Bariatric Surgery
Weight loss surgery
Reduces the size of the stomach with a device or by removing portion of the stomach or by resecting and re-routing the small intestine to a small stomach pouch
US National Institutes of Health (NIH) recommends this surgery
For people who have a body mass index (BMI) of at least 40
BMI of 35 and other serious co-existing medical conditions
BMI of 30-35 with significant comorbities
Surgical procedure types
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Malabsorptive procedures
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Biliopancreatic diversion
- replaced by modification known as duodenal switch
- part of stomach is resected and distal part of small intestine is connected to the pouch, bypassing duodenum and jejunum.
- no restrictive diet
- must take vitamin and dietary minerals above and beyond recommended daily allow
- risk of serious illness, if this is not done
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Jejunoilial bypass
- procedure is no longer performed due to multiple complications
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Endoluminal Sleeve
- weight loss surgery without incisions or scarring
- can be used before gastric bypass surgery or can be used as the only weight loss method
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strict guidelines must be followed
- rigorous exercise program
- healthy diet
- behavior modification to change lifestyle habits
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Biliopancreatic diversion
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Restrictive procedures
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Vertical banded gastroplasty
- replaced by modification known as duodenal switch
- essentially stomach stapling
- part of stomach is permanently stapled to create a smaller stomach
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Adjustable gastric band (lap band)
- performed laproscopically
- stomach is restricted by using a band that can be adjusted with saline
- considered one of safest procedures performed today
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Sleeve gastrectomy (gastric sleeve)
- performed laproscopically
- not reversible
- stomach is reduced to about 15% of its normal size
- most food items can be eaten in small amounts
- very effective as first stage procedure for high BMI patients
- limited results for patients with BMI 35-45.
- appealing option for people with existing anemia, IBS, Chron's disease
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Intragastric balloon (gastric balloon)
- not yet approved by FDA for use in the United States
- deflated balloon is placed in the stomach and can be filled to decrease the space of the stomach
- balloon can only be left in for six months
- can be used prior to another bariatric surgery
- can be used on multiple occasions, if necessary
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Gastric Plication (gastric imbrication or laproscopic greater curvature plication)
- version of gastric sleeve or gastrectomy
- a sleeve is created by suturing stomach tissue
- preserves the natural nutrient absorption capabilities
- reduces the volume of a patient's stomach
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Vertical banded gastroplasty
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Mixed Procedures
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Gastric bypass surgery
- Roux-en-Y is the common form
- considered the "gold standard" in the United States
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Sleeve gastrectomy with duodenal switch
- variation of biliopancreatic diversion
- part of the stomach along the greater curve is resected
- volume of stomach is reduced, restricting food intact
- anatomically and functionally irreversible
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Implantable gastric stimulation
- currently being studied in the United States
- device similar to a heart pacemaker is implanted
- trying to determine electrical stimulation can modify the enteric nervous system of the stomach, which is interpreted by the brain to give a sense of being full
- early evidence suggest that this is less effective than other forms of weight loss surgery
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Gastric bypass surgery
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Revision surgery
- surgical procedure performed on patients who have already had a type of bariatric surgery
- performed due to failure or dysfunctional previous surgery
- can be done laparoscopically or if there is extensive scarring, through an open surgery
Postsurgical diet
- clear liquid diet immediately after surgery
- continued until the gastrointestinal tract has recovered from surgery
Blended or pureed sugar-free diet for at least two weeks
- skimmed milk, cream of wheat, small amount of margarine, protein drinks, pureed fruit and mashed potatoes with gravy
Diet restrictions after recovery from surgery depend on the procedure performed
- daily multivitamin for life to compensate for reduced absorption or essential
- Nutrients
- high protein diet
- low fat diet
- low alcohol intake
Common problems after surgery
Gastric dumping syndrome (rapid gastric emptying)
- Foods bypass the stomach too rapidly and go into small intestine undigested
- Symptoms of early dumping can include: nausea, vomiting, bloating, cramping, diarrhea, dizziness, fatigue
- Symptoms of late dumping can include: weakness, sweating and dizziness
- May also suffer from hypoglycemia (low blood sugar) due to release of excessive amounts of insulin
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reatment:
- avoid foods that cause it
- have a balanced diet
- eat several small meals a day low in carbohydrates
- avoid simple sugars
- drink liquids between meals
- add fiber to diet as this slows gastric emptying and reduces insulin peaks
- medications can be prescribed in severe cases
- surgical intervention may be necessary
Infections
Pneumonia
Metobolic bone disease
- osteopenia
- secondary hyperparathyroidism
- due to decreased calcium absorption
- occurs because duodenum has been bypassed and this is where the highest concentration of calcium transporters is located
Gallstones
Kidney problems
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hyperoxaluria – excessive urinary excretion of oxalate
- can lead to kidney stones
- can lead to kidney failure
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rhabdomyolysis – breakdown of skeletal muscle fibers, that leads to release of muscle fiber contents into the bloodstream
- can lead to acute kidney injury and
Nutritional derangements
- due to deficiencies of iron, vitamin B12, fat soluble vitamins, thiamine and folate
Seizures
- have been reported due to inappropriate insulin secretion secondary to islet cell hyperplasia