THURSDAY, October 13th, 2011 —SWLC is delighted to return to the largest trade show for women in Canada on Friday,  November 11 – Sunday, November 13 at the Toronto National Women’s Show at the Metro Toronto Convention Centre. This is SWLC’s 3^rd consecutive year in showcasing its clinic and effective weight loss programs for achieving and maintaining weight loss. Since 2005, SWLC has been a proud contributor and have helped over 3,000 patients overcome their struggle with obesity.

At this year’s National Women’s Show, SWLC will be introducing an exciting never before feature in which visitors will get a chance to meet a Lap-Band patient and ask their questions. This is a great opportunity for those interested in learning more about SWLC’s  program in recognizing the benefits and life-changing possibilities associated with the Lap-Band.

Most notably, SWLC Medical Director and Surgeon, Dr. Chris Cobourn, will be making an appearance on the Health & Wellness Stage on Sunday, November 13^th at 11:15am for his presentation on “The Lap-Band and Gastric Balloon: Innovative Solutions for Sustained Weight Loss”. Not only has Dr. Cobourn been a recognized surgeon in the medical community since 1989, but he has served on expert committees to help establish worldwide standards for bariatric surgery. In addition to his record of accomplishments, Dr. Cobourn is an international and national contributor to Lap-Band research regarding its effectiveness and safety with three publications in his profile.

Find out more by stopping at the SWLC booth! Meet Dr. Cobourn, ask your questions, and get free goodies during your visit!

See you there!

SWLC is proud to announce the publication of our 2^nd clinical research report in the prestigious “Obesity Surgery Journal” in September of 2011.  This study shows that the Lap-Band procedure can be safely performed in out-patient facilities – even for patients who would otherwise be considered high risk due to sleep apnea or respiratory problems. If you are a health care professional or you would like more information about this research report, please go to the SWLC HCP section.

This study documented that Laparoscopic Adjustable Gastric Banding (LAGB) can be safely performed in an outpatient facility in a group of patients at high risk for sleep apnea. This review was conducted in association with Dr. M. Kurrek, Dr. A. Kiss and Dr. S.L. Dain & Dr. Z. Wojtasik and myself from the Surgical Weight Loss Centre (SWLC). We reviewed 2,370 patients who undergone Lap-Band surgery between 2005 and 2009 who were classified as high risk for sleep apnea or met at least three STOP-BANG criterias.

A total of 746 of the 2,370 patients (31%) met criteria for or were at high risk for sleep apnea. There were no deaths and no cases of respiratory failure or re-intubation. The 30 day anesthesia related morbidity was less than 0.5%.

This clinical report was conducted due to the controversy that exists regarding perioperative management of patients at high risk of sleep apnea.

For more information on the clinical study, tables, figures and references, visit http://bit.ly/p2Vh5p.

Happy reading!

Dr. Cobourn

THURSDAY, September 15th, 2011 —- The Surgical Weight Loss Centre (SWLC) is pleased to announce the latest added service dedicated to providing excellence in care for patients. Effective September 1^st SWLC can now assist our patients arrange financing with payments as low as $85 per week with $0 down payment.  As part of SWLC’s ongoing commitment in providing the highest quality of care to patients, not only will this new service provide assistance to those financing their weight loss procedures, but is also convenient.

Since 2005, SWLC has helped over 3,000 patients throughout Canada in achieving sustained weight loss to improve their overall health and quality of life. SWLC is Canada’s distinguished provider of the Lap-Band and Gastric Balloon programs. Its qualified surgeons are internationally known as experts and are active in research and submitting publications regarding the Lap-Band, its efficacy and safety.

For more information on how SWLC can assist with financing, please contact a patient coordinator at (905) 278-8000 or toll-free 1 (888)278-7952 or at info@swlc.ca.

Written by: Ted Michaels

WEDNESDAY, Sept 7th, 2011 (Sports Network)— Mike Jovanovich knew exactly when it happened.

The former offensive lineman, who graduated from Boston College, signed as a free agent with the Seattle Seahawks in 1992. He joined the Hamilton Tiger- Cats after being released by Seattle, and also played for the Toronto Argonauts, Ottawa and Montreal.

