BARIATRIC SURGERY <ul><li>Dr. Onkar Singh, Dr. Shilpi Gupta, </li></ul><ul><li>Dr. Praveen Baghel, Dr. Mohan Soni </li></u...
BARIATRIC SURGERY <ul><li>Bariatric surgery: Surgical t/t for morbid obesity </li></ul><ul><li>Alteration of metabolic pro...
Indications: <ul><li>a) BMI > 40 or BMI > 35 with co morbid conditions {BMI=Wt / (Ht*2)} </li></ul><ul><li>b) Failed dieta...
Co-morbid conditions: <ul><li>CVS: HTN, DVT, Pulm. HTN , cardiomyopathy </li></ul><ul><li>Pulmonary: obstructive sleep apn...
Co-morbid conditions: <ul><li>Genitourinary: stress incontinence, end stage renal disease </li></ul><ul><li>Gynaecologic: ...
Pre-op investigations: <ul><li>Weight , height , BMI </li></ul><ul><li>CBC , BT , CT , PT </li></ul><ul><li>LFT , RFT , bl...
Pre-op investigations: <ul><li>UGI Endoscopy </li></ul><ul><li>Barium meal </li></ul><ul><li>Venous doppler lopwer limbs <...
Pre-op preparation: <ul><li>1 st  generation cephalosporin– 24 hrs before surgery </li></ul><ul><li>Prophylaxis against DV...
Operations & Mechanisms: <ul><li>RESTRICTIVE  </li></ul><ul><li>Vertical banded gastro-plasty </li></ul><ul><li>Lap adjust...
Sleeve resection
Operative details: <ul><li>Patient position: Supine, hips flexed at 30 degree & abducted , anti trendelenburg position </l...
Operative details: <ul><li>Port placement: </li></ul><ul><li>supraumblical- 10 mm optical port </li></ul><ul><li>Rt. subco...
Resected specimen: Greater curvature Fundus (upper end) Body pylorus junction (Lower end)
Postoperative care: <ul><li>Appropriate fluid resuscitation </li></ul><ul><li>Foleys catheter – 24 hrs </li></ul><ul><li>A...
Lap adjustable gastric banding
ADVANTAGES: <ul><li>Short duration op </li></ul><ul><li>Early discharge </li></ul><ul><li>Flexibility </li></ul><ul><li>Re...
DISADVANTAGES: <ul><li>Band slippage </li></ul><ul><li>Erosion </li></ul><ul><li>Port access site problems </li></ul><ul><...
Roux-en-Y gastric bypass
DISADVANTAGES: <ul><li>Anastomotic leak </li></ul><ul><li>Bowel obstruction </li></ul><ul><li>Stenosis of GJ </li></ul><ul...
Bilio pancreatic diversion
DISADVANTAGES: <ul><li>Protein malnutrition </li></ul><ul><li>Abdominal bloating </li></ul><ul><li>Elevated parathyroid ho...
Duodenal switch
DISADVANTAGES: <ul><li>Same as BPD </li></ul><ul><li>2 stage operation </li></ul>
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Bariatric Surgery By Dr. Onkar, Dr. Shilpi, Dr. Mohan Soni, Dr. Ankur Hastir, Dr. Praveen Baghel

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Bariatric Suregry, Gastrectomy, Roux-en-Y bipass for morbid obesity, Morbid Obesity, Gasrtric banding, Bilio-Pancreatic Bipass, Duodenal switch.

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Bariatric Surgery By Dr. Onkar, Dr. Shilpi, Dr. Mohan Soni, Dr. Ankur Hastir, Dr. Praveen Baghel

