Lecture 20: The Role of Surgery in the Management of Morbid Obesity

Question 1

What is the vicious weight gain?

Answer 1

Cannot lose weight long-term by diet, behavior, and pharmaceuticals

Question 2

What are the NIH recommendations for surgery?

Answer 2

BMI > 40 or >35 with significant comorbidities
Trial of medically supervised weight loss before considering surgery
Lifelong surveillance is necessary

Question 3

What comorbidities can be relieved by bariatric surgery?

Answer 3

1. diabetes
2. hyperlipidemia
3. hypertension
4. obstructive sleep apnea
   Many of these symptoms resolved or improved after bariatric surgery

Question 4

What are the choices of surgical procedure?

Answer 4

1. Restrictive
   
   • vertical stapled or banded gastroplasty
   • gatric banding
   • LapBand gastric banding
2. Mal-absorptive
   
   • gastric bypass
   • duodenal switch/biliopancreatic diversion

Question 5

What is the most common bariatric procedure in Europe?

Answer 5

LapBand laparoscopic gastric banding

Question 6

What is Roux-en-Y gastric bypass?

Answer 6

When you connect the proximal pouch of the stomach to the small intestine limb (roux or short small bowel limb)
Gold Standard

Question 7

What is the gold standard type of gastric bypass surgery in the US?

Answer 7

Roux-en-Y gastric bypass

Question 8

Why do you keep the stomach in for a Roux-en-Y gastric bypass?

Answer 8

Because stomach produces intrinsic factor for B12

Question 9

What is duodenal switch operation?

Answer 9

When you bypass the duodenum and jejunum and connect the ileum to the pyloric valve

Question 10

What does bariatric surgery prevent?

Answer 10

Bariatric surgery prevents

i. diabetes
ii. cancer