Clinically Severe Obesity is considered a chronic disease. In the United States, more than 12 million people suffer from this condition and from its medical, psychological, social and economic consequences including job loss and higher insurance fees. Clinically Severe Obesity is typically defined as an excess weight of 45 kilograms (kg) or more as compared with a person's Ideal Body Weight (IBW). Being more than 25% above your IBW is linked with increased risk of health problems, disease and death. The BMI (Body Mass Index) is a weight and height calculation which helps determine weight-related health risks. To calculate your BMI: Body Mass Index Calculator (http://www.halls.md/body-mass-index/bmi.htm)
According to medical literature, clinically severe obese people can never achieve long-term weight loss with dietary or behavioral modifications alone. A 100% failure rate is reported and a series of failures will again lead to enormous psychological problems. Known as the "yo-yo Syndrome," this situation creates additional physical burden on these already high-risk patients. Surgery is therefore indicated in these patients.
Conventional obesity surgery is a high-risk procedure because of preoperative and postoperative
morbidity. Preoperatively, access to the stomach is somewhat limited because of the enormous amount
of fat surrounding the organ. Postoperatively, relative immobility of those patients facilitates
blood clotting in deep veins of the legs and lung complications.
The laparoscopic placement of an adjustable gastric band combines the advantages of this type of restrictive surgery that is less invasive than other obesity procedures because the abdomen is not actually opened. With this combination, operative risk is reduced as well as morbidity and patient discomfort. Total reversibility and adjustability of the band are clearly positive points. In October 1992, we were the first in the world to perform a laparoscopic gastric banding with the original, first generation Adjustable Silicone Gastric Band (ASGB), invented by Dr. Kuzmak. Technical modifications were made to the band in order to conform to the laparoscopic approach.
The selection criteria as defined by the American Society of Bariatric Surgery Consensus are listed in the table below.
| Selection Criteria for Obesity Surgery | ||
|---|---|---|
|
1. |
BMI* (Body Mass Index) above 40 or between 30 to 40 in the presence of other associated diseases that may improve with weight loss (high blood pressure, diabetes, sleep apnea, and painful joint condition arthritis proven by x-ray) | |
|
2. |
Age between 18 and 55 years | |
|
3. |
Stable obesity for more than five years | |
|
4. |
Failure of dietary or weight-loss drug therapy for more than one year | |
|
5. |
Absence of glandular diseases such as hypothyroidism | |
|
6. |
Comprehension of the procedure and compliance by the patient | |
|
7. |
No dependency on alcohol or drugs | |
|
8. |
Acceptable operative risk | |
|
* BMI = weight in kg/height in meters squared. | ||