Role of Bariatric Surgery

Question 1

What BMI is considered overweight?

Answer 1

25-29.9

Question 2

What BMI is considered obesity I?

Answer 2

30-34.9

Question 3

What BMI is considered obesity II?

Answer 3

35-39.9

Question 4

What BMI is considered obesity III/morbidly obese?

Answer 4

40+

Question 5

In which patients would you consider bariatric surgery?

Answer 5

Obesity II and III

Question 6

How is relative risk of death affected by obesity?

Answer 6

Dramatic increase if obese

Question 7

What is the difference in being apple and pear shape?

Answer 7

Apple - more visceral fat + hence higher risk of wt related problems

Pear - less visceral fat, lower risk of wt related problems

Question 8

What conditions can obesity metabolic syndrome predispose to?

Answer 8

Strokes
Cataracts
CHD
DM
Dyslipidaemia
HTN
Pancreatitis
Cancer
Phlebitis
Gout
OA
Gynae problems
Gallbladder dx
NAFLD
Pulmonary disease
Idiopathic intracranial hypertension

Question 9

Can bariatric surgery make a difference?

Answer 9

Decreases risk of cancer, MI related deaths and all deaths

Question 10

Define bariatric surgery

Answer 10

All surgical procedures used to achieve reduction of excess weight

Question 11

What are the three types of bariatric surgery?

Answer 11

Restrictive
Malabsorptive
Combination

Question 12

What are restrictive surgeries?

Answer 12

Decreases size of stomach leading to satiety with smaller volumes of food

Question 13

Give examples of restrictive surgeries

Answer 13

Gastric banding, stapling or sleeve gastrectomy

Question 14

What is involved in the malabsorptive surgeries?

Answer 14

Bypassing segments of bowels which causes malabsorption of nutrients

Question 15

Give an example of a malabsorptive surgery

Answer 15

Biliopancreatic diversion with or without duodenal switch and ileal interposition

Question 16

Give an example of a combination surgery

Answer 16

Roux-en-Y gastric bypass (this is gold standard for bariatric surgery)

Question 17

What occurs in laparoscopic adjustable gastric banding?

Answer 17

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

Question 18

What are the advantages of laparoscopic adjustable gastric banding?

Answer 18

Minor surgery
Reversible
Adjustable
Low complication and mortality rate

Question 19

What are the disadvantages of laparoscopic adjustable gastric banding?

Answer 19

Requires implanted medical device
Easier to cheat
Risk of prolapse/slippage
15% req. revision

Question 20

What is involved in a laparoscopic sleeve gastrectomy?

Answer 20

Removal of most of stomach, with the remainder looking like a half moon

Question 21

What are the advantages of a laparoscopic sleeve gastrectomy?

Answer 21

Good medium term outcomes
No dumping syndrome
No small bowel manipulation
No FB

Question 22

What are the disadvantages of a laparoscopic sleeve gastrectomy?

Answer 22

More invasive
Long staple line - bleeding, leak
Short pedigree
Mortality higher

Question 23

What is involved in a laparoscopic gastric bypass?

Answer 23

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

Question 24

What are the advantages of a laparoscopic gastric bypass?

Answer 24

Quick, dramatic wt loss
Pedigree
Dumping syndrome

Question 25

What are the disadvantages of a laparoscopic gastric bypass?

Answer 25

More invasive
Malabsorption req. lifelong supplements
Highest mortality

Question 26

What are the complications of a laparoscopic gastric bypass?

Answer 26

Anastomatic leak 
DVT/PE
Infection 
Malasbrotpion 
Vit and mineral deficiencies
Hair loss
xs skin