Bariatric Surgery, C42 P281-283

Question 1

What is it?

P281

Answer 1

Weight reduction surgery for the

morbidly obese

Question 2

Define morbid obesity.

P281

Answer 2

1. BMI >40 (basically, >100 pounds
   above ideal body weight) or
2. BMI >35 with a medical problem
   related to morbid obesity

Question 3

What is the BMI?

P281

Answer 3

Body Mass Index

Question 4

What is the formula for BMI?

P281

Answer 4

Body weight in kg divided by height in

meters squared

Question 5

What is a formula for a
rough estimate of BMI
without using metric
measures?
P282

Answer 5

Wt (pounds) x 703 / (Ht in inches)

Question 6

What medical conditions
are associated with morbid
obesity?
P282

Answer 6

Sleep apnea, coronary artery disease, pulmonary
disease, diabetes mellitus, venous
stasis ulcers, arthritis, infections, sexhormone
abnormalities, HTN, breast
cancer, colon cancer

Question 7

What are the current
options for surgery?
P282

Answer 7

Gastric bypass (malabsorptive)
Vertical-banded gastroplasty

Question 8

Define gastric bypass.

P282 (picture)

Answer 8

Stapling off of small gastric pouch
(restrictive)
Roux-en-Y limb to gastric pouch (bypass)

Question 9

How does gastric bypass work?

P282

Answer 9

1. Creates a small gastric reservoir
2. Causes dumping symptoms when a
   patient eats too much food or highcalorie
   foods; the food is “dumped”
   into the Roux-en-Y limb
3. Bypass of small bowel by Roux-en-Y
   limb

Question 10

Which operation works best
overall?
P283

Answer 10

Gastric bypass (mean weight loss 50% of
excess weight)

Question 11

What are the possible
postoperative complications
after weight reduction
surgery?
P283

Answer 11

Gallstones (if gallbladder in situ),
anastomotic leak, marginal ulcer, stenosis
of pouch/anastomosis, malnutrition,
incisional hernia, spleen injury, iron
deficiency, B12 deficiency

Question 12

What is the most common
sign of an anastomotic leak
after a gastric bypass?
P283

Answer 12

Tachycardia

Question 13

What is the incidence of
anastomotic leak?
P283

Answer 13

≈3% (1%–5%)

Question 14

What is the mortality rate of
an anastomotic leak?
P283

Answer 14

≈10%

Question 15

What is a lap-band?

P283 (picture)

Answer 15

Laparoscopically placed band around
stomach with a subcutaneous port to
adjust constriction; results in smaller
gastric reservoir

Question 16

What is a Petersen’s hernia?

P283

Answer 16

Seen after bariatric gastric bypass—
internal herniation of small bowel through
the mesenteric defect from the Roux-en-Y
limb