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Patient selection and choosing the optional procedure in bariatric surgery. A.R khalaj M.D Minimal Invasive Surgery Research Center university of Iran. The rational for weight loss surgery . 70% of diabets risk can be attributed to obesity
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Patient selection and choosing the optional procedure in bariatric surgery A.R khalaj M.D Minimal Invasive Surgery Research Center university of Iran
The rational for weight loss surgery • 70% of diabets risk can be attributed to obesity • Prevalene of hypertention in BMI>30 Men:41.9% women:37.8% • prevalence of cholesterol in BMI >30 Men:22% women:27% • mortality in BMI >30 50-100% • Medical treatment for obesity is met with discouraging results • 95% regain in 2 years
Indications of bariatric surgery • Be well-informed and motivated • Have a BMI >40 • Have acceptable risk for surgery • Have failed previous non-surgical weight loss • The NIH also suggested that adults with a BMI >35 who have serious comorbidities such as diabetes, sleep apnea, obesity-related cardiomyopathy, or severe joint disease may also be candidates
Contraindications to bariatric surgery • untreated major depression or psychosis, • binge eating disorders, • current drug and alcohol abuse, • severe cardiac disease with prohibitive anesthetic risks • severe coagulopathy • inability to comply with nutritional requirements including life-long vitamin replacement • Bariatric surgery in advanced (above 65) or very young age (under 18) is controversial.
Evaluation of obese patient for bariatric • Is he or she well informed and motivated? • Dose this patient have any contraindications to weight loss surgery? • Will this patient be able to tolerate general anesthesia? • Are there any medical conditions that would make one operation better suited? • Will this patient be able to tolerate the most common complications? • What is dietary history of the patient? • Is psychologic evaluation important?
Buchwald algorithm for patient selection • There is no gold standard operation . • A surgeon should be able to perform more than one operation. • Patient can be matched to a specific procedure
Operation of choice for a patient : • Patients dietary and psychology history • Medical and surgical history • Surgeon experience • Patient comfort and expectation • Ability of medical facility to handle most known complications
Gastric bypass • Best candidates: • Diabetics • BMI<50 • Single • Bad candidates: • Noncompliance • Who must take NSAID • High risk for gastric pathology
Gastric band • Best candidates: • High risk patients • Extremes of age • Prior abdominal operations • IBD • Whom cannot tolerate malabsorbtion • Bad candidates: • Not able to participate in follow-up • Hiatal hernia • Super morbid obese • Unwilling to make lifestyle change
Biliopancreatic diversion with duodenal switchBiliopancreatic diversion with duodenal switch
BPD/DS Best candidates: BMI>50 High risk for Gastric pathology Bad candidates: High operative risk Noncompliant