Bariatric treatment

Question 1

Give 2 examples of restrictive surgery

Answer 1

Laparoscopic gastric banding

Laparoscopic sleeve gastrectomy

Question 2

Give an example of malabsorptive bariatric surgery

Answer 2

Laparoscopic BilioPancreatic Diversion with Duodenal Switch

Laparoscopic BPD with DS

Question 3

Give an example of a combined bariatric surgery

Answer 3

Laparoscopic gastric bypass

Also known as Laparoscopic Roux-en-Y Gastric Bypass

Question 4

What are the NICE guidlines criteria for bariatric surgery

Answer 4

BMI > 40
BMI > 35 with co-morbidities
Failure of conservative treatment
No alcoholism or major psychiatric problems
No pregnancy within 2 yrs

Question 5

What is the welsh entry criteria for bariatric surgery?

Answer 5

BMI > 50
T2DM- uncontrolled
Hypertension- uncontrolled
OSA (obstructive sleep apnoea)

Question 6

Describe a Laparoscopic Adjustable Gastric Band

Answer 6

Gastric band produces a small stomach pouch (30ml)

Adjustable through titanium port under skin at sternum

Question 7

What are the advantages and disadvantages of LAGB?

Answer 7

Advantages:
Simplest procedure
Reversible
Quick recovery
55-60% excess weight loss

Disadvantages:
Need ptx compliance, portion control
Reflux 
Band displacement
Erosion
Infected port site
10-15% will require further surgery

Question 8

Describe a Laparoscopic Sleeve Gastrectomy

Answer 8

Removal of 80% of the stomach; most of fundus removed, which has the highest concentration of ghrelin secreting cells

Gold standard

Question 9

What are the advantages and disadvantages of LSG?

Answer 9

Advantages:
60% excess weight loss at 2 yrs
Reduces transit time

Disadvantages:
Leak
Reflux
Stenosis
Dilatation
Pt comliance, portion control

Question 10

Describe a BPD with DS

Answer 10

Sleve gastrectomy
Duodenum cut and attached further down GI tract
Bypasses small intestine, which carries bile & pancreatic secretions, which joins stomach contents shortly before reaching caecum

Question 11

Advantages and disadvantages of BPD with DS?

Answer 11

Advantages:
Normal portion sizes
90% excess weight loss at 2yrs
Excellent co-morbidity resolution

Disadvantages:
Most complex surgery
Lifetime on high protein diet
Ptx can be profoundly malabsorbed, vitamins & proteins
0.5% mortality
2% leek rate

Question 12

Describe Laparoscopic Roux-en-Y Gastric Bypass

Answer 12

Similar to BPD
Stomach cut to create small puch, but fundus remains in abdomen attached to duodenum
Billiary and pancreatic juices meet chyme earlier