Role of Bariatric Surgery in the Management of Obesity and its Impact on Obesity Related Comorbidities Flashcards
how does fat distribution differ between males and females?
visceral fat is the main thing that causes problems - Visceral fat is body fat that is stored within the abdominal cavity and is therefore stored around a number of important internal organs such as the liver, pancreas and intestines
what things may obesity cause?
not just calorie intake contributes to obesity, what else does?
genetic aspect
environmental aspect
does bariatric sugery make a difference?
Gastric bypass – GBP
VBG - Vertical banded gastroplasty (VBG), also known as stomach stapling, is a form of bariatric surgery for weight control. The VBG procedure involves using a band and staples to create a small stomach pouch
how does bariatric surgery affect diabetes?
how do MI and stroke events change after a bariatric surgery
how do cancer events change following bariatric surgery?
how does mortality risk change after bariatric surgery?
is bariatric surgery cost effective?
- Bariatric surgery is more cost effective than conventional controls
- Saving on medication and on co-morbities so long term this saves patient as the original surgery is expensive but form then on it is cheaper
what is a gastric band?
A laparoscopic adjustable gastric band is an inflatable silicone device placed around the top portion of the stomach to treat obesity, intended to decrease food consumption
Not put in regularly
Taken out a lot as they cause problems
Nothing cut or joined
Very low chance of dying
Band around upper part of stomach
Inject water into port and inflates band and constricts stomach
Vagal nerve fibres tell brain it is full
Sometimes patients can cheat
Lose 15-20% of body weight
Can slip
Can get infected
What is a Laparoscopic Sleeve Gastrectomy?
Laparoscopic sleeve gastrectomy is a restrictive procedure without the malabsorptive component present in other bariatric procedures. It involves resection of two-thirds of the stomach to provide increased satiety and decreased appetite
Taking 4/5 of the stomach away and left with tiny cylinder
Also doesn’t work completely due to hormonal factors
Switches off a patient hunger
Liver reduction diet for 2 weeks and all they eat is protein before surgery
Ghrelin is the hunger hormone removed
25% body weight lost
what is Laparoscopic Gastric Bypass?
considered the “gold standard” for weight-loss surgery. RYGB works by restricting food intake and by decreasing the absorption of food
Staple off a bit of stomach and leave the rest of the stomach where it is and take a bit of small bowel and bring it up
Can only eat small volumes
Some degree of malabsorption as bypassing duodenum and part of jejunum
how is bariatric surgery carried out?
Open surgery they will have big wounds and be at risk of DVTs, infections etc, so often done laparoscopically
what is a Intra-gastric Balloon?
A gastric balloon, also known as stomach balloon, is an inflatable medical device that is temporarily placed into the stomach to reduce weight
Don’t cut anything but put a balloon in stomach and inflate it
Not as much weight loss, maybe around 5-10%
When comes out they put weight back on
what are the advantages of an intra-gastri balloon?
- Non operative weight loss option
- Removable
- BMI 27-50
what ar ethe disadvantages of an intra-gastric balloon?
- Potential weight regain after removal
- CI: Large hiatus hernia, PUD (peptic ulcer disease), Anticoagulation
what are the statistics of bariatric surgery?
- Average BMI 49 kg/m2
- 76% female
- Average number of obesity-related comorbidities was 3.6
- 8 recorded deaths with in-hospital mortality 0.05%
- i.e. Survival rate 99.95%
- Average hospital stay 2.6 days
how do you classify someone for bariatric surgery?
These are the different classifications/criteria for bariatric surgery
Asian population can have a lower BMI and get it
what is the tier management of dealing with people who have diabetes?
what is the NHS prioritisation criteria for bariatric surgery?
who is involved in the MDT that deals with an obese patient?
what problems may occur following weight loss surgery?
hair loss
excessive skin
Drinking more difficult. Eating and drinking at the same time is tough due to small stomach
Can lead to constipation
What does someone need to do for the rest of their lifes after having bariatric surgery?
Keep an eye on nutritional status
Iron deficiency anaemia, Vitamin d and calcium deficiencies, Vitamin B12 are all common
Give all patients vitamin supplements
what is the reason many people have problems with bariatric surgery?
People go abroad like praque and get bariatric surgery and then come back and don’t get follow up and then there is complications
A lot of work is revisional surgery
Summary:
- Surgery is NOT an ____ fix
- Surgery is for ____
- Contract to comply with ____ ____ follow up
- Surgery is NOT an easy fix
- Surgery is for life
- Contract to comply with long term follow up
