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Metabolic Surgery and Complications for the General Surgeon

Metabolic Surgery and Complications for the General Surgeon. Scott Welle, DO, FACOS, FACS. Morbid Obesity. BMI >40 kg/m 2 100 lbs over ideal body weight Twice ideal body weight. Metabolic Surgery. Surgery indicated in patients with: BMI > 40 BMI > 35 with major comorbidity

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Metabolic Surgery and Complications for the General Surgeon

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  1. Metabolic Surgery and Complications for the General Surgeon • Scott Welle, DO, FACOS, FACS

  2. Morbid Obesity • BMI >40 kg/m2 • 100 lbs over ideal body weight • Twice ideal body weight

  3. Metabolic Surgery • Surgery indicated in patients with: • BMI > 40 • BMI > 35 with major comorbidity • Diabetes, hypertension, heart disease, sleep apnea, fatty liver

  4. Surgical Options • Adjustable Gastric Banding • Sleeve Gastrectomy • Roux-en-Y Gastric Bypass • Gastric Plication • Biliopancreatic Diversion/Duodenal Switch • Vertical Banded Gastroplasty

  5. Complications • DVT/PE • Most common cause of death following bariatric surgery (30-50%) • 1-2% of cases • 20-30% mortality

  6. DVT/PE • Risk factors • BMI > 55 • Previous DVT • Obesity hypoventilation syndrome • Treatment • Anticoagulation

  7. Complications • Respiratory Complications • High prevalence of sleep apnea • Obesity hypoventilation syndrome • Narcotics • hypercapnea, resp acidosis, cardiac arrest

  8. Complications • Nutritional Deficiencies • Iron, Ca, B12 (most common), Thiamine • Wernicke’s Polyneuropathy • Permanent neuro-deficits • Thiamine (B1) deficiency • Limb weakness, unsteady gait, diplopia, confusion, nausea, emesis • Treatment: Thiamine, folic acid, MVI

  9. Complications • Adjustable Gastric Banding • Port/tubing complications ~ iatrogenic injury • Wound infection • Esophageal dysmotility • Band slippage/gastric prolapse • Erosion

  10. Complications • Sleeve gastrectomy • Staple line bleed • Stricture • Staple line leak

  11. Complications • Gastric Bypass • Bleeds • Leaks • Anastomotic stricture • Bowel obstruction

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