surgery for obesity - taddona

8/6/2019 Surgery for Obesity - TAddona

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Obesity

An excess of body fat; body mass index

(BMI) >30 kg/m2

Affects ~30% adults in U.S.; $70Billion

annual health cost

Co-morbidities (CAD, HTN, DM II)

affect increasing mortality risk in

proportion to BMI


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Body Mass Index -kg/m2

[Wt(lb) x 703/Ht (inches)2 ]

Underweight 30

Severe (morbidly) obese >40


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Obesity rates, 1991 vs 2000

Obesity defined as BMI>30. Data were obtainedby calculating

BMI from phone questionnaire on height and weight on 185000

participants >age 18. CDC study ,JAMA 2001;286,1195-1200


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A typical fast food meal Big Mac: 570 kcal

Large Fries: 540 kcal

32 0z (large) soda: 400 kcal

TOTAL 1510 kcal

A 70 kg moderately active man requires2100 kcal/day (3 meals).


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Obesity co-morbidities

Metabolic syndrome:

DM II (15% of all

obese), HTN (40% ofobese), &

hyperlipidemia

related to visceral

adiposity and insulinresisitance

Sleep apnea

Cardiopulmonary

failure

Osteoarthritis

Gallstones

GERD NASH

Breast cancer


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Increases in obesity and diabetes 1991-2000


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Medical management of obesity

Energy equation: wt stability when

calories in = calories out

Can therefore reduce by decreasing

intake and/or increasing expenditure of

calories


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Medical management of obesity

Diet (according to ideal body weight forheight) + exercise (30 min/d moderate

5d/wk) + behavioral modification = 5-10% wt loss in 6 months, most rebound.

Very low calorie dieting (


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Thesuper-obese (BMI 50 + )

Incidencein U.S. population: 2.1% (4.4 million)

Increased riskofosteoarthritis, cardiopulmonary

failure,sleep apnea, all consequences ofmetabolicsyndrome (DM, NASH, HTN, hyperlipid)

Medical treatment essentially hopeless, thoughmet syndromeimproves with 5-10% weight loss


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Rationale for surgery for morbid

obesity

>2x mortality with BMI>40 kg/m2 due to

cardiopulmonary failure, sleep apnea, diabetes

Poor results of all medical therapies to date

Relative safety and efficacy of gastric bypass

compared to older jejuno-ileal bypassprocedure


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Criteria for obesity surgery BMI > 40, or >35 with significant co-

morbidities

Documented failure of medical

management (diet + exercise; pharm)

Psychological ability to undergo surgery

Absence of other chronic disease


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What are thesurgical options? Restrictive:Adjustablegastric banding &

Vertical band gastroplasty

Malabsorptive: Roux-en-Y gastric bypass &

Biliopancreatic diversion


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Adjustablegastric

band

Verticalband

gastroplasty


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RGB BPD


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BPD-DS


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Steinbrook, R. N Engl J Med 2004;350:1075-1079

Estimated Number of Bariatric Operations Performed in the United States, 1992-2003


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Laparoscopic VersusOpen Gastric Bypass:A

Randomized Study ofOutcomes, Quality of

Life, and Costs

Nguyen, Ninh T. MD*; Goldman, Charles MD*; Rosenquist,

C. John MD; Arango,Andres BS*; Cole, Carol J. BS*;Lee, StevenJ. MS* and; Wolfe, Bruce M. MD, FACS


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155 patients w/ BMI 40-60 randomly

assigned to lap (79) or open (76)

Nguyenet al. Laparoscopic Versus Open Gastric Bypass: A Randomized Study of

Outcomes, Quality of Life, and Costs. Ann Surg. 234, 2004. 279-91.


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OUTCOMES




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OUTCOMES




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OUTCOMES

Nguyenet al. Laparoscopic Versus Open Gastric Bypass: A Randomized Study ofOutcomes ualit o Li e and Costs. Ann Sur . 234 2004. 279-91.


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OUTCOMES




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OUTCOMES




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CONCL

USIONS Laparoscopic GBP issafe alternative to

open GBP

Lap pt sbenefited from dec EBL,shorterLOS

& more rapid improvement in QOL than open

GBP

surgery for obesity - taddona

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