Like many of his peers, Jovanovich waged a running battle with his weight, during and after his playing days.

“My first year as a freshman at Boston College, I weighed 300 pounds,” he told Inside the CFL. “At the end of my playing days there, I weighed 285 pounds. In my CFL days, I played around 300-305 pounds.”

Then, he admits, the problems started.

“I left football in 1996, got married and started having kids. After all the years of lifting weights and maintaining my weight, you get to a stage in life where other activities become more important. I wasn’t as active as when I was playing, so in the first three years or so after I retired, I probably ballooned up to 340 or 350 pounds. It took me around three years to finally get motivated enough to go back into the gym and resume some sort of the grind, similar to when I was playing.”

However, as he points out, when you battle a weight problem, it’s not a matter of just exercising.

“My defining moment was in February 2009,” said Jovanovich. “I went for a physical. We did the usual tests, cholesterol, blood pressure and so forth. I was as healthy as a 6-foot-5, 250-pound person. But one of the comments from the doctor was ‘Mike, you’re in fantastic shape, but as you get older, as you carry this excess weight, it’ll start to put a toll on your body.’ I had the exercise part down, but the eating in moderation part wasn’t working. I’d go to the gym in the morning, and come home and eat three bagels.”

So, he decided to resort to a drastic measure: Laparoscopic band surgery.

“Dr. Chris Cobourn, my bariatric surgeon, is a pioneer in the field,” Jovanovich said. “In essence, in layman’s terms, they put a throttle on the gas tank. They put a band on the top of the stomach, and create a little pouch. It tricks your brain into thinking you’re fuller, faster, so it reduces the caloric intake. The band can either be constricted or you can fill it up. It’s not invasive surgery at all.”

The Toronto native says the decision wasn’t too difficult to make.

“A friend of mine had it, and had great results. I talked it over with my wife, and because I wanted to coach my daughters’ hockey team and we had travel plans, I just decided, I didn’t want to be big anymore.”

Jovanovich also knows he was a good candidate for the surgery, because, even though he weighed well over 300 pounds, he didn’t suffer from any long-term effects from playing football.

“I was pretty fortunate that I didn’t have serious injuries. I had pulled muscles, but never had reconstructive surgery on the knees or my back or shoulders. I was healthy bone-structure wise, but getting into my 40s, I thought I should do something about it.”

Once he had the surgery, he noticed the difference in his diet.

“I could eat a whole pizza for lunch, but now, I have a slice of pizza maybe once a month. I just know the volume of breads, starches and carbs that I consumed was a vast amount, and now, it’s 10 percent of what I used to eat.”

The reaction he gets from ex-teammates and friends is one of amazement, and concern.

“The first thing people ask me, is ‘Jovo, are you sick?’” he chuckled. “Normally you don’t see a lineman drop that much weight. I know it is a cause for concern for some O-linemen, because most of the guys I played with are now in their late 40ss.”

While he doesn’t recommend the surgery for everyone, he says, the numbers show that, for him, it’s a success.

“When I stepped on the scale prior to the surgery, I was 348 pounds and today, I’m about 257,” he said. “My waist size went from 50 to 40.”

TUESDAY, June 14th, 2011 (www.newscanada.com) — A new survey from the Canadian Obesity Network–Réseau canadien en obésité (CON–RCO) found that 84 per cent of Canadians with severe obesity are motivated to lose weight and eight–in–ten respondents say their main motivating factor is to improve their overall health. This is not surprising given that 75 per cent report having one or more accompanying conditions, including high blood pressure, high cholesterol and diabetes.

Lucille Bisignano is familiar with the motivation to lose weight to improve her overall health. “In addition to being severely obese I was also living with diabetes and high blood pressure, taking countless medications. I had seen a number of doctors and dietitians about my weight but nothing worked for me. I knew I needed to make a change and that’s when I decided to undergo the gastric banding procedure. Since having the procedure, I’ve lost over 190 pounds. As a result of my weight loss, my blood pressure has stabilized, my diabetes is in remission and I no longer have to take any medication.”

