1 / 23

Gastric Surgery for Severe Obesity

Gastric Surgery for Severe Obesity. David L. Gee, PhD Professor of Food Science and Nutrition Central Washington University. Carnie Wilson Gastroplasty, Aug 1999 weight loss ~ 150 lbs 2003 poses for Playboy 2005 delivers baby daughter (gained 70 pounds, lost ~ 40 pounds).

elsie
Download Presentation

Gastric Surgery for Severe Obesity

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Gastric Surgery for Severe Obesity David L. Gee, PhD Professor of Food Science and Nutrition Central Washington University

  2. Carnie WilsonGastroplasty, Aug 1999weight loss ~ 150 lbs2003 poses for Playboy2005 delivers baby daughter (gained 70 pounds, lost ~ 40 pounds)

  3. Charlie WeissNew England PatriotsOffensive CoordinatorGastric Bypass SurgeryWt loss = 85 poundsSurgical complications:internal bleedingsepsisnerve damage to lower limbs

  4. Bariatric Surgery TrendsJAMA, 289(14): 1761‑1762, April 9, 2003 • US Bariatric surgeries performed per year • 2001: 47,000 • 2002: 63,000 • 2003 (projected): 98,000

  5. Source: Health Affairs, July/Aug 2005

  6. Criteria for Patient Selection • Unlikely to lose weight with non-surgical procedure • BMI > 40 • Have high risk of obesity related problems • not pregnant or planning pregnancy during weight loss • Informed of risks, lifestyle effects

  7. Surgical Mechanisms for Weight Loss • Decrease food intake • Decrease digestion and absorption of nutrients

  8. Surgery to Decrease Food Intake • Gastroplasty • Gastric banding • Vertical banded gastroplasty

  9. Gastric Banding

  10. Vertical Banded Gastroplasty

  11. Weight Loss Outcomes of Gastroplasty • 80% lose weight • 30% achieve normal weight • some regain some of lost weight • improves obesity related conditions • success depends on motivation and behaviors

  12. Risks of Gastroplasty • vomiting • erosion of band, breakdown of staple line • 10-20% require follow-up operations • 1/3 develop gallstones

  13. Surgery to Reduce Food Intake and Nutrient Absorption • Gastric Bypass Surgery • Roux-en-Y Gastric Bypass

  14. Roux-en-Y Gastric Bypass

  15. Outcomes of Gastric Bypass Surgery • produces more weight loss than gastroplasty • generally lose 2/3rds of excess weight within 2 years

  16. Risks of Gastric Bypass Surgery • like gastroplasty • chronic diarrhea • nutritional deficiencies • vitamin B-12 • iron • calcium

  17. Gastric Bypass Surgery Complications: 14-Year Followup Surgical Complications Number of Patients % of Patients Vitamin B12 deficiency 239 39.9 Readmit for various reasons 229 38.2 Incisional hernia 143 23.9 Depression 142 23.7 Staple line failure 90 15.0 Gastritis 79 13.2 Cholecystitis 68 11.4 Anastomotic problems 59 9.8 Dehydration, malnutrition 35 5.8 Dilated pouch 19 3.2 Data derived from source (Pories et al.) and modified based on personal communication. Source: Pories WJ, Swanson MS, MacDonald KG Jr, et al. Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg. 1995;222:339-350; discussion 350-352.

  18. What are the dietary guidelines following bariatric surgery?JADA 104: 487-488 (2004) • General guidelines • Eat for >20 min to allow for satiety • Well chewed, small volumes • Liquids ingested well before or after meals • Proteins eaten before fats and carbs • Nutritional Considerations • Gastric banding: iron & B-12 deficiencies • Gastric bypass: iron, calcium, folate, B-12 deficiencies, dumping syndrome • Fat malabsorption and lactose intolerance • Dehydration • Vitamin/mineral supplements recommended

  19. Early Mortality Among Medicare Beneficiaries Undergoing Bariatric Surgical ProceduresFlum, D. et al. JAMA. 2005;294:1903-1908 • Subjects: • All fee-for-service Medicare beneficiaries,1997-2002 • 16,155 patients • Mean age = 47.7 yrs (SD=11.3) • 75.8% female • Outcome Measures: • 30 day, 90 day, 1 year mortality

  20. Findings:1. Overall mortality rate at 1 year = 4.6%2. Mortality rate in men >> women (7.5% vs. 3.7%)3. Mortality rate in >65 yr >> <65 yr (11.1% vs 3.9%)

  21. Early Mortality Among Medicare Beneficiaries Undergoing Bariatric Surgical ProceduresFlum, D. et al. JAMA. 2005;294:1903-1908 • Conclusions  • Among Medicare beneficiaries, the risk ofearly death after bariatric surgery is considerably higher thanpreviously suggested • Risk of early death associated with advancing age, malesex, and lower surgeon volume of bariatric procedures • Patientsaged 65 years or older had a substantially higher risk of deathwithin the early postoperative period than younger patients.

  22. Conclusions • Bariatric surgery generally results in • substantial weight loss • Marked improvement in health risks • Improved quality of life • Bariatric surgery is not risk free • Mortality rate ~5% • Complications and further surgeries • High costs • Permanent changes in eating/lifestyle • Risks of malnutrition

More Related