With thanks to Dr Milton Owens & Rancho Speciality hospital California

The procedure was originally conceived of in England and has been further developed and utilized in the U.S, Germany and Belgium. The technique is an improvement over earlier gastroplasty procedures which included placement of foreign bodies, and left the excess stomach intact. It was originally used for very high BMI patients (~ 500 lbs.) to try to reduce the overall risk of surgery. It was then followed by a second surgery when the patient had lost enough weight to safely go through a second procedure like the Gastric Bypass.
The new procedure was started in England about 5 years ago as a stand alone procedure for patients of BMI’s of 35-45. It proved to be quite safe and effective even at 5 years post op.

U.S. studies have been very impressive; in one study of almost 100 very high risk, very high BMI patients there were no deaths, and only 1 leak, and 1 pulmonary embolus.

Dr. Owens has used this procedure for high risk, high BMI patients with good results. It can be considered by patients who are:

Concerned about bowel obstructions and leaks that may occur with Gastric Bypass due to the re-arrangement of the anatomy required.
Concerned about the dietary changes and vitamin supplements required by Gastric Bypass
Concerned about the foreign body introduced with the Lap Band placement
Concerned about the need for follow up, fills required with the Lap Band
It should also be considered for patients weighing over 500 lbs, patients with existing anemia, Crohn’s disease, or other conditions that make them too high risk for Bypass procedures.

Dr Owens is the first surgeon in Southern California to offer Sleeve Gastrectomy. His expertise in Sleeve Gastrectomy offers our patients another option to help them receive the best weight loss procedure for their individual needs. Vertical Sleeve Gastrectomy procedure also called Sleeve Gastrectomy, vertical gastroplasty, Greater Curvature Gastrectomy, Parietal Gastrectomy, Gastric Reduction and Sleeve Gastroplasty is performed by approximately 18 surgeons worldwide.

Choosing the Sleeve:

 • Those who are concerned about the potential long term side effects of an intestinal bypass such as bowel obstruction, ulcers, anemia, osteoporosis, protein deficiency and vitamin deficiency.
• Those who are considering a LapBand but are concerned about a foreign body or the need for fills and more frequent follow up.
• Those who have other medical problems that prevent them from having weight loss surgery such as anemia, Crohn’s disease, extensive prior surgery, and other complex medical conditions.
• Those taking anti-inflammatory medications that may need to be avoided after gastric bypass due to increased risk of ulcers. Advantages of the Sleeve:
• Stomach holds less but tends to function normally so most food items can be consumed in small amounts
• Thought to eliminate the portion of the stomach that produces the hormones that stimulates hunger (Ghrelin).
• No dumping syndrome
• Minimizes the chance of an ulcer occurring.
• Very effective as a first stage procedure for high BMI patients (BMI >55 kg/m2).
• Limited results appear promising as a single stage procedure for low BMI patients (BMI 35-45 kg/m2).

Extract from study paper published in Obesity Surgery. 2007 Jul
 Andrew A Gumbs , Michel Gagner , Gregory Dakin , Alfons Pomp 

The rising prevalence of morbid obesity and the increased incidence of super-obese patients (BMI >50 kg/m2) seeking surgical treatments has led to the search for surgical techniques that provide adequate EWL with the least possible morbidity. Sleeve gastrectomy (SG) was initially added as a modification to the biliopancreatic diversion (BPD) and then combined with a duodenal switch (DS) in 1988. It was first performed laparoscopically in 1999 as part of a DS and subsequently done alone as a staged procedure in 2000. With the revelation that patients experienced weight loss after SG, interest in using this procedure as a bridge to more definitive surgical treatment has risen. Benefits of SG include the low rate of complications, the avoidance of foreign material, the maintenance of normal gastro-intestinal continuity, the absence of malabsorption and the ability to convert to multiple other operations. Reduction of the ghrelin-producing stomach mass may account for its superiority to other gastric restrictive procedures. SG should be in the armamentarium of all bariatric surgeons. Nonetheless, long-term studies are necessary to see if it is a durable procedure in the treatment of morbid obesity. 

5 October 2007 Easier.com

Almost one million (918,000) image conscious British adults are planning to borrow a whopping £1.4 billion to pay for plastic surgery, according to the research from Abbey Loans.

With all those celebrities showing off their beach bodies over the summer, most Britons appear most concerned about perfecting their curves and honing their six packs. Indeed breast augmentation is the most common cosmetic procedure sought by Brits, accounting for 27 per cent of all surgery, followed by tummy tucks with 25 per cent. Rhinoplasties, or nose jobs, were cited as the third favourite area with 17 per cent.