Many Canadians face the same struggles that Lucille did in achieving sustained weight loss. Sixty-one per cent of Canada’s severely obese population report that weight loss is an uphill battle for them as they have too much to lose, and four in 10 feel discouraged about trying another weight loss program for fear of failing again.

Dr. Christopher Cobourn is the medical director and surgeon at the Surgical Weight Loss Centre. He sees hundreds of patients each year who want to lose weight, but struggle.

“Many patients who come into my office are frustrated and depressed with their repeated failure to sustain weight loss,” says Dr. Cobourn. “It’s critical that these patients understand that there is no ‘one–size–fits–all’ approach to weight loss. Only after understanding all the treatment options, including surgery and medically–assisted weight loss procedures, can these patients make an informed decision. This allows them to feel empowered to live their life without being controlled by their weight issues.”

In Canada, there are different medically–assisted weight loss procedures available, including: the gastric balloon, laparoscopic adjustable gastric banding (or gastric banding) and gastric bypass. You can learn more about these procedures online at www.yourmomentoftruth.ca.

TUESDAY, May 31st, 2011 (24 Hours) — Gillian Taggart was tired with dealing with her obesity and did something about it.

In January 2010, Taggart, a mother of two from Brampton decided to undergo Lap Band surgery, a minimally invasive procedure that places a band around the top part of the stomach. The band holds food for a short time before letting it pass through the stomach, sending signals to the brain of being full or satisfied.

“I had reached a point in being overweight where I felt trapped, I felt I couldn’t lose weight on my own, or I could but I would just gain it all back,” said Taggart who has since lost 120lbs. and is living an active lifestyle.

According to a survey released by the Canadian Obesity Network, 31% of Canadians with severe obesity have struggled with weight their entire life.

Dr. Chris Cobourn, Medical Director and Surgeon of Surgical Weight Loss Centre in Mississauga says not only do these individuals have health issues such as high blood pressure and diabetes to deal with, but also social pressures.

“Some people come to this moment, and we call it the moment of the truth…’why are you here now?’ after dealing with weight issues all their lives,” Dr. Cobourn said.

“For most people, something’s happened in their lives…it’s a health motivator and a social one also.”

Surgical Weight Loss Centre Lap-Band Information Seminar – A Solution to Achieving & Maintaining Weight Loss

Tuesday, May 3rd 2011

7:00 pm to 8:30 pm

Delta Bow Valley (Downtown Calgary Hotel) – Conservatory Room

209-4^th Avenue SE, Calgary, AB

Parking: $6.00 flat rate (underground parking)

Surgical Weight Loss Centre Alberta is hosting its first Lap-Band Information Seminar for those interested in learning about an effective sustained weight loss treatment that has been performed on over 750,000 patients worldwide. Dr. Phil Mitchell, Medical Director and Surgeon of SWLC Alberta will be hosting the seminar and cover topics such as:

• What is the Lap-Band and how does it work?
• How much weight will I lose and how fast?
• What are the benefits of the Lap-Band versus other weight loss procedures?
• What are the risks and how fast is the recovery?
• How will the Surgical Weight Loss Centre support me after the procedure?
• How do I know if I am a candidate for the procedure?

If you have a family member or a friend who is also interested in the Lap-Band program, we encourage their attendance. Light refreshments will be provided.

Register now to reserve your seat and the chance to win an exciting door prize. Please RSVP to info@swlc.ca by May 1^st or call 1-888-278-7952.

We look forward to seeing you there!

Dr. Mitchell and the Surgical Weight Loss Centre Team

Authors: Jacque Himpens, MD; Guy-Bernard Cadiere, MD, PhD; Michel Bazi, MD; Michael Vouche, MD; Benjamin Cadiere, MD; Giovanni Dapri, MD

ABSTRACT

Objective: To determine the long-term efficacy and safety of laparoscopic adjustable gastric banding (LAGB) for morbid obesity.

Design: Clinical assessment in the surgeon’s office in 2009 (>12 years after LAGB).

Setting: University obesity centre in Brussels, Belgium.

