Bariatric Surgery

Question 1

What’s the criteria for bariatric surgery?

Answer 1

BMI>40 or 35-39.99 with a significant obesity-related comorbidity, plus documented failure of nonsurgical weight management programs, plus no poorly controlled psychiatric problems

Question 2

What’s the BMI criteria for adolescent bariatric surgery?

Answer 2

BMI 50+

Question 3

What are the two categories of bariatric operations?

Answer 3

1. Restrictive

2. Malabsorptive

Question 4

What are the two types of restrictive bariatric surgeries?

Answer 4

1. Adjustable gastric banding

2. Sleeve gastrectomy

Question 5

What’s the mechanism of adjustable gastric banding?

Answer 5

Silastic band placed around the stomach below the gastroesophageal junction, forming the outlet of a small gastric pouch; balloon attached to band’s inner surface is connected into a subcutaneous port- when sterile water is injected into the port the balloon inflates, which narrows the outlet and limits food intake

Question 6

Is adjustable gastric banding reversible?

Answer 6

Yes, easily

Question 7

What’s the mechanism of sleeve gastrectomy?

Answer 7

Creates a narrow tube from the lesser curvature of the stomach by resection of the greater curvature of the gastric body and fundus; reduces food intake by impeding its transit through the stomach

Question 8

Is sleeve gastrectomy reversible?

Answer 8

No

Question 9

What are the two types of malabsorptive bariatric operations?

Answer 9

1. Biliopancreatic diversion

2. Biliopancreatic diversion with duodenal switch

Question 10

What’s the mechanism of biliopancreatic diversion?

Answer 10

Resection of the gastric antrum and distal gastric body to create a pouch created from the proximal stomach; small intestine is divided proximal to the ileocecal valve to form the alimentary limb which is used to drain the gastric pouch. The biliopancreatic limb is composed of the remaining small intestine and is anastomosed to the alimentary limb proximal to the ileocecal valve

Question 11

What’s a complication of biliopancreatic diversion?

Answer 11

Dumping syndrome

Question 12

What’s the mechanism of biliopancreatic diversion with duodenal switch?

Answer 12

Gastric sleeve is used as the gastric pouch, thereby preserving the pylorus and eliminating the risk of dumping syndrome as a complication

Question 13

What’s the combined restriction and malabsorption bariatric operation?

Answer 13

Gastric bypass

Question 14

What’s the mechanism of gastric bypass?

Answer 14

Alimentary limb is formed from the entire small intestine except for the 40-75cm required to provide hepatic/pancreatic secretions; volume of gastric pouch is reduced to 15-30mL

Question 15

Does gastric bypass have lots of nutritional complications?

Answer 15

No; it has fewer

Question 16

What supplements do you need after bariatric surgery?

Answer 16

Multivitamin, B12, D, Ca, and Fe

Question 17

How often do you have to follow up after bariatric surgery?

Answer 17

At least 4 times in first postoperative year and annually thereafter

Question 18

What’s the average weight loss of any of these surgeries?

Answer 18

Approx 50%, sometimes more, sometimes less

Question 19

What’s the overall reduction of 10-year risk of death from disease?

Answer 19

50%

Question 20

What’s the mortality rate?

Answer 20

0.2%

Question 21

What are the 3 most common causes of death?

Answer 21

1. Sepsis
2. Cardiac
3. PE

Question 22

Which type of operations are the most dangerous in terms of mortality rates?

Answer 22

Malabsorptive