Surgery of stomach and duodenum

Bariatric surgery

STOMACH & DUODENUM-3

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?