Role of Bariatric Surgery

Question 1

Describe an apple shape.

Answer 1

• More visceral fat

- higher risk of weight-related health problems

Question 2

Describe a pear shape

Answer 2

• Less visceral fat

- Lower risk of weight related health problems

Question 3

What are the features of obesity metabolic syndrome?

Answer 3

• Stroke
• Cataracts
• Coronary heart disease
• Diabetes
• Dyslipidaemia
• Hypertension
• Severe pancreatitis
• Cancer
• Phlebitis
• Gout
• Skin problems
• Osteoarthritis
• Gynaegologic abnormalities
• Gall bladder disease
• NAFLD
• Pulmonary disease
• Idiopathic intracranial hypertension

Question 4

What are the options for bariatric surgery?

Answer 4

• Restritive
• Malabsorptive
• Combiantion

Question 5

What should be taken into account when deciding a management plan?

Answer 5

Patients choice

• Peers
• Celebrities
• Safety

Bariatric MDT choice

• Personal/units experience
• Patients BMI/co-morbidities/diet

Question 6

What are the advantages of a laparoscopic adjustable gastric banding procedure?

Answer 6

Relatively minor surgery
-Reversible and adjustable
Low operative complication rate
-Mortality 0.1%

Question 7

What are the disadvantages of a laparoscopic adjustable gastric banding procedure?

Answer 7

• Requires an implanted medical device
• Easier to cheat
• Risk of prolapse or slippage
• 15% will require revisional surgery

Question 8

What are the advantages of a laparoscopic sleeve gastrectomy?

Answer 8

• Good medium term outcomes
• No ‘dumping’ syndrome
• No small bowel manipulation
• No foreign body

Question 9

What are the disadvantages of a laparoscopic sleeve gastrectomy?

Answer 9

• More invasive surgery
• Long staple line (bleeding/leak)
• Short pedigree
• Mortality 0.4%

Question 10

What are the advantages of laparoscopic gastric bypass?

Answer 10

• Quick and dramatic weight loss
• Pedigree
• Dumping syndrome

Question 11

What are the disadvantages of a laparoscopic gastric bypass?

Answer 11

• More invasive surgery
• Malabsorptive component requires lifelong supplements
• More complex if requires revision
• Mortality 0.5%

Question 12

What are the possible complications of bariatric surgery?

Answer 12

• Anastomotic leak
• DVT/PE
• Infection
• Malnutrition
• Vitamin and mineral deficiencies
• Hair loss
• Excess skin
• Addiction transfer

Question 13

What effect will an increase in GLP-1 have on the brain?

Answer 13

• Decrease migraine
• Decrease depression
• Decrease BIH
• Decrease stroke
• Decrease appetite
• Increase satiety
• Increase cognitive function

Question 14

What effect will an increase in GLP-1 have on the skin?

Answer 14

Decrease psoriasis

Question 15

What effect will an increase in GLP-1 have on the pancreas?

Answer 15

• Decrease T2DM

- Increase insulin production

Question 16

What effect will an increase in GLP-1 have on the respiratory tract?

Answer 16

• Decrease OSA

- Decrease asthma

Question 17

What effect will an increase in GLP-1 have on the musculoskeletal system?

Answer 17

• Decrease osteoarthritis

- Decrease gout

Question 18

What effect will an increase in GLP-1 have the heart?

Answer 18

• Decrease CVD
• Decrease hypercholesterolemia
• Decrease hypertension

Question 19

What effect will an increase in GLP-1 have on the GIT?

Answer 19

• GERD
• Decrease Ghrelin
• Increase PYY
• Altered bile acids
• Altered gut microbiota

Question 20

What are the general effects an increase in GLP-1 will have on the body?

Answer 20

• Decrease mortality
• Decrease certain cancers
• Difference in metabolic adaptation to weight loss
• Increase in diet induced thermogenesis
• Decrease in insulin resistance
• Increase in glucose disposal
• Decrease in PCOS
• Decrease in urinary stress incontinence

Question 21

What are the 4 tiers of management in bariatric medicine?

Answer 21

• Universal interventions
• Lifestyle interventions
• Specialist services
• Surgery