Patients: A total of 151 consecutive patients who had benefited from LAGB between January 1, 1994, and December 31, 1997, were contacted for evaluation.

Intervention: Laparoscopic adjustable gastric banding.

Main Outcome Measures: Mortality rate, number of major and minor complications,  number of corrective operations, number of patients who experienced weight loss, evolution of comorbidities, patient satisfaction, and quality of life were evaluated.

Results: The median age of patients was 50 years (range, 28-73 years). The operative mortality rate was zero. Overall, the rate of follow up was 54.3% (82 of 151 patients). The long-term mortality rate from unrelated causes was 3.7%. Twenty-two percent of patients experienced minor complications, and 39% experienced major complications (28% experienced band erosion). Seventeen percent of patients had their procedure switched to laparoscopic Roux-en-Y gastric bypass. Overall, the (intention to treat) mean (SD) excess weight loss was 42.8% (33.92%) (range, 24%-143%). Thirty-six patients (51.4%) still had their band, and their mean excess weight loss was 48% (range, 38%-58%). Overall, the satisfaction index was good for 60.3% of patients. The quality-of-life score (using the Bariatric Analysis and Reporting Outcome System) was neutral.

Conclusion: Based on a follow up of 54.3% of patients, LAGB appears to results in a mean excess weight loss of 42.8% after 12 years or longer. Of 78 patients, 47 (60.3%) were satisfied, and the quality of life index was neutral. However, because nearly 1 out of 3 patients experienced band erosion, and nearly 50% of the patients required removal of their bands (contributing to a reoperation rate of 60%), LAGB appears to results in relatively poor long-term outcomes.

Arch Surg. Published online March 21, 2011. doi: 10.1001/archsurg.2011.45

__________________________________________________________________________________________

I have reviewed the article published in the Archives of Surgery by Dr. Jacques Himpens and colleagues from Belgium.  Review of the paper shows that the authors completed 151 gastric band procedures over a four year period (average of 38 procedures per year). The technique and device implanted are no longer used in today’s gastric banding procedures. This is an ill-constructed, single-center clinical assessment that does not meet the high clinical standards we should expect from peer-reviewed data, and is not reflective of today’s clinical standards. 

This particular study in question contains various flaws and is contradictory to a large number of well-controlled clinical studies published in peer-reviewed literature today.  Specifically, I would like to call your attention to the following important facts that impact the study’s conclusions:

• The study was conducted in Europe, where band-adjustment and follow-up have not been emphasized as important to success.
• Completeness of follow up is severely deficient. Nearly half of the 151 patients (69) were lost to follow up. A further 12 patients appear to have had follow up by correspondence only. This should not be considered acceptable. Only 70 of the 151 patients had office follow up and weight measurement.

1. The study’s reported results were based on a very small number of patients (82).

2. The weight loss data was only provided for even fewer patients at the 12-year mark (70).

3. Follow-up occurred in just over 50% of the patients – this leaves a large number for which data is not accountable.

• As mentioned, this was a single-center retrospective study, therefore patient selection was potentially biased and one cannot generalize the data to represent the population in general.
• This report represents early experience with surgeons still on the learning curve. A total of 151 patients were treated over 4 years (<38 patients per year) at the very beginning of the introduction of the gastric band procedure – from Jan 1994 to Dec 1997.  This is a very low volume of procedures.  Our clinic has performed over 3000 procedures since 2005.  These were among the first patients treated with LAGB anywhere in the world and it is misleading to report these patients as if they represent what can be expected of LAGB today.
• The study used older band models that have not been used since 2006.
• Importantly, Himpens et al used an inferior and outdated band implantation technique (peri-gastric technique).  This technique was shown to lead to a much higher rate of complications and has not been used for over a decade.   The current technique (pars-flaccida) is the standard method used around the world and has been shown to lead to a significantly reduced rate of complications. 
• Some of the other criticisms’ of the reported technique are: 
  1. The authors used radiological adjustment without any clear definition of how this was done.  Most high volume gastric band clinics adjust bands according to individual patient results and clinical criteria.  This has been shown to lead to significant improvement in results and fewer complications.
  2. Infrequent follow up visits. They aimed for 2-4 visits in first year and 2 per year thereafter but provided no data on whether this was achieved.  Most high volume gastric band clinics aim for at least 6 – 8 visits or follow up consultations in the first year.
  3. The authors provided no data on patient information/education. Good patient education and guidance is critical for success and is not documented in this report.
• The erosion rate in the study is uniquely high (29%) and is strongly suggestive of problems with the technique of gastric band insertion.  The accepted erosion rate based on a number of studies reported in the literature is less than 1%.  Our experience with erosion (<1%) and explantation (<1%) is more representative of the world’s literature and nowhere near the results in the paper quoted. A review of this issue is to be published soon.

