Flashcards in Bariatric Surgery Deck (16)
Who is a candidate for surgery?
1. If you have failed medical therapy
2. BMI 40 and over
3. BMI of 35 to 40 and at least 2 obesity comorbidities (diabetes, hypertension, etc)
What are the 4 surgical options?
2. Sleeve Gastrectomy
3. Gastric Bypass
4. Duodenal Switch
What is the benefit to laparoscopic surgery?
less infection rate
What is a lap-band?
- gives the least amount of weight loss (30-40lbs)
- gastric band with a balloon is wrapped around the top of the stomach, it is filled with a certain amount of saline, tightening the head of the stomach so patient can only eat a cup of food at a time and must eat very slowly.
- prolapse can occur
What are the advantages of a Lap-band?
1. simple procedure
2. no intestinal bypass
3. fewer long-term nutritional concerns
4. low risk of complications
What are the disadvantages of a lap-band?
1. band might prolapse and have to be removed
2. least amount of weight loss
3. artificial material in the body
4. frequent followups for saline adjustments
What is a sleeve gastrectomy?
cut away the greater curvature of the stomach leaving a small sleeve that is able to stretch in the presence of food
What are the advantages of a sleeve gastrectomy?
1. no foreign body
2. GI tract still accessible for endoscopy since duodenum is not bypassed
3. iron and calcium are better absorbed than in a bypass
4. can convert to a bypass or duodenal switch
5. way more weight loss, almost equal to gastric bypass
What are the disadvantages of a sleeve gastrectomy?
1. might worsen reflux (less space for food)
2. is a permanent change
3. sleeve may dilate over time
4. may need a second procedure
What is a gastric bypass?
take a small pouch from the proximal stomach and attach to part of the duodenum so the food completely skips the stomach
What are the advantages of a gastric bypass?
1. rapid and drastic weight loss
2. minimally invasive
3. most common
4. highest short term total weight loss
What are the disadvantages of gastric bypass?
1. cutting and stapling of stomach and bowel
2. reduced absorption of essential nutrients
4. mortality rate of 0.2-0.3%
What deficiencies can you get from a bypass?
Vit B, calcium and iron?
What is a duodenal switch?
a sleeve gastrectomy and a bypass to reduce fat absorption.
What are the advantages of a duodenal switch?
1. better for BMI over 50
2. up to 70% excess weight loss over long-term
3. less fat absorption