Bariatric Surgery Flashcards
Compare how men and women store fat?
Men tend to store fat inside their abdomen (apple shape), this visceral fat is far more dangerous
Women store fat in the hips/thighs (pear shaped), i.e. non visceral
What is the obesity metabolic syndrome?
A number of diseases developing due to someones obesity
e.g. cancer, hypertension, diabetes, NAFLD, heart disease etc
Categories of bariatric surgery?
Malabsorptive e.g biliopancreatic diversion
Restrictive e.g. gastric band
Combination e.g. gastric bypass
Describe a Laparascopic Adjustable gastric band?
- Small incisions in upper part of abdomen
- Usually laparascopic
- The band is placed in the upper part of the stomach, just below the gastr-oesophageal junction
- The band can inflated with saline
- Usually tightened enough to reduce food intake but not enough to cause nausea, vomiting or discomfort
- Allows smaller meals to be consumed and satiety is reached earlier
- The size of the pouch determines how quickly food will leave the stomach
Pros and cons of gastric bands?
Pros:
- Minor surgery
- Reversible/adjustable
- Low risk of complications
Cons:
- implanted device
- Easier to cheat
- 15% need further surgery
- Less effective
Describe a Sleeve Gastrectomy?
Cutting out most of the stomach, basically reducing its size
A type of restrictive surgery it reduces hunger
Pros and cons of a sleeve gastrectomy?
Pros:
- No foreign body or small bowel manipulation
Cons:
- quite invasive
- Long staple line that can bleed/leak
How does a laprascopic gastric bypass work?
- Makes a pouch of the upper stomach
- Connect Jejunum direct to the stomach pouch
- Connect duodenum to further down jejunum.
This means you don’t eat so much and it bypasses some of the small bowel (while still allowing gastric acid/bile/pancreatic enzymes to reach the main tube.
Pros and cons of a laparscopic gastric bypass?
Pros:
- Quick and dramatic effect
- Gold standard
- Up and about the day after
Cons:
- Invasive
- Lifelong supplements required
- Risk of dumping syndrome (although it does put patients off high sugar foods)
- Difficult if revision required
What complications can arise from bariatric surgery?
General surgical complications:
- Anastomotic leaks
- Infection
- DVT/PE
Specific:
- Malnutrition
- Vitamin Deficiency
- Hair Loss
- Excess Skin
- Addiction transfer (adjusting to a new potentially dangerous coping mechanism e.g. alcohol)
What is intra-gastric baloon?
- In pill form- once it reaches the stomach it opens up and balloon is released
- Band placed around the stomach
- Creates a pouch with passage into stomach
- Given to patients with a BMI between 27-41
- Inflated with saline
- Advantage: Non-operative, removable
- Disadvantages: potential regain of weight after removal. Long term complications e.g. hernia
Women referral for bariatric surgery
- Over 35
- 90Kg
- BMI 35kg/m2
- Type 2 DM
Men referral for bariatric surgery
- Over 50
- 150kg
- BMI: 55kg/m2
- Hormone therapy
- Ischeamic heart disease
- Chronic kidney disease
- Sleep apnea
Gastric bypass description
- Most common bariatric surgery/ GOLD STANDARD with quick results
- Stomach is stapled into 2 sections
- The Jejunum is also stapled into 2 sections. The distal section is then connected to the stomach pouch.
- This helps decrease the amount of food that is consumed before feeling full
- It also limits the amount of food which is absorbed in the SI.
- The rest of the stomach, pancreas and liver are excluded from the alimentary path and connected to the proximal part of the SI which then connects to the rest of the SI
Risk associated with bariatric surgery
-High chance of remission compared to control
-Poor control of hyperglycemia
-Risk of MI/Stroke
-Risk of cancer
However:
-Cost compared with control is lower
-Reduced risk of mortality
