Obesity Care and Bariatric Surgery

The following sections are included:

• Contents
• Preface

The prevalence of both overweight and obesity are increasing in the United States and worldwide. More than one third of adults in the US are currently obese. The estimated financial impact of obesity in 2008 was over 140 billion dollars, including both direct and indirect costs. The health impact of obesity, including morbidity and mortality, is devastating. Both years of life and quality of life are affected; obesity at age 40 decreases life expectancy by 7 years, and the quality-adjusted years of life lost in the USA due to obesity and obesity related diseases have doubled recently. It is estimated that obesity leads to between 111,000 and 365,000 excess deaths annually in the United States. WHO describes obesity as most visible but neglected health issue affecting both developed and developing countries…

The following sections are included:

• Introduction
• Jejunoileal Bypass (JIB)
• Gastric Bypass
• Gastroplasty
• Biliopancreatic Diversion (BPD) and Duodenal Switch (DS)
• Gastric Banding
• Sleeve Gastrectomy
• Minimally Invasive Techniques
• Conclusions
• References

The following sections are included:

• Introduction and Indications
• Procedure
• Outcomes
• References

The following sections are included:

• Introduction
• Background
• Development of BPD/DS
• Framework for BPD/DS
• Principles of BPD/DS
• Diabetes and the Entero-Insulin Axis
• Advantages/Indications
• Disadvantages of the BPD/DS
• Preoperative Evaluation and Preparation
• Preoperative Testing
• Postoperative Management
• Operative Technique
• Early and Late Complications of DS
• Conclusion
• References

The following sections are included:

• Introduction
• Indications
• Procedure
• Benefits/Risks
• Outcomes
• Reasons for Failure
• Conclusion
• References

The following sections are included:

• Introduction
• Comparative Outcomes of Bariatric Surgical Approaches
• Surgery vs Medical Therapy for the Treatment of Type 2 Diabetes
• Conclusion
• References

The following sections are included:

• Introduction
• Early Complications
• Late Complications
• Procedure Specific Complications
• Conclusion
• References

In balancing the risks of surgery and the associated co-morbidities of obesity with the risk reduction associated with weight loss, the National Institute of Health has recommended bariatric surgery in the following individuals: Those diagnosed with Class III obesity (BMI > 40 kg/m²), or Class II obesity (BMI = 35–39.9 kg/m²) with co-morbid conditions, when dietary and lifestyle modifications have failed. Certainly, the most common bariatric procedures performed are laparoscopic Roux-en-Y gastric bypass (LRYGB), adjustable gastric band (LAGB) and sleeve gastrectomy (LSG). Several recent studies have demonstrated stable long-term outcomes, with 61–68% excess weight loss (EWL) in LRYGB, 47–50% EWL in LAGB and 56–60% in LSG. Despite the promising results regarding weight loss, these procedures can result in several well-known complications, particularly in patients with BMI > 60 or morbid obesity with severe co-morbidities. Malabsorptive surgeries possess the risk for dumping syndrome, anastomotic disruption or leak in 0%–7%, anastomotic stricture and long-term nutritional deficiencies in 3–22%, while LAGB is associated with band slippage, erosion and ulcer. Taking these risks and complications into account, this should encourage further and continued development of less invasive techniques and devices as either primary, adjunct, or bridging therapies, mimicking the effects of conventional bariatric surgery on weight and co-morbidities with the hope of minimizing these undesired side effects. The American Society for Gastrointestinal Endoscopy (ASGE) and The American Society for Metabolic and Bariatric Surgery (ASMBS) recommend that for any non-primary weight loss procedures (e.g. bridging or metabolic surgery) a minimum threshold of 5% total body weight lost should be attained, as this has demonstrated significant reduction in diabetes and cardiovascular risk factors dyslipidemia in association with morbid obesity…

All candidates for bariatric surgery require preoperative nutrition education, in the form of medical weight management, to help them prepare for the immediate and long term diet and lifestyle changes needed after surgery. Following surgery, ongoing coordinated care, including monitoring of diet and nutrition status, is required to ensure health and weight goals are achieved and maintained. The principles of the postoperative diet progression, macro- and micronutrient requirements, prevention and management of diet related complications as well as strategies for successful weight loss are reviewed for the three most commonly performed bariatric procedures, the Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG) and adjustable gastric band (AGB).

The following sections are included:

• Background
• Metabolic Comorbidities due to Obesity
• Effects of Bariatric Surgery on Metabolism
• Relative Impact of Various Bariatric Surgeries
• References

The following sections is included:

• Index