Bariatric Surgery
-
Upload
mukhtar-khan -
Category
Documents
-
view
22 -
download
8
description
Transcript of Bariatric Surgery
![Page 1: Bariatric Surgery](https://reader035.fdocuments.in/reader035/viewer/2022081603/55721289497959fc0b90869d/html5/thumbnails/1.jpg)
Weight Loss Surgery:Weight Loss Surgery: The First Step Toward a More Healthy LifeThe First Step Toward a More Healthy Life
![Page 2: Bariatric Surgery](https://reader035.fdocuments.in/reader035/viewer/2022081603/55721289497959fc0b90869d/html5/thumbnails/2.jpg)
![Page 3: Bariatric Surgery](https://reader035.fdocuments.in/reader035/viewer/2022081603/55721289497959fc0b90869d/html5/thumbnails/3.jpg)
Pre-operative Medications Post-operative Medications
![Page 4: Bariatric Surgery](https://reader035.fdocuments.in/reader035/viewer/2022081603/55721289497959fc0b90869d/html5/thumbnails/4.jpg)
Defining the ProblemDefining the Problem
![Page 5: Bariatric Surgery](https://reader035.fdocuments.in/reader035/viewer/2022081603/55721289497959fc0b90869d/html5/thumbnails/5.jpg)
The ProblemThe 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;289:76-79Flegal KM et al. JAMA 2005;293:1861-1919
![Page 6: Bariatric Surgery](https://reader035.fdocuments.in/reader035/viewer/2022081603/55721289497959fc0b90869d/html5/thumbnails/6.jpg)
Excess U.S. Medical Costs Related Excess U.S. Medical Costs Related to Abnormal Body Weightto Abnormal Body Weight
Int J Obesity 2005;29:334-339
![Page 7: Bariatric Surgery](https://reader035.fdocuments.in/reader035/viewer/2022081603/55721289497959fc0b90869d/html5/thumbnails/7.jpg)
Diabetes
Gall bladder disease
Hypertension
Dyslipidemia
Insulin resistance
Breathlessness
Sleep apnea
Greatly increased(relative risk >>3)
Coronary heart disease
Osteoarthritis (knees)
Hyperuricemia and gout
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
Moderately increased(relative risk 2-3)
Slightly increased(relative risk 1-2)
Relative risk of health problems associated with obesity
![Page 8: Bariatric Surgery](https://reader035.fdocuments.in/reader035/viewer/2022081603/55721289497959fc0b90869d/html5/thumbnails/8.jpg)
1Chan JM et al. Diabetes Care 1994;17:961-969; 2Colditz G et al. Ann Intern Med 1995;122:481-486.
Age-adjusted relative risk of type 2 diabetes
The Effect of Obesity The Effect of Obesity on the Development on the Development of Health Risksof Health Risks
0
10
20
30
40
50
1.02.2
12
42
0
25
50
75
100
1.08.1
40
93
<23 25 31 35 <22 25 31 35
Men1 Women2
BMI
![Page 9: Bariatric Surgery](https://reader035.fdocuments.in/reader035/viewer/2022081603/55721289497959fc0b90869d/html5/thumbnails/9.jpg)
Causes of ObesityCauses of Obesity
Genetics Behavior
Environment
![Page 10: Bariatric Surgery](https://reader035.fdocuments.in/reader035/viewer/2022081603/55721289497959fc0b90869d/html5/thumbnails/10.jpg)
The Environment: Portion SizeThe Environment: Portion Size
![Page 11: Bariatric Surgery](https://reader035.fdocuments.in/reader035/viewer/2022081603/55721289497959fc0b90869d/html5/thumbnails/11.jpg)
Non-operative Treatment of ObesityNon-operative Treatment of ObesityHow does it add up?How does it add up?
Diet
Exercise
Behavioral therapy
+ Drug therapy .
??????
![Page 12: Bariatric Surgery](https://reader035.fdocuments.in/reader035/viewer/2022081603/55721289497959fc0b90869d/html5/thumbnails/12.jpg)
Fed up with how her diet is going Charlene takes a more serious aim at her target weight
![Page 13: Bariatric Surgery](https://reader035.fdocuments.in/reader035/viewer/2022081603/55721289497959fc0b90869d/html5/thumbnails/13.jpg)
Surgical Treatment of Obesity: Surgical Treatment of Obesity: The BasicsThe Basics
![Page 14: Bariatric Surgery](https://reader035.fdocuments.in/reader035/viewer/2022081603/55721289497959fc0b90869d/html5/thumbnails/14.jpg)
What is Body Mass Index ( BMI ) ?What is Body Mass Index ( BMI ) ?
