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 surgeryBe well-informed and motivatedHave a BMI >40Have acceptable risk for surgeryHave failed previous non-surgical weight lossThe 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 riskssevere 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 selectionThere 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 historyMedical and surgical historySurgeon experiencePatient comfort and expectationAbility of medical facility to handle most known
complications
Roux-en-Y gastric bypass (RYGB)
Gastric bypassBest candidates:DiabeticsBMI<50Single
Bad candidates:NoncomplianceWho must take NSAIDHigh risk for gastric pathology
Laparoscopic adjustable gastric band (LAGB)
Gastric bandBest candidates:High risk patientsExtremes of agePrior abdominal operationsIBDWhom cannot tolerate malabsorbtion
Bad candidates:Not able to participate in follow-upHiatal herniaSuper morbid obeseUnwilling to make lifestyle change
Biliopancreatic diversion
Biliopancreatic diversion with duodenal switch
Biliopancreatic diversion with duodenal switch
BPD/DSBest candidates:BMI>50High risk for Gastric pathology
Bad candidates:High operative riskNoncompliant
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