Surgical Management of Obesity

Question 1

What body mass index definition of obesity serves as the standard indication for the bariatric surgery when medical therapy hs failed and comorbid conditions exist?

Answer 1

Class II obesity (BMI 35 -39.9)

• when no comorbid conditions BMI of 40 or greater

Question 2

BAriatric procuedure primarily intended to induce weight loss through malabsorption of ingested nutrients?

Answer 2

Duodenal switch

• BAriatric procedures are classified as restrictive, malabsorptive or a combination of restrictive and malabsorptive in the mechanism of weight loss
• Restrictive operations
  
  • adjustable gastric band
  • gastric sleeve
• Malabsorptive operations
  
  • duodenal switch
  • bilopancreatic diversion
• Combined
  
  • Roux-en-Y gastric bypass

Question 3

Complications of adjustable gastric banding

Answer 3

• Slippage of the band
• Failure to lose weight
• Port and tubing complications

Question 4

Early postoperative complications after a RYGB procedure includes

Answer 4

• Anastomotic leak from the staple line
• Pulmonary embolus
• Hyperglycemia
• intraabdominal bleeding
• atelectasis and pulmonary embolus

Question 5

Small bowel obstruction after RYGB should be treated as an urgent surgical emergency because

Answer 5

It is frequently due to an incarcerated internal hernia which can progress to bowel necrosis and perforation

• located of the closure of the mesenteric defect/
• This can progress rapidly to strangulation and necrosis of the bowel with subsequent oerforation

Question 6

In addition to weight loss, the benefits of RYGB includes

Answer 6

• reduced long-term mortality
• Resolution of type 2 diabetes mellitus
• Resolution of sleep apnea

The success of the operation is dependent upon the patient’s success in adopting a healthy eating habit, despite continued cravings for snacks and sweets

Question 7

The gastric sleeve procedure originated as part of what operation?

Answer 7

Duodenal switch

• First stage of the duodenal sleebe is creation of gastric sleeve
• intented to promote weight loss in morbidly obese candidates whose massive obesity creates an unacceptable risk of perioperative complications

Question 8

In addition to the effects of weight loss, the resolution of type 2 DM after the gastric sleeve procedure and RYGB is thought to be contributed to by

Answer 8

• Reduced ghrelin production
• Increased secretion of glucagon-like peptide 1
• \Appetite suppression

Question 9

ADolescent patients with morbid obesity are increasingly being referred for consideration of bariatric procedures due to failure of medical management and the risks associated with a lifetime of obesity. What a nutritional deficiency require life-long treatment after RYGB, the most common procedure performed in this age group

Answer 9

loss of intrinsic factor, gastric fundus, impaired iron absorption, and a deficiency of a fat soluble vitamins

• Pernicious anemia due to Vit. B12 deficiency
• IDA
• ADEK deficiency

Question 10

The gastric sleeve procedure and RYGB result in similar degrees of resolution of ____

Answer 10

• Hypertension
• Type 2 DM
• OSA

More than 90% of RYGB patients report relief in GERD