There are several disorders that may directly affect AGB surgery. GERD, also known as gastroesophageal reflux disease, is one of the most typical. Heartburn, chest discomfort, food regurgitation, and other symptoms associated with this disorder are brought on by the aberrant migration of stomach contents, mostly acid, up into the esophagus. For years, many of my patients have been taking drugs to lessen the quantity of stomach acid produced. Naturally, they have also heard over and time again that decreasing weight would make their reflux better. Because their reflux has gotten out of control, some patients are actually referred for the AGB for weight loss. While the AGB can significantly reduce the symptoms of GERD, it's crucial to understand that reflux can also be linked to a hiatal hernia, a disorder that affects the stomach and diaphragm.
A big, flat muscle called the diaphragm divides the stomach cavity from the chest cavity. The esophagus can pass through the diaphragm's natural opening, known as the esophageal hiatus, before emptying into the stomach. In a relaxed state, the abdominal pressure is much higher than the chest pressure. We can breathe air into our lungs because of the negative pressure in our chests. The pressure in the abdomen, however, is elevated. The pressure gradient between the chest and belly is exacerbated in obese patients by the excess weight pressing down on the abdomen. This contributes to the fact that many overweight persons have breathing problems.
Long-term abdominal pressure can extend the diaphragm's hiatal opening, forcing the stomach through the larger aperture and up into the chest. The medical term for this problem is hiatal hernia. A substantial hiatal hernia could be problematic because the band needs to be on the abdominal side of the diaphragm in order to function since it is intended to be wrapped around the top of the stomach. Typically, a modest hiatal hernia can be fixed when the AGB is implanted, but for patients with
a hernia hiatal The band is typically a bad choice if it is larger than a few inches.
Documenting the existence and extent of a hiatal hernia is crucial for anyone who has a history of the condition or severe reflux symptoms. A series of upper GI X-rays are the most straightforward method for determining this. The patient is instructed to ingest a liquid solution that contains barium, which is visible on X-rays. This test will typically show whether a hiatal hernia exists, where it is located, and roughly how big it is. An endoscopic examination of the esophagus and stomach can also reveal the presence of a hiatal hernia. A pliable, illuminated tube is inserted into the stomach through the mouth, esophagus, and stomach. The position of the diaphragm and the location of the junction between the esophagus and the stomach are both assessed during this examination.
A hidden hiatal hernia that is not discovered until the time of surgery can cause the surgeon serious difficulties. While it is possible to perform a band treatment to repair a minor hernia, doing so involves more dissection and may also raise the surgical risk. The hernia repair could also loosen with time, allowing the stomach and the band to slide up and into the chest over the diaphragm. It might even force the surgeon to stop the band operation entirely. Therefore, it is much better to be aware of a hiatal hernia in advance. Before proposing the band, the surgeon will probably request either an upper GI X-ray or an endoscopy if there is any doubt regarding the existence of a hiatal hernia. Before determining whether the band is the best option for you, you should definitely talk to the surgeon about your condition.
Gallbladder disease is a different medical problem that is frequently seen in obese persons. The surgeon may advise having your gallbladder removed concurrently with your band surgery if you have known gallstones or have been given a diagnosis of gallbladder illness. Based on confirmation of gallbladder issues, which calls for a gallbladder ultrasound or a gallbladder function test known as a HIDA scan, that decision will be made. Combining the elective removal of the gallbladder with the AGB operation is typically not problematic, however if the gallbladder is very inflamed or
If it is diseased, it is usually preferable to remove it during a different surgery rather than run the chance of the band becoming contaminated.
Chronic illnesses of the digestive or gastrointestinal systems may potentially affect your eligibility for the AGB. The surgeon may decide that a band is the best option for you if you have been diagnosed with Crohn's disease or another inflammatory bowel condition. The surgeon's assessment of the AGB will undoubtedly be impacted by chronic liver illness, particularly when it is worsened by cirrhosis and dilated veins in the esophagus, known as esophageal varicies.
Before having AGB surgery, these conditions may need to be treated.
the hiatal hernia (Even if you haven't been given a diagnosis, the presence of gastroesophageal reflux disease or stomach reflux is a symptom, and you should be tested for it before having band surgery.)
a gallbladder condition
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Crohn's illness
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persistent liver disease
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esophageal varicies and hepatic cirrhosis are two examples of these conditions.
You might want to seek a second opinion if, following your initial evaluation, the surgeon informs you that he or she doesn't believe the band is a good option. Even if you do locate someone willing to perform the AGB operation, you should probably take that counsel if you receive the same opinion from a second surgeon.
The surgeon will also go into great detail about the surgery during your examination. The surgeon should also discuss any potential issues and drawbacks that might arise before, during, or after surgery.
that process. Patients occasionally pay less attention to the surgeon's explanation of the surgery, the drawbacks, or the risks because they are so eager to start losing weight and obtain a band that they are distracted by their own excitement. Pay close attention to these explanations so you understand exactly what you're getting into.
