Bariatric Surgery PDF

Bariatric surgery   Bariatric =Baros: heaviness, and pressure. It is the field of medicine encompassing the study of obesity, its causes, prevention, and treatment. Introduction  Obesity: - it is ≥ 20% than the ideal weight - Body Mass Index (BMI) ≥ 30 kg/m². BMI 25- 27 = normal subject 28-30 = o...

Bariatric surgery   Bariatric =Baros: heaviness, and pressure. It is the field of medicine encompassing the study of obesity, its causes, prevention, and treatment. Introduction  Obesity: - it is ≥ 20% than the ideal weight - Body Mass Index (BMI) ≥ 30 kg/m². BMI 25- 27 = normal subject 28-30 = over-weight 31= obese 40- 50 = morbid obesity 50-60 = super MO Medical Complications of obesity           Type 2 diabetes Hypertension Hyperlipidemia CAD, CHF, CVA PVD DVT and pulmonary embolism SLEEP APNEA Pulmonary HTN Edema, skin breakdown Venous stasis, ulcers          Osteoarthritis Gastroesophageal reflux Gallbladder Disease Fatty Liver Menstrual irregularities Infertility Hypogonadism, ED, anorgasmia Urinary stress incontinence Pseudotumor cerebri The Changing concept Bariatric Surgery: Indications  1991 NIH Consensus BMI > 40 kg/m2 BMI > 35 kg/m2 but with a serious co-morbidity: Diabetes, severe hypertension, obstructive sleep apnea, etc… Several failed attempts at dieting: “patients seeking treatment for the first time should be considered” for a non-surgical program. ASBS, SAGES, SSAT, EAES Important points  Metabolic syndrome  BMI ≥ 40  Surgery is supportive method not for treatment How surgery can treat obesity The mechanism by which weight loss surgery improves weight:  Reduce food intake,  Modifications of the enteroinsular axis  Reduce certain GI hormonal level Types of surgery Gastric bypass  First Laparoscopic gastric bypass was in 1993 by Wittgrove, Clark, and Tremblay. Biliopancreatic diversion ± DS Surgical indications    Sweet eater Older patients, less activity and motivation Better: - bigger BMI ( BMI ≥ 50) - DM Malabsorpative complications      Dumping syendrom Diarreah Hair loss Anemia Vitamines deficiency Sleeve gastrectomy Sleeve gastrectomy    First introduced by Ganger Micheal in 2002 It is the first step when you do Biliopancreatic diversion with Duodenal switch procedure (BPD+DS) It is temporary step to reduce weight before the permanent procedure which is BPD+DS (when BPD+DS is difficult to be done duo to excessive fat or huge Lt. liver lobe) Indications for SG   Super-super obese (BMI >65) First step to reduce weight before attempting BPD+DS General OR information     OR time is 1-2 hours Excess weight loss is 80% but can not be maintained for longer than 3 years It is a temporary procedure, which it need to be completed later on Stable line leakage is 5% Mechanism of SG       Vertical Gastrectomy Advantages Stomach volume is reduced, but it tends to function normally so most food items can be consumed in small amounts. Eliminates the portion of the stomach that produces the hormones that stimulates hunger (Ghrelin). No dumping syndrome because the pylorus is preserved. Minimizes the chance of an ulcer occurring. By avoiding the intestinal bypass, the chance of intestinal obstruction (blockage), anemia, osteoporosis, protein deficiency and vitamin deficiency are almost eliminated.     Very effective as a first stage procedure for high BMI patients (BMI >55 kg/m2). Limited results appear promising as a single stage procedure for low BMI patients (BMI 35-45 kg/m2). Appealing option for people with existing anemia, Crohn’s disease and numerous other conditions that make them too high risk for intestinal bypass procedures. Can be done laparoscopically in patients weighing more than 500 pounds Complication of SG          As with any surgery, there can be complications. Complications can include: DVT (blood clot in leg) 0.5%Pulmonary Embolus (blood clot to lung) 0.5%Pneumonia 0.2%Splenectomy 0.5%Gastric leak and fistula1. 0%Postoperative bleeding 0.5%Small bowel obstruction.0%Death INTRA-GASTRIC BALLON BIB STEPS OF BIB  This is done under sedation. A special balloon is gently passed down through the mouth into the stomach, and inflated under direct vision with a camera in the stomach (Gastroscope) By filling the stomach, the appetite is suppressed, and patients feel full. However, it must be removed after 6 months, so it has some limitations to being used in:-. 1. In adolescents 2. In those who are massively obese, whereby reducing their size pre-operatively would make the operation safer. 3. Those who have a BMI