Perioperative Optimization of Patients Undergoing Bariatric Surgery

Bariatric surgery is fast becoming an efficient and safe method of weight reduction, especially for patients in whom conservative measures have failed. As the obese population of the world increases, so will the number of patients requesting or requiring surgical weight loss methods. Bariatric patients however have numerous co-morbidities that make their operative course more difficult, and therefore is important to have a good understanding of the important issues surrounding their pre, peri and post operative management. This article aims to educate the reader about optimal management of the bariatric surgical patient.

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Endoscopic Evaluation of Symptomatic Patients following Bariatric Surgery: A Literature Review

Diagnostic and Therapeutic Endoscopy ◽

10.1155/2012/753472 ◽

2012 ◽

Vol 2012 ◽

pp. 1-8 ◽

Cited By ~ 5

Author(s):

Miral Subhani ◽

Kaleem Rizvon ◽

Paul Mustacchia

Keyword(s):

Bariatric Surgery ◽

Weight Loss ◽

Abdominal Pain ◽

Drug Therapy ◽

Upper Gastrointestinal Bleeding ◽

Comorbid Conditions ◽

Endoscopic Evaluation ◽

Number Of Patients ◽

Upper Gastrointestinal

Obesity is an epidemic in our society, and rates continue to rise, along with comorbid conditions associated with obesity. Unfortunately, obesity remains refractory to behavioral and drug therapy but has shown response to bariatric surgery. Not only can long-term weight loss be achieved, but a majority of patients have also shown improvement of the comorbid conditions associated with obesity. A rise in the use of surgical therapy for management of obesity presents a challenge with an increased number of patients with problems after bariatric surgery. It is important to be familiar with symptoms following bariatric surgery, such as nausea/vomiting, abdominal pain, dysphagia, and upper gastrointestinal bleeding and to utilize appropriate available tests for upper gastrointestinal tract pathology in the postoperative period.

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When to resume bariatric surgery after COVID-19 pandemic?: results of patients’ and surgeons’ survey

BMC Surgery ◽

10.1186/s12893-021-01145-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Alicja Dudek ◽

Michał Wysocki ◽

Maciej Walędziak ◽

Jacek Szeliga ◽

Monika Proczko-Stepaniak ◽

...

Keyword(s):

Bariatric Surgery ◽

Body Mass Index ◽

World Health ◽

Online Surveys ◽

The World ◽

Bariatric Patients ◽

Group 2 ◽

Health Organization ◽

Current Body Mass Index ◽

Group 1

Abstract Background Coronavirus Disease 2019 is affecting most countries around the world, including Poland. In response, all elective surgeries have been postponed. We asked patients and surgeons when they want bariatric surgery to resume after pandemic. The main aim of the study was to determine patients’ and surgeons’ expectations about when to resume bariatric surgery regarding COVID-19 pandemic state. Methods The study was conducted in two groups: Group 1—bariatric patients; Group 2—bariatric surgeons. Two online surveys were distributed. Results A total of 895 patients, 299 before, 596 after surgery and 32 surgeons took part in survey. All patients and surgeons declared willingness to resume bariatric surgeries after pandemic and responded that they should be resumed immediately the World Health Organization announces end of pandemic (42%). The majority of patients before surgery answered that bariatric procedures should be resumed immediately the number of daily incidents begins to decrease (53%). In the patient group, current body mass index (p < 0.001) and contact with COVID+/quarantined persons (p < 0.001) had impact on the response to resumption of bariatric procedures. Conclusions Patients opted to wait for bariatric surgery until the oncological queue has become shorter. Surgeons presented a readiness to resume both procedures in parallel.

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Causes and Timing of Nonelective Reoperations after Bariatric Surgery: A Review of 1304 Cases at a Single Institution

The American Surgeon ◽

10.1177/000313481508101012 ◽

2015 ◽

Vol 81 (10) ◽

pp. 969-973 ◽

Cited By ~ 2

Author(s):

Erin Thompson ◽

Lisa Ferrigno ◽

Jonathon Grotts ◽

Jenna Knox ◽

Samantha Sobelman ◽

...

