Gastric Band Service

Pre-Operative Support

To form a full picture and exclude any endocrine or medical conditions that may be contributing to weight gain or are a result from being obese (e.g. type 2 diabetes) it is advisable to have an endocrine and physicians appointment. This page aims to provide information of various aspects of this pre-operative support.

Why Should an Obese Person See an Endocrinologist?

Who/What is an Endocrinologist?

An Endocrinologist is a specially trained doctor who diagnoses and treats diseases related to hormones and glands. Hormones control reproduction, metabolism (food burning and waste elimination), growth and development; these specialist doctors study the management and treatment of obesity and related diseases and then evaluate patients to see if there is a primary reason for being obese.

When Should an Obese Person See a Clinical Endocrinologist?

In general it may be appropriate for you to see an endocrinologist if:-

• You have changed or tried to change your behaviour in an attempt to loose weight e.g. if you have increased your exercise and improved your diet but these have not been effective for weight loss;
• If you are obese and have an endocrine disorder, such as diabetes, metabolic syndrome or Poly Cystic Ovarian Disorder PCOS, that may be made worse by being obese.
• If you have an underlying endocrine condition that increases your risk for obesity, such as Cushing's syndrome or thyroid diseases.

The Top 5 Reasons to See an Endocrinologist About Obesity

• A BMI greater than 30 and signs of weight gain without a clear increase in food intake.
• A BMI greater than 30 and has weight gain centered around the abdomen and stomach with thin arms and legs OR weight gain with easy bruising.
• For women, a BMI greater than 30 and has experienced irregular periods or abnormal hair growth.
• A BMI greater than 30 and unusual stretch marks have developed on the skin.
• A BMI greater than 30 and has high blood pressure (hypertension) with abnormal potassium levels.

Areas of Research and Treatment by the Endocrinologist

Endocrinologists identify and possibly prescribe treatment for medical conditions associated with obesity. Areas include research and treatment of : -

• diabetes,
• thyroid diseases:hypothyroidism,
• hypertension,
• bone disorders,
• reproduction/fertility problems e.g.PCOS,
• Pituitary conditions,
• growth problems,
• lipid disorders and obesity/overweight,
• insulin resistance,
• reproductive difficulties and genetic problems,
• liver disease,
• established coronary heart disease (CHD),
• hypertension,,
• high LDL cholesterol,
• low HDL cholesterol,
• high serum triglycerides,
• other atherosclerotic diseases.
• Type 2 diabetes, and sleep apnoea.

Other obesity-associated diseases such as:

• osteoarthritis,
• gallstones and their complications,
• stress urinary incontinence,
• cardiovascular risk factors such as cigarette smoking and other risk factors including physical inactivity.

Possible Pre-Operative Medication

Clexane ® (Enoxaparin Sodium)

Innohep ® (Tinzaparin Sodium)

Indications for use - related to Gastric Band placement

A treatment to prevent (Prophylaxis) the formation of a blood clot in veins (DVT - deep-vein thrombosis). This may be prescribed for people who are about to have surgery or have had surgery.

Amount prescribed by the doctor is dependent upon patient's risk factors.

In the case of gastric band placement this is usually given by Subcutaneous injection approx. 2 hours before surgery.

Patients may be discharged with the equipment to continue to self administer the drug at home for approx. 7-10 days following surgery.

Glossary

• Propholaxis - A treatment used aimed to prevent disease
• Subcutaneous injection - An injection under the skin (see image below)

• Thrombosis - Formation of a clot
• Embolism - Blocking of an artery after a clot has moved e.g. Pulmonary Embolus P.E. (blood clot in the lung) which can cause sudden death.

Other Possible Indications - not related to gastric band placement

• Prevention of deep vein thrombosis (D.V.T) after surgery.
• Treatment of established D.V.T.
• Acute treatment of unstable angina.
• Prevention of D.V.T in bedridden medical patients.
• Prevention of thrombosis during haemodialysis.

Contra Indications

• Allergy to Heparin or its derivatives.
• Acute bacterial Endocarditis
• Conditions with a high risk of haemorrhage
• Major Bleeding Disorders
• Focal Lesions
• Stroke
• Peptic ulcer
• Ulcerative colitis