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  1. 1.
  2. 2. Patient selection and choosing the optional procedure in bariatric surgery<br />A.R khalaj M.D Minimal Invasive Surgery Research Center<br />university of Iran<br />
  3. 3. The rational for weight loss surgery <br />70% of diabets risk can be attributed to obesity<br />Prevalene of hypertention in BMI>30 Men:41.9% <br /> women:37.8% <br /> prevalence of cholesterol in BMI >30 Men:22% <br /> women:27% <br /><ul><li>mortality in BMI >30 50-100% </li></ul>Medical treatment for obesity is met with discouraging results<br /> 95% regain in 2 years<br />
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  5. 5. Indications of bariatric surgery<br />Be well-informed and motivated<br />Have a BMI >40<br />Have acceptable risk for surgery<br />Have failed previous non-surgical weight loss<br />The NIH also suggested that adults with a BMI >35 who have serious comorbidities such as diabetes, sleep apnea, obesity-related cardiomyopathy, or severe joint disease may also be candidates<br />
  6. 6. Contraindications to bariatric surgery<br /> untreated major depression or psychosis, <br />binge eating disorders, <br />current drug and alcohol abuse, <br />severe cardiac disease with prohibitive anesthetic risks<br />severe coagulopathy<br /> inability to comply with nutritional requirements including life-long vitamin replacement<br /> Bariatric surgery in advanced (above 65) or very young age (under 18) is controversial.<br />
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  8. 8. Evaluation of obese patient for bariatric <br />Is he or she well informed and motivated?<br />Dose this patient have any contraindications to weight loss surgery?<br />Will this patient be able to tolerate general anesthesia?<br />Are there any medical conditions that would make one operation better suited?<br />Will this patient be able to tolerate the most common complications?<br />What is dietary history of the patient?<br />Is psychologic evaluation important?<br />
  9. 9. Buchwald algorithm for patient selection<br />There is no gold standard operation .<br />A surgeon should be able to perform more than one operation.<br />Patient can be matched to a specific procedure<br />
  10. 10. Operation of choice for a patient :<br />Patients dietary and psychology history<br />Medical and surgical history<br />Surgeon experience<br />Patient comfort and expectation<br />Ability of medical facility to handle most known complications<br />
  11. 11. Roux-en-Y gastric bypass (RYGB)<br />
  12. 12. Gastric bypass<br />Best candidates:<br />Diabetics<br />BMI<50<br />Single <br />Bad candidates:<br />Noncompliance<br />Who must take NSAID<br />High risk for gastric pathology<br />
  13. 13. Laparoscopic adjustable gastric band (LAGB)<br />
  14. 14. Gastric band<br />Best candidates:<br />High risk patients<br />Extremes of age<br />Prior abdominal operations<br />IBD<br />Whom cannot tolerate malabsorbtion<br />Bad candidates:<br />Not able to participate in follow-up<br />Hiatal hernia<br />Super morbid obese<br />Unwilling to make lifestyle change<br />
  15. 15. Biliopancreatic diversion<br />
  16. 16. Biliopancreatic diversion with duodenal switchBiliopancreatic diversion with duodenal switch<br />
  17. 17. BPD/DS<br />Best candidates:<br />BMI>50<br />High risk for Gastric pathology<br />Bad candidates:<br />High operative risk<br />Noncompliant<br />