![Page 15: Bariatric Surgery](https://reader035.fdocuments.in/reader035/viewer/2022081603/55721289497959fc0b90869d/html5/thumbnails/15.jpg)
Surgical Treatment of Obesity: Surgical Treatment of Obesity: Indications and Surgical OptionsIndications and Surgical Options
![Page 16: Bariatric Surgery](https://reader035.fdocuments.in/reader035/viewer/2022081603/55721289497959fc0b90869d/html5/thumbnails/16.jpg)
Patient SelectionPatient 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
![Page 17: Bariatric Surgery](https://reader035.fdocuments.in/reader035/viewer/2022081603/55721289497959fc0b90869d/html5/thumbnails/17.jpg)
Operative ApproachesOperative 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 )
![Page 18: Bariatric Surgery](https://reader035.fdocuments.in/reader035/viewer/2022081603/55721289497959fc0b90869d/html5/thumbnails/18.jpg)
The Gastrointestinal SystemThe Gastrointestinal System
![Page 19: Bariatric Surgery](https://reader035.fdocuments.in/reader035/viewer/2022081603/55721289497959fc0b90869d/html5/thumbnails/19.jpg)
Vertical Banded Gastroplasty (VBG)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
![Page 20: Bariatric Surgery](https://reader035.fdocuments.in/reader035/viewer/2022081603/55721289497959fc0b90869d/html5/thumbnails/20.jpg)
Vertical banded gastroplasty: Vertical banded gastroplasty: ComplicationsComplications
• Stomal narrowing with persistent vomiting
• Staple line leak or disruption
• Band erosion
• Wound infection or hernia
• Death 0.1%
• Overall re-operation rate 43 %
![Page 21: Bariatric Surgery](https://reader035.fdocuments.in/reader035/viewer/2022081603/55721289497959fc0b90869d/html5/thumbnails/21.jpg)
Adjustable Silastic Gastric Banding Adjustable Silastic Gastric Banding (ASGB): LapBand(ASGB): LapBandTMTM
GENERAL FEATURES
• Inflatable balloon within the band orifice can be adjusted via a reservoir under the skin
Average Weight loss• 50% of excess weight
![Page 22: Bariatric Surgery](https://reader035.fdocuments.in/reader035/viewer/2022081603/55721289497959fc0b90869d/html5/thumbnails/22.jpg)
Adjustable Silastic Gastric Banding : ComplicationsAdjustable Silastic Gastric Banding : Complications
• Splenic injury
• Esophageal injury
• Wound infection
• Persistent vomiting
• Acid reflux
• Band slippage
• Reservoir leak/deflation
• Band erosion
• Death 0.3 %
Re-operation 5 -20 %
![Page 23: Bariatric Surgery](https://reader035.fdocuments.in/reader035/viewer/2022081603/55721289497959fc0b90869d/html5/thumbnails/23.jpg)
Biliopancreatic Diversion with Biliopancreatic Diversion with Duodenal Switch (BPD-DS)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
![Page 24: Bariatric Surgery](https://reader035.fdocuments.in/reader035/viewer/2022081603/55721289497959fc0b90869d/html5/thumbnails/24.jpg)
Duodenal Switch (BPD-DS) : Duodenal Switch (BPD-DS) : ComplicationsComplications
• Protein malnutrition15%
• Anemia < 5 %• Marginal ulcer < 3 %• Peripheral neuropathy 1.3 %• Night Blindness 3 %• Osteoporosis 14 %• Renal stones• Nausea 65 %• Diarrhea 62 %• Vitamin deficiencies: A, D, E, K, B12
• Incisional hernia 10 %
• Death 1.1 %
First 6 mo
![Page 25: Bariatric Surgery](https://reader035.fdocuments.in/reader035/viewer/2022081603/55721289497959fc0b90869d/html5/thumbnails/25.jpg)
Roux-en-Y Gastric Bypass Roux-en-Y Gastric Bypass (RYGBP)(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”
![Page 26: Bariatric Surgery](https://reader035.fdocuments.in/reader035/viewer/2022081603/55721289497959fc0b90869d/html5/thumbnails/26.jpg)
Gastric Bypass: ComplicationsGastric Bypass: Complications
Early:
• Staple line leak 1-5%
• Acute gastric distention
• Roux-Y obstruction
• Death 0.5 %
Late:• Stomal narrowing /vomiting 15
%• Marginal ulcer 13%• Heartburn / inflammation of
esophagus• Anemia
• Folate deficiency• Vitamin B12 deficiency • Iron deficiency
• Calcium deficiency / osteoporosis• Gallstones 10 %
![Page 27: Bariatric Surgery](https://reader035.fdocuments.in/reader035/viewer/2022081603/55721289497959fc0b90869d/html5/thumbnails/27.jpg)
General Complications of General Complications of Weight-Loss SurgeryWeight-Loss Surgery
• Post-operative depression• Food issues
• Changes in relationships
• Hair loss• Usually temporary
• Cause: protein, vitamin A, mineral
• Excess skin
![Page 28: Bariatric Surgery](https://reader035.fdocuments.in/reader035/viewer/2022081603/55721289497959fc0b90869d/html5/thumbnails/28.jpg)
Weight Maintenance after Bariatric SurgeryWeight Maintenance after Bariatric Surgery
Sjöström L, Lindroos AK, Peltonen M et al. N Engl J Med. 2004;351:26
![Page 29: Bariatric Surgery](https://reader035.fdocuments.in/reader035/viewer/2022081603/55721289497959fc0b90869d/html5/thumbnails/29.jpg)
ConclusionsConclusions• 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.