Gastric Bypass Surgery and Sleeve Flashcards
Indications for bariatric surgery
BMI >40
BMI >35 with medical comorbidity
BMI calculation
kg/m2
or roughly: (wt x 703)/in2
Options for surgical weight loss
Gastric bypass (best) Sleeve
Parts of gastric bypass
Stapling off pouch (restrictive)
Roux-en-Y limb to gastic pouch (bypass)
Mech of bypass:
- Small gastric reservoir
- Intentional dumping when overeats - dumped into Roux-en-Y limb
- Bypass of small bowel by limb
Postoperative complications
Gallstones Anastomotic leak (3%) Marginal ulcer (.6-16%) Stenosis (6-20%) Incisional hernia Reminant distension
Dumping syndrome
Malnutrition
Iron def
B12 def
Most common sign of leak after surgery?
Tachycardia
Incidence of anastomotic leak
~3% (1-5%)
Mortality rate with anastomotic leak
10%
Define Petersen’s hernia
Internal herniation of small bowel through mesenteric defect from roux-en-Y limb (specifically at the transverse mesocolon)
Possiblity of SBO d/t defect is 3-5% lifetime
Ventral incision hernia risk (laproscopic)
0-1.8%
Ventral incision hernia risk (open)
Up to 26% (30% per Dr. Roller, all comers)
Post-op bypass stenosis:
rate
def
tx
6-20%
Lumen <10mm
Tx with balloon
Post-op bypass gallstones: rate
Up to 38% w/in 6 months
Rapid weight loss leads increasing lithogenicity of bile
Ppx ursodeoxycholic acid decreased to 6%
Dumping syndrome (early)
W/in 15 minutes of eating
High simple carb/amount
Fluid shifts in -> dumping
Colicky pain, nausea, diarrhea, tachy
Dumping syndrome (late)
Aka postprandial hyperinsulinemic hypoglycemia (PHH)
Up to 0.3%, 1-3 hours after meal, years after surgery
B12 deficiency
Up to 1/3 of patients
Pathophys: inadequate gastric acid available (less intrinsic factor activation) and less intrinsic factor (less parietal cells)
IF-B12 absorbed in terminal jejunum
What is the ligament of tritz?
Remanent of middle bowel looping in embryology
Marks end of duodenum and beginning of ileum
Causes of marginal ulcers
Poor tissue perfusion Foreign material near anastomosis Acid exposure NSAID use H pylori infection Smoking
Marginal ulcer complication rate
0.6-16%
