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20 Cards in this Set
- Front
- Back
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When to use surgical treatment?
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-Poor weight loss with:
Diet Exercise Behavior Modification Pharmacotherapy -meet criteria... |
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Timescale management obese adult
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1) Lifestyle change
2) Drug treatment (at least 3 monthss) 3) if no 5% loss at least, surgery |
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Criteria for Surgical Selection and management (2,3,16, RAEN)
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Class II with sig comorbidity
Class III 16-65 y.o. Risk acceptable Attempts unsuccessful Expectations realistic Informed/Motivated/committed No substance abuse/pschosis |
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Popularity of treatment
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900% increase in past decade
(lifelong follow-up, lifelong vitamin supp required) |
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2 Mechanisms of Surgery and defs
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Restrictive: Delay digestion or reduce stomache size
Malabsorptive:(last resort) parts of intestines no longer invovled in digestion |
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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 |
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Jejunoileal bypass (JIB)
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Shortens gut, only fraction nutrients ingested aborbed but often reversed (20-50%!)
-MANY complications: renal, bypass, hepatic, arthritis, metabolic) |
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Biliopancreatic Diversion and Duodenal Switch
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-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) |
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Vertical Banded Gastroplasty
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-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) |
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Laparoscopic Adjustable Gastric Band (LABG)/ Lap Band
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-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) |
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LABG PROS x 3
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lower complication
lowest mortality (but also done on lower risk, lower bmi ppl) removable |
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Gastric Bypass definition
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-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 |
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Gastric Bypass complications
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GI leak
Internal hernia thromboembolic events Deficiencies in nutrition |
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Gastric Bypass results:
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MOST COMMON
good early weight loss IF Laparoscopically perforemd surgery even less pain, infection, hernia too! |
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Surgical Procedure Selection: Consider following
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Individualized
magnitude of weight loss related comorbidities Diet adherence ? behavior change? Motivated? |
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Post-operative requirements:
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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) |
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Children obesity guidelines:
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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) |
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Characteristics affecting outcome (tons, see slides, last page)
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last page, page 3
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Surgery improvements on patient
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Decrease comorbid condition
Increase QoL (esp cuase of sleep apnea, back pain, osteoarthritis) (long-term improvement unknown, few followup study) |
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elements of successful surgery program
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Multidisciplinary Team
Mental Health screening full Consultation Ongoing Staff training Follow-up infrastructure Outcomes tracking and reporting standardized clinical protocols |
