any questions they may have of the surgeon. We encourage the patient's significant other and family to be present and in agreement with the patient's plans for GBP. Our patients fill out a psychological questionnaire at home that they bring to the office along with a psychiatric past history. They are further referred for psychological consultation if deemed necessary; some insurance carriers require a psychological consultation on all patients before approval is given.
After the patients leave the office, a letter is written to the insurance carrier to approve the surgery. Patients who have symptoms of sleep apnea (daytime somnolence, loud snoring, frequent awakening) are sent for a sleep study, with possible nasal CPAP treatment to begin before the operation. Because the waiting process for insurance approval takes 4 to 6 weeks, our patients are encouraged to attend our GBP club monthly meeting, where they can discuss the postoperative changes with patients who have already had the surgery.
During the week of surgery, the patients undergo routine preoperative testing, including arterial blood gasses if obesity hypoventilation syndrome is suspected. They then attend a required preoperative class, where our GBP nurse coordinator and dietician discuss details of the operation and postoperative course and answer any questions the patients may have. Gastric Bypass
  In 1969, Mason and Ito introduced the GBP operation for morbid obesity after observing that patients who had a subtotal gastrectomy for peptic ulcer disease lost considerable weight postoperatively. The original operation had a proximal pouch that was approximately 10% the size of the stomach with a retrocolic loop gastrojejunostomy and a wide 2- to 3-cm stoma. Griffen et al. later modified this in 1971 by changing the loop to a Roux-en-Y gastrojejunostomy. At the Medical College of Virginia, the GBP procedure that is performed involves creating a small gastric pouch (15 to 30 ml) by placing three or four superimposed 55- or 90-mm staple lines in a vertical direction and draining the pouch with a Roux-en-Y limb through a 1-cm stoma ( Fig. 15-1 ).
Preoperatively on the day of surgery, the patient is administered 2 g of cefazolin and 40 mg of low-molecular-weight heparin (enoxaperin) subcutaneously. The patient is also fitted with thigh-length intermittent venous compression boots, and the pump is turned on before the start of surgery. An upper midline incision is made from the xiphoid process to the umbilicus. The deep subcutaneous fat layer is best divided by equal traction in a lateral direction, which will dissect down to the midline linea alba. On exploration of the abdominal cavity, if the gallbladder is chronically diseased, gallstones are palpated, or an intraoperative ultrasound reveals stones or polyps, then a cholecystectomy is performed. If the ultrasound shows no abnormality, then the patient is placed on 6 months of ursodiol (300 mg twice daily) after surgery; this was shown in a multicenter, randomized, double-blind, prospective study to reduce the incidence of gallstone
Figure 15-1 Roux-en-Y gastric bypass. (From Sugerman, H.J., Starkey, J.V., and Birkenhauer, R.: A randomized prospective trial of gastric bypass versus vertical banded gastroplasty for morbid obesity and their effects on sweets versus non-sweet eaters. Ann. Surg., 205:613, 1987.)
Figure 15-2 Vertical banded gastroplasty. (From Sugerman, H.J., Starkey, J. V., and Birkenhauer, R.: A randomized prospective trial of gastric bypass versus vertical banded gastroplasty for morbid obesity and their effects on sweets versus non-sweet eaters. Ann. Surg., 205:613, 1987.)
s. An endoscopic stapler is used to divide the stomach into a vertical 15- to 30-ml gastric pouch.
Figure 15-7 Percentage of excess weight ±SD (n) over 3 years after Roux-en-Y gastric bypass (RYGBP) compared with vertical banded gastroplasty (VBGP). (From Sugerman, H.J., Starkey, J. V, and Birkenhauer, R.: A randomized prospective trial of gastric bypass versus vertical banded gastroplasty for morbid obesity and their effects on sweets versus non-sweet eaters. Ann. Surg., 205:613, 1987.)
Figure 15-9 Significantly improved PaO2 and PaCO2 in 18 patients with obesity hypoventilation syndrome 3 to 9 months after surgically induced IEW loss of 42 ± 19%. (From Sugerman, H.J., Baron, P.L., Fairman, R.P., et al.: Hemodynamic dysfunction in obesity hypoventilation syndrome and the effects of treatment with surgically induced weight loss. Ann. Surg., 207:604, 1988.)
3-9 after months surgery surgery
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Virtual Gastric Band Hypnosis Audio Programm that teaches your mind to use only the right amount of food to keep you slim. The Virtual Gastric Band is applied using mind management techniques, giving you the experience of undergoing surgery to install a virtual gastric band or virtual lap-band, creating a small pouch at the top of the stomach which limits how much food can be eaten. Once installed, the Virtual Gastric Band creates the sensation of having a smaller stomach that is easily filled and satisfied with smaller amounts of food.