Transcript Gastrointestinal Surgery for Severe Obesity

Gastrointestinal Surgery
for Severe Obesity
Prepared By:
Dr. Fahad Al-Jindan
Outline





Introduction
Who are the candidates for Surgeries
The Normal Digestive Process
Surgical Options
Benefits and Risks
Introduction
Obesity is chronic
condition
 BMI>= 30 (26%)
 Severe Obesity
BMI>=40 (2.9%)

Introduction
 Obesity
Related Medical conditions
 Methods of Weight loss
• Dietary
• Physical Activity
• Behavior therapy
• Surgery
Surgery



well-established method of long-term weight
control
weight loss of 60% of excess weight after five
years (1)
Benefits outweigh the Risks (2)
Candidates for Surgery
Candidates






BMI >=40
Obesity Related Physical Problem
Obesity Related Health problems
Unlikely to lose weight with non surgical
methods
Understand procedures, risks and effects
Life long behavioral commitment
Normal Digestive Process
How Does Surgery Work??
Restrictive
 Malabsorptive (Intestinal Bypass)
 Combined

Restrictive Procedures
Limit food intake without effecting the normal
digestive process
 Creation of a small pouch with a narrow outlet
 Delay emptying of food and feeling of fullness
 Include
 Adjustable Gastric Banding (ABG)
 Vertical Banded Gastroplasty (VBG)

AGB

Hollow band of silicone

Inflatable with Salt
solution
Can be
Tightened/loosened
the pouch holds about 1
ounce of food and later
expands to 2-3 ounces


VBG



Uses both a band and
Staples
upper stomach near the
esophagus is stapled
vertically to create a
small pouch
The outlet from the
pouch to the rest of the
stomach is restricted by a
band
Advantages





Easier to perform
Safer
AGB can be done
Laparoscopically
Can be Reversed
Few nutritional
deficiencies
Advantages



80% of patients lose some weight, 30% reach
normal weight category with VBG (3)
Success rate with VBG is 40 to 63% of excess
body weight over a three year period. (4)
50 to 60% after five years (1)
Disadvantages



Less Weight loss
Less likely to maintain
weight loss over long
term
Patient Factors
Risks






Vomiting
Slippage of the Band
Tube Breaks
Infection
Bleeding
Death
Combined Restrictive/Malabsorptive
Most common Bariatric procedures
 Restrict food intake/amount of calories and
nutrients the body absorbs
 Include
 Roux-en-Y gastric bypass (RGB)
 Biliopancreatic Diversion (BPD)

RGB



creating a stomach
pouch and attaching it
directly to the small
intestine
bypassing a large part of
the stomach and
duodenum
Reduction of calories
and nutrients absorption
BPD
Extensive Type



Lower Portion of
stomach is removed
Remaining pouch is
connected to final
segment of small
intestine
High Risk of Nutrition
Deficiency
BPD
Duodenal Switch


Leaves a large portion of
stomach including
pyloric valve
Keeps a small part of the
duodenum
Advantages

Rapid Weight loss

greater weight loss in
gastric bypass (93.3
pounds) compared to
gastroplasty (67 pounds)
after one year (2)
Advantages

The success rate for weight loss for RGB is 68
to 72% of excess body weight over a three year
period, and 75% for BPD (4)

However, after five years the average excess
weight loss from gastric bypass surgery ranges
from 48 to 74% (1)
Disadvantages

More difficult

Nutritional deficiencies
(Ca, Fe, Vitamins)

Dumping Syndrome
Dumping Syndrome
Risks
Risk of Death
RGB <1% , BPD 2.5-5%


Abdominal Hernias 28%
Finally



Remember:
There are no guarantees
for any method to
produce and maintain
weight loss.
Success is possible only
with maximum
cooperation and
commitment to
behavioral change and
medical follow-up
References



1-American Society for Bariatric Surgery. Rationale for the
Surgical Treatment of Obesity. Updated April 6, 1998.
2-National Heart, Lung, and Blood Institute. Clinical Guidelines
on the Identification, Evaluation, and Treatment of Obesity in
Adults: The Evidence Report. NHLBI Obesity Education
Initiative Expert Panel on the Identification, Evaluation, and
Treatment of Obesity in Adults. Washington, DC: U.S.
Department of Health and Human Services, 1998
3-Gastric Surgery for Severe Obesity. National Institute of
Diabetes and Digestive and Kidney Diseases. NIH Publication
No. 96-4006, April 1996.

4-Shape Up America!, American Obesity Association. Guidance for the
Treatment of Adult Obesity. Bethesda, MD, revised 1998.


National Institute of diabetes and digestive and kidney diseases
The Cleveland Clinic Health Information Center