In contrast, there have been a number of well-conducted clinical studies that have been published in recent years both in the United States and in Europe, which support the safety and efficacy of the gastric band procedure.  

• Carelli AM, Youn HA, Kurian MS, Ren CJ, Fielding GA, Safety of the laparoscopic adjustable gastric band: 7-year data from a U.S. center of excellence, published in Surgical Endoscopy in February 2010
  • Retrospective analysis of almost 3,000 patients who underwent gastric banding between January 1, 2001 and February 29, 2008, which is the largest series to date on gastric banding outcomes at a single institution (NYU, NY).
  • Key Findings: Gastric Banding is a relatively safe procedure with few early or late complications; Few patients undergo reoperation for weight gain and mortality is very rare 

• J.-M. Chevallier (Paris, France) Gastric Banding in 2010, published in Journal of Visceral Surgery (2010) 147S, e21-e29
  • 1,000 patients followed for 8 years
  • Key Findings: Gastric banding results in satisfactory and safe weight loss and risk of band removal with banding at 7 years is low, approximately 7%.

In summary, the authors arrived at conclusions regarding the safety and effectiveness of the gastric banding procedure based on surgical techniques and gastric band devices that are not current to the practice of gastric band surgery today.  As such it is inappropriate to generalize their results to the procedure as it is performed today.  It is unfortunate that this report has received widespread media coverage.  There are plenty of well performed studies that demonstrate the safety and effectiveness of Lap-Band surgery and these studies should be included with any balanced discussion of the options in weight loss surgery.

Respectfully submitted.

Dr. C.S. Cobourn

Written By: Celia Milne

TUESDAY, January 18th, 2011 (Metro Canada) — You could call it the belly bandwagon.  Belly band surgery is increasingly popular among obese patients.

Dr. Chris Cobourn, a general surgeon at The Surgical Weight Loss Centre in Mississauga, performs Lap-Band surgery, and watches as patients as heavy as 575 lbs lose weight and get healthy.

“They love their band. No one wants to be obese. They are incredibly frustrated and depressed and a lot of patients have low self-esteem. This gives them a simple, elegant solution and they are the happiest patients in the world,” says Dr. Cobourn.

“It’s very safe,” he adds, “We’ve done over 3,000 here with no major complications or deaths.”

Lap-Band surgery is not for folks who just want to lose 10 pounds. It’s for those with a BMI over 35 or a BMI over 30 coupled with medical problems such as diabetes, high blood pressure or sleep apnea.

“It should be about improving one’s health. The goal is to induce significant weight loss and keep it off,” says Dr. Cobourn. The Centre has a clinic in Vancouver and hopes to open soon in Calgary and on the east coast.

Lap-band surgery is done laparoscopically, and takes about half an hour. The surgeon places an adjustable band around the upper stomach, which decreases the amount of food the stomach can hold. The band can then be adjusted through an access port just under the skin on the abdomen. People generally return to work after about four days.

The idea, says Dr. Cobourn, is to lose one or two pounds a week. When weight plateaus, the band gets tightened. If a female patient gets pregnant, the band can be loosened.

The procedure has been popular and successful, says Dr. Cobourn. “Only about 10 per cent of patients either didn’t lose 25 per cent of their body weight, or asked to have their band removed.”

For more on the article, please visit  http://www.metronews.ca/toronto/life/article/745956–obese-patients-belly-up.