Number of Bariatric Surgeries Performed

American Society for Metabolic and Bariatric Surgery

IndicationsIndications

for Bariatric Surgery

Patients must meet the following criteria for consideration for bariatric surgery:

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• BMI >40 kg/m2 or BMI >35 kg/m2 with an associated medical comorbidity worsened by obesity

• Failed dietary therapy• Psychiatrically stable without alcohol

dependence or illegal drug use• Knowledgeable about the operation and its

sequela• Motivated individual• Medical problems not precluding probable

survival from surgery

Obesity Related Conditions

• Diabetes• Hypertension• Hyperlipidemia• Respiratory disease • Sleep apnea• Depression• Menstrual irregularity• Cardiovascular disease• Urinary stress incontinence• Asthma/pulmonary disorder• Gastroesophageal reflux

disease (GERD)

• Degenerative joint disease (DJD)

• Congestive heart failure • Gallstones• Coronary heart disease • Stroke• Osteoarthritis• Cancer• Amenorrhea• Polycystic ovary syndrome• Infertility• Dysmenorrhea

Preop Evaluation •Nutritionist visits•Psychological evaluation•Exercise Physiology evaluation•EGD with biopsies for H. pylori•UGI series• IVC filter placement•Cardiopulmonary evaluation•Routine bloodwork•Vitamin levels

• Silicone band

• Encircles proximal stomach

• Purely restrictive procedure

Adjustable Gastric Band

Roux-en-Y Gastric Bypass

20 to 30 cc pouch Disconnected

pouch-stomach ~ 1 cm diameter

outlet Intestinal bypass of

either 75 to 150 cm +/- Cholecystectomy

The Foregut TheoryExclusion of Duodenum from transit of nutrientsprevents secretion of signal that promotesinsulin resistance and DM type 2

Rubino F. Annals of Surgery • Vol 244, Nov 2006

• A gastric tube of 60 to 120mL is created

• Induces weight loss by 2 mechanisms:1) Mechanical restriction2) Hormonal modification

Sleeve Gastrectomy

%EWL 57 %New GERD 21 % (3% preop)Leak 4.9 %Mortality 0

Himpens J. Ann Surg 252: 319–324 2010

n=53, av. follow-up 6 yrs

Sleeve Gastrectomy Long Term results

Tice J. Am J Med. Vol 121, 10. 2008

Resolution%

Preoperative Morbidity

■ Bypass

■ Band

DM DyslipidemiaHTN OSA

908070605040302010

Bypass versus Band

Band%

Sleeve%

Bypass%

%EWL 49 57 63

DMRemission

47 63 83

Mortality 0.2 1 0.6

Morbidity 33 9 7

Vit Def 0 32 58

Comparison of Bariatric Surgery

Buchwald, H. JAMA 2004

Meta Analysis

Bariatric Surgery versus Intensive Medical Therapy

Schauer P, NEJM 2012

Change in BMI

Intensive medical therapy

Gastric Bypass

Gastric Sleeve