Speciality
Spotlight

   




   

Surgery


   

 





Bariatric
Surgery

     

  • John N. Baxter

    Recent advances in Bariatric Surgery

    Recent Advances in Surgery-23, Year-2000, Pg. 95

        

    Morbid obesity is defined as a body mass index [BMI] of equal to, or greater than, 40 kg/m2. 

        

    There have been 20 chromosomes identified containing genes [10 autosomal dominant] which are thought to be responsible for obesity.

        

    Untravelling how all these genes interact is only in its infancy but will, in the fullness of time, provide insights into the molecular management of this condition.

         

    The disease of morbid obesity has a genetic landscape, which is acted on by medical, lifestyle and psychological factors which interact to decide the final obesity phenotype.

           

    These patients have excessive somatization, anxiety and depression but not psychoses.

          

    Counselling and use of self-help groups are thought to be helpful in the long-term management of morbid obesity after operation. 

          

    Surgery for the morbidly obese can never be curative but it ameliorates lifestyle and psychological variables, which allows the condition to improve.

           

    Obesity surgery is not a cosmetic procedure but is carried out to ameliorate the co-morbid factors. Viz.-

          

    · Diabetes mellitus [Type II]

    · High blood pressure

    · Osteoarthritis

    · Decreased mobility

    · Chronic respiratory hypoventilation [Pickwickian syndrome]

    · Poor quality of life

    · Increased neuroses

    · Gastro-oesophageal reflux disease

          

    There is general consensus that obesity surgery is highly effective in reducing BMI or taking greater than 50% of excess body weight off.

          

    What is not readily appreciated is that the aim of obesity surgery is not necessarily to approach the ideal body weight for a given individual but to alleviate or ‘cure’ the co-morbidity which these patients suffer.

            

    There is some evidence that is little as 10-20% of excess weight reduction may reduce risk factors for co-morbidity to reasonable levels.

          

    Much of the perceived improvement after bariatric surgery was related to the improved mental and physical health rather than actual weight lost.

           

    There is a clear improvement in quality of life with gastroplasty having caused a profound change in the patient’s lives.

           

    Recent studies have shown that bariatric surgery offers drastic improvement in health released quality life’s left ventricular mass, Blood pressure, glucose lipid profiles. e.g. – 

           

    1. Amelioration of metabolic parameters [i.e. Triglycerides, insulin, HDL, Cholesterol]

    2. Cure of type two diabetes mellitus.

    3. Long term control of non-insulin dependant and also insulin dependant diabetes mellitus – primarily due to reduction in caloric intake.

    4. Loss of left ventricular mass thereby decreasing overall cardiac risk.

    5. Improvement in L.V. filling and positive ejection fraction.

           

    It is important to remember that, after malabsorption procedures, vitamin and mineral supplementation is important, viz. iron, calcium, folate, vitamin B12 and vitamin A. 

           

    The time honoured argument of what is better – a gastric restrictive or a malabsorption procedure – still goes on. 

           

    There has generally been agreement that gastric bypass of one form or another gives better results than gastric restrictive surgery.

           

    There is no doubt that gastric restrictive surgery has made a comeback with the increasing use of gastric bands and the ability to insert these bands laparoscopically.

        

    All patients have a higher risk of postoperative deep vein thrombosis despite adequate prophylaxis which means extra vigilance is necessary.

          



 

   

Speciality Spotlight

   

   
Surgery
   

 

Bariatric Surgery
     

  • John N. Baxter
    Recent advances in Bariatric Surgery
    Recent Advances in Surgery-23, Year-2000, Pg. 95
        
    Morbid obesity is defined as a body mass index [BMI] of equal to, or greater than, 40 kg/m2. 
        
    There have been 20 chromosomes identified containing genes [10 autosomal dominant] which are thought to be responsible for obesity.
        
    Untravelling how all these genes interact is only in its infancy but will, in the fullness of time, provide insights into the molecular management of this condition.
         
    The disease of morbid obesity has a genetic landscape, which is acted on by medical, lifestyle and psychological factors which interact to decide the final obesity phenotype.
           
    These patients have excessive somatization, anxiety and depression but not psychoses.
          
    Counselling and use of self-help groups are thought to be helpful in the long-term management of morbid obesity after operation. 
          
    Surgery for the morbidly obese can never be curative but it ameliorates lifestyle and psychological variables, which allows the condition to improve.
           
    Obesity surgery is not a cosmetic procedure but is carried out to ameliorate the co-morbid factors. Viz.-
          
    · Diabetes mellitus [Type II]
    · High blood pressure
    · Osteoarthritis
    · Decreased mobility
    · Chronic respiratory hypoventilation [Pickwickian syndrome]
    · Poor quality of life
    · Increased neuroses
    · Gastro-oesophageal reflux disease
          
    There is general consensus that obesity surgery is highly effective in reducing BMI or taking greater than 50% of excess body weight off.
          
    What is not readily appreciated is that the aim of obesity surgery is not necessarily to approach the ideal body weight for a given individual but to alleviate or ‘cure’ the co-morbidity which these patients suffer.
            
    There is some evidence that is little as 10-20% of excess weight reduction may reduce risk factors for co-morbidity to reasonable levels.
          
    Much of the perceived improvement after bariatric surgery was related to the improved mental and physical health rather than actual weight lost.
           
    There is a clear improvement in quality of life with gastroplasty having caused a profound change in the patient’s lives.
           
    Recent studies have shown that bariatric surgery offers drastic improvement in health released quality life’s left ventricular mass, Blood pressure, glucose lipid profiles. e.g. – 
           
    1. Amelioration of metabolic parameters [i.e. Triglycerides, insulin, HDL, Cholesterol]
    2. Cure of type two diabetes mellitus.
    3. Long term control of non-insulin dependant and also insulin dependant diabetes mellitus – primarily due to reduction in caloric intake.
    4. Loss of left ventricular mass thereby decreasing overall cardiac risk.
    5. Improvement in L.V. filling and positive ejection fraction.
           
    It is important to remember that, after malabsorption procedures, vitamin and mineral supplementation is important, viz. iron, calcium, folate, vitamin B12 and vitamin A. 
           
    The time honoured argument of what is better – a gastric restrictive or a malabsorption procedure – still goes on. 
           
    There has generally been agreement that gastric bypass of one form or another gives better results than gastric restrictive surgery.
           
    There is no doubt that gastric restrictive surgery has made a comeback with the increasing use of gastric bands and the ability to insert these bands laparoscopically.
        
    All patients have a higher risk of postoperative deep vein thrombosis despite adequate prophylaxis which means extra vigilance is necessary.
          

 

By |2022-07-20T16:41:44+00:00July 20, 2022|Uncategorized|Comments Off on Bariatric Surgery

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