Bariatric/MIS

Question 1

management of a slipped gastric band?

Answer 1

immediately remove saline from the band and take pt to OR for removal (can strangulate the herniated stomach)

Question 2

where is a gastric band placed?

Answer 2

proximal stomach, oriented medial to lateral in an inferior to superior position

Question 3

what is a highly selective vagotomy?

Answer 3

removes only the innervation to the lesser curvature of the stomach and preserves the innervation to the pylorus (does not require a drainage procedure, low risk of dumping syndrome)

Question 4

what is a truncal vagotomy?

Answer 4

severs both vagi as they course along the esophagus near the diaphragmatic hiatus, thus pylorus loses innervation so you need a drainage procedure and higher risk of dumping syndrome

Question 5

where do the vagi nerves sit for truncal vagotomy?

Answer 5

LARP: left anterior, right posterior

Question 6

what is the #1 MCC dysphagia following fundoplication?

Answer 6

Postop edema

Question 7

what are the percentages of average Excess BW loss for:

1. gastric band
2. sleeve
3. NYGB

Answer 7

1. 50% (slower, pks at 2yrs)
2. 60% (faster pks 1.5yrs)
3. 75% (faster, pks 1.5yrs)

Question 8

what is afferent loop syndrome and what are the risk factors for it? (technical) tx?

Answer 8

obstruction of the afferent limb (kinking, stricture, internal herniation) in B2 anastomoses

• risks: long afferent limb (30-40cm), antecolic anastomosis
• tx: convert to B1 or RNYGB, enteroenterostomy

Question 9

MOA Orlistat

Answer 9

inhibits gastric and pancreatic lipases for weight loss, decreases absorption of FFA