Heaviest person in the world: ( 612 KG ) Pre operative Obesity Pic
WHAT IS OBESITY.
According to WHO..
- Obesity and overweight is defined as abnormal or excessive fat accumulation that may impair health.
- BMI is commonly used to classify overweight and obesity in adults.
Super Obesity
Heaviest person in the world:
Pre operative Obesity
Pre Operative work up.
- Detailed history and physical examination.
- Discussion of various wt loss option with the Patient and family and risk involved.
- Successful outcome based on 3 components:
- Exercise and compliance with the new dietary regime. 50 to 75% excess body weight loss in lap gastric bypass and lap sleeve gastrectomy.
- 40% to 50% excess body weight loss in lap gastric band.
- Lifelong follow up: vitamin and mineral life long, psychological assessment for substance abuse, eating disorder and suicide tendencies.
| BMI Index. | |
| 20 to 25 | Normal. |
| 25 to 30 | Over weight. |
| 30 to 35 | Obese. |
| 35 to 40 | Morbid Obese. |
| 40 Onwards | Super Obesity. |
Lab and Radiological Tests.
CBC, LFTS, RFTS, Lipid profile , Glycosylated Hb .
Serum CA, Serum iron ,Serum iron binding capacity, uric acid ,Serum copper and selenium.
Vit-A,B-1,B-6,B-12,Vit-C,Vit-D.
Para hormone.
Glucose tolerance test.
Pulmonary function test.
X-ray chest over 40 and usg abdomen to rule out gallstones.
Upper GI endoscopy to rule out Hiatus hernia.
Echo and cardiac evaluation for super obese pt.
OPTIONS FOR MORBID OBESITY.
- Endoscopic intragastric balloon insertion.
- Lap Gastric banding.
- Lap gastric by pass/Duodenal switch.
- Lap Sleeve Gastrectomy.
Indications – Bariatric surgery
Patients with BMI > 40 Kg/m2
Those with BMI of 35 and associated co morbid like DM, HTN, SLEEP APNEA, BACKACHE .
Failure of medical treatment and behavioral intervention including diet and exercise.
Intra Gastric balloon Technique.
- Weight loss in the range of 12 to 15%.
- It is inserted endoscopically.
- Out pt procedure under sedation.
- Usually saline or methelene blue filled balloon is inserted.
- Post insertion antiemetic and proton pump inhibitor.
- Balloon must be removed after 6 months.
Lap Gastric Banding Technique.
Silicone rubber balloon wrapped around upper portion of the stomach distal to GE.
Has sub cut access port in ant abdominal wall .
It allows adjustable amount of gastric restriction.
Ideally band provide 3 to 4 kg wt per week.
Lap Gastric by pass
Technique of lap by pass.
It is performed laproscopically using 5 ports.
It was considered as gold standard against other procedures.
Involves creation of a small gastric pouch 15_20ml using linear stapler.
Pouch is attached to the Roux Limb of the small intestine which is 50 to 150 cm in length.
The Y connection is usually done more distally usually
100 to 150 cm from the lower end of the bowel.
Switch/Billio pancreatic diversion
Duodenal switch
It is both absorptive and restrictive procedure.
Capacity of stomach is reduced up to 70 %.
Pylorous is preserved.
Laproscopic Sleeve Gastrectomy
Technique and indication.
This is the procedure of choice nowadays ,have best results so far and every where in the world this procedure has gain popularity.
Also referred as Vertical sleeve Gastrectomy .
Greater curvature of stomach is resected and lesser
Curvature along with the pylorus is left behind.
Long term results need to be assessed.
Sleeve is successful if you loose 25 of extra wt in three months and 60% in 6 months.
Positions of ports
Surgical Complications
Intra operative
Injury to viscous
Hemorrhage
Staple failure
Leakage
Early Post Op Complications
DVT & PE
Hemorrhage
Leak
Chest Infection
Wound Infection
Collection
Late Complications
Iron & Vitamin Deficiency
Internal Herniation
Bronco pleural Fistula
Post Sleeve
Post by Pass
Sleeve Gastrectomy @ KFMC—Outcome
Post sleeve
After plastic surgery
Post sleeve and plastic surgery
Post Operative Follow up.
Usually for LSG.LGBYPASS. It is 3 weeks , 3 Months, 6 Months and one year .
For lap gastric band it is 6 week when the first adjustment is done.
At each visit blood study is done to see the nutritional status.
Surgical Outcome.
Mortality in good centers is 0.35%.
Improvement in life style and risk factors associated with obesity.
Early satiety and therefore reduced intake? Hormonal
Role too.
Improvement in insulin secretion due to alteration in the gut hormone esp. GLP-1(INCERTIN) so better glycemic control.
Bariatric surgery has shown to improve or resolve DM, Hypercholestremia & HTN.
It also relieves knee & back problems
Bariatric surgery has proved itself as a dramatic treatment in medical science.
