BARIATRIC SURGERY:

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BARIATRIC SURGERY

• GOING UNDER THE KNIFE
• TO LOSE WEIGHT

HEATHER PLASTER PSB 4710
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SOME TERMS YOU SHOULD KNOW

• Adhesion scar tissue that unites two body parts
  that are normally not united
• Bariatrics a field of medicine specializing in
  treatment of obesity
• Dumping Syndrome a group of symptoms that occur
  when a high sugar load causes the pancreas to
  release too much insulin
• Morbid Obesity BMI of 40-50 100lbs. Overweight
• Super-Morbid Obesity BMI 50 200lbs.
  Overweight
• Restrictive surgery that reduces stomach
  capacity
• Malabsorptive surgery that reduces nutrient
  absorption

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What Bariatric Surgery Can (and Cant) Do

• It CAN cause loss of large amounts of weight
• It CAN improve cholesterol ratios, reduce insulin
  resistance, and improve appearance
• It CAN cause serious malnutritional conditions
  post-surgery, and can kill you
• It CAN be extremely expensive
• It CANT fix emotional problems that may have
  contributed to obesity
• It CANT give you six-pack abs and the body
  definition of a bodybuilder
• It CANT cure obesity-it is a tool that can be
  used for initial weight lossbut it requires
  active participation to maintain the weight loss

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SoWho Qualifies for Surgery?

• A BMI 40or 80lbs. above normal weight for
  women, 100lbs. for men
• Co-morbidities (arthritis, heart conditions,
  diabetes) can qualify a person with a BMI
• Psychological evaluation to determine suitability
  (ability to adhere to diet, ability to cope with
  complications, no major psychiatric conditions)
• Has tried conventional weight loss techniques and
  cannot maintain a lower weight
• Undergoes strict nutritional evaluation and
  education prior to and after surgery
• Ability to pay for procedure (insurance or
  otherwise)

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What Are the Risks?

• MAJOR RISKS
• Death (1 of patients die within 30 days)
• Severe malnutrition (anemia, PEM, osteomalacia)
• Peritonitis (from leakage or ruptures at staple
  sites) or other infection
• Obstructions caused by scar tissue in the stomach
  or bowels

• MINOR RISKS
• Dumping Syndrome (unpleasant but not harmful)
• Diarrhea and malodorous gas production
• Lactose intolerance
• Hair loss (short-term post-surgery)
• May have to eventually undergo surgical revision
• Pain post-surgery

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OkayGrab a Scalpel and Scrub Up!Time To Operate!

• VERTICAL BANDED GASTROPLASTY
• 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.

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• GASTRIC BYPASS SURGERY
• 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 surgeons
  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 surgerybut 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).

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BILIOPANCREATIC DIVERSION

• 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.

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ADJUSTABLE GASTRIC BAND

• 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.

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IMPLANTABLE GASTRIC STIMULATION SYSTEM

• 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 isnt
  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
  wouldnt be practical for morbid obesity
  treatment.

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SUMMARYAND MORE!

• 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.
• Bariatric surgery is considered successful if a
  patient maintains 70 of initial weight loss
  after 5 years, with no major complications.
• 69 of bariatric surgery patients self-reported
  childhood maltreatment or neglect (2-3 times that
  of a normal- weight population sample)
• Ghrelin levels drop substantially in
  post-gastric-bypass surgery patients, but the
  decrease DOES NOT correlate with actual eating
  periodshmm.
• 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
• The youngest person on whom surgery was performed
  was 9 years old and 200lbs. Overweight (for that
  age group)

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REFERENCES

• Blackburn, G. 2005. Solutions in weight control
  lessons from gastric surgery. American Journal of
  Clinical Nutrition -Vol.82, No.1 248-252.
• Grilo, C.M. et al. 2005. Childhood maltreatment
  in extremely obese male and female bariatric
  surgery candidates. Obesity Research -Vol.13
  123-130.
• Hochstrasser, A., Ph.D. The Patients Guide to
  Weight Loss Surgery. Hatherleigh Press, 2004.
  3-26, 54-57, 206-223.
• Morinigo, R. 2004. Short-term effects of gastric
  bypass surgery on circulating ghrelin levels.
  Obesity Research -Vol.12 1108-1116.
• 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.
• 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.