Bariatric Surgery

Question 1

Bariatric Surgery Indications

Answer 1

BMI above 40 w/o comorbidities

Question 2

Contraindications of Bariatric Surgery

Answer 2

History of bulimia
Age > 65 or < 18
For lipid or glycemic control
For CV risk reduction
Untreated major depression or psychosis
Binge-eating disorders
Current drug or alcohol abuse
Severe cardiac disease with prohibitive anesthetic risks
Severe coagulopathy
Inability to comply with requirements including (life-long nutritional supplements) & dietary changes**

Question 3

Malabsorptive surgeries

Answer 3

Jejunoileal bypass

Duodenal switch operation

Question 4

Restrictive surgeries

Answer 4

Vertical banded gastroplasty
Laparoscopic adjustable gastric banding
Sleeve gastrectomy

Question 5

Combination restrictive/malabsorptive surgeries

Answer 5

Roux-en-Y gastric bypass (RYGB): DOES NOT cause significant macronutrient deficiencies
Biliopancreatic diversion
Biliopancreatic diversion with duodenal switch

Question 6

Micronutrient Deficiency

Answer 6

Lap Band: Folate deficiency

Sleeve gastrectomy: B12

RYGB:
Vit A, D, E, K, B1 (thiamine), B12
Iron, Copper, Zinc
Folic acid, Biotin, Selenium

Question 7

Medication management post surgery

Answer 7

Oral contraceptive pills may be less effective
In general avoid NSAIDs:
Especially in patients who have had a Roux-en-Y, are set up for ulcers!

Question 8

Early dumping syndrome

Answer 8

15 min after eating development of colicky abdominal pain, diarrhea, nausea and tachycardia
Up to 50% of patients develop either early or late dumping syndrome after bypass surgery
Prominent post ingestion of simple carbohydrates

Question 9

Late dumping syndrome

Answer 9

2-3 hours after a meal
Dizziness, fatigue
Diaphoresis and weakness