Bariatric surgery

Question 1

What is the role of bariatric surgery?

Answer 1

Direct management of obesity and obesity-related comorbidities

Question 2

What is the metabolic syndrome?

Answer 2

The cluster of conditions caused by obesity

They act as the risk factors for the complications for obesity

Question 3

What conditions are included in the metabolic syndrome?

Answer 3

Heart disease

Hyperglycaemia

Hypertension

Type 2 diabetes

Dementia

Cancer

Polycystic ovarian syndrome

Non-alcoholic fatty liver disease

Question 4

What is the effect of bariatric surgery on patients long term weight?

Answer 4

All forms of Bariatric surgery cause long term weight loss. Following the weight lost from the surgery, patients tend to put weight back on - but not nearly as much as previously

Question 5

What is the effect of bariatric surgery on diabetes remission?

Answer 5

Huge increase in 2-year remission rate - with bariatric surgery

So 65% return to state of ‘no indication of diabetes’ at 2 years

Over 10 year period - remission rate drops however remains significantly higher than in those who do not receive surgery

Question 6

Summarise what risks bariatric surgery reduces in patients who are obese

Answer 6

Diabetes

MI, Stroke

Cancer (except in men in the short term)

General mortality

Question 7

What is the cost-effectiveness of bariatric surgery?

Answer 7

Bariatric surgery is more cost-effective than conventional controls

Question 8

What are the types of bariatric surgeries?

Answer 8

Gastric band

Laparoscopic sleeve gastrectomy

Laparoscopic gastric bypass

Question 9

What is a gastric band?

Answer 9

inflatable silicone device placed around the top portion of the stomach to treat obesity, intended to decrease food consumption

Question 10

What is a laparoscopic sleeve gastrectomy?

Answer 10

Procedure in which the stomach is reduced to about 15% of its original size, by surgical removal of a large portion of the stomach along the greater curvature

Question 11

What is a laparoscopic gastric bypass?

Answer 11

process in which the stomach is divided into a small upper pouch and a much larger lower “remnant” pouch and then the small intestine is rearranged to connect to both

Question 12

What is a non-operative option for the management of obesity?

What are its advantages and disadvantages?

Answer 12

Intra-gastric balloon

Advantages:

• Non-operative
• Removable
• BMI 27-50 (can be done at lower BMI’s than surgery I think)

Disadvantages:

• Potential weight regain after removal

Contraindications - Large hiatus hernia, PUD, Anticoagulation

Question 13

Complete the ranges for the different groups of obesity

From what BMI is surgery indicated?

Answer 13

BMI of 40 and up

Question 14

What healthcare workers are in the MDT for bariatric surgery?

Answer 14

Dietitian

Radiologist

Psychologist

Bariatric nurse specialists

Anaesthetists

Gastroenterologists

Surgeons

Question 15

Other than surgery stuff - what referrals are made/who does a bariatric patient see?

Answer 15

Bariatric physicians

Education programme

Psychologists

Dietitian

Question 16

What are common problems that occur following bariatric surgery?

Answer 16

Constipation

Thirst

Flabby skin

Hair loss

Question 17

What nutritional supplements are given to patients following a sleeve gastrectomy and gastric bypass?

Answer 17

• Multivitamins & minerals
• Iron
• Vitamin B₁₂
• Calcium & Vitamin D

Question 18

What blood tests are required for sleeve gastrectomy or gastric bypass?

Answer 18

• LFTs
• FBC
• Ferritin
• Folate
• Vitamin B₁₂
• Calcium
• Vitamin D
• Parathyroid hormone
• Zinc, copper

Question 19

What legal sort of thing do patients need to complete for bariatric surgery and why?

Answer 19

Contract to comply with long term follow-up