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Patient selection and choosing the optional procedure in bariatric surgery

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

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  1. Patient selection and choosing the optional procedure in bariatric surgery A.R khalaj M.D Minimal Invasive Surgery Research Center university of Iran

  2. 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

  3. 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

  4. 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.

  5. 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?

  6. 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

  7. 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

  8. Roux-en-Y gastric bypass (RYGB)

  9. Gastric bypass • Best candidates: • Diabetics • BMI<50 • Single • Bad candidates: • Noncompliance • Who must take NSAID • High risk for gastric pathology

  10. Laparoscopic adjustable gastric band (LAGB)

  11. 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

  12. Biliopancreatic diversion

  13. Biliopancreatic diversion with duodenal switchBiliopancreatic diversion with duodenal switch

  14. BPD/DS Best candidates: BMI>50 High risk for Gastric pathology Bad candidates: High operative risk Noncompliant

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