STOMACH & DUODENUM-3 Bariatric surgery

A multidisciplinary team (MDT) is mandatory for patient selection and follow-up: surgeon, physician, dietician, specialized bariatric nurse, psychiatrist.. CAUSES OF OBESITY: genetic predisposition eating disorders psychological issues, lack of exercise and comorbid conditions

Definition of body mass index (BMI) = weight (kg)/height (m)2 Normal BMI = 20–25 kg/m2 Morbid obesity : - BMI >40 kg/m2 - BMI >35 kg/m2 with comorbidity

Comorbidity: Metabolic syndrome Type II diabetes mellitus High blood pressure Dyslipidaemia Obstructive sleep apnoea Venous and lymphatic stasis Osteoarthritis Decreased mobility Chronic respiratory hypoventilation (Pickwickian syndrome) Hypertrophic cardiomyopathy Pseudotumour cerebri (idiopathic intracranial hypertension) Poor quality of life Urinary stress incontinence Gastro-oesophageal reflux disease

It must always be emphasized to patients that bariatric surgery does not cure the obesity problem but is an adjunct to help them to manage the problem more readily.   Rationale for surgery _ Increase life expectancy _ Decrease comorbidities _ Decrease health-care costs to society

CURRENT SURGICAL OPTIONS

Restrictive Procedures: Gastric banding - The least risky procedure - Most patients can expect to lose around 45–50 % of Wt

Sleeve gastrectomy Around 65 % excess weight loss can be expected at two years

Malabsorbtive Procedures: Roux-en-Y gastric bypass

Biliopancreatic diversion – with or without a duodenal switch: It is the most effective with 75–85 % excess weight loss but at the expense of the highest perioperative mortality of 1–2 %.

Risk of baritric surgery

Thank you Any Questions?