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Number of Bariatric Surgeries Performed

Number of Bariatric Surgeries Performed. American Society for Metabolic and Bariatric Surgery. Indications. BMI >40 kg/m 2 or BMI >35 kg/m 2 with an associated medical comorbidity worsened by obesity Failed dietary therapy

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Number of Bariatric Surgeries Performed

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  1. Number of Bariatric Surgeries Performed American Society for Metabolic and Bariatric Surgery

  2. Indications • BMI >40 kg/m2 or BMI >35 kg/m2 with an associated medical comorbidity worsened by obesity • Failed dietary therapy • Psychiatrically stable without alcohol dependence or illegal drug use • Knowledgeable about the operation and its sequela • Motivated individual • Medical problems not precluding probable survival from surgery

  3. Obesity Related Conditions • Diabetes • Hypertension • Hyperlipidemia • Respiratory disease • Sleep apnea • Depression • Menstrual irregularity • Cardiovascular disease • Urinary stress incontinence • Asthma/pulmonary disorder • Gastroesophageal reflux disease (GERD) • Degenerative joint disease (DJD) • Congestive heart failure • Gallstones • Coronary heart disease • Stroke • Osteoarthritis • Cancer • Amenorrhea • Polycystic ovary syndrome • Infertility • Dysmenorrhea

  4. Preop Evaluation • Nutritionist visits • Psychological evaluation • Exercise Physiology evaluation • EGD with biopsies for H. pylori • UGI series • IVC filter placement • Cardiopulmonary evaluation • Routine bloodwork • Vitamin levels

  5. Adjustable Gastric Band • Silicone band • Encircles proximal stomach • Purely restrictive procedure

  6. The Foregut Theory Exclusion of Duodenum from transit of nutrients prevents secretion of signal that promotes insulin resistance and DM type 2 Rubino F. Annals of Surgery • Vol 244, Nov 2006

  7. Sleeve Gastrectomy • A gastric tube of 60 to 120mL is created • Induces weight loss by 2 mechanisms:1) Mechanical restriction2) Hormonal modification

  8. Sleeve Gastrectomy Long Term results Himpens J. Ann Surg 252: 319–324 2010

  9. Bypass versus Band • Bypass 90 80 70 60 50 40 30 20 10 • Band Resolution % DM HTN Dyslipidemia OSA Preoperative Morbidity Tice J. Am J Med. Vol 121, 10. 2008

  10. Comparison of Bariatric Surgery Meta Analysis Buchwald, H. JAMA 2004

  11. Bariatric Surgery versus Intensive Medical Therapy Change in BMI Intensive medical therapy Gastric Sleeve Gastric Bypass Schauer P, NEJM 2012

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