Your surgeon should assist you in developing some reasonable expectations about where you are likely to end up and how quickly you'll get there during the surgery examination. Almost all of the patients have seen the "before and after" pictures of people who have had great success with the band. Even some are shown in this book. In many cases, patients were persuaded to seek having a band for themselves by those photographs and the success stories. These particular patients are obviously a good way to sell the treatment because they show the best outcomes. But not everyone succeeds in getting the best outcomes. Therefore, you should learn what the surgeon views as typical results before making any assumptions. Understanding what constitutes poor results as well as what causes poor results is crucial.
We'll talk about how a full program that includes food, activity, and psychological assistance in addition to the band is associated to optimal results in the following chapter. However, how effective you are will depend on your willingness and dedication to take part in such a program. Patients will commonly lose between 50 and 75 percent of their excess body weight and keep it off if they utilize all components of the program. To put it another way, if you weigh 100 pounds more than you should, you should realistically expect to lose between 50 and 75 pounds over the course of 12 to 24 months, at a rate of 1 to 2 pounds per week. If you weigh 150 pounds too much, your weight loss should be closer to 75 to 115 pounds over the same time frame. Keep in mind that these are average findings; some people perform better than others.
Many of my patients have suggested that they can and will perform far better after looking at these figures. They do in some instances. The truth is, nevertheless, that (1) those who have been overweight for a long time typically are unable to ever reach their ideal body weight, and (2) the goal of the
The goal of AGB or any other weight-loss program is to get the person back to a healthy weight that they can keep up in the long run. Most patients experience a considerable improvement in their general health when they lose at least half of their excess weight. That is not to suggest that everyone is happy with the outcome all the time, and maybe they shouldn't be. Setting a reasonable goal and realizing that losing 1 to 2 pounds each week is typical are both crucial.
You owe it to yourself to have complete knowledge of every detail pertaining to the procedure. This covers the surgeon's credentials, the anesthesiologist's experience, the facility's capabilities, the support staff's skills, the procedure's hazards, and the expected outcomes. The time to learn about these things is before you move on because they are all a part of the Comprehensive Weight Management Program.
The next phases comprise evaluations by the team members after you have been informed that you may be a candidate for the AGB. The ideal scenario would be for you to receive evaluation and guidance from a psychologist, a trained and professional dietitian, and an exercise physiologist. These evaluations serve to guarantee your success by detailing every facet of the curriculum. It will also benefit you to avoid putting time and effort into the AGB if it is obvious that it won't be beneficial to you.
Although you could feel scrutinized by all of these tests, they also give you a valuable chance to evaluate the team you'll be working with in the weeks, months, and even years to come. You need to feel at ease with them and have confidence that they have your best interests in mind because you will be meeting with them frequently. You might wish to enquire about their objectives and expectations for you and other patients. Before beginning, it's crucial that everyone is "on the same page of the program."
The Way to Success Is Through a Mindshift
psychologist G. Dick Miller
I see the band as a start, as a beginning. Many people will form bands, but those that modify their perspectives will be successful. These patients get away from the idea that someone will "fix" them. Instead of focusing on the outside world, they embrace an internal locus of control.
Many band patients have lost control for a while in other areas as well as their weight. Additionally, their social and emotional life have gotten out of hand. When I enter a store, I notice it. If a fat person is waiting for a clerk and I am, I will be seen. When I observe how people who are overweight are treated, it is evident to me that they are viewed as inferior. And in my view, those ideas cause heavier people to have an attitude of waiting for someone to give them something that will make them feel better.
Successful musicians don't hold out for someone or something outside of themselves to correct their circumstances or grant them permission to be at peace with themselves. They accept responsibility for forming new social, emotional, and physical habits. Those who adopt a "wait and see" mentality are setting themselves up for failure. Not a gallbladder operation, this. You cannot simply wait for your body to recover before carrying on with your life as usual. It's a continuous process that starts with and is centered on change.
And not only patients with band syndrome must adjust their beliefs. This necessitates a change on the part of the surgeon as well, whose training is in permanently "fixing" problems through cutting. Many people wait for the surgeon to fix them, and if they can't, the doctors become irate—sometimes even toward the patient. This "quick fix" is embodied by the gastric bypass. The band is slow and gradual, which is much safer. Additionally, changes need for continual communication between the patient and the medical team.
According to my observations, a lot of people want to buy into the marketing hype that says all they need to do is get surgery to solve their problems. However, in the long run, a person's belief systems will be what determine their emotional health.As a
Man thinks, therefore he is, not as the band "works or does not work," Many people will receive a band, but some will have their perspectives altered. These patients will understand that the band is just a tool, but the real victory—and the path to success—lies in helping them to alter their way of thinking.