Bariatric Surgery By Dr. Onkar, Dr. Shilpi, Dr. Mohan Soni, Dr. Ankur Hastir, Dr. Praveen Baghel
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Transcript of Bariatric Surgery By Dr. Onkar, Dr. Shilpi, Dr. Mohan Soni, Dr. Ankur Hastir, Dr. Praveen Baghel
BARIATRIC SURGERY
Dr. Onkar Singh, Dr. Shilpi Gupta,Dr. Praveen Baghel, Dr. Mohan Soni
-MGM Medical College & MY Hospital, Indore, India.
Dr. Ankur Hastir-MGM Medical College & Hospital, Bombay, India.
BARIATRIC SURGERY
Bariatric surgery: Surgical t/t for morbid obesity
Alteration of metabolic process & durability of weight loss
1st malabsorptive operations was done in 1950
Indications:
a) BMI > 40 or BMI > 35 with co morbid conditions {BMI=Wt / (Ht*2)}
b) Failed dietary therapyc) Psychiatrically stable without
addictionsd) Motivated individualse) Medical problems not precluding
probable survival from surgery
Co-morbid conditions: CVS: HTN, DVT, Pulm. HTN ,
cardiomyopathy Pulmonary: obstructive sleep apnea ,
asthma Metabolic: diabetes , hyperlipidemia GIT: GERD , Cholelithiasis Musculoskeletal: osteoarthritis, ventral
hernias
Co-morbid conditions:
Genitourinary: stress incontinence, end stage renal disease
Gynaecologic: menstrual disturbances Skin: fungal inf., boils, abscess Oncologic: uterus, breast, colon Neurologic: stroke, pseudotumor
cerebri Psychiatric: depression Social: discrimination, abuse
Pre-op investigations: Weight , height , BMI CBC , BT , CT , PT LFT , RFT , blood sugar, lipid profile X – ray chest PFT ECG , 2 D Echo Thyroid profile Insulin levels Serum cortisol
Pre-op investigations:
UGI Endoscopy Barium meal Venous doppler lopwer limbs Ct abdomen
Pre-op preparation: 1st generation cephalosporin– 24 hrs
before surgery Prophylaxis against DVT: 1. subcutaneous heparin 2. early ambulation post op
Operations & Mechanisms: RESTRICTIVE Vertical banded gastro-plasty Lap adjustable gastric banding Sleeve resection
LARGELY RESTRICTIVE/ MILDLY MALABSORPTIVE Roux-en-Y gastric bypass LARGELY MALABSORPTIVE \ MILDLY RESTRICTIVE Bilio-pancreatic diversion
(BPD) Duodenal switch
Sleeve resection
Operative details:
Patient position: Supine, hips flexed at 30 degree & abducted , anti trendelenburg position
Surgeon position: French position Assistant 1st: Right side of pt. Assistant 2nd: Left side of pt.
Operative details: Port placement:
supraumblical- 10 mm optical portRt. subcostal- 12 mm retracting portLt. subcostal- 05 mm retracting portRt. umbilical- 05 mm working portLt umbilical- 10 mm working port
Resected specimen:
Greater curvature
Fundus (upper end)
Body pylorus junction(Lower end)
Postoperative care: Appropriate fluid resuscitation Foleys catheter – 24 hrs Adequate analgesia DVT proohylaxis GIT radiographic study Dietary management Long term follow up
Lap adjustable gastric banding
ADVANTAGES:
1. Short duration op2. Early discharge3. Flexibility4. Resolving of comorbid conditions:
DM, HTN, dyslipidemia , GERD ,
DISADVANTAGES:
1. Band slippage2. Erosion3. Port access site problems4. Leakage of access tubing5. Kinking of the tubing
Roux-en-Y gastric bypass
DISADVANTAGES:
1. Anastomotic leak2. Bowel obstruction3. Stenosis of GJ4. Marginal ulcer at GJ5. Dumping syndrome & dehydration6. Iron & vit b12 def
Bilio pancreatic diversion
DISADVANTAGES:
Protein malnutrition1. Abdominal bloating2. Elevated parathyroid hormone levels3. Bone pains4. Iron & vitamin def5. Marginal ulcers
Duodenal switch
DISADVANTAGES:
1. Same as BPD2. 2 stage operation