Definition
Bariatric surgery is the surgical procedures done on patients with morbidly obesity to help achive weight reduction.
Morbid Obesity
What is it
Body mass index (BMI) in excess of 40kg/sqm or body weight twice the ideal body weight or body weight 100 pounds above the ideal body weight.
Increased level of the hormone Ghrelin seems to be responsible for increased hunger. The hormone is secreted in the proximal stomach.
Medical Therapy
Diet regimens like atkins and medifast are availabe in the market. They only have a short lasting effect, No long term benefit has been seen with them
Before surgery a medically supervised diet is started with a goal of weight loss of .5lb-2lb/week
Indications of Surgery
- BMI more than 40 kg/sqm
- BMI more than 35 with associated morbid condition
- Failed dietary therapy
- Pschychitrically stable
- Motivated individual
Special Tests and workup
- Complete cardiovascular work up
- Pulmonary Workup
- metabolic workup for diabetes, hypercholesterolemia
- Ultrasound for cholelithiasis, Ventral hernia
- Evaluation for Gastroesophageal reflux diseases
For questions and answers see here
Who will benefit from Bariatric (Weight Loss) Surgery. What are the advantages and potential complcations
Results
All the bariatric surgery procedures are associated with weight loss and reversal of comorbidities.
There is no consensus on the definition of success for any of these operations in terms of percentage of weight loss or extent of reversal of comorbidities.
Adjustable Gastric Band
Average weight loss is 50-60% of excess body weight in 3 years.
The band is initially placed without adding any saline to distend it. Additions of 1.0 to 1.5 mL of saline are added to produce a desired weight loss of 1 to 2 kg/wk.
The LAP-BAND has been shown to resolve type II diabetes 65-70%. Improved blood glucose control resulted for all patients. Hypertension was resolved in 55%-60% . Patients also experienced a decrease in fasting triglyceride levels and elevation of high-density lipoprotein levels.
Obstructive sleep apnea, asthma and gastro esophageal reflux have all decreased.
Roux-en-Y Gastric Bypass
Excess weight loss from long-term follow-up studies shows that open RYGB provides a weight loss of over 65% at 1 year in many studies. Long-term follow-up studies show that there is a tendency for patients to regain some weight after the first year.
Diabetes improve in 80-85%
Hypertension resolves in 60-65%
Sleep apnea improves in about 65%
Complications
Mortality Percentage
Banding .05%
RYGB .03-1%
Others Less than 1%
Adjustable Gastric Band
Band slippage, erosions
Roux-en-Y Gastric Bypass
Excess follow-up studies show that there is a tendency for patients to regain some weight after the first year.
Diabetes improve in 80-85%
Hypertension resolves in 60-65%
Sleep apnea improves in about 65%weight loss from long-term follow-up studies shows that open RYGB provides a weight loss of over 65% at 1 year in many studies. Long-term
Problems associated with Morbid Obesity -
Cardiovascular Metabolic Pulmonary Musculoskeletal Gastrointestinal Genitourinary
Hypertension Diabetes Sleep Apnea Degenerative joint disease GER Incontinence
Cardiomyopathy Hyperlipidemia Ashtma Osteoarthritis Cholelithiasis Renal diseases