Bariatric Surgery Flashcards
Who is a candidate for surgery?
- If you have failed medical therapy
- BMI 40 and over
- BMI of 35 to 40 and at least 2 obesity comorbidities (diabetes, hypertension, etc)
What are the 4 surgical options?
- Lap-Band
- Sleeve Gastrectomy
- Gastric Bypass
- Duodenal Switch
What is the benefit to laparoscopic surgery?
less infection rate
What is a lap-band?
- gives the least amount of weight loss (30-40lbs)
- gastric band with a balloon is wrapped around the top of the stomach, it is filled with a certain amount of saline, tightening the head of the stomach so patient can only eat a cup of food at a time and must eat very slowly.
- prolapse can occur
What are the advantages of a Lap-band?
- simple procedure
- no intestinal bypass
- fewer long-term nutritional concerns
- low risk of complications
What are the disadvantages of a lap-band?
- band might prolapse and have to be removed
- least amount of weight loss
- artificial material in the body
- frequent followups for saline adjustments
What is a sleeve gastrectomy?
cut away the greater curvature of the stomach leaving a small sleeve that is able to stretch in the presence of food
What are the advantages of a sleeve gastrectomy?
- no foreign body
- GI tract still accessible for endoscopy since duodenum is not bypassed
- iron and calcium are better absorbed than in a bypass
- can convert to a bypass or duodenal switch
- way more weight loss, almost equal to gastric bypass
What are the disadvantages of a sleeve gastrectomy?
- might worsen reflux (less space for food)
- is a permanent change
- sleeve may dilate over time
- may need a second procedure
What is a gastric bypass?
take a small pouch from the proximal stomach and attach to part of the duodenum so the food completely skips the stomach
What are the advantages of a gastric bypass?
- rapid and drastic weight loss
- minimally invasive
- most common
- highest short term total weight loss
What are the disadvantages of gastric bypass?
- cutting and stapling of stomach and bowel
- reduced absorption of essential nutrients
- permanent
- mortality rate of 0.2-0.3%
What deficiencies can you get from a bypass?
Vit B, calcium and iron?
What is a duodenal switch?
a sleeve gastrectomy and a bypass to reduce fat absorption.
What are the advantages of a duodenal switch?
- better for BMI over 50
- up to 70% excess weight loss over long-term
- less fat absorption
