Flashcards in Bariatric Surgery Deck (25):
What is the Body Mass Index (BMI)?
weight (kg)/ height (m)^2
What BMI qualifies a pt for bariatric surgery?
- severely obese (BMI 35 - 39.9)
- morbidly obese (BMI 40 or more)
What does leptin do?
- decreases appetite
*obese patients may have a decreased sensitization to this hormone.
What does ghrelin do?
- increases appetite.
What is important about the gallbladder regarding bariatric surgery?
following surgery, pts are more prone to gallstones, and thus if a pt has gallstones prior to surgery, they will likely be getting a cholecystectomy during the surgery as well.
How has obesity changed over the past 30 years?
it has increased in both sexes in all age groups and all racial groups.
How have bariatric operations since 1992 increased?
- increased steadily (200,000 per year now).
*this is reaching 1% those whom need it.
What are the requirements for bariatric surgery?
- BMI >40
- BMI 35-40 then need either obstructive sleep apnea, T2DM, or HTN.
- Age >18 (this doesn't hold true today).
Why do we no longer do jejunoileal bypass?
bc it left a large portion of the jejunum with no flow through it, leading to electrolyte abnormalities, osteoporosis, steatosis, protein malnutrition, edema, gallstones, and toxic overgrowth of bacteria in the bypassed intestine.
Why do we no longer do vertical banded gastroplasty?
- its a restrictive procedure that creates a small pouch that empties into the rest of the stomach through a small opening. PTs regained weight eventually.
What general procedures are done today?
- combination of the two.
What are the most common surgical options today?
- gastric bypass
- sleeve gastrectomy
- adjustable gastric band
What is gastric bypass?
small gastric pouch (15-30cc) is created by stapling or transecting the proximal stomach to the jejunum (roux limb) called the gastrojejenostomy. A separate jejunojejunal anastomosis is made connecting the original jejunum (near the distal duodenum; called the biliopancreatic limb) to a portion in the midjejunum, for which bile and pancreatic enzymes can enter.
*the length of the roux limb determines how much malabsorption you will have (75-150 cm).
What specific vitamin deficiencies must we take into account for gastric bypass?
- iron because it is absorbed in the duodenum (which you have bypassed) and some in the jejunum.
What are some medical co-morbidities resolved with gastric bypass?
T2DM, HTN, hypercholesterolemia, GERD, SLEEP APNEA, and osteoarthritis.
What is dumping syndrome?
- vasomotor response to pts eating a lot of sugar following gastric bypass surgery. Symptoms include swelling, cramping, and light-headedness.
Most will experience this on occasion.
Can anastomic ulcer formation occur where the stomach is connected to the jejunum in gastric bypass?
Risk factors include smoking, NSAIDS, H. pylori, alcohol use, steroids.
What almost always accompanies ulcers in gastric bypass?
- stricture formation
What is an important concern to be aware of following gastric bypass?
abdominal pain over 4 hours could be closed loop obstructions or internal hernias unique to gastric bypass and lethal if ischemic bowel (ischemia usually in 6 hours).
What is a vertical sleeve gastrectomy?
resection of about 80% of the stomach.
*advantages= no malabsorption bc we are just making the stomach smaller and reduces grehlin (made in the fundus and body which is removed.
What are some limitations of vertical sleeve gastrectomy?
- Barrett's esophagus or esophageal dysmotility bc this surgery increases intraabdominal pressure, increasing the risk of more gastric acid reflux.
What are some complications with vertical sleeve gastrectomy?
- gastric leak (due to increased pressure)
- postop bleeding
Are laparoscopic adjustable gastric banding procedures going out of style?
YES due to band slippage.
What is biliopancreatic diversion with duodenal switch (BPD-DS)?
combination of sleeve gastrectomy with a very long gastric bypass, used for patients who are EXTREMELY obese.
*not commonly performed due to severe malabsorption problems.