Bariatric Surgery (Obesity)

Question 1

What is only effective method of sustaining weight loss for individual with BMI>35?

Answer 1

Bariatric surgery

Question 2

Ideal bariatric surgery candidate

Answer 2

Failed other modalities
No endocrine cause of obesity
No alc/drugs
Knowledgeable about procedure
Motivated

Question 3

What are requirements regarding weight management before surgery

Answer 3

Pt must have history of multiple diet attempts

Question 4

Are adolescents acceptable for bariatric surgery?

Answer 4

Ya, but slower process.

Careful consideration, need consensus with patient and family

Question 5

What are surgical options?

Answer 5

Roux-en-Y: Combination malabsorptive and restrictive
Laparoscopic gastric banding: restrictive
Sleeve gastrectomy: restrictive

Question 6

Describe metabolic effects of bariatric surgery procedures:

Answer 6

Rewatch

Question 7

Describe adjustable gastric band operation timeline

Answer 7

Operation=30-45 minutes
Overnight hospital stay
Normal activity in 5-7days
Diet from liquid=>puree=>regular diet

Question 8

What are risks/complications of adjustable gastric band

Answer 8

Bleeding: PE, MI
Intestinal obstruction
hernias
Mechanical failure: slippage, migration, erosion
10-15% re-operative rate

Question 9

What are expected weight loss with adjustable gastric band?

Answer 9

20-30lb in first month
1-2lbs per week
average in 1 year=60lbs

Question 10

What is most freuently performed bariatric procedure?

Answer 10

Roux en Y

Question 11

Roux en Y timeline

Answer 11

Operation time: 1-3hr
Hospital stay: 2.5d
return to normal activity: 7-10d
Diet advancement from liquids to puree to regular diet
Not reversible

Question 12

What is expected weight loss in Roux en Y?

Answer 12

20-30lbs in first month

75-100lbs in first 6 months

Question 13

What are risks/complications related to Roux-en-Y?

Answer 13

Bleeding
intestinal obstruction
hernias
Leaks: .5-2%
Strictures: 3%
ulcers ,dumping syndrome, malnutrition

Question 14

Vertical Sleeve Gastrectomy Timeline

Answer 14

Operation time: 1-2hr
Hospital stay: 2.5d
Return to normal activity: 7d

Irreversible

Question 15

Risks/complications of vertical sleeve gastrectomy

Answer 15

Bleeding
Intestinal obstruction
hernias
Leaks/vistulas
Injury to spleen/splenectomy
Stricture

Question 16

What are mortality rates for each procedure?

What are causes? (2)

Answer 16

Adjustable gastric band: .1%
Roux-en-Y bypass: .5%
Vertical sleeve gastrectomy: .25%

Causes are PE and MI