  1. 1. BARIATRIC SURGERY <ul><li>Dr. Onkar Singh, Dr. Shilpi Gupta, </li></ul><ul><li>Dr. Praveen Baghel, Dr. Mohan Soni </li></ul><ul><li>-MGM Medical College & MY Hospital, Indore, India. </li></ul><ul><li>Dr. Ankur Hastir </li></ul><ul><li>-MGM Medical College & Hospital, Bombay, India. </li></ul>
  2. 2. BARIATRIC SURGERY <ul><li>Bariatric surgery: Surgical t/t for morbid obesity </li></ul><ul><li>Alteration of metabolic process & durability of weight loss </li></ul><ul><li>1 st malabsorptive operations was done in 1950 </li></ul>
  3. 3. Indications: <ul><li>a) BMI > 40 or BMI > 35 with co morbid conditions {BMI=Wt / (Ht*2)} </li></ul><ul><li>b) Failed dietary therapy </li></ul><ul><li>c) Psychiatrically stable without addictions </li></ul><ul><li>d) Motivated individuals </li></ul><ul><li>e) Medical problems not precluding probable survival from surgery </li></ul>
  4. 4. Co-morbid conditions: <ul><li>CVS: HTN, DVT, Pulm. HTN , cardiomyopathy </li></ul><ul><li>Pulmonary: obstructive sleep apnea , asthma </li></ul><ul><li>Metabolic: diabetes , hyperlipidemia </li></ul><ul><li>GIT: GERD , Cholelithiasis </li></ul><ul><li>Musculoskeletal: osteoarthritis, ventral hernias </li></ul>
  5. 5. Co-morbid conditions: <ul><li>Genitourinary: stress incontinence, end stage renal disease </li></ul><ul><li>Gynaecologic: menstrual disturbances </li></ul><ul><li>Skin: fungal inf., boils, abscess </li></ul><ul><li>Oncologic: uterus, breast, colon </li></ul><ul><li>Neurologic: stroke, pseudotumor cerebri </li></ul><ul><li>Psychiatric: depression </li></ul><ul><li>Social: discrimination, abuse </li></ul>
  6. 6. Pre-op investigations: <ul><li>Weight , height , BMI </li></ul><ul><li>CBC , BT , CT , PT </li></ul><ul><li>LFT , RFT , blood sugar, lipid profile </li></ul><ul><li>X – ray chest </li></ul><ul><li>PFT </li></ul><ul><li>ECG , 2 D Echo </li></ul><ul><li>Thyroid profile </li></ul><ul><li>Insulin levels </li></ul><ul><li>Serum cortisol </li></ul>
  7. 7. Pre-op investigations: <ul><li>UGI Endoscopy </li></ul><ul><li>Barium meal </li></ul><ul><li>Venous doppler lopwer limbs </li></ul><ul><li>Ct abdomen </li></ul>
  8. 8. Pre-op preparation: <ul><li>1 st generation cephalosporin– 24 hrs before surgery </li></ul><ul><li>Prophylaxis against DVT: </li></ul><ul><li>1. subcutaneous heparin </li></ul><ul><li>2. early ambulation post op </li></ul>
  9. 9. Operations & Mechanisms: <ul><li>RESTRICTIVE </li></ul><ul><li>Vertical banded gastro-plasty </li></ul><ul><li>Lap adjustable gastric banding </li></ul><ul><li>Sleeve resection </li></ul><ul><li>LARGELY RESTRICTIVE/ MILDLY MALABSORPTIVE </li></ul><ul><li>Roux-en-Y gastric bypass </li></ul><ul><li>LARGELY MALABSORPTIVE MILDLY RESTRICTIVE </li></ul><ul><li>Bilio-pancreatic diversion (BPD) </li></ul><ul><li>Duodenal switch </li></ul>
  10. 10. Sleeve resection
  11. 11. Operative details: <ul><li>Patient position: Supine, hips flexed at 30 degree & abducted , anti trendelenburg position </li></ul><ul><li>Surgeon position: French position </li></ul><ul><li>Assistant 1 st : Right side of pt. </li></ul><ul><li>Assistant 2 nd : Left side of pt. </li></ul>
  12. 12. Operative details: <ul><li>Port placement: </li></ul><ul><li>supraumblical- 10 mm optical port </li></ul><ul><li>Rt. subcostal- 12 mm retracting port </li></ul><ul><li>Lt. subcostal- 05 mm retracting port </li></ul><ul><li>Rt. umbilical- 05 mm working port </li></ul><ul><li>Lt umbilical- 10 mm working port </li></ul>
  13. 13. Resected specimen: Greater curvature Fundus (upper end) Body pylorus junction (Lower end)
  14. 14. Postoperative care: <ul><li>Appropriate fluid resuscitation </li></ul><ul><li>Foleys catheter – 24 hrs </li></ul><ul><li>Adequate analgesia </li></ul><ul><li>DVT proohylaxis </li></ul><ul><li>GIT radiographic study </li></ul><ul><li>Dietary management </li></ul><ul><li>Long term follow up </li></ul>
  15. 15. Lap adjustable gastric banding
  16. 16. ADVANTAGES: <ul><li>Short duration op </li></ul><ul><li>Early discharge </li></ul><ul><li>Flexibility </li></ul><ul><li>Resolving of comorbid conditions: DM, HTN, dyslipidemia , GERD , </li></ul>
  17. 17. DISADVANTAGES: <ul><li>Band slippage </li></ul><ul><li>Erosion </li></ul><ul><li>Port access site problems </li></ul><ul><li>Leakage of access tubing </li></ul><ul><li>Kinking of the tubing </li></ul>
  18. 18. Roux-en-Y gastric bypass
  19. 19. DISADVANTAGES: <ul><li>Anastomotic leak </li></ul><ul><li>Bowel obstruction </li></ul><ul><li>Stenosis of GJ </li></ul><ul><li>Marginal ulcer at GJ </li></ul><ul><li>Dumping syndrome & dehydration </li></ul><ul><li>Iron & vit b12 def </li></ul>
  20. 20. Bilio pancreatic diversion
  21. 21. DISADVANTAGES: <ul><li>Protein malnutrition </li></ul><ul><li>Abdominal bloating </li></ul><ul><li>Elevated parathyroid hormone levels </li></ul><ul><li>Bone pains </li></ul><ul><li>Iron & vitamin def </li></ul><ul><li>Marginal ulcers </li></ul>
  22. 22. Duodenal switch
  23. 23. DISADVANTAGES: <ul><li>Same as BPD </li></ul><ul><li>2 stage operation </li></ul>
  24. 24. Thanks
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