Role of Bariatric surgery on obesity and its complications

Question 1

At what levels of obesity/BMI are people indicated for bariatric surgery?

Answer 1

Obesity II - BMI 35-39

Obesity III - BMI >40

Question 2

What is metabolic syndrome, and what diseases can it cause?

Answer 2

Metabolic syndrome, sometimes known by other names, is a clustering of at least three of the five following medical conditions: abdominal obesity, high blood pressure, high blood sugar, high serum triglycerides and low high-density lipoprotein (HDL) levels.

CVD, stroke, cataracts, pulmonary disease, nonalcoholic fatty liver disease, cancer, pancreatitis, phlebitis, gout

Question 3

What are the mechanisms of bariatric surgery?

Answer 3

• Restrictive
• Malabsorptive
• Combination

Question 4

What are the 3 different types of bariatric surgery?

Answer 4

Laparoscopic Adjustable Gastric Banding
Laparoscopic Sleeve Gastrectomy
Laparoscopic Gastric Bypass

Question 5

What are the advantages and diasadvantages of laparoscopic adjustable gastric banding?

Answer 5

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

Disadvantages
–	Requires an implanted medical device
–	Easier to ‘cheat’ e.g. soft ice cream etc
–	Risk of prolapse or slippage
–	15% will require revisional surgery

Question 6

What are the advantages and disadvantages of laparoscopic sleeve gastrectomy?

Answer 6

Advantages:
o	Good medium term outcomes
o	No ‘dumping’ syndrome
o	No small bowel manipulation
o	No foreign body

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

Question 7

What is dumping syndrome, and what procedure is it associated with?

Answer 7

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.

Most commonly seen in those who have undergone laparoscopic gastric bypass surgery

Question 8

What are the advantages and disadvantages of laparoscopic gastric bypasses?

Answer 8

Advantages:
– Quick and dramatic weight loss
– Pedigree
– Dumping syndrome

Disadvantages:
–	More invasive surgery
–	Malabsorptive component; lifelong supplements
–	More complex if requires revision
–	Mortality 0.5%

Question 9

What % of those with bands will require revision surgery?

Answer 9

15% will require revisional surgery

Question 10

What is the mortality rate in those with gastric sleeves?

Answer 10

Mortality 0.4%

Question 11

What is the mortality rate in those with gastric bypasses?

Answer 11

Mortality 0.5%

Question 12

What are some complications of bariatric surgeries?

Answer 12

• Anastomotic leak
• DVT/PE – risk of surgery
• Infection
• Malnutrition
• Vitamin and mineral deficiencies – give supplements
• Hair loss
• Excess Skin

Question 13

What % of BMI eligible patients are suitable for surgery?

Answer 13

80%

Question 14

How many bariatric operations are done every year?

Answer 14

6000

Question 15

What is the european bariatric surgery average?

Answer 15

50,000