to great lengths to make sure our information is accurate and useful, we recommend you consult a qualified medical practitioner if you want professional assurance that our information, and your interpretation of it, is appropriate to your particular situation. The Results You Can ExpectYou will notice an improvement in your body contour immediately. However, your shape will continue to improve in the following weeks as the swelling subsides. You should be up and walking the day following surgery, although you will be sore for several days. You should be able to resume your normal daily activities within several days following surgery, and you should be able to resume all of your physical activities within three to four weeks of surgery. << Back to Top >> XXX << Back to Top >> A hernia is a weakness or defect in the abdominal wall. It may be present from birth, or develop over a period of time. If the defect is large enough, abdominal contents such as the bowels may protrude through the defect causing a lump or bulge felt by the patient. Why do they occur? There are sites of potential inherent weakness in the abdominal wall. The areas in which hernias most commonly develop are the umbilicus (belly button), the groin and in previous surgical scars for a different operation. Other causes include incisions from old operations which may weaken the abdominal wall, if they do not heal properly after surgery or are weakened by infection. Muscle wall deterioration with age, inactivity or strain may allow the muscle wall to tear or bulge, resulting in the development of various forms of hernias. Signs and Symptoms
What types of hernia are there? The most common type is the groin or inguinal hernia. Herniae may also occur through the umbilicus (umbilical hernia), through old abdominal scars (incisional hernia), through the muscles in the upper abdomen (ventral hernia) or alongside blood vessels running into the thigh (femoral hernia). Laparoscopic repair is mainly used for inguinal or femoral hernia repairs, although increasingly ventral hernias are being repaired by laparoscopic techniques. Course of a hernia Once a hernia has developed, it will tend to enlarge and cause increasing discomfort. If a loop of bowel gets caught in the hernia, it may become obstructed or its blood supply may be cut off. This could then become a life-threatening situation. Since hernias can be repaired effectively and with minimal risk, most surgeons therefore recommend that hernias be repaired when diagnosed, unless there is a serious medical problem which makes it too risky. Why should it be repaired? There are a number of reasons for advising repair. In decreasing order of importance they are:
How are hernias repaired? Various forms of repairs have been utilized over the years. The defect or hole in the muscle layer may be repaired by stitching the muscles on each side of the defect together and allowing them to heal together (just like a tear in your pants or shirt), thus closing the opening. This is the traditional method of repair which is becoming obsolete because of the introduction of Mesh. Hernias are now mostly repaired by placing a synthetic mesh to cover the opening. This can be done open or laparoscopically. The body’s tissue will grow into the mesh creating a strong new layer, thus repairing the hernia. Why choose laparoscopic repair? We believe that laparoscopic repair is less painful than conventional repair, both in the short and long term. It allows for shorter hospitalization, and the patients are able to resume normal activities at an earlier stage than with traditional repairs. Mesh repairs carry a much lower recurrence rate (about 1 - 2%), whereas traditional methods carry a 5% recurrence rate. The only disadvantages are that the procedure requires a general anaesthetic and that there are more equipment expenses, namely the laparoscopic ports, the mesh and the hernia tacker, that is used to fix the mesh in place. As mentioned however, hospital stays and convalescent times tend to be shorter than with open repairs. How is it performed? Briefly, the procedure is performed by inflating the abdomen with CO2 gas and placing 3-4 laparoscopic ports out to one side of the abdominal wall. The hernial contents then have to be reduced back into the abdominal cavity. They are often stuck and have to be dissected away from the sac of the hernia. Once the defect or hole is fully exposed, a piece of mesh, such as Gortex Dual Mesh, is placed into the abdomen and over the hernia or hole. The mesh is then tied up to the abdominal wall at the four corners. This fixes the mesh up against the abdominal wall and keeps it in place. The mesh is then further fixed around its edges with hernia tacks to hold it firmly in place. Simply put, a patch is placed over the hole and then secured into place. The laparoscopic ports are withdrawn and the wounds closed with dissolving sutures. The mesh should then heal into place over the next six weeks, thus repairing the hernia. << Back to Top >> Laparoscopic Gallbladder Removal What is the gallbladder ? The gallbladder is a small, pear-shaped organ attached to your liver and bile ducts. Its main function is to store bile and then release it (squeeze out) when needed to digest fat in the food. If stones (gallstones) are present inside the gallbladder, these stones can block the duct draining the gallbladder and can cause the gall bladder to go into spasm and cause severe pain. Once the stone unblocks the drainage duct the pain goes away. It may be a few days or years before another stone blocks the duct again causing another gallbladder attack. The only way to prevent this and the other problems that can occur with gall