Obesity and Surgical Management Flashcards
Why does BMI matter?
higher BMI = higher risk of mortality due to comorbidities liked diabetes, htn, etc.
What must be required before considering bariatric surgery?
trial of medically supervised weight loss
Requirements for bariatric surgery
BMI>40 or >30+comorbidities, qualified surgeon, trial of medically supervised weight loss, multidisciplinary team, lifelong surveillance to avoid surgical complications
Is bariatric surgery effective?
effective weightloss achieved in morbidly obese patients –> substantial # of patients have resolution or improvement of comorbidities like diabetes, hyperlipidemia, hypertension, obstructive sleep apnea
2 choices of bariatric procedures
restrictive (reduces functional space) or mal absorptive (changes transit of food but does nothing to amount of food that can be consumed)
Restrictive procedures
verticle stapled/banded, gastric banding, lap band
Malabsorptive procedures
gastric bypass, duodenal switch/biliopancreatic diversion
T/F more invasive procedures in gastric surgery are associated with increased efficacy
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What is the most common bariatric procedure in europe?
lap band laparascopic gastric band –> recently approved in US –> makes you eat less and slows rate of eating
What is VBGP?
vertical banded gastroplasty = stomach staples –> not so effective because pouch reconnects with stomach
What is the surgical gold standard for bariatric surgery?
Roux en Y Gastric Bypass
Risks of RYGB
malnutrition (due to bypassing 6 feet of bowel), need vitamin/mineral supplements, internal hernia/volvulus –>as fat is lost, bowel has more space to move about
Why is the resected portion of stomach in RYGB left in the patient?
to ensure gastrin, intrinsic factor production
Risks of gastric sleeve
malnutrition, renal/liver failure
Where is ghrelin produced?
fundus –> makes you eat more –> resected in gastric sleeve resection
