Page 11 - World Journal of Laparoscopic Surgery

Bariatric Surgery and Obesity
Table 1: Selection and exclusion criteria for bariatric surgery The effect of surgery on anthropometric parameters like weight,
Selection criteria BMI, waist circumference, hip circumference, and waist–hip ratio
Able to adhere to postoperative care (e.g., follow-up visits and tests, was studied. The biochemical parameters included HbA1c and
medical management, and use of dietary supplements) lipid profile (serum cholesterol, triglycerides, HDL, LDL, and VLDL).
BMI ≥40 kg/m 2
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BMI ≥35 kg/m with obesity-related comorbidity mAterIAls And methods
Previous failed nonsurgical attempts at weight reduction, including Preoperative Evaluation
nonprofessional programs (e.g., weight watchers) The study was carried out in the Department of Surgery, Dayanand
Exclusion criteria Medical College and Hospital, Ludhiana, on male obese subjects
Cardiopulmonary disease that would make the risk prohibitive who underwent bariatric surgery for morbid obesity. After due
Current drug or alcohol abuse institutional ethics committee approval, the study was conducted
Lack of comprehension of risks, benefits, expected outcomes, in a 1.5-year time period. Preoperative evaluation was done by a
alternatives, and required lifestyle changes dedicated bariatric team which included the bariatric surgeon,
Reversible endocrine or other disorders that can cause obesity dietician, endocrinologist, gastroenterologist, respiratory medicine
Uncontrolled severe psychiatric illness physician, psychiatrist, anesthesiologist, and cardiologist.
The preoperative preparation of the patient included the
following:
The current surgical options can be broadly classified as
gastric restrictive, malabsorptive procedures, or a combination Counseling
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of these two. Jejunoileal bypass is the archetype malabsorptive All patients were counseled regarding:
procedure but has been largely abandoned because of profound
adverse metabolic consequences that include renal calculi, vitamin • Management options available for obesity, including diet,
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deficiency, hypokalemia, hepatic dysfunction, and osteoporosis. exercise, pharmacotherapy, and surgery.
Bariatric surgery has been shown to decrease fat mass in various • Expected weight loss and benefits in terms of sustained weight
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studies that measured body composition after bariatric surgery. loss and resolution/improvement of comorbidities.
There is a decrease in both subcutaneous and visceral fat after • General information regarding all available surgical options
bariatric surgery. 14 and risks of surgery including irreversibility of the procedure.
Three procedures are commonly done: (i) laparoscopic adjustable • Need for regular follow-up and strict compliance with the
gastric banding (LAGB), (ii) laparoscopic sleeve gastrectomy (LSG), dietary, exercise, and lifestyle modifications advised before and
and (iii) Roux-en-Y gastric bypass (RYGB). In LAGB, a hollow, flexible after the surgery.
silicone band is placed around the upper stomach, which causes a
restrictive effect thereby reducing stomach capacity and, henceforth, Nutritional Counseling
causes rapid feelings of satiety. The band is tightened by injecting Preoperative and postoperative diet was planned in consultation
saline into the band via a subcutaneous port which is located just with the dietician. The target weight was calculated in that session.
inferior to the sternum or lateral to the umbilicus.
The LSG procedure resects most of the body and all of Detailed Patient Interview to be Included
the fundus of the stomach, creating a long, narrow, tubular Specific inclusion and exclusion criteria and appropriate statistical
stomach. This procedure was first used as an initial step before methods and tests were applied (Table 1).
a malabsorptive procedure in very high-risk patients but is now Patient’s complete medical history including history of
approved as a primary stand-alone procedure. 15,16 diabetes mellitus (DM), hypertension, hypothyroidism, and other
In RYGB, a small gastric pouch is formed by dividing the upper comorbidities along with details of treatment, duration, and the
stomach and joining it with the resected end of jejunum, so that dosages of medicines was obtained.
food bypasses the stomach and upper small bowel, thereby
restricting the size of the stomach and causing some malabsorption. • History of sleep apnea and snoring, including requirement for
Roux-en-Y gastric bypass may be a better choice in more obese assisted ventilation, home-based oxygen therapy.
patients and in those with type II diabetes [RYGB is the most All patients underwent a comprehensive multidisciplinary
common procedure (51%) performed in the United States and bariatric evaluation, which included the following:
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Canada, followed by LAGB (44%)]. The biliopancreatic diversion, • Cardiology evaluation: electrocardiogram, echocardiography,
with or without duodenal switch, is an older procedure that is no and, if required, stress thallium.
longer commonly performed. 6 • Gastroenterology evaluation: an upper gastrointestinal
The choice of procedure depends on the expertise of endoscopy was done to rule out reflux esophagitis, hiatus hernia,
the surgeon and surgical center, patient preference, and risk and gastric ulcers.
stratification. Several studies have shown that the risk of serious • Evaluation by pulmonary physician included pulmonary
complications decreases with increasing procedure volume of the function tests and arterial blood gas analysis.
surgeon and center. 18–21 • Endocrinology evaluation for detection, assessment and
management of diabetes and hypothyroidism.
AIms And objectIves Out of a total of 17 patients, 12 (70.59%) underwent laparoscopic
The aim of this study was to study the effect of bariatric surgery sleeve vertical gastrectomy (LSVG). Mini gastric bypass (MGB) was
on the anthropometric and biochemical parameters of patients. performed in 4 (23.53%) and open sleeve gastrectomy (OSG) in

World Journal of Laparoscopic Surgery, Volume 12 Issue 3 