Bariatric Surgery

Question 1

Compare how men and women store fat?

Answer 1

Men tend to store fat inside their abdomen (apple shape), this visceral fat is far more dangerous

Women store fat in the hips/thighs (pear shaped), i.e. non visceral

Question 2

What is the obesity metabolic syndrome?

Answer 2

A number of diseases developing due to someones obesity

e.g. cancer, hypertension, diabetes, NAFLD, heart disease etc

Question 3

Categories of bariatric surgery?

Answer 3

Malabsorptive e.g biliopancreatic diversion
Restrictive e.g. gastric band
Combination e.g. gastric bypass

Question 4

Describe a Laparascopic Adjustable gastric band?

Answer 4

Inflatable bound around Gastrooesophageal junction which is inflated/adjusted from a surface valve

Question 5

Pros and cons of gastric bands?

Answer 5

Pros:

• Minor surgery
• Reversible/adjustable
• Low risk of complications

Cons:

• implanted device
• Easier to cheat
• 15% need further surgery
• Less effective

Question 6

Describe a Sleeve Gastrectomy?

Answer 6

Cutting out most of the stomach, basically reducing its size

A type of restrictive surgery it reduces hunger

Question 7

Pros and cons of a sleeve gastrectomy?

Answer 7

Pros:

• No foreign body or small bowel manipulation
• No risk of dumping syndrome

Cons:

• quite invasive
• Long staple line that can bleed/leak

Question 8

How does a laprascopic gastric bypass work?

Answer 8

• Makes a pouch of the upper stomach
• Connect Jejunum direct to the stomach pouch
• Connect duodenum to further down jejunum.

This means you don’t eat so much and it bypasses some of the small bowel (while still allowing gastric acid/bile/pancreatic enzymes to reach the main tube.

Question 9

Pros and cons of a laparscopic gastric bypass?

Answer 9

Pros:

• Quick and dramatic effect
• Gold standard
• Up and about the day after

Cons:

• Invasive
• Lifelong supplements required
• Risk of dumping syndrome (although it does put patients off high sugar foods)
• Difficult if revision required

Question 10

What complications can arise from bariatric surgery?

Answer 10

General surgical complications:

• Anastomotic leaks
• Infection
• DVT/PE

Specific:

• Malnutrition
• Vitamin Deficiency
• Hair Loss
• Excess Skin
• Addiction transfer (adjusting to a new potentially dangerous coping mechanism e.g. alcohol)