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BARIATRIC SURGERY: GOING UNDER THE KNIFE
BARIATRIC SURGERY: GOING UNDER THE KNIFE
BARIATRIC SURGERY: GOING UNDER THE KNIFE
BARIATRIC SURGERY: GOING UNDER THE KNIFE
BARIATRIC SURGERY: GOING UNDER THE KNIFE
BARIATRIC SURGERY: GOING UNDER THE KNIFE
BARIATRIC SURGERY: GOING UNDER THE KNIFE
BARIATRIC SURGERY: GOING UNDER THE KNIFE
BARIATRIC SURGERY: GOING UNDER THE KNIFE
BARIATRIC SURGERY: GOING UNDER THE KNIFE
BARIATRIC SURGERY: GOING UNDER THE KNIFE
BARIATRIC SURGERY: GOING UNDER THE KNIFE
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BARIATRIC SURGERY: GOING UNDER THE KNIFE

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  • 1. BARIATRIC SURGERY: GOING UNDER THE KNIFE TO LOSE WEIGHT HEATHER PLASTER PSB 4710
  • 2. SOME TERMS YOU SHOULD KNOW: <ul><li>Adhesion : scar tissue that unites two body parts that are normally not united </li></ul><ul><li>Bariatrics : a field of medicine specializing in treatment of obesity </li></ul><ul><li>Dumping Syndrome : a group of symptoms that occur when a high sugar load causes the pancreas to release too much insulin </li></ul><ul><li>Morbid Obesity : BMI of 40-50; >100lbs. Overweight </li></ul><ul><li>Super-Morbid Obesity : BMI >50; >200lbs. Overweight </li></ul><ul><li>Restrictive : surgery that reduces stomach capacity </li></ul><ul><li>Malabsorptive : surgery that reduces nutrient absorption </li></ul>
  • 3. What Bariatric Surgery Can (and Can’t) Do: <ul><li>It CAN cause loss of large amounts of weight </li></ul><ul><li>It CAN improve cholesterol ratios, reduce insulin resistance, and improve appearance </li></ul><ul><li>It CAN cause serious malnutritional conditions post-surgery, and can kill you </li></ul><ul><li>It CAN be extremely expensive </li></ul><ul><li>It CAN’T fix emotional problems that may have contributed to obesity </li></ul><ul><li>It CAN’T give you six-pack abs and the body definition of a bodybuilder </li></ul><ul><li>It CAN’T cure obesity-it is a tool that can be used for initial weight loss…but it requires active participation to maintain the weight loss </li></ul>
  • 4. So…Who Qualifies for Surgery? <ul><li>A BMI >40 …or 80lbs. above normal weight for women, 100lbs . for men </li></ul><ul><li>Co-morbidities (arthritis, heart conditions, diabetes) can qualify a person with a BMI<40 </li></ul><ul><li>Psychological evaluation to determine suitability (ability to adhere to diet, ability to cope with complications, no major psychiatric conditions) </li></ul><ul><li>Has tried conventional weight loss techniques and cannot maintain a lower weight </li></ul><ul><li>Undergoes strict nutritional evaluation and education prior to and after surgery </li></ul><ul><li>Ability to pay for procedure (insurance or otherwise) </li></ul>
  • 5. What Are the Risks? <ul><li>MAJOR RISKS: </li></ul><ul><li>Death (1% of patients die within 30 days) </li></ul><ul><li>Severe malnutrition (anemia, PEM, osteomalacia) </li></ul><ul><li>Peritonitis (from leakage or ruptures at staple sites) or other infection </li></ul><ul><li>Obstructions caused by scar tissue in the stomach or bowels </li></ul><ul><li>MINOR RISKS: </li></ul><ul><li>Dumping Syndrome (unpleasant but not harmful) </li></ul><ul><li>Diarrhea and malodorous gas production </li></ul><ul><li>Lactose intolerance </li></ul><ul><li>Hair loss (short-term post-surgery) </li></ul><ul><li>May have to eventually undergo surgical revision </li></ul><ul><li>Pain post-surgery </li></ul>
  • 6. Okay…Grab a Scalpel and Scrub Up! Time To Operate! <ul><li>VERTICAL BANDED GASTROPLASTY </li></ul><ul><li>This procedure is a restrictive-type surgery, with staples placed vertically along the stomach to create a pouch of about 30-40mL, and the opening which remains to the lower stomach is surrounded with a Silastic band that slows emptying from the pouch. No intestinal resectioning is done, and food follows the normal digestive route after ingestion. Problems can occur with scarring and ulceration of tissue at the band site. This surgery tends to cause less malnutrition than others, but tends to have less success than other procedures. Note: This surgery is usually performed laparoscopically, and evolved from the original “stomach stapling” surgery. </li></ul>
  • 7. <ul><li>GASTRIC BYPASS SURGERY </li></ul><ul><li>This procedure is a restrictive-malabsorptive combination procedure. A staple line is created horizontally through the upper stomach, and a pouch of 30-40mL is created that is disconnected from the lower stomach. A section of the jejunum is removed, attached to this pouch, and reconnected onto a portion of the small intestine. Most of the duodenum, where most digestion takes place, is bypassed. Still, gastric acid and bile are able to travel from the unused stomach and gallbladder to the juncture point of the resectioned jejunum. Surgeons disagree as to the optimal length of bypassed small intestine and location of juncture, so variations often occur due to the surgeon’s preference. Weight loss tends to be substantial initially, with most patients maintaining lower weights at 5 years post-surgery. Problems include bacterial growth in the duodenum, stretching of the pouch (which may require revision), and Dumping Syndrome . Dumping Syndrome usually occurs in reaction to simple sugar consumption and tends to abate 1-3 years post surgery…but it can also occur with other foods and be a permanent side-effect. Note: This surgery is the most common bariatric surgery in the United States and can be performed either openly or laparoscopically (usually depending on patient size). </li></ul>
