Role of Bariatric Surgery Flashcards
What BMI is considered overweight?
25-29.9
What BMI is considered obesity I?
30-34.9
What BMI is considered obesity II?
35-39.9
What BMI is considered obesity III/morbidly obese?
40+
In which patients would you consider bariatric surgery?
Obesity II and III
How is relative risk of death affected by obesity?
Dramatic increase if obese
What is the difference in being apple and pear shape?
Apple - more visceral fat + hence higher risk of wt related problems
Pear - less visceral fat, lower risk of wt related problems
What conditions can obesity metabolic syndrome predispose to?
Strokes Cataracts CHD DM Dyslipidaemia HTN Pancreatitis Cancer Phlebitis Gout OA Gynae problems Gallbladder dx NAFLD Pulmonary disease Idiopathic intracranial hypertension
Can bariatric surgery make a difference?
Decreases risk of cancer, MI related deaths and all deaths
Define bariatric surgery
All surgical procedures used to achieve reduction of excess weight
What are the three types of bariatric surgery?
Restrictive
Malabsorptive
Combination
What are restrictive surgeries?
Decreases size of stomach leading to satiety with smaller volumes of food
Give examples of restrictive surgeries
Gastric banding, stapling or sleeve gastrectomy
What is involved in the malabsorptive surgeries?
Bypassing segments of bowels which causes malabsorption of nutrients
Give an example of a malabsorptive surgery
Biliopancreatic diversion with or without duodenal switch and ileal interposition
Give an example of a combination surgery
Roux-en-Y gastric bypass (this is gold standard for bariatric surgery)
What occurs in laparoscopic adjustable gastric banding?
Hollow silicon band placed around stomach near upper end –> pouch and narrow passage to rest of stomach
Band inflated with isotonic fluids so can be tightened or loosened
What are the advantages of laparoscopic adjustable gastric banding?
Minor surgery
Reversible
Adjustable
Low complication and mortality rate
What are the disadvantages of laparoscopic adjustable gastric banding?
Requires implanted medical device
Easier to cheat
Risk of prolapse/slippage
15% req. revision
What is involved in a laparoscopic sleeve gastrectomy?
Removal of most of stomach, with the remainder looking like a half moon
What are the advantages of a laparoscopic sleeve gastrectomy?
Good medium term outcomes
No dumping syndrome
No small bowel manipulation
No FB
What are the disadvantages of a laparoscopic sleeve gastrectomy?
More invasive
Long staple line - bleeding, leak
Short pedigree
Mortality higher
What is involved in a laparoscopic gastric bypass?
A small pouch is created to restrict food intake + Y shaped section of small intestine is attached to the pouch to allow food to bypass the lower stomach, jejunum + first part of jejunum
What are the advantages of a laparoscopic gastric bypass?
Quick, dramatic wt loss
Pedigree
Dumping syndrome
What are the disadvantages of a laparoscopic gastric bypass?
More invasive
Malabsorption req. lifelong supplements
Highest mortality
What are the complications of a laparoscopic gastric bypass?
Anastomatic leak DVT/PE Infection Malasbrotpion Vit and mineral deficiencies Hair loss xs skin
