Bariatric Surgery

Question 1

Indications for bariatric surgery

Answer 1

BMI > 40 without comorbidities

BMI 35-39.9 w/ comorbidity

Question 2

CI to bariatric surg

Answer 2

Hx of bulemia
Age > 65 or < 18
For lipid or glycemic control
for CV risk reduction
Major depression
Drug, etoh abuse

Question 3

Most common bariatric surgery

Answer 3

Roux-en Y gastric bypass

Question 4

Roux-en Y gastric bypass (RYGB)

Answer 4

Gastric pouch less than 30 ml.
Small pouch is restrictive and malabsorptive
70% extra weight loss in 2 years

Question 5

Sleeve gastrectomy

Answer 5

Second most common weight loss surgery.
greater curvature of stomach is removed.
Safter than RYGB
Restrictive
60% loss in 2 yrs

Question 6

LAP band

Answer 6

3rd most common
Soft silicone ring that inflates
Allows early satiety
Lowest mortality rate
Restrictive
45-55% loss

Question 7

Surgery follow up

Answer 7

BP and weight every 4-6 weeks for 1st 6 months.

then 9 and 12 months, then anually.

Question 8

Which deficiency does LAP band cause?

Answer 8

Folate

Question 9

Which deficiency does sleeve cause?

Answer 9

B12

Question 10

Med changes post surgery

Answer 10

Change meds to immediate release.
Switch from metformin to insulin
DC antireflux, except with sleeve.

Question 11

How does DM control change?

Answer 11

It gets better.

Question 12

Gastric remnant distention

Answer 12

Rare, possible fatal distention of gastric pouch.

Emergent surgery

Question 13

Stomal stenosis

Answer 13

6-20% of pts
Narrowing on anastamosis to roux limb.
Dysphagia, N/V

Question 14

Marginal ulcers

Answer 14

Acid Injury to jejunum.

Tx with PPI’s

Question 15

Early dumping

Answer 15

Usually happens with ingestion of simple carbs or sugars.
Colicky abd pain soon after ingestion
Diarrhea, nausea, tachy

Question 16

Stomal obstruction

Answer 16

From lap band
Persistent N/V, dysphagia
Band needs to be loosened or decompressed.

Question 17

Band erosion

Answer 17

Usually happens around 22 months

Must be removed