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20 Cards in this Set

  • Front
  • Back
When to use surgical treatment?
-Poor weight loss with:
Behavior Modification
-meet criteria...
Timescale management obese adult
1) Lifestyle change
2) Drug treatment (at least 3 monthss)
3) if no 5% loss at least, surgery
Criteria for Surgical Selection and management (2,3,16, RAEN)
Class II with sig comorbidity
Class III
16-65 y.o.
Risk acceptable
Attempts unsuccessful
Expectations realistic
No substance abuse/pschosis
Popularity of treatment
900% increase in past decade
(lifelong follow-up, lifelong vitamin supp required)
2 Mechanisms of Surgery and defs
Restrictive: Delay digestion or reduce stomache size

Malabsorptive:(last resort) parts of intestines no longer invovled in digestion
Sleeve Gastrectomy
+ (effects good and bad)
(use before BPD/DS)
-Greater curvature of stomache is removed (gastric sleeve remains)
-gut hormones affected, but nutritional defficiency rare
Jejunoileal bypass (JIB)
Shortens gut, only fraction nutrients ingested aborbed but often reversed (20-50%!)
-MANY complications:
renal, bypass, hepatic, arthritis, metabolic)
Biliopancreatic Diversion and Duodenal Switch
-food diverted from bile and some digestive enzymes
-late nutritional problems possible! (calcium, parathyroid, fat soluble vits hypoalbuminemia)
-uncommon in US (HIGH RISK/BMI only)
Vertical Banded Gastroplasty
-Vertical staple line to create small gastric pouch, which can also be banded
-Absorptive function intact BUT staple line dehiscence, weight regain and vomiting possible (lots of revision/attention needed)
Laparoscopic Adjustable Gastric Band (LABG)/ Lap Band
-Silicon elastomer place around upper stomach to make small pouch (inflated or deflated as necessary)
-Delay gastric emptying and especially good diabetes
-but can cause prolapse gastric wall or vomiting
(good mild obese, diabetic, lifestyle conscious person)
lower complication
lowest mortality (but also done on lower risk, lower bmi ppl)
Gastric Bypass definition
-Small gastric pouch + reroute directly to jejunum (bypass duodenum)
-RESTRICTIVE AND MALABSORPTIVE; limits gi emptying (but high calories foods cause discomfort now)
+weight loss for morbidly obese, resolve comorbidities often, fewer complications but
Gastric Bypass complications
GI leak
Internal hernia
thromboembolic events
Deficiencies in nutrition
Gastric Bypass results:
good early weight loss
IF Laparoscopically perforemd surgery even less pain, infection, hernia too!
Surgical Procedure Selection: Consider following
magnitude of weight loss
related comorbidities
Diet adherence ?
behavior change?
Post-operative requirements:
Hydration and protein intake
Well defined diet progression (from liquid diet onward)
Micronutrient assessment
Multivit + calcium, Iron, Thiamine daily
Periodic assessment of BMD (bone mineral density)
Children obesity guidelines:
Achieved physiological maturity
BMI > 40, >35 sig disease (III or IId)
last resort
Intensive management
Fit for anesthesia and surgery
(acceptable b/c longer kid obese, higher chance comorbidity develop)
Characteristics affecting outcome (tons, see slides, last page)
last page, page 3
Surgery improvements on patient
Decrease comorbid condition
Increase QoL (esp cuase of sleep apnea, back pain, osteoarthritis)

(long-term improvement unknown, few followup study)
elements of successful surgery program
Multidisciplinary Team
Mental Health screening
full Consultation
Ongoing Staff training
Follow-up infrastructure
Outcomes tracking and reporting
standardized clinical protocols