1. BY: HILLARY SULLIVAN MEDICAL NUTRITION THERAPY BASIC EXPLANATION OF BARIATRIC SURGERY TYPES

2. WHAT IS BARIATRIC SURGERY? Surgical manipulation of the GI tract to induce long- term weight loss in severely obese individuals Introduced in the 1950s Shown to substantially improve or resolve many common obesity-related conditions, including type II diabetes hypertension sleep apnea dyslipidemia

3. 2 CATEGORIES OF SURGERIES Restrictive Procedures Reduces the amount of food consumed at one time Does NOT interfere with the normal digestion and absorption of food Malabsorptive Procedures Works by altering digestion Causes food to be poorly digested and incompletely absorbed limits the absorption of calories

4. TYPES OF BARIATRIC SURGERY Vertical Banded Gastroplasty (VBG) Roux-en-Y Gastric Bypass Laparoscopic Adjustable Gastric Banding Sleeve Gastrectomy Biliopancreatic Diversion and Duodenal Switch

5. VERTICAL BANDED GASTROPLASTY (VBG) The upper stomach is stapled vertically about 2 ½ inches to create a small stomach pouch The outlet from the pouch is restricted by a band or a ring that slows the emptying of food to create a feeling of fullness. Pros- Relatively simple procedure Nutrient and vitamin absorption not affected Cons- Staple line can cause leakages or infection Stretching of pouch. “Soft calorie syndrome” -Due to the discomfort caused by eating solid food, many patients revert to eating soft high calorie foods which may cause weight gain.

6. ROUX-EN-Y GASTRIC BYPASS Most commonly performed weight loss surgery in the US A small pouch is created by stapling and dividing the stomach. The outlet of the pouch empties directly into the lower portion of the jejunum, bypassing the duodenum, and reducing calorie absorption. Pros- Faster and typically greater weight loss then purely restrictive procedures. long term weight loss maintained after 10-14 years. Cons- Leakage may occur Because the duodenum is bypassed, lower absorption of iron, and calcium can occur. The absorption of certain B vitamins may also be affected. This can lead to deficiencies of these nutrients, which in turn can predispose patients to medical problems such as anemia and osteoporosis.

7. LAPAROSCOPIC ADJUSTABLE GASTRIC BANDING A band is placed around the upper most part of the stomach creating a small pouch. The band can be adjusted through a port attached to the abdominal muscle layer Food passes through the band area into the larger portion of the stomach and is digested in the normal manner Pros No stapling or cutting of the digestive system Normal digestion More reversible Band can be adjusted to increase or decrease restriction Very low mortality rate Cons Band slippage or malfunction Band erosion into stomach wall Vomiting or acid reflux

8. SLEEVE GASTRECTOMY Restricts the amount of food than can be eaten by removing 85 % of the stomach The surgeon creates a small, sleeve-shaped stomach-about the size of a banana The idea is to preserve the functions of the stomach while severely reducing its volume and without bypassing the intestines or causing any GI malabsorption. Pros Quick surgery and recovery time Benefits metabolism Cons Potential leaks and stricture non-reversible May need a 2 nd procedure or two- part treatment for patients with a BMI of 60 or higher

9. BILIOPANCREATIC DIVERSION AND DUODENAL SWITCH A more drastic version of a gastric bypass, in which 70% of the stomach is removed, and even more of the small intestine is bypassed. A somewhat less extreme version of this weight loss surgery is called biliopancreatic diversion with a duodenal switch Thisprocedure removes less of the stomach and bypasses less of the small intestine. It also reduces the risk of malnutrition and ulcers, which are more common with a standard biliopancreatic diversion. (A) Illustration of the biliopancreatic diversion. (B) Illustration of the biliopancreatic diversion with duodenal switch

10. CRITERIA FOR BARIATRIC SURGERY Patients should exceed IBW by 100 pounds, or have a BMI greater than 40. Patients with a BMI between 35-40 may be considered if they have a serious health problem related to obesity They should have tried and failed to lose weight by other means They should understand the full risks and complications Patients must be willing to comply with needed long term follow up care

11. MOST IMPORTANTLY A patient needs to be mentally ready! Weight loss surgery can be lifesaving, but it is not a cure Instead, it's the first step in a lifelong commitment They need to be dedicated to making dramatic and permanent changes to how they eat, exercise, and live.

12. SOURCES Smith, Brian R., Phil Schauer, and Ninh T. Nguyen. "Surgical Approaches to the Treatment of Obesity: Bariatric Surgery." Medical Clinics of North America 95.5 (2011): 1009-030. Print. "Information Packet for Morbid Obesity." Information Packet for Morbid Obesity. Certified American Board of Surgery, n.d. Web. 17 Feb. 2013. "Sleeve Gastrectomy." Bariatric Surgery, Weight Loss and You. Stony Brook University Medical Center. N.p., n.d. Web. 17 Feb. 2013.