Slides

Indications & c.i in bariatric surgery

Description
Bariatric Surgery is rapidly gaining popularity. Knowing the right Indications and Contra Indications is paramount for Surgeons starting their career in Bariatric Surgery.
Categories
Published
of 28
All materials on our website are shared by users. If you have any questions about copyright issues, please report us to resolve them. We are always happy to assist you.
Related Documents
Share
Transcript
  • 1. Bariatric Surgery Indications & Contraindications DR. SUMEET SHAH MS, DNB, MNAMS, FIAGES Fellowship (Minimal Access Surgery) SENIOR CONSULTANT & COORDINATORMINIMAL ACCESS, METABOLIC & BARIATRIC SURGERYMAX SUPER SPECIALTY HOSPITAL, SHALIMAR BAGH NEW DELHI (INDIA)
  • 2. Bariatric SurgeryIndications & Contraindications What is obesity? ?
  • 3. Bariatric SurgeryIndications & Contraindications Morbid obesity is a chronic, lifelong, multifactorial, genetically related disease of excessive fat storage with highly significant medical, psychological, social, physical and economic co- morbidities IFSO Sept, 1996
  • 4. Bariatric SurgeryIndications & Contraindications  Quantification of obesity BMI = Body Mass Index = Body weight (Kg) Height (in m2)
  • 5. Bariatric Surgery Indications & ContraindicationsBARIATRIC RECOMMENDATIONS WHO CRITERIA RECOMMENDATION FOR ASIANS BMI (kg per m2) Normal < 25.0 < 23.0 Overweight > 25.0 > 23.0 Obese > 30.0 > 27.5 Severe Obesity > 35.0 > 32.5 Morbid Obesity > 40.0 > 37.5
  • 6. Bariatric Surgery Indications & ContraindicationsBariatric Surgery: Multiple Health Benefits  ~77 % Excess weight loss  ~ 85 % resolution of OSA  ~ 52 to 92 % resolution of HTN  ~ 73 – 83% resolution of type 2 diabetes  > 80 % resolution of Metabolic Syndrome Sjostrom et al New Engl J Med 2004 Sjostrom et al, N Engl J Med 2007
  • 7. Bariatric Surgery Indications & Contraindications Optimal Patient Selection Assess indications / contraindications Multi-disciplinary evaluation Optimize & manage comorbidities Educate,set realistic expectations
  • 8. Bariatric SurgeryIndications & Contraindications NIH Consensus Conference Criteria(1991) BMI > 40 or > 35 kg/m2 with co-morbidity Failure of non-operative Rx Absence of contraindications Well informed, compliant, motivated patient
  • 9. Bariatric SurgeryIndications & Contraindications Controversies Surgery for Adolescents & Elderly ( Age < 18 / > 65 yrs ) Surgery for BMI < 35 Surgery for Metabolic indications only
  • 10. Bariatric Surgery Indications & Contraindications ? Surgery for Adolescents  Adolescent bariatric surgery (<18 yrs) has proven effective but should be performed only in a specialty centre  Selection criteria similar to adultsSAGES Guidelines for Clinical Application of LaparoscopicBariatric Surgery, 2008; Level II, Grade B,C evidence.
  • 11. Bariatric SurgeryIndications & Contraindications Panel of experts on Adolescent Obesity BMI > 40 with comorbidities Skeletal / physiologic maturity Failure of > 6 mths of structured wt loss attempts Commitment, ability to follow post-op instructions Decision making capacity Commitment to avoid pregnancy x 1 year Curr Opin Paediatr 2005.
  • 12. Bariatric SurgeryIndications & Contraindications ? Surgery for Age > 65 Patients > 65 yrs at risk of death (early & late) after WLS Should have life expectancy > 5 yrs Should be evaluated & treated in an established Center of Excellence JAMA 2005 Annals of Surgery 2004 SAGES Guidelines for Clinical Application of Laparoscopic Bariatric Surgery, 2008; Level II, Grade B evidence.
  • 13. Bariatric SurgeryIndications & Contraindications ? Surgery for BMI < 35 “Individuals with BMI 30-35 kg/m2 may benefit from Lap. bariatric surgery given the poor results of non-surgical Rx” SAGES Guidelines for Clinical Application of Laparoscopic Bariatric Surgery, 2008; Level I, Grade B evidence.
  • 14. Bariatric Surgery Indications & ContraindicationsSurgery for Diabetes / Metabolic Syndrome ? Risks vs Benefits? Choice of procedure? Economic Considerations? When to intervene? ? BMI < 35
  • 15. Bariatric SurgeryIndications & Contraindications Contraindications
  • 16. Bariatric Surgery Indications & Contraindications Medical Severe co-morbidities / unacceptable risk Uncontrolled coagulopathy Incurable disease (cancer,AIDS, cirrhosis) ? Certain GI diseases (Crohns, dysmotilities) V.Poor QOL not expected to improve with WLS
  • 17. Bariatric Surgery Indications & Contraindications Unacceptable risk of Anaesthesia Uncontrolled severe OSA + Pulmonary HTN (Pulm. Syst. Pressure > 50mm Hg) Severe COPD (Gold Spirometric Criteria) - FEV1 / FVC < 0.7 - FEV1 < 30% predicted, or - FEV1 < 50% predicted + chr. resp. failure CHF, unstable angina ? Complete prolonged immobility
  • 18. Bariatric Surgery Indications & Contraindications Surgical (Relative) Multiple previous surgeries Abdominal irradiation / Liver transplant Very large incisional hernia Previous int. resection for GBP / BPD-DS Severe GERD / Barrets for LAGB Need for surveillance endoscopy for GBP
  • 19. Bariatric SurgeryIndications & Contraindications Behavioral / Psychosocial Significant psychatric dis./ major depression Severe mental retardation Self destructive tendency Active bullimia, drug or alcohol abuse Inability to comprehend behavioral changes Inability to integrate basic lifestyle adjustments
  • 20. Bariatric Surgery Indications & ContraindicationsIndications for Retreat / Change of surgical plan Extreme hepatomegaly / cirrhosis with large varices Profuse visceral fat Poor exposure Extensive adhesions Cardiopulmonary instability
  • 21. Bariatric Surgery Indications & ContraindicationsIndications for Retreat / Change of surgical plan
  • 22. Bariatric SurgeryIndications & ContraindicationsRevision Surgery: After Lap. Gastric Banding Early Late  Gastric perforation  Stomach slippage  Stomach slippage  Malpositioned band  Erosion  Psychological intolerance  AIDS  Gastric necrosis
  • 23. Bariatric SurgeryIndications & ContraindicationsRevision Surgery: After Lap. Gastric Bypass Mechanical problems Marginal ulcer Refractory GJ stricture Entero-enterostomy stenosis
  • 24. Bariatric SurgeryIndications & ContraindicationsRevision Surgery: After Lap. Gastric Bypass Insufficient Weight loss Normal anatomy Abnormal anatomy - Disrupted staple line - Gastro-gastric fistula in divided GBP - Enlarged pouch Metabolic / Functional Nut. deficiency / food intolerance Severe dumping / unexplained chronic pain
  • 25. Bariatric SurgeryIndications & Contraindications
  • 26. Bariatric SurgeryIndications & Contraindications
  • 27. Bariatric SurgeryIndications & Contraindications
  • Search
    Similar documents
    View more...
    Related Search
    We Need Your Support
    Thank you for visiting our website and your interest in our free products and services. We are nonprofit website to share and download documents. To the running of this website, we need your help to support us.

    Thanks to everyone for your continued support.

    No, Thanks