stones is to remove the gall bladder. Since the gall bladder is only one of the mechanisms of fat digestion, its removal does not cause any major interference with the patient’s digestive process. What causes gall stones? A number of causes have been suggested. It is thought that some people secrete more cholesterol than others. As the gallbladder concentrates the bile stored in it, the cholesterol precipitates forming crystals and then the crystals continue to grow into stones (just like sugar). The stones then tend to enlarge or multiply especially if there is any infection involved. Pregnancy, obesity, weight loss and a family history of gallstones are factors that increase the chances of developing gallstones. What problems do they cause? The main symptom is pain, known as gall stone colic or attack. This commonly occurs in the mid upper abdomen or under the right ribs. It tends to radiate around the rib margin and into the back. It can be precipitated by eating fatty foods. It is severe and can last some hours. The pain will usually subside but frequently returns at a later date. In some cases infection sets in (cholecystitis), and the patient develops severe pain under the right ribs with fever. Intravenous antibiotics are necessary to treat the infection and the problem usually takes 3-4 days to settle. More mild symptoms such as burping, flatulence and heartburn can also occur with gallbladder disease. If a gallstone passes down the cystic duct into the bile duct it can block the flow of bile leading to jaundice. This is a surgical emergency requiring removal of the obstruction especially if infection sets in. A stone in the bile duct may also cause inflammation of the pancreas causing a serious condition known as pancreatitis. Should I have the gall bladder removed? If the gall bladder is causing symptoms ( particularly recurrent symptoms) or if multiple small stones are present that can escape into the bile duct, then removal of the gall bladder is advised as an elective operation. If there is a solitary large stone causing no symptoms, it can be left, although these can cause problems later in life. The surgery, when performed, entails removal of the whole gall bladder with the stones inside. The stones alone can not be removed. Symptoms Many people with gallstones have no symptoms. These patients are said to be asymptomatic, and these stones are called "silent stones." Gallstone symptoms are similar to those of heart attack, appendicitis, ulcers, irritable bowel syndrome, hiatal hernia, pancreatitis, and hepatitis. So accurate diagnosis is important. Symptoms may vary and often follow fatty meals, and they may occur during the night.
It may be associated with
Diagnoses Ultrasound is the most sensitive and specific test for gallstones. Other diagnostic tests may include
How is the surgery performed? The gallbladder at this time and age is removed laparoscopically. It is removed open only under certain circumstances. The laparoscopic removal of the gall bladder (cholecystectomy) is performed under general anesthetic so that the patient must be in reasonable health. Four punctures are made in the abdominal wall. The first is in the umbilicus. After inflating the abdominal cavity with CO2, a telescope attached to a tiny video camera is introduced and the abdominal contents inspected. The gall bladder is readily located and is grasped with forceps. It is freed from attachments to the liver. A small tube, the cystic duct, connecting the gall bladder to the bile duct is dissected free of the fatty tissue that encases it. The cystic duct and the little artery feeding the gall bladder are clipped with little metal clips and divided. The gallbladder is then dissected away from the liver and removed through the small incision at the umbilicus. An open operation may have to be performed if there are difficulties experienced in identifying the anatomy and there is a danger of damaging vital structures such as the bile duct. This can occur if there has been chronic or acute infection in the gall bladder or where there is abnormal anatomy. Open surgery may also be necessary when the abdomen is full of adhesions due to previous surgery as these can prevent views of the abdominal cavity and of the gall bladder. What are the complications of surgery?
<< Back to Top >> At some point, after you have spent a considerable amount of time exploring the option of weight loss surgery, you will need to determine if your insurance company covers it. A growing number of states have passed legislation that requires insurance companies to provide benefits for weight loss surgery for patients that meet the National Institute of Health weight loss surgery criteria. And while insurance coverage is widespread, it can often require a lengthy approval process. The best chance for obtaining approval for insurance coverage comes from working together with your bariatric surgeon's office. Once you become our patient we will automatically obtain medical insurance pre-approval for your operation. Below we will try to provide you with some basic information about how medical insurance companies operate and how to optimize approval for your weight loss surgery operation. First, we recommend you read the three points outlined below before making your first office visit.
Once your surgeon determines you qualify for obesity surgery (1991 NIH Consensus Conference criteria) the usual next step is to obtain pre-certification from your insurance company for the surgery. This can be difficult or easy! Below we will attempt to list some helpful hints that will help you and your doctors to maximize your success.
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