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 sdukes@firstcoastymca.org  

 

 

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: bariatrics@bmcjax.comWeb: 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: bariatrics@bmcjax.comWeb: baptistbariatrics.com

Thank you for allowing us to care for your patients’ weight loss and bariatric surgical needs.