Clinical Briefing:
Adjustable Gastric Band Surgery for
Morbid Obesity
July / August 2006
Diet,
pharmacotherapy and behavior modification may achieve weight
loss success in patients with mild to moderate obesity, but
surgery is the only proven weight loss method for patients
with clinically severe obesity.1 Clinically
severe obesity is defined by a BMI > 40 kg/m2 or a BMI >35
kg/m2 with co-morbid conditions caused by the increased weight.
Adjustable gastric band (AGB) surgery is the least invasive
bariatric surgical approach. The adjustable band is placed
around the upper stomach to form a small gastric pouch and
stoma. The device restricts the amount of food consumed and
creates a sensation of satiety to achieve weight loss; a
subcutaneous access port allows intermittent adjustments
to achieve optimal outcomes.
Case Study
Mr. M., a 46-year-old Caucasian male,
presented with a history of morbid obesity, hypertension
and diabetes mellitus. At 5 feet 10 inches tall and a weight
of 340 pounds, his BMI was 48.9. Numerous attempts over the
past several years to lose weight had been unsuccessful.
Additionally, worsening back and knee pain had limited his
ability to ambulate and significantly affected his quality
of life. These issues led Mr. M.’s primary care provider
to refer him to the Bariatric Surgery
Program at Penn.
Mr. M. attended a general information session on weight
loss surgery. He learned about available options, asked questions
and met the team members. He returned two weeks later for
surgical consultation with the Bariatric Surgery team at
the Hospital of the University of Pennsylvania. Preoperative
testing was scheduled during this visit.
Testing revealed obstructive sleep apnea, for which continuous
positive airway pressure (CPAP) therapy was prescribed. Medically
cleared, AGB surgery was scheduled. Mr. M. returned three
weeks prior to his surgery for reevaluation and to attend
nutrition and education classes.
Mr. M.’s surgery occurred without complications and
he was discharged on post-op day two. At discharge, one antihypertensive
medication was discontinued, and he was placed on half the
dose of sulfonylurea. At his follow-up appointment on post-op
day eight, he reported feeling well, post-op diet compliance
and increased activity tolerance; he had lost 6 pounds.
Mr. M continues with follow-up appointments, including
three AGB adjustments, over nine months. His greater than
20 percent weight reduction enabled his primary care provider
to discontinue all diabetes medication and an additional
antihypertensive. A repeated sleep study is planned at one
year post-op to determine if he can reduce or discontinue
the CPAP therapy. He regularly attends Penn’s AGB support
group and continues to see the bariatric team at Penn for
ongoing evaluation and nutritional support.
AGB Surgery vs. Alternate Bariatric Surgical
Approaches 2
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Advantages
- Smaller Incisions
- Reduced OR times
- Decreased Hospital LOS
- Reversible
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Disadvantages
- Slower weight loss
- Less weight loss
- Possible device malfunction
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1 Nguyen, N.T., et al (2005).
Accelerated Growth of Bariatric Surgery With the Introduction of Minimally
Invasive Surgery. Archives of Surgery, 140:
1198-1202. Retrieved February 22, 2006, from www.archsurg.com.
2 United States Department of Health and Human
Services, National Institutes of Health Gastrointestinal
Surgery for Severe Obesity; Bethesda, MD: National Institute
of Diabetes and Digestive and Kidney Diseases, December 2004.
About Our Team
Our comprehensive team of experts from psychology, nutrition,
medicine, nursing and surgery is dedicated to treating morbidly
obese patients, ultimately helping them to improve their
health and quality of life.
Noel N. Williams, MD, FRCSI
Director of the Bariatric Surgery Program
Assistant Professor
of Surgery
Katie Foster-Kilgarriff, MSN, CRNP
Program Manager
Diane Filter, MSN, MPH, CRNP
Nurse Practitioner
Kelley Smydra, MSN, CRNP
Nurse Practitioner
Angela Votodian, MSN, CRNP
Nurse Practitioner
David B. Sarwer, PhD
Weight and Eating Disorders Center Psychologist
Thomas A. Wadden, PhD
Weight and Eating Disorders Center Psychologist
Patti Lipschutz, MSN
Weight and Eating Disorders Center Psychologist
Robert Kuehnel, PhD
Weight and Eating Disorders Center Psychologist
Anthony Fabricatore, PhD
Weight and Eating Disorders Center Psychologist
Rachel Griehs, MS, RD, LDN
Clinical Nutrition Specialist
Wanda Rooney, MS, RD, LDN
Dietitian
Samantha Warner Grimsley, RN
Outpatient Clinical
Nurse
Robin Stott-McNulty, MSPT
Physical Therapist
Elizabeth Sheldon
Social Worker
Diane Limbert, RN
Clinical Resource Management/Discharge
Planning
Calculation of Body Mass Index (BMI)
BMI is calculated by dividing weight in pounds (lbs) by
height in inches (in) squared and then multiplying by a conversion
factor of 703. Calculate
your BMI online here.
Formula: weight (lbs)/{height (in)}2 *703
For adults (20 years of age and older), BMI is interpreted
using weight status categories that are the same for all
ages and for both men and women. See the table below.
Source: Centers for Disease Control and
Prevention;
Division
of Nutrition and Physical Activity, National Center for Chronic
Disease Prevention and Health Promotion
Access
Patient appointments are available at:
Hospital of the
University of Pennsylvania
3400 Spruce Street
Silverstein Building, 4th Floor
Philadelphia, PA
To refer a patient and/or
consult with a doctor:
Please contact your UPHS physician liaison with
any concerns or problems you may experience when referring
your patient.
Locations
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Referring Physicians: To speak with a Penn physician
or refer a patient, contact PennHealth through the secure online
referral form or by calling
1-800-789-PENN
(7366). |
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