Keyword(s):

Bariatric Surgery ◽

Weight Loss ◽

Gastric Band ◽

Biliary Disease ◽

Single Institution ◽

Index Procedure ◽

Common Cause ◽

Common Indication ◽

Number Of Patients ◽

Gastric Bands

As the number of patients undergoing bariatric procedures for weight loss increases, an understanding of the causes and timing of complications requiring reoperation is critical. The aim of our study was to characterize the type and timing of nonelective (NE) reoperations in these patients. Over five years, 1304 patients undergoing index procedures were identified: 769 laparoscopic Roux-en-Y gastric bypasses (LRYGB), 301 laparoscopic sleeve gastrectomies, and 234 laparoscopic adjustable gastric bands. We identified 117 NE reoperations, which were grouped by index procedure as well as whether they occurred early (≤90 days) or late (>90 days). In the laparoscopic adjustable gastric bands group, slipped gastric band was the most common indication for early (n = 2) and late (n = 2) reoperations. Biliary disease was the most common cause for early reoperations (n = 4), and the only cause for late reoperations (n = 2) after laparoscopic sleeve gastrectomies. For LRYGB, diagnoses differed between the early and late groups, with the most common early indications being bowel obstruction (n = 8) and anastomotic leak (n = 4) of the 18 early reoperations, and internal hernia (n = 36) and biliary disease (n = 17) of the 82 late reoperations. The vast majority of NE reoperations were performed laparoscopically (92%), with conversions and primarily open procedures only occurring in the LRYGB group.

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When to Resume Bariatric Surgery after COVID-19 Pandemic? – Results of Patients’ and Surgeons’ Survey.

10.21203/rs.3.rs-39705/v1 ◽

2020 ◽

Author(s):

Aicja Dudek ◽

Alicja Dudek ◽

Michał Wysocki ◽

Maciej Walędziak ◽

Jacek Szeliga ◽

...

Keyword(s):

Bariatric Surgery ◽

Body Mass Index ◽

World Health ◽

Online Surveys ◽

The World ◽

Bariatric Patients ◽

Group 2 ◽

Health Organization ◽

Current Body Mass Index ◽

Group 1

Abstract BackgroundCOVID-19 is affecting most countries around the world, including Poland. In response, all elective surgeries have been postponed. We asked patients and surgeons when they want bariatric surgery to resume after pandemic. The main aim of the study was to determine patients’ and surgeons’ expectations about when to resume bariatric surgery regarding COVID-19 pandemic state.MethodsThe study was conducted in two groups: Group 1 – bariatric patients; Group 2 – bariatric surgeons. Two online surveys were distributed.Results A total of 895 patients, 299 before, 596 after surgery and 32 surgeons took part in survey. All patients and surgeons declared willingness to resume bariatric surgeries after pandemic and responded that they should be resumed immediately the World Health Organization announces end of pandemic (42%). The majority of patients before surgery answered that bariatric procedures should be resumed immediately the number of daily incidents begins to decrease (53%). In the patient group, current body mass index (p<0.001) and contact with COVID+/quarantined persons (p<0.001) had impact on the response to resumption of bariatric procedures.ConclusionsPatients opted to wait for bariatric surgery until the oncological queue has become shorter. Surgeons presented a readiness to resume both procedures in parallel.

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The Role for Prophylaxis Inferior Vena Cava Filters in Patients Undergoing Bariatric Surgery: Replacing Anecdote with Evidence

The American Surgeon ◽

10.1177/000313481207801227 ◽

2012 ◽

Vol 78 (12) ◽

pp. 1349-1361 ◽

Cited By ~ 5

Author(s):

Ben Shamian ◽

Ronald S. Chamberlain

Keyword(s):

Bariatric Surgery ◽

Inferior Vena Cava ◽

Inferior Vena ◽

Vena Cava ◽

Early Mobilization ◽

Vein Thrombosis ◽

Ivc Filters ◽

Vena Cava Filters ◽

Number Of Patients ◽

Bariatric Patients

The number of patients choosing surgical alternatives for weight reduction continues to increase. Despite common thromboembolic preventive methods, which include perioperative subcutaneous heparin injections, early mobilization, and sequential compression devices, postoperative deep vein thrombosis/pulmonary embolism remains a devastating complication after bariatric surgery. The role prophylactic inferior vena cava (IVC) filters may play in bariatric surgery remains controversial, and this article aims to address the risks and benefits of prophylactic IVC filters in high-risk bariatric patients and suggest an evidence-based algorithm for their use.

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Nutritional Support for Bariatric Surgery Patients: The Skin beyond the Fat

Nutrients ◽

10.3390/nu13051565 ◽

2021 ◽

Vol 13 (5) ◽

pp. 1565

Author(s):

Paolo Toninello ◽

Alvise Montanari ◽

Franco Bassetto ◽

Vincenzo Vindigni ◽

Antonio Paoli

Keyword(s):

