Bariatric Surgery Flashcards

1
Q

How can we quantify obesity?

A

BMI = kg/square of height in meters

1 pound = 0.5 kg

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2
Q

What are the BMI weight categories?

A
  • underweight: < 18.5
  • normal: 18.5 - 25
  • overweight: 25 - 29.9
  • obese class I: 30 - 34.9
  • obese class II: 35 - 39.9
  • obese class III: >/= 40
  • super obese: >/= 50 - 59.9
  • super super obese: >/= 60
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3
Q

Which BMI categories qualify for weight loss surgery?

A
obese class II (severe) = 35 - 39.9 
obese class III (morbid) = 40 or more
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4
Q

What are the complications of obesity?

A

BIOMECHANICAL

  • dismotility/disability
  • GERD
  • Lung function defects
  • Osteoarthritis
  • sleep apnea
  • urinary incontinence

CARDIOMETABOLIC

  • dyslipidemia
  • hypertension
  • prediabetic & diabetes
  • non alcoholic fatty liver disease (steatohepatitis)
  • PCOS
  • cardiovascular disease

OTHER

  • androgen deficiency
  • gallstones
  • psychological disorders
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5
Q

What are the indications of bariatric surgery?

A

BMI > 40kg/m2
BMI > 35 kg/m2 but with comorbidities: diabetes, severe hypertension, sleep apnea..

there should be several failed attempts at dieting first

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6
Q

What does the non surgical management of obesity consist of?

A
  • behavioral therapy
  • dietary modifications
  • pharmacologic treatments
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7
Q

What are the types of surgical management of obesity?

A

MAL-ABSORPTIVE

  • jejunoileal bypass
  • bilio-pancreatic diversion (BPD)
  • bilio-pancreatic diversion with duodenal switch (BPD-DS)

RESTRICTIVE

  • vertical band gastroplasty (VBG)
  • laparoscopic adjustable gastric banding (LAGB)
  • sleeve gastrectomy (SG)

COMBINED
- gastric bypass

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8
Q

What are the complications of biliopancreatic diversion with duodenal switch (BPD-DS)?

A
  • protein malnutrition
  • anemia
  • marginal ulcer
  • osteoporosis
  • ADEK + B12 vitamin deficiencies
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9
Q

What are the complications of the vertical banded gastroplasty (VBG)?

A
  • staple line disruption
  • wound infection
  • vomiting
  • re-operation rate up tp 43%
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10
Q

What is the difference in the average weight loss of excess weight in BPD-DS vs VBG vs RYGBP?

A

BPD-DS -> 80%
VBG -> 50%
RYGBP -> 70%

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11
Q

What are the advantages vs disadvantages of the LAP-BAND system?

A

ADVANTAGES

  • lowest mortality & complication rate
  • least invasive surgical approach
  • adjustable
  • reversible
  • no stapling, cutting, or intestinal diversion
  • low malnutrition risk
  • takes 1hr/outpatient surgery

DISADVANTAGES

  • slower initial weight loss than gastric bypass
  • needs regular follow up critical for optimal results
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12
Q

How does sleeve gastrectomy work?

A
  • creates gastric restriction

- appetite suppression -> removes Ghrelin producing part of the stomach

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13
Q

What are the complications of the Roux-en-Y gastric bypass?

A
  • anastomotic leaks
  • stricture formation
  • pulmonary embolism
  • sepsis
  • gastric prolapse
  • bleeding
  • dumping syndrome
  • nutritional deficiencies
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14
Q

What is the most important contraindication in restrictive bariatric surgery?

A

SWEET EATERS

- do bypass instead

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15
Q

When can BIB (gastric balloon) be used?

A
  • in adolescents
  • in massively obese patients to reduce their weight before surgery
  • those who have a BMI <35

must be removed after 6 months

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16
Q

What are the complications of BIB?

A
  • pressure necrosis of the gastric wall
  • bleeding from stomach
  • migration & intestinal obstruction or impaction
  • migration & aspiration
  • intolerance needing removal