Define morbid obesity:
BMI>35 with comorbid medical problem
What medical conditions are associated with morbid obesity?
- sleep apnea
- pulmonary dz
- venous stasis ulcers
- sex hormone abnormalities
- breast cancer
- colon cancer
Indications for bariatric surgery?
BMI>35 with severe weight related comorbidity
BMI>40 even w/out comorbid condition
MOA of Gastric banding?
band wrapped around upper part of stomach=creation of smaller pouch
band can be inflated or deflated to affect restriction based on weight loss outcomes.
MOA of Roux-En-Y gastric bypass?
30mL pouch constructed and loop of jejunum is anastamosed
BOTH restrictive and malabsorptive procedure
Gold standard of bariatric procedures in USA
MOA of Biliopancreatic Diversion and Duodenal Switch?
subtotal gastrectomy leaving a 200-400mL gastric remnant
not very restrictive
can be done open or laparoscopically
malabsorptive result can lead to debilitating diarrhea
MOA of sleeve gastrectomy?
majority of stomach on greater curve is removed, leaving "sleeve" of stomach on lesser curve
open or laparoscopic
Contraindications to bariatric surgery?
- unstable angina
- end stage pulmonary dz
- bad end organ dysfunction
Possible post op complications of bariatric surg?
- anastomotic leak
- marginal ulcer
- stenosis of pouch/anastamosis
- incisional hernia
- spleen injury
- iron deficiency
- B12 deficiency
Which operation works best overall?
gastric bypass: mean weight loss of 50% excess weight
Which bariatric operations are restrictive, which are malabsorptive, and which are both?
Restrictive: bands and sleeves
Malabsorptive: bypasses, diversions, and switches