1. “Losing it is only the beginning…” Complications of Bariatric Surgery
Samaad Malik, MD, MSc (Surg), FRCSC
Head, Division of General Surgery
Clinical Assistant Professor, University of British Columbia,
Victoria General Hospital, Victoria, BC

2. Disclosures
No disclosures

3. Intro
Comorbidities
Bariatric Surgery
Variations

4. Etiology Genetic Behavioral Physiological Psychological
Social Environmental Cultural Medications Endocrine

5. Bariatric Surgery BPD REY Gastric Bypass Sleeve Gastrectomy Band
Mini gastric bypass
SADI
Sleeve Gastrectomy
Band
Do not cure Morbid Obesity
lb weight loss

6. Predictors of Morbid Obesity
Age
Gender
Social inactivity
Stress
Emotional Anxiety

7. Elements of Bariatric Care
Morbid Obesity is a real disease
Surgery is not cure
Laparoscopic
Best for now
Complication Rate
Multidisciplinary team involvement

8. Elements of Bariatric Care
Diet, Exercise and Behavioral Modification
Journal
Active process
Family members
Weight Loss support group
club

9. Preoperative Pathway Provincial Program Central Intake
2 Sites: Victoria and Richmond
6 Surgeons
Patient Preparation:
Education
Protein Shakes

10. Surgical Options

11. Surgical Options

12. Surgical Options

13. Surgical Options
REY Gastric BYPASS
Sleeve Gastrectomy

14. NKOTB

15. Results Type II DM resolution rates BPD >90% REY GB up to 80%
Sleeve up to 75%

16. Results REY Bypass 60-80% EWL in 1st year 50-60% EWL at 5 years Sleeve
Long term data
REFLUX
BMI<30 excellent response
BMI moderate response
BMI >35 poor response

17. Complications Surgical Medical Quality of Life
Multiple anastomoses
leak/stenosis/obstruction/bleed
Increased procedure specific complications
Internal herniation
Marginal ulceration
NSAIDs contraindicated
Gastric remnant distention
Recurrent hyperinsulinemic hypoglycemia
Dumping syndrome
Nutritional deficiencies
Unpredictable medication absorption
Quality of Life
bowels
Nutritional deficiencies
Iron deficiency anemia

18. REY GASTRIC BYPASS
Pain
Internal herniation

19. REY GASTRIC BYPASS
REY GB
Marginal ulceration

20. LEAK
REY GB
Sleeve

21. CBD STONES
REY GB
Sleeve

22. REFLUX
REY GB
Sleeve

23. Weight Regain
Long-term weight loss in laparoscopic sleeve gastrectomy.
Sepúlveda M1, Alamo M2, Saba J3, Astorga C3, Lynch R3, Guzmán H3.
Surg Obes Relat Dis Jul 25. pii: S (17)30343

24. Bariatric Surgery in Victoria
Program
Infrastructure
Dietician, patient navigator
Bariatric Surgeons
Dr Brad Amson
Dr Samaad Malik
Dr Elaine Lam
Single Waitlist
First available surgeon model
Timeline:
Long
Ideally 6-9 month
N=120 cases/yr
Sleeves

25. Conclusions
Bariatric Surgery is the most effective treatment for patients suffering from obesity related comorbidities: DM, HTN, OSA, lipids
Not Cure
Lap Sleeve Gastrectomy
Complications
Cannot operate on everyone
Need a better option
Surgery is best solution now, but far from perfect

26.
THANK YOU!