  • 8. <ul><li>BILIOPANCREATIC DIVERSION: </li></ul><ul><li>This procedure is a restrictive-malabsorptive procedure in which most of the stomach is removed after a pouch is created that empties into a resectioned portion of the jejunum. This section is then reattached at the ileum directly preceding the large intestine. The duodenum is bypassed by food, but bile and pancreatic secretions travel down the duodenal section to mix with foods at the iliac junction. Very little absorption of nutrients occur, as food almost immediately enters the colon. This surgery carries a VERY high risk of severe surgical and nutritional complications, cannot be reversed (due to stomach removal), and has a history of causing numerous severe gastro-intestinal problems. Note: This surgery is extremely effective for weight loss, but due to the numerous complications and high mortality, it is rarely performed in the United States. This surgery requires an open abdominal incision. </li></ul>
  • 9. <ul><li>ADJUSTABLE GASTRIC BAND: </li></ul><ul><li>This restrictive surgery is the newest accepted development in bariatric surgery. It consists of a silicon tube placed around the stomach by laparoscopic procedure. This tube is adjusted to decrease or increase stomach volume by the addition or removal of sterile water through a port placed underneath the skin that connects to the tube. The sterile solution is simply added or withdrawn by a needle inserted into this port...patients and doctors can decide how much to adjust the band based on reports of hunger and actual weight loss. This technique is relatively safe with few reported complications, and significant weight loss is possible. The only major problem documented with this procedure is a tendency to regain lost weight after removal. No significant nutritional deficiencies occur with this procedure. </li></ul>
  • 10. <ul><li>IMPLANTABLE GASTRIC STIMULATION SYSTEM </li></ul><ul><li>This surgery (considered restrictive) consists of implanting a wire electrode (pacemaker) near the vagus nerve in the stomach, with a small device implanted beneath the skin that can be programmed to send electrical stimulation signals (“shocks”) directly to the vagus nerve. Theoretically, this stimulation causes a feeling of fullness and satiation that reduces the overall food intake of the recipient. Generally, the doctor programs the device until nausea occurs, then reduces the stimulation until just a feeling of satiety is reached. The patient can then place an electronic device over the implanted device to cause vagus stimulation whenever they feel hungry, resulting in a diminished desire to eat. The research isn’t all in on this procedure, and only 10 U.S. hospitals are doing the procedure for testing purposes. Also, the current information seems to suggest that this procedure is more appropriate for those needing to lose less than 100lbs., and wouldn’t be practical for morbid obesity treatment. </li></ul>
  • 11. SUMMARY…AND MORE! <ul><li>Bariatric surgery is a proven effective tool for weight control in the morbidly obese, but it has many risks and possible complications. Various types of surgery each carry different benefits and risks, and, overall, surgery should be considered only after all other methods of weight control have failed. </li></ul><ul><li>Bariatric surgery is considered successful if a patient maintains 70% of initial weight loss after 5 years, with no major complications. </li></ul><ul><li>69% of bariatric surgery patients self-reported childhood maltreatment or neglect (2-3 times that of a normal- weight population sample) </li></ul><ul><li>Ghrelin levels drop substantially in post-gastric-bypass surgery patients, but the decrease DOES NOT correlate with actual eating periods…hmm. </li></ul><ul><li>One study showed that evidence of a previous infection of an organism called “adenovirus Ad-36” was found in obese individuals, but not in lean individuals </li></ul><ul><li>The youngest person on whom surgery was performed was 9 years old and 200lbs. Overweight (for that age group) </li></ul>
  • 12. REFERENCES: <ul><li>Blackburn, G. 2005. Solutions in weight control: lessons from gastric surgery. American Journal of Clinical Nutrition -Vol.82, No.1: 248-252. </li></ul><ul><li>Grilo, C.M. et al. 2005. Childhood maltreatment in extremely obese male and female bariatric surgery candidates. Obesity Research -Vol.13: 123-130. </li></ul><ul><li>Hochstrasser, A., Ph.D. The Patient’s Guide to Weight Loss Surgery. Hatherleigh Press, 2004. 3-26, 54-57, 206-223. </li></ul><ul><li>Morinigo, R. 2004. Short-term effects of gastric bypass surgery on circulating ghrelin levels. Obesity Research -Vol.12: 1108-1116. </li></ul><ul><li>Saltzman, E. et al. 2005. Criteria for patient selection and multidisciplinary evaluation and treatment of the weight loss surgery patient. Obesity Research -Vol.13: 234-243. </li></ul><ul><li>Valera-Mora, M.E. et al. 2005. Predictors of weight loss and reversal of comorbidities in malabsorptive bariatric surgery. American Journal of Clinical Nutrition -Vol.81, No.6: 1292-1297. </li></ul>

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