Bariatric Surgery Flashcards
How can we quantify obesity?
BMI = kg/square of height in meters
1 pound = 0.5 kg
What are the BMI weight categories?
- underweight: < 18.5
- normal: 18.5 - 25
- overweight: 25 - 29.9
- obese class I: 30 - 34.9
- obese class II: 35 - 39.9
- obese class III: >/= 40
- super obese: >/= 50 - 59.9
- super super obese: >/= 60
Which BMI categories qualify for weight loss surgery?
obese class II (severe) = 35 - 39.9 obese class III (morbid) = 40 or more
What are the complications of obesity?
BIOMECHANICAL
- dismotility/disability
- GERD
- Lung function defects
- Osteoarthritis
- sleep apnea
- urinary incontinence
CARDIOMETABOLIC
- dyslipidemia
- hypertension
- prediabetic & diabetes
- non alcoholic fatty liver disease (steatohepatitis)
- PCOS
- cardiovascular disease
OTHER
- androgen deficiency
- gallstones
- psychological disorders
What are the indications of bariatric surgery?
BMI > 40kg/m2
BMI > 35 kg/m2 but with comorbidities: diabetes, severe hypertension, sleep apnea..
there should be several failed attempts at dieting first
What does the non surgical management of obesity consist of?
- behavioral therapy
- dietary modifications
- pharmacologic treatments
What are the types of surgical management of obesity?
MAL-ABSORPTIVE
- jejunoileal bypass
- bilio-pancreatic diversion (BPD)
- bilio-pancreatic diversion with duodenal switch (BPD-DS)
RESTRICTIVE
- vertical band gastroplasty (VBG)
- laparoscopic adjustable gastric banding (LAGB)
- sleeve gastrectomy (SG)
COMBINED
- gastric bypass
What are the complications of biliopancreatic diversion with duodenal switch (BPD-DS)?
- protein malnutrition
- anemia
- marginal ulcer
- osteoporosis
- ADEK + B12 vitamin deficiencies
What are the complications of the vertical banded gastroplasty (VBG)?
- staple line disruption
- wound infection
- vomiting
- re-operation rate up tp 43%
What is the difference in the average weight loss of excess weight in BPD-DS vs VBG vs RYGBP?
BPD-DS -> 80%
VBG -> 50%
RYGBP -> 70%
What are the advantages vs disadvantages of the LAP-BAND system?
ADVANTAGES
- lowest mortality & complication rate
- least invasive surgical approach
- adjustable
- reversible
- no stapling, cutting, or intestinal diversion
- low malnutrition risk
- takes 1hr/outpatient surgery
DISADVANTAGES
- slower initial weight loss than gastric bypass
- needs regular follow up critical for optimal results
How does sleeve gastrectomy work?
- creates gastric restriction
- appetite suppression -> removes Ghrelin producing part of the stomach
What are the complications of the Roux-en-Y gastric bypass?
- anastomotic leaks
- stricture formation
- pulmonary embolism
- sepsis
- gastric prolapse
- bleeding
- dumping syndrome
- nutritional deficiencies
What is the most important contraindication in restrictive bariatric surgery?
SWEET EATERS
- do bypass instead
When can BIB (gastric balloon) be used?
- in adolescents
- in massively obese patients to reduce their weight before surgery
- those who have a BMI <35
must be removed after 6 months
