Bariatrics

Question 1

What are the three classifications of morbid obesity
operations? What operations fall under these
classifications?

Answer 1

1. Restrictive (operations include gastric banding and vertical
   banded gastroplasty) 2. Malabsorptive (jejunoileal bypass) 3.
   Combination (Roux-en Y gastric bypass)
   Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
   Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
   Wolters Kluwer Health, 2014: 611.

Question 2

Open bariatric surgical techniques are organized into

two categories. Name and describe each category.

Answer 2

1. Restrictive procedures. These procedures reduce gastric
   pouch size. The quantity of food that a person can eat at one
   time, therefore, is limited. 2. Malabsorptive procedures. These
   procedures produce a chronic malabsorptive state by bypassing
   the majority of the small bowel.
   Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
   Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
   Wolters Kluwer Health, 2014: 7841.

Question 3

What general types of open bariatric procedures are

the most effective in the promotion of weight loss?

Answer 3

Malabsorptive procedures, however gastric partitioning
procedures are more popular because they are associated with
fewer complications.
Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
Wolters Kluwer Health, 2014: 511.

Question 4

1. What is the BMI requirement for a patient desiring
   bariatric surgery with no associated comorbidities?
2. What is the BMI requirement for patients with
   associated comorbidities?

Answer 4

1. > 40 kg/m2 2. 35-40 kg/m2
   Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
   Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
   Wolters Kluwer Health, 2014: 612.

Question 5

How should the morbidly obese patient be positioned

for preoxygenation?

Answer 5

Reverse trendelenburg position.
Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
Wolters Kluwer Health, 2014: 616.

Question 6

What are possible postoperative complications

associated with open bariatric surgical techniques?

Answer 6

Wound dehiscence, pulmonary embolus, wound infection,
leakage of the anastomosis.
Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
Wolters Kluwer Health, 2014: 513.

Question 7

List possible postoperative complications of

laparoscopic bariatric surgery.

Answer 7

Stricture development, anastamotic leak, pneumonia,
hemorrhage, thromboembolus, hernia development,
obstruction, and infection
Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
Wolters Kluwer Health, 2014: 613.

Question 8

What patient situations would necessitate an open

approach to Roux-en Y gastric bypass?

Answer 8

Previous upper abdominal surgery; patients presenting for
revision of bariatric surgery; patients who cannot tolerate
increased intra-abdominal pressure, such as patients with
severe pulmonary disease, CHF, or severe CAD.
Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
Wolters Kluwer Health, 2014: 612.

Question 9

List benefits associated with a laparoscopic Roux-en

Y as opposed to an open approach.

Answer 9

Benefits include: earlier patient discharge, less pain, earlier
ambulation, decrease wound complication rates, earlier return
to normal activity
Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
Wolters Kluwer Health, 2014: 612.

Question 10

A patient presenting for bariatric surgery had
preoperative pulmonary function tests performed.
What type of breathing pattern would you expect to
be reflected in the results?

Answer 10

A restrictive breathing pattern
Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
Wolters Kluwer Health, 2014: 614.