Surgery: bariatrics, risks

Question 1

Benefits of bariatric surgery

Answer 1

sustained weight loss

symptom improvement (sleep apneoa, mobility, HTN, DM)

Question 2

Indication for bariatric surgery

Answer 2

all criteria must be met:

• BMI ≥40 or ≥35 with significant co-morbidities
• failure of non-surgical mx for 6 months
• fit for surgery and anaesthesia
• well-informed & motivated patient

(if BMI >50, surgery is 1st-line treatment)

Question 3

laparoscopic gastric banding

Answer 3

Inflatable silicone band around proximal stomach

→small pre-stomach pouch

(limits food intake, slows digestion)

at 1 year 46% mean excess weight loss

Question 4

Roux-en-Y gastric bypass

Answer 4

Oesophagojejunostomy allows bypass of stomach,duodenum and proximal jejunum.

Alters satiety.

Question 5

Adv of Roux-en-Y bypass

Answer 5

Greater wt loss

Lower reoperation rate

Question 6

Complications of Roux-en-Y gastric bypass

Answer 6

Dumping syndrome

Wound infection

Hernias

Malabsorption

Diarrhoea

Mortality 0.5%

Question 7

immediate post-op complications (<24h)

Answer 7

Intubation → oropharyngeal trauma

Surgical trauma to local structures

Primary or reactive haemorrhage

Question 8

Early post op complications (1 day-1 month)

Answer 8

Secondary haemorrhage

VTE

Urinary retention

Atelectasis and pneumonia

Wound infection and dehiscence

Antibiotic association colitis (AAC)

Question 9

Late post op complications (>1 month)

Answer 9

scarring

neuropathy

failure or recurrence

Question 10

Primary haemorrhage

Answer 10

continuous bleeding starting during surgery

Question 11

Reactive haemorrhage

Answer 11

bleeding at the end of surgery or early post-op,

secondary to cardiac output and BP

Question 12

Secondary haemorrhage

Answer 12

bleeding >24h post-op,

usually due to infection