The major reason people want to alter their appearance is to gain more confidence in themselves according to 51 per cent, a further 32 percent claim it is for medical purposes. Two percent go plastic fantastic after being egged on by a friend, and one percent does so to stop people teasing them about a particular part of their body.

Females account for two thirds of Britons wanting plastic surgery. Three-in-five procedures are planned by those between the ages of 18-34.

The UK is still the most desirable location to undergo plastic surgery with 83 per cent opting to stay close to their home comforts. Six per cent opt for Eastern Europe where surgery is cheaper and two per cent of ‘Nip,Tuck’ Brits head to the USA – presumably taking advantage of the cheap dollar.

Paul Morrish, Head of Abbey Loans, commented: “Whether striving for visible perfection or as part of a medical treatment, plastic surgery is getting more and more popular amongst Britons. We are seeing an increase in requests to borrow for plastic surgery and with Abbey offering a competitive loan rates, starting at 7.9% APR on internet loans, we’d be more than happy to speak to anyone who is seriously considering cosmetic procedures.�

By LYNDSAY MOSS
HEALTH CORRESPONDENT Scotsman
A SURGEON opted to go under the knife himself for an operation that is becoming popular in the fight against obesity.

Chris Oliver lost more than seven stone after the procedure to limit his food intake. And now he is to donate his surgical robes, or “blues”, which he had to have specially made to cope with his 26-stone bulk, to a museum.

He is hoping his story will inspire others who have struggled with serious weight problems to consider the radical operation.

Mr Oliver, 47, a consultant orthopaedic surgeon at Edinburgh Royal Infirmary, decided on the operation – known as bariatric surgery – last year after visiting the Great Wall of China and being unable to walk it.

He had also developed type-2 diabetes linked to his obesity, which increases the risk of heart disease and stroke.

Although Mr Oliver never struggled with his weight early in life, the pressures of work and professional exams saw him pile on ten stone in 20 years.

“Making the choice to have surgery took me a while, and I guess for many people the choice is really hard.

It’s the individual who finally makes the choice,” Mr Oliver said.

After considering the complications, and writing a living will in case something went wrong, he had a gastric band fitted at the Nuffield Hospital, Glasgow, in February. The band is a belt that is tightened around the stomach, reducing the amount of food that can be consumed.

Mr Oliver has since lost almost 100lb, taking him to 19st, and is hoping to shed a further 4st by Christmas. The father of two teenage daughters has also been taking regular exercise, including cycling. “I’ve had to cut links out of my watch strap and all my shoes are too big,” he said.

Mr Oliver has just handed over his surgical blues for public display. “I can now fit into normal surgical wear, so I donated them to the Royal College of Surgeons Museum – a bit of bariatric social surgical history,” he said.

The operation came to prominence when the former television presenter Anne Diamond admitted last year that she had had a similar procedure.

Choosing to pay for gastric band surgery – which costs between £7,500 and £8,000 – means patients can avoid long NHS waiting lists. But surgeons will still carry out the operation only as a last resort.

David Galloway, a consultant bariatric surgeon in Glasgow, said he had performed up to 500 gastric-band operations in the past seven years – 200 of these in the past year alone.

“My strong impression is that this type of surgery is increasing,” he said. “It can be difficult to access this surgery on the NHS, which rightly tries every other option for patients.”

Mr Galloway said weight-control surgery was not a “magic bullet” and was not the only option for patients. But he added:

“For the right patients, surgery can be a passport to a happier and more fulfilled life.”

Shona Robison, the public health minister, said: “Surgery for obesity is rare and should only be used when all appropriate and available non-surgical measures have failed.”

Centres for obesity surgery are run in Glasgow and Aberdeen, with plans for a further one in Dundee or Edinburgh.

THE PLASTIC BAND THAT STOPS YOU EATING
GASTRIC banding is the most commonly used weight-control surgery in the UK.

The plastic band acts like a belt, positioned around the top portion of the stomach.

This reduces the space in the stomach so patients feel full after eating only a small quantity of food – around three small meals a day.

• A more major procedure is a gastric bypass operation. This works by making the stomach smaller and removing part of the bowel to make the digestive system shorter. It means patients can only eat small meals and their body will take up fewer calories from what they eat.

• Any kind of weight-control surgery is a major procedure, with a small risk of complications. Doctors also warn surgery will not be successful unless patients exercise and eat properly.

• The risk of complications means some patients opt for quicker fixes such as liposuction. But the fat can easily return unless a healthy diet is followed.

• Doctors can also prescribe certain weight-control drugs.

Scotsman 5 Nov 2007
LEADING surgeon Chris Oliver, who has had gastric band surgery, says he is “delighted” at being re-elected on to the council for the Royal College of Surgeons.

The consultant trauma orthopaedic surgeon at Edinburgh Royal Infirmary had the “life-changing” operation after tipping the scales at 26 stone.

Dr Oliver, 47, said: “I am delighted I have been re-elected to RCSEd Council for five years. Congratulations also to Judy Evans who got the other place.

“It has been an amazing year for me. My life has changed completely since my lap band surgery as I have now lost 100 pounds in weight. My new-found fitness and energy will allow me to return to my previous sporting activities.”

Surgical videos on WeBSurg

You can watch a Sleeve Gastrectomy on the Web. This video demonstrates a routine case of laparoscopic sleeve gastrectomy for morbid obesity. This is usually the first stage of a two-stage procedure. The surgeon starts at the mid portion of crow’s foot about 7 cm from the pylorus and mobilizes all the greater curvature vessels and attachments using bipolar cautery. After full mobilization of the greater curvature up to the angle of His, the gastric sleeve is constructed using a linear stapler. A bougie is used to calibrate the diameter of the gastric sleeve. The specimen is removed from an enlarged trocar site. The surgeon in this case placed a drain.
To watch the procedure visit http://www.websurg.com/ref/Laparoscopic_sleeve_gastrectomy-vd01en1853.htm 

In a normal city you would expect a special bus line that goes from the international airport to the city center. Not everybody can afford a cab, and not everybody likes cabs as such.

In Brno, the airport is served by regular bus line number 76 that has about ten stops on the way to the center and thus is used also by people from the neighborhood the bus goes through. And it is also used by people who work in the industrial zone that neighbors the airport.

Result?

I took a test ride about three days ago. Six people boarded the bus at the airport, all of them had the now-favorite trolleys, huge suitcases on wheels. These suitcases jam-packed the aisle and seats. From the second bus stop on the way to the center it was practically impossible to board the bus as a normal passenger.

Brno Transport Authority should use special buses with less seats and more space for suitcases and luggage in general. It should not stop on the way between the two end-stations. I am quite sure airline travellers would appreciate it. And they would not need to ask the are-we-there-yet question, just like a certain U.K. couple did during my test ride.

Plus I can imagine a better route for the bus than the one it is taking now with the bus stops on the way. It goes through one street that is one of the worst in the city. Nothing to be proud of. Sometimes it feels as if a JFK shuttle on the way to Central Park West was going through the worst part of Harlem. No offense to New Yorkers….

Thanks to Petr Bokuvka 24/09 http://czechdaily.wordpress.com/page/5/

DON’T WORRY! COSMETIC BLISS PACKAGE CLIENTS HAVE TAXI TRANSPORT ARRANGED FOR THEM

The Sunday Times October 14, 2007
These days it’s not just women who are opting for a nip or tuck. Since 2004, the number of men turning to cosmetic surgery has more than doubled to about 2,500 last year, according to figures from the British Association of Aesthetic Plastic Surgeons (BAAPS).

The most popular procedures are nose jobs (rhinoplasty), eyelid surgery (blepharoplasty), liposuction, ear correction (otoplasty) and face or neck lifts. Many people expect surgery to change their life, improve their job prospects or fix a relationship, but this is not necessarily the case. About half the men who have nose jobs aren’t happy with the immediate results, warns BAAPS.

more http://www.timesonline.co.uk/tol/life_and_style/men/article2642484.ece

Channel 4 News 16/10/07
Less than one in ten women who lose weight by dieting manage to keep it off, according to a new survey.

Only 9% diet successfully while the remaining 91% put the fat back on and are doomed to a cycle of calorie counting for the rest of their lives.

Researchers found women used a range of substances – including class A drugs – to lose weight. Almost four out of 10 (37%) had tried slimming pills, laxatives (26%) and amphetamines or cocaine (15%).

Three out of 10 (31%) women admitted they had made themselves sick after eating and one in ten (10%) said they would have a gastric band fitted.

More than eight out of ten (82%) of those questioned had dieted. Almost a third (32%) counted the calories all the time, a further 20% watched what they ate every month, 11% three or four times a year, 6% twice a year and 13% once a year. Only 18% of women never tried to diet.

The survey of 2,000 people, commissioned by women’s magazine Now, revealed that only 2% of those questioned were happy with their body while the average woman would spend £11,000 for a better one.

Now editor Helen Johnston said: “Women today have a shocking relationship with food and are living a binge/purge lifestyle. Six out of 10 British women are so hooked on quick fix diets they say they no longer know how to eat normally.”

She added: “Body image is the female curse of the 21st Century. Whatever a woman’s achievements in life, her whole self image is totally bound up in her body shape.”

A third of women said they would give up sex to be slim forever and 86% said they would rather drop a dress size than sleep with David Beckham.

Just over half the women said they would have cosmetic surgery, now or in the future. The three most popular treatments were liposuction, tummy tuck and breast enhancement.