Bariatric Surgery ◽

Weight Loss ◽

Postoperative Period ◽

Body Contouring ◽

Massive Weight Loss ◽

Water Soluble ◽

Nutritional Deficiencies ◽

Multivitamin Supplementation ◽

Bariatric Patients ◽

The Aesthetic

Body contouring surgery after the massive weight loss due to bariatric surgery deals with different kinds of complications. The aim of this review is to analyze the role that some nutrients may play in tissue healing after surgery, thus helping plastic surgeons to improve the aesthetic and health outcomes in massive weight loss patients under a multidisciplinary approach. As a matter of fact, preoperative nutritional deficiencies have been shown for vitamins and minerals in a large percentage of post-bariatric patients. Preoperative deficiencies mainly concern iron, zinc, selenium, and vitamins (both fat-soluble and water-soluble), but also total protein. During the postoperative period, these problems may increase because of the patients’ very low intake of vitamins and minerals after bariatric surgery (below 50% of the recommended dietary allowance) and the patients’ low compliance with the suggested multivitamin supplementation (approximately 60%). In the postoperative period, more attention should be given to nutritional aspects in regard to the length of absorptive area and the percentage of weight loss.

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Endoscopic plasma argon coagulation in treatment of weight regain after bariatric surgery: what does the patient think about this?

ABCD Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) ◽

10.1590/s0102-6720201400s100012 ◽

2014 ◽

Vol 27 (suppl 1) ◽

pp. 47-50 ◽

Cited By ~ 5

Author(s):

Simone Dallegrave MARCHESINI ◽

Giorgio Alfredo Pedroso BARETTA ◽

Maria Paula Carlini CAMBI ◽

João Batista MARCHESINI

Keyword(s):

Bariatric Surgery ◽

Weight Loss ◽

Multidisciplinary Team ◽

Weight Regain ◽

Argon Plasma Coagulation ◽

Argon Plasma ◽

The Internet ◽

Bariatric Patients ◽

Second Chance

BACKGROUND: Bariatric surgery, especially Roux-en-Y gastric bypass is an effective treatment for refractory morbid obesity, causing the loss of 75% of initial excess weight. After the surgery, however, weight regain can occur in 10-20% of cases. To help, endoscopic argon plasma coagulation (APC) is used to reduce the anastomotic diameter. Many patients who undergo this treatment, are not always familiar with this procedure and its respective precautions. AIM: The aim of this study was to determine how well the candidate for APC understands the procedure and absorbs the information provided by the multidisciplinary team. METHOD: We prepared a questionnaire with 12 true/false questions to evaluate the knowledge of the patients about the procedure they were to undergo. The questionnaire was administered by the surgeon during consultation in the preoperative period. The patients were invited to fill out the questionnaire. RESULTS: We found out that the majority learned about the procedure through the internet. They knew it was an outpatient treatment, where the anesthesia was similar to that for endoscopy, and that they would have to follow a liquid diet. But none of them knew that the purpose of this diet was to improve local wound healing. CONCLUSION: Bariatric patients who have a second chance to resume weight loss, need continuous guidance. The internet should be used by the multidisciplinary team to promote awareness that APC will not be sufficient for weight loss and weight-loss maintenance in the long term. Furthermore, there is a need to clarify again the harm of drinking alcohol in the process of weight loss, making its curse widely known.

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Application of BAROS’ questionnaire in obese patients undergoing bariatric surgery with 2 years of evolution

Arquivos de Gastroenterologia ◽

10.1590/s0004-2803.2017v54n1-12 ◽

2017 ◽

Vol 54 (1) ◽

pp. 60-64 ◽

Cited By ~ 3

Author(s):

Caetano de QUEIROZ ◽

José Afonso SALLET ◽

Pedro Gabriel Melo DE BARROS E SILVA ◽

Luzia da Gloria Pereira de Sousa QUEIROZ ◽

Jélis Arenas PIMENTEL ◽

...

Keyword(s):

Bariatric Surgery ◽

Weight Loss ◽

Long Term Results ◽

Morbidly Obese ◽

Obese Patients ◽

Index Reduction ◽

Clinical Complications ◽

Number Of Patients ◽

Prevalence Of Obesity

ABSTRACT BACKGROUND -In recent decades, the high prevalence of obesity in the general population has brought serious concerns in terms of public health. Contrarily to conventional treatment involving dieting and physical exercising, often ineffective in generating long term results, bariatric operations have been an effective method for sustained weight loss in morbidly obese individuals. The Bariatric Analysis and Reporting Outcome System (BAROS) is an objective and recognized system in the overall evaluation of results after bariatric surgery. OBJECTIVE To investigate results concerning a casuistic of morbidly obese patients undergoing bariatric surgery over a 2-year follow-up in terms of weight loss, related medical conditions, safety and changes in quality of life. METHODS A total of 120 obese (17 male and 103 female) patients, who underwent bariatric surgery, were assessed and investigated using the BAROS system after a 2- year follow-up. RESULTS Patients obtained a mean excess weight loss of 74.6 (±15.9) % and mean body mass index reduction of 15.6 (±4.4) Kg/m2. Pre-surgical comorbidities were present in 71 (59%) subjects and they were totally (86%) or partially (14%) resolved. Complications resulting specifically from the surgical procedure were observed in 4.2% of cases (two bowel obstructions requiring re-operation, and three stomal stenosis treated with endoscopic dilation). Sixteen subjects (13% of total number of patients) presented minor clinical complications managed through outpatient care. The final scores for the BAROS questionnaire showcased excellent to good results in 99% of cases (excellent 44%, very good 38%, good 23%, acceptable 1%). CONCLUSION According to the BAROS questionnaire, bariatric surgery is a safe and effective method for managing obesity and associated clinical comorbidities, allowing for satisfactory results after a 2-year follow-up. Future studies should address other clinical and psychosocial variables that impact outcome as well as allow for longer follow-ups.

