| What is the WHO definition of obesity? | Epidemic disease of the XXI century
Abnormal or excessive fat accumulation that presents a risk to health
Overall, more than 10% of the world’s adult population are obese |
| How is classification of obesity according to BMI? | . |
| What are the different body shapes in obesity? | Android (apple, weight is mostly above waist, higher risk of M&M)
Gynoid (pear, weight is below waist, less harmful) |
| What are some facts about obesity? | Multifactorial (genetics, psychology, environment)
Genetics loads the gun, environment pulls the trigger |
| What is the solution to obesity? | Surgery is the only effective durable tool for weight loss, indications (BMI>40, BMI>35 w/comorbidities [DM, HTA, hyperlipidemia, sleep apnea, severe arthrosis]) |
| What are the 3 major concepts of bariatric surgery? | Restrictive procedures (R, include Vertical banded Gastroplasty, gastric banding and sleeve gastrectomy)
Malabsorption (biliopancreatic diversion, duodenal switch)
Combined (Gastric bypass, mini-gastric bypass)
Another technique is used non-FDA approved by Iranian which is plicated stomach |
| What are the most frequently used bariatric procedures? | . |
| What is gastric bypass surgery? | Developed by Mason in 1967
The size of the stomach is reduced by almost 90% and is directly connected to the middle part of the small intestine
Shortens the path of the food so less of it is absorbed |
| What are gastric bypass complications? | Anastamotic leak
Anastomotic stricture
Ulceration of anastomosis
Gastric Dumping syndrome
Lack of absorption of nutrients |
| Image of gastric bypass? | . |
| What is adjustable gastric banding? | Developed by Dr. Kuzmak in 1982 later by Cadiere in 1993
No staples
Ability to adjust stoma size
Completely reversible
Nearly 50% of patients required removal of their Bands (Mercola 2012)
60 percent needed to undergo
additional surgery (Mercola 2012) |
| What are gastric banding complications? | Regurgitation of ingested food
Slip of the band
Gastric erosion
Infection of the fluid inside the band
Megaesophagus |
| What is mini-gastric bypass? | Developped by Rutledge 1997
The size of the stomach is reduced by almost 80%
Shortens the path of the food so less of it is absorbed |
| What are mini-gastric bypass complications? | Anastamotic leak
Anastomotic stricture & ulceration
Gastric Dumping syndrome
Lack of absorption of nutrients
Biliary gastritis |
| Image of mini-gastric bypass? | . |
| What is sleeve gastrectomy | Developped by Gagner in 2000
Mechanism (combined R&M
Restriction: Volume 100-150 ml
Hormonal: Ghrelin (stimulates appetite))
Advantages include no anastomosis or prosthetic implant making it technically easier in higher BMI patients |
| What are sleeve complications? | Gastric angle Stenosis
Angle of Hiss: Leak / fistula |
| What are stats of successful bariatric surgery? | Weight loss surgery is considered successful:
When a patient loses 50% or more of excess body weight EBW
Keeps the weight off for at least five years
%EBW loss after 5 years:
Gastric-bypass & Minigastric-bypass: the average weight loss is 50-70 percent
Gastric Banding: patient may lose an average of 30 to 40 percent
Sleeve Gastrectomy: the average weight loss is between 55 to 70 percent |
| What are percentages of complications of bariatric surgeries? | About 20 percent of people who opt for weight loss surgery require further procedures for complications (Klein, 2013)
30 percent deal with complications relating to malnutrition, like anemia or osteoporosis since the intestinse are absorbing fewer nutrients (Klein, 2013)
As many as 20 percent of people will gain a significant amount of weight back (Klein, 2013)
Honeymoon period : 2 to 3 years
Weight regain might be related to :
Alcohol abuse
Liquid calories intake
Technical failures of the surgery |
