1. Bariatric Surgery By Sue Gabriel, ARNP, CCRN, MSN Nursing made Incredibly Easy! January/February 2006 2.5 ANCC/AACN contact hours Online: www.nursingcenter.comwww.nursingcenter.com © 2006 by Lippincott Williams & Wilkins. All world rights reserved.

2. Obesity Defined Body mass index (BMI) > 30 kg/m 2 Morbidly obese: BMI > 40 kg/m 2 or more Goal of bariatric surgery is weight reduction

3. Candidates for Bariatric Surgery BMI > 40 kg/m 2, or more than 35 kg/m 2 with a comorbidity of sleep apnea, diabetes, hypertension, degenerative joint disease, asthma, or history of stroke 18 years or older Obese for 5 years or more Unsuccessfully attempted weight loss using other methods Able to complete intense screening process, including commitment to long-term weight loss

4. Types of Bariatric Surgery Restrictive-Creates a gastric pouch with a narrow outlet, so patient feels full sooner; examples: gastroplasty, gastric banding Vertical banded gastroplasty: Surgical staples create a small gastric pouch and a band as an outlet for the pouch Circumgastric banding: Adjustable, inflatable band placed around fundus of stomach

5. Types, continued Malabsorptive-Bypasses a significant amount of small intestine, greatly reducing amount of calories/nutrients absorbed Jejunocolic bypass: Reroutes the jejunum directly to the colon Jejunoileal bypass: Small intestine attached to the distal ileum

6. Combination Surgery Most effective procedures combine restrictive and malabsorptive types of surgery Gold standard in the U.S. is the Roux-en-Y gastric bypass; creates a small stomach pouch with a connection to the jejunum Food ingested bypasses 90% of stomach Can be done laparoscopically

7. Preoperative Teaching Deep breathing/coughing exercises to be done post-op I.V. and drains to be in place post-op DVT prophylaxis Pain management options post-op Possible need for abdominal binder/wound dressings post- op BP/pulmonary function: Should be peak pre-op Need for reliable birth control for childbearing-age patients, especially during post-op period Lifelong commitment to weight loss

8. Post-Operative Nursing Care Frequently monitor patients BP, cardiac function, I & O; tachycardia/hypertension common post-op in this population Pain management is a priority DVT prevention: Early ambulation, sequential compression devices, anticoagulation Aggressive pulmonary toilet

9. A New Diet NPO immediately post-op Once bowel sounds return, patient starts small meals; 600-800 calories/day Clear liquids progressing to regular diet Diet rich in protein, low in sugars/fats Drink liquids separate from meals Eat slowly/chew food thoroughly

10. Long-Term Implications Increased risk for abdominal hernia, gall bladder disease; dietary supplement containing bile salts, cholecystectomy may be recommended Nutritional deficiencies: Recommend daily vitamin, calcium supplement Follow-up important both physically and psychosocially