Bariatric Surgeries

Question 1

Biliopancreatic diversion with duodenal switch (BPD/DS)

Answer 1

Procedure:
- Step 1: sleeve gastrectomy in which 80 percent of the stomach is removed leaving a smaller tube-shaped stomach –> the pyloric valve and duodenum remain
Step 2: connects the end portion of the intestine to the duodenum near the stomach

Points:
- limits how much you can eat
- reduces absorption of nutrients

Target Population:
- significantly overweight with trouble losing a large amount of weight
- BMI > 50
- lower BMI but other weight-related conditions

Benefits: decreased risk of
- Heart disease, high blood pressure, high cholesterol, sleep apnea, T2DM, stroke, infertility

Risks:
- Short Term: bleeding, infection, adverse effects of anesthesia, blood clots, breathing issues, GI leaks
- Long Term: Bowel obstruction, dumping syndrome, gallstones, hernias, low blood sugar, malnutrition, stomach perforation, ulcers, vomiting

Question 2

Endoscopic sleeve gastroplasty

Answer 2

Procedure:
- no cuts associated
- suturing device is inserted into the throat and down the stomach and the stomach is sutured to make it smaller

Target Population:
- BMI > 30
- unable to maintain weight loss with lifestyle changes
- do not qualify for traditional bariatric surgery

Benefits: decreased risk of
- Heart disease, stroke, sleep apnea, T2DM, GERD, joint pain by osteoarthritis

Risks:
- pain and nausea

Question 3

Gastric bypass (Roux-en-Y)

Answer 3

Procedure:
- creating a small pouch from the stomach and connecting the newly created pouch directly to small intestine
- swallowed food will then go into small pouch and directly into the small intestine

Target Population:
- BMI > 40
- BMI 35.5-39.9 + weight-related issues (T2DM, HTN, sleep apnea)

Benefits: decreased risk of
- Heart disease, GERD, HTN, High cholesterol, sleep apnea, T2DM, Stroke, Cancer, Infertility

Risks:
- Short Term: bleeding, infection, adverse reaction to anesthesia, blood clots, breathing issues, GI leakage
- Long Term: bowel obstruction, dumping syndrome, gallstones, hernias, low blood sugar, malnutrition, stomach perforation, ulcers, vomiting

Question 4

Intragastric balloon

Answer 4

Procedure:
- places a saline filled silicone ballon in the stomach by limiting how much you can eat and cause satiety

Target Population:
- BMI 30-40
- willing to commit to healthy lifestyle changes
- not had any previous stomach & esophageal surgery

Benefits: decreased risk of
- GERD, heart disease, stroke, HTN, sleep apnea, fatty liver disease, steatohepatitis, T2DM

Risks:
- pain and nausea
- if balloon deflates, may move through digestive system and cause blockage
- overinflation
- acute pancreatitis
- ulcers

Question 5

Sleeve gastrectomy

Answer 5

Procedure:
- vertical sleeve gastrectomy typically performed laparoscopically involving insertion of small instruments through multiple incisions in the upper abdomen removing 80% of the stomach and leaving a tube-shaped stomach

Target Population:
- BMI > 40
- BMI 35.5-39.9 + weight related problem (T2DM, HTN, sleep apnea)

Benefits: decreased risk of
- heart disease, HTN, high cholesterol, sleep apnea, T2DM, stroke, cancer, infertility

Risk:
- Short Term: bleeding, infection, adverse reactions anesthesia, blood clots, breathing issues, GI leaks
- Long Term: GI obstruction, hernias, GERD, low blood sugar, malnutrition, vomiting