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    Bariatric Surgery

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    Mukhtar Khan
    Weight loss surgery provides an effective treatment for obesity, allowing patients to lose a significant amount of excess weight and greatly reducing health risks. The four main types of weight loss surgery are restrictive procedures like gastric banding which use bands or staples to shrink the stomach, malabsorptive procedures like biliopancreatic diversion which alter nutrient absorption, and combined procedures like gastric bypass which use both restriction and malabsorption. While surgery has risks, it enables weight loss of 50-80% of excess body weight on average and improves obesity-related conditions like diabetes and hypertension. Maintaining lifestyle changes is important for sustaining weight loss long term.

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    Bariatric Surgery

    Uploaded by

    Mukhtar Khan
    172 views29 pages
    Weight loss surgery provides an effective treatment for obesity, allowing patients to lose a significant amount of excess weight and greatly reducing health risks. The four main types of weight loss surgery are restrictive procedures like gastric banding which use bands or staples to shrink the stomach, malabsorptive procedures like biliopancreatic diversion which alter nutrient absorption, and combined procedures like gastric bypass which use both restriction and malabsorption. While surgery has risks, it enables weight loss of 50-80% of excess body weight on average and improves obesity-related conditions like diabetes and hypertension. Maintaining lifestyle changes is important for sustaining weight loss long term.

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    Bariatric Surgery

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    Weight loss surgery provides an effective treatment for obesity, allowing patients to lose a significant amount of excess weight and greatly reducing health risks. The four main types of weight loss surgery are restrictive procedures like gastric banding which use bands or staples to shrink the stomach, malabsorptive procedures like biliopancreatic diversion which alter nutrient absorption, and combined procedures like gastric bypass which use both restriction and malabsorption. While surgery has risks, it enables weight loss of 50-80% of excess body weight on average and improves obesity-related conditions like diabetes and hypertension. Maintaining lifestyle changes is important for sustaining weight loss long term.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    172 views29 pages

    Bariatric Surgery

    Uploaded by

    Mukhtar Khan
    Weight loss surgery provides an effective treatment for obesity, allowing patients to lose a significant amount of excess weight and greatly reducing health risks. The four main types of weight loss surgery are restrictive procedures like gastric banding which use bands or staples to shrink the stomach, malabsorptive procedures like biliopancreatic diversion which alter nutrient absorption, and combined procedures like gastric bypass which use both restriction and malabsorption. While surgery has risks, it enables weight loss of 50-80% of excess body weight on average and improves obesity-related conditions like diabetes and hypertension. Maintaining lifestyle changes is important for sustaining weight loss long term.

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    of 29

    Weight Loss Surgery:

    The First Step Toward a More Healthy Life

    Pre-operative Medications

    Post-operative Medications

    Defining the Problem

    The Problem
    Prevalence of obesity in U.S. increased from 12% to 21% between 1991 and 2001 = 15 million people Obesity is the 2nd most common cause of death from a modifiable behavioral risk factor
    111,909 excess deaths annually

    Mokdad AH et al. JAMA. 2003;289:76-79 Flegal KM et al. JAMA 2005;293:1861-1919

    Excess U.S. Medical Costs Related to Abnormal Body Weight

    Int J Obesity 2005;29:334-339

    Relative risk of health problems associated with obesity


    Greatly increased (relative risk >>3)
    Diabetes Gall bladder disease Hypertension Dyslipidemia

    Moderately increased (relative risk 2-3)


    Coronary heart disease Osteoarthritis (knees) Hyperuricemia and gout

    Slightly increased (relative risk 1-2)


    Cancer (breast cancer in postmenopausal women, endometrial cancer, colon cancer) Reproductive hormone abnormalities Polycystic ovary syndrome Impaired fertility Low back pain Increased anesthetic risk Fetal defects arising from maternal obesity

    Insulin resistance
    Breathlessness Sleep apnea

    The Effect of Obesity on the Development of Health Risks


    Age-adjusted relative risk of type 2 diabetes
    50 40 30 50 20
    12

    Men1

    100
    42

    Women2

    93

    75

    40

    10
    2.2

    25
    8.1

    0 <23

    1.0

    25

    31

    35

    1.0

    <22

    25

    31

    35

    BMI
    1Chan

    JM et al. Diabetes Care 1994;17:961-969; 2Colditz G et al. Ann Intern Med 1995;122:481-486.

    Causes of Obesity

    Genetics

    Behavior

    Environment

    The Environment: Portion Size

    Non-operative Treatment of Obesity How does it add up?


    Diet Exercise Behavioral therapy

    + Drug therapy ??????

    Fed up with how her diet is going Charlene takes a more serious aim at her target weight

    Surgical Treatment of Obesity:


    The Basics

    What is Body Mass Index ( BMI ) ?

    Surgical Treatment of Obesity:


    Indications and Surgical Options

    Patient Selection
    Age 18 - 55 AND BMI 40 kg/m2 OR BMI 35 - 40 kg/m2 with
    High risk health problems OR Obesity-induced physical problems

    NIH Consensus Development Conference

    Operative Approaches
    Restrictive Procedures
    Vertical banded gastroplasty ( VBGP ) Adjustable silastic gastric banding (ASGB)

    Malabsorptive Procedures
    Biliopancreatic diversion ( BPD ) Duodenal switch modification of BPD

    Combined Procedures
    Roux-en-Y gastric bypass ( GBP )

    The Gastrointestinal System

    Vertical Banded Gastroplasty (VBG)


    General Features
    Pouch size: 1 oz Triple staple line Pouch opening: 0.5 in

    Average Weight Loss


    50 % of excess weight

    Vertical banded gastroplasty: Complications


    Stomal narrowing with persistent vomiting Staple line leak or disruption Band erosion Wound infection or hernia Death 0.1% 43 %

    Overall re-operation rate

    Adjustable Silastic Gastric Banding (ASGB): LapBandTM


    GENERAL FEATURES

    Inflatable balloon within the band orifice can be adjusted via a reservoir under the skin

    Average Weight loss


    50% of excess weight

    Adjustable Silastic Gastric Banding : Complications


    Splenic injury Esophageal injury Wound infection Persistent vomiting Acid reflux Band slippage Reservoir leak/deflation Band erosion

    Re-operation 5 -20 %

    Death

    0.3 %

    Biliopancreatic Diversion with Duodenal Switch (BPD-DS)


    General Features
    Gastric pouch size:
    Standard: 14 oz (1.5 cups)

    Three segments
    Alimentary tract: 6.5 ft Biliary tract: 13 ft Common channel: 1.5 ft

    Average Weight Loss


    80 % of excess weight

    Duodenal Switch (BPD-DS) : Complications


    Protein malnutrition Anemia Marginal ulcer Peripheral neuropathy Night Blindness Osteoporosis Renal stones Nausea First 6 mo Diarrhea Vitamin deficiencies: A, D, E, K, B12 Incisional hernia 15% <5% <3% 1.3 % 3% 14 % 65 % 62 % 10 %

    Death

    1.1 %

    Roux-en-Y Gastric Bypass (RYGBP)


    General Features
    Pouch size: 1 oz Pouch opening: 0.5 in Roux-en-Y limb
    Standard: 2 ft

    Average Weight Loss


    70 % of excess weight

    The Pouch-Tool

    Gastric Bypass: Complications


    Early:

    Late: Stomal narrowing /vomiting 15 % Staple line leak 1-5% Marginal ulcer 13% Acute gastric Heartburn / inflammation of distention esophagus Anemia Roux-Y obstruction Folate deficiency Vitamin B12 deficiency Death 0.5 % Iron deficiency Calcium deficiency / osteoporosis Gallstones 10 %

    General Complications of Weight-Loss Surgery


    Post-operative depression
    Food issues Changes in relationships

    Hair loss
    Usually temporary Cause: protein, vitamin A, mineral Excess skin

    Weight Maintenance after Bariatric Surgery

    Sjstrm L, Lindroos AK, Peltonen M et al. N Engl J Med. 2004;351:26

    Conclusions
    Bariatric surgery is an effective means to achieve clinically significant, permanent weight loss with low rates of complications. Bariatric surgery results in significant improvement in health risks associated with obesity. Surgical weight loss increases life-span. Surgical therapy is cost-effective.

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