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Weight Regain after Bariatric Surgery

10.1093/med/9780190608347.003.0025 ◽

2018 ◽

Author(s):

Bartolome Burguera ◽

Amani Mohamed Hag ◽

Leslie J. Heinberg

Keyword(s):

Bariatric Surgery ◽

Weight Loss ◽

Weight Regain ◽

Scientific Evidence ◽

Treatment Options ◽

Behavioral Factors ◽

Number Of Patients ◽

Medical Therapies ◽

Successful Weight Loss ◽

Definition Of

Bariatric surgery is the most effective therapy for morbid obesity. Unfortunately, a significant number of patients experience significant postoperative weight regain, which undermines the metabolic and cardiovascular benefits of weight loss associated with surgery. When revisional procedures are not indicated and/or when behavioral factors are present (e.g., nonadherence, eating pathology), bariatric programs currently do not have any empirically evaluated treatment options to offer those burdened with less favorable outcomes. This chapter reviews the definition of successful weight loss after bariatric surgery, as well as some biologic and behavioral factors that could be implicated in weight regain after surgery. Finally, we outline the scientific evidence supporting the use of behavioral and medical therapies to prevent weight regain after surgery. Bariatric programs need to determine from clinical experience, as well as through clinical trials, what behavioral/medical therapies are the most effective for managing weight gain after bariatric surgery.

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Impact of weight loss on the cardiovascular system after bariatric surgery

Problems of Endocrinology ◽

10.14341/probl201662543 ◽

2016 ◽

Vol 62 (5) ◽

pp. 43

Author(s):

Bianca Maria Leca ◽

Ionuț Stanca ◽

Suzana Florea ◽

Simona Fica ◽

Anca Elena Sîrbu

Keyword(s):

Bariatric Surgery ◽

Weight Loss ◽

Left Ventricle ◽

Cardiovascular System ◽

Negative Response ◽

Obese Patients ◽

Left Ventricle Mass ◽

Post Surgery ◽

Number Of Patients

Introduction. Obesity is a chronic disease with a great impact on the cardiovascular system through its association with type II diabetes, hypertension, dyslipidemia, metabolic syndrome (MetS) and also through direct alterations in cardiac performance and morphology. Recent long term studies prove that substantial weight loss obtained via bariatric surgery is capable of improving cardiac risk factors associated with severe obesity, decreasing the mortality rates.Aim: to assess the long-term changes in cardiovascular risk and cardiac structure in obese patients who had lost weight after laparoscopic sleeve gastrectomy (LSG).Methods. Fifty-two severe obese patients (44±9 years, 57.7% women, BMI=45±8 kg/m2) underwent clinical and biochemical examination and Doppler echocardiograms before and 5 years after LSG.Results. Pre-operatively, 78.4% of patients were hypertensive, 46.2% had diabetes, 73.1% MetS and 44.2% presented left ventricle hypertrophy (LVH), reflecting high cardio-metabolic risk. The patients reassessment was made 61.7±10.5 months after LSG, when a decrease in BMI of 21.9±10% was achieved (p<0.001). The prevalence of hypertension (64.7%), diabetes (32.7%) and MetS (28.8%) decreased compared to the pre-operative examination (p=0.019, p<0.001, p=0.036). An increase in left ventricle mass and left ventricle mass index (LVMI) (p<0.001) and in the prevalence of LVH (57.7%-p=0.001) was recorded. Patients were divided into two groups based on the decrease in LVMI (positive response-38.5%) or increase in LVMI post-surgery (negative response-61.5%), compared with pre-operative values. The group of patients with negative response had lost less weight (p=0.006), had a poor glycemic control (p=0.022), and higher systolic (p=0.004) and diastolic (p=0.030) pressure values compared to the first evaluation.Conclusion. The increase of LVMI after LSG indicates that this study should continue, including a larger number of patients. It is important to identify the factors that can predict an inappropriate response to surgery, in order to prevent and treat them.

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