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Jaime Ponce, MD FACS FASMBS Director of Bariatric Surgery Hamilton Medical Center Dalton GA

MISS Morbid Obesity Salt Lake City, Utah. February 24-26, 2011. New Band Concepts: Pressure Stabilizer Self-Adjusted Band Device. Jaime Ponce, MD FACS FASMBS Director of Bariatric Surgery Hamilton Medical Center Dalton GA. Disclosures. Allergan: speaker, proctor, consultant, research

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Jaime Ponce, MD FACS FASMBS Director of Bariatric Surgery Hamilton Medical Center Dalton GA

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  1. MISS Morbid Obesity Salt Lake City, Utah. February 24-26, 2011 New Band Concepts: Pressure Stabilizer Self-Adjusted Band Device Jaime Ponce, MD FACS FASMBS Director of Bariatric Surgery Hamilton Medical Center Dalton GA

  2. Disclosures • Allergan: speaker, proctor, consultant, research • Vibrynt: consultant • ReShape: research • Cavu Medical: consultant

  3. Green Zone • Requires: • Band in good position • No hiatal hernia • Modification of eating habits • Follow-up visits • Frequent adjustments during the first year

  4. Green Zone • Roughly: • 1/3 relatively easy • 1/3 difficult • 1/3 unable or difficult to mantain

  5. Factors affecting staying in the Green Zone • Diurnal variations (i.e. AM tightness) • Food irritation, stuck, etc. • Stoma gastritis (i.e. NSAID’s, medications) • Stress • Etc.

  6. Hypothetical Fills for First 6 Months Add 1.0 1.0 0.5 TEV 3.8 4.8 5.3

  7. What happen between adjustments? • Patients feel “less” restriction and weight plateaus, why?: • Stomach gets thinner? • Perigastric fat melts? • Fluid “permeate” out? • Air left in the system (air tends to leak out) • Band silicone balloon “relaxes”?

  8. Dixon, O’Brien: Permeability of the Silicone Membrane Discrepancy in vivo: 0.1-0.3cc in 100 days Obes Surg (2005) 15, 624-9

  9. Intra-Band Pressures in LAGBRauth et al (Vanderbilt University) JACS 2008; 206:926-34 Decrease in intraband pressure between adjustments: possibly related to a change in the elastic properties of the band’s silicone diaphragm over time

  10. Factors affecting restriction • Amount of perigastric fat enclosed in the band • Gastric tissue thickness • Degree of inflammation • Fibrotic capsule formation • Tightness of gastro-gastric plication.

  11. Intraluminal Manometry vs Intra-Band PressureFried et al, Obes Surg 2010;20:1102-9

  12. Intraluminal Manometry vs Intra-Band PressureFried et al, Obes Surg 2010;20:1102-9

  13. Effects of Gastric Band Adjustments on Intraluminal PressureBurton et al, (CORE Melbourne Australia) Obes Surg 2009;19:1508-14

  14. Effects of Gastric Band Adjustments on Intraluminal Pressure IBP

  15. Concept:Pressure Stabilizer Self-Adjusted Band Device • Premise: intra-band pressure correlates with stoma diameter and adjustment volume for a designated restriction level • Concept: utilize intra-band pressure to maintain the level of restriction designated (ideally “green zone”)

  16. Device Design Goals • Maintain the band setting that is tuned by the surgeon • Behave like a band that is continuously being adjusted by moving fluid in and out of the band

  17. Possible Approach • Rather than modifying the fundamentals of how a band works add something to augment the band • Alter compliance/capacitance of system- make pressure less sensitive to changes in volume • Solution has to be simple, safe, easy to use

  18. Modified Rauth- Stabilized Pressure Stabilized Pressure

  19. Better Maintenance of Pressure When Stomach Size Changes

  20. Schematic of Band and Reservoir Empty, no pressure/volume reservoir port band Filled, pressure/volume P reservoir port band Fluid flows back and forth between band and reservoir to maintain pressure equilibrium P Stomach/stoma

  21. Stomach, Band and Reservoir in Pressure Equilibrium P P • Compressive contact between stomach and band • As a result of the contact pressure stomach outer diameter is reduced and band inner diameter is increased • Stomach and Band are in pressure equilibrium • Reservoir and Band are in pressure equilibrium

  22. Stomach Shrinks P P Stomach fat/tissue within band shrinks reducing contact pressure and intra-band pressure Without reservoir contact is lost and pressure drops dramatically In response to stomach fat/tissue shrinkage fluid flows from reservoir to band to backfill the new volume and maintain pressure equilibrium and contact with the stomach

  23. Stomach Swells P P P P Stomach tissue swells and increases contact pressure against band P P In response fluid flows from the band to the reservoir to restore pressure equilibrium

  24. Conclusion • Hypothesis: IBP stabilizer can be used to prolong maintaince of a band patient in the “green zone” • Avoiding excessive tightness from other source • Mantaining green zone during physiologic variations • Less adjustments, self-adjusted and less “emergency” fluid removal

  25. Third Annual And Endoluminal / Restrictive Procedures • March 21-22, 2011 • The Loews Hotel • Miami, Florida • Fundamentals of Gastric Band & Patient Management • Management of Complex Patients & Complex Operative Scenarios • Scientific Evidence for Mechanisms of Action • Emerging Technologies in Minimal Access, Endoluminal Procedures & Robotic Register at GastricBandSummit.com

  26. Thank you!

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