Transcript Slide 1
American Society for Metabolic and Bariatric Surgery • BMI >40 kg/m2 or BMI >35 kg/m2 with an Indications for Bariatric Surgery • • • • • associated medical comorbidity worsened by obesity Failed dietary therapy Psychiatrically stable without alcohol • dependence or illegal drug use Knowledgeable about the operation and its sequela Motivated individual Medical problems not precluding probable survival from surgery Patients must meet the following criteria for considerati on for bariatric surgery: • • • • • • • • • • • • • • • • Diabetes Hypertension Hyperlipidemia Respiratory disease Sleep apnea Depression Menstrual irregularity Cardiovascular disease Urinary stress incontinence Asthma/pulmonary disorder Gastroesophageal reflux disease (GERD) • • • • • • • • • • • Degenerative joint disease (DJD) Congestive heart failure Gallstones Coronary heart disease Stroke Osteoarthritis Cancer Amenorrhea Polycystic ovary syndrome Infertility Dysmenorrhea •Nutritionist visits •Psychological evaluation •Exercise Physiology evaluation •EGD with biopsies for H. pylori •UGI series •IVC filter placement •Cardiopulmonary evaluation •Routine bloodwork •Vitamin levels • Silicone band • Encircles proximal stomach • Purely restrictive procedure Roux-en-Y Gastric Bypass 20 to 30 cc pouch Disconnected pouch-stomach ~ 1 cm diameter outlet Intestinal bypass of either 75 to 150 cm +/- Cholecystectomy The Foregut Theory Exclusion of Duodenum from transit of nutrients prevents secretion of signal that promotes insulin resistance and DM type 2 Rubino F. Annals of Surgery • Vol 244, Nov 2006 • A gastric tube of 60 to 120mL is created • Induces weight loss by 2 mechanisms: 1) Mechanical restriction 2) Hormonal modification n=53, av. follow-up 6 yrs %EWL New GERD Leak Mortality 57 % 21 % (3% preop) 4.9 % 0 Himpens J. Ann Surg 252: 319–324 2010 ■ Bypass 90 80 70 60 Resolution 50 % 40 30 20 10 ■ Band DM HTN Dyslipidemia OSA Preoperative Morbidity Tice J. Am J Med. Vol 121, 10. 2008 Meta Analysis %EWL Band % 49 Sleeve % 57 Bypass % 63 DM Remission Mortality 47 63 83 0.2 1 0.6 Morbidity 33 9 7 Vit Def 0 32 58 Buchwald, H. JAMA 2004 Change in BMI Intensive medical therapy Gastric Sleeve Gastric Bypass Schauer P, NEJM 2012