Role of Bariatric Surgery

Question 1

What is the classification of overweight and obese?

Answer 1

Overweight: BMI above 25

Obese: BMI above 30

Question 2

What is the relevance of the apple vs pear shape?

Answer 2

Apple - more visceral fat and higher risk of weight related health problems

Question 3

What are the common health problems associated with obesity?

Answer 3

Dementia

Non-alcoholic fatty liver disease

Hypertension

Diabetes

Cardiovascular disease

Polycystic ovaries

Cancer

Question 4

Define restrictive operations, malabsorptive operations and combination group of operations

Answer 4

Restrictive: Decrease the size of the stomach (gastric band, stapling, sleeve gastrectomy) - satiety with smaller volumes of food

Malabsorptive: Bypassing segments of bowel, cause malabsorption of nutrients

Combinations: Roux -en-Y - ‘gold standard’ for bariatric operation

Question 5

What are the advantages for laparoscopic adjustable gastric banding?

Answer 5

Advantages:

–Relatively minor surgery

–Reversible and adjustable

–Low operative complication rate

–Mortality 0.1%

Question 6

What are the disadvantages for laparoscopic adjustable gastric banding?

Answer 6

–Requires an implanted medical device

–Easier to ‘cheat’

–Risk of prolapse or slippage

–15% will require revisional surgery

Question 7

How does sleeve gastrectomy work?

Answer 7

Decrease in stomach size inhibits distension of the stomach

It becomes fuller sooner - increasing the patients sensation of fullness

Question 8

What are the advantages of sleeve gastrectomy?

Answer 8

–Good medium term outcomes

–No ‘dumping’ syndrome

–No small bowel manipulation

–No foreign body

Dumping syndrome:

a group of symptoms, including weakness, abdominal discomfort, and sometimes abnormally rapid bowel evacuation, occurring after meals in some patients who have undergone gastric surgery.

Question 9

What are the disadvantages of sleeve gastrectomy?

Answer 9

–More invasive surgery

–Long staple line (bleeding/leak)

–Short pedigree

–Mortality 0.4%

Question 10

How does a laparascopic gastric bypass work?

Answer 10

Small tomach pouch is created to restrict food intake. Small portion of the small intestine is attached to the puch to allow food to bypass the lower stomach and the duodenum and the first portion of the jejunum.

Question 11

What are the advantages of laparascopic gastric bypass?

Answer 11

–Quick and dramatic weight loss

–Pedigree

–Dumping syndrome

Question 12

What are the disadvantages of gsatric bypass?

Answer 12

–More invasive surgery

–Malabsorptive component requires lifelong supplements

–More complex if requires revision

–Mortality 0.5%

Question 13

What are the complications associated with bariatric surgery?

Answer 13

• Anastomotic leak
• DVT/PE - important to get the patient mobile very soon after the operation
• Infection
• Malnutrition
• Vitamin and mineral deficiencies (including vitamin B12)
• Hair loss
• Excess Skin
• Addiction transfer

Question 14

What is GLP-1? What is the function?

Answer 14

Glucagon-like peptide 1 (GLP-1) is an incretin hormone that is released into the bloodstream postprandially from the ileum and colon

Function: stimulates insulin secretion in a glucose-dependent manner and decreases appetite

Question 15

What is the effect of bariatric surgery on GLP-1?

Answer 15

Said to create an enhanced postprandial GLP-1 secretion

Question 16

Some statistics:

Answer 16

Roughly 6000 operations per year

60% of patients were aged between 35 and 54

76% of the patients were female

Emphasis on increasing the number of surgeries per year

4% of the UK population reach the threshold for bariatric surgery (2600000)

10% may want surgery

less then or equal to 0.3 % actually receive surgery