bariatric surgery Flashcards
indication for bariatric surgery
morbid obesity BMI:-
- above 40
- 35 with co morbidity (ex.DM)
35 year old male came to the clinic asking if he can do bariatric surgery his BMI is 36 he is known case of major depressive disorder ..
can the patient undergo the sugery?
what is the initial steps prior to doing the surgery?
patient BMI is 36 and have depression (co morbid dissease)
1- inital steps is to refer the patient to a nutritenist and runing some lab result like TSH (some conditions like hypothyroidsm can be treated with hormonal therapy)
also you need to request a psychological assessment to see if obesity is a cause of his depression in which the surgery would be indicated
1- hormonal study, nutritional assessment
2- upper GI endoscopy (H.pylori, hiatel hernia)
3- then abdominal ultra sound (gallstone)
name of this operation? what is the mechanism? complication? is it restrictive, malabsobtive or both?
Adjustable gastric band,
spliting the stomach into 2 pouches to decrese food intake
rarely any complication but its not done anymore as its sucsuss rate are low (patient cheat the the mechanism drinking high calorie drink like milkshake which passes the band easily)
name of this operation? what is the mechanism? complication?
is it restrictive, malabsobtive or both?
gastric bypass
spliting stomach to 2 pouch, upper small pouch, lower big pouch
distal part of jeujenum connect to upper part of stomach
proximal part of jeujenum is side connected to dudenom
- Gastrojejunostomy
- Jejunojejunostomy
restriction of food intake and malabsorbtion (not all food have the time to get absobed )
not used now due to 1% mortailty rate because of leakage
vitamin deficiency (patient must take vitamin b12, calcium, vitamin D, iron, folic acid (so iron deficiency dose not hsppen), multivitamin because it include zinc (loss of hair, knee problem))
name of this operation? what is the mechanism? complication?
is it restrictive, malabsobtive or both?
biliopancreatic diversion (scopinaro) done with or without dudenal switch
very dangerous procedure
basically we cut a large portion of small bowel bypassing the stomach to the remaining part so that only small amount of food is absorbed
leading to significant weight loss (super morbid obese patients bmi 60)
high mortality rate, protein deficency do not recommend
name of this operation? what is the mechanism? complication?
is it restrictive, malabsobtive or both?
Gastric sleeve
removing 2/3 of stomach 75% using a calibration tube and stapling the remaining 1/3,, residual part is removed from body
note: removing fundus (which produces gherlin; hunger secreting hormon)
its restrictive not malabsobtive no life time of vitamins
1-3% leak due to pyloric back pressure usually at gastroesophageal junction in this case stents are placed from the esophegus to the stomach and precutanous ct guided drain is placed for 2 days ,, stent removed after 6 weeks
do patients reach ideal weight after they go through gastric sleeve?
dosent lead to ideal weight .. patient must excersize ( the operation make you lose up to 2/3 of the excess weight
name of this operation? what is the mechanism? complication?
is it restrictive, malabsobtive or both?
intra gastric ballon
insertion of an inflapable ballon in the stomach, once inside the ballon is inflated
its restrictive , taking space so the stomach cant hold much food
no complication
for patients who are not indicated for bariatric surgery (obese patiants need to lose a lot of weight gastric ballon will only help losing small amount of weight)
Why do we add methylene blue inside gastric ballon?
if the ballon bursts the gut absorb methylene blue leading to change in color of urin to green ,, we tell patients to notice the color of the urine and if it changes they come to the hospital
name of this operation? what is the mechanism? complication?
is it restrictive, malabsobtive or both?
mini gastric bypass
cutting stomach into 2 pouch (upper lower)
upper (smaller) pouch bypass to jejunum single anastomosis
we do test during the operation to test for leakage
restricitve and malabsorbtive
complication: vitamin deficency, lifetime neeed of (calcium, D, B12, iron, folic acid, multi vitamin)
ideal bariatric surgery for dm type 2 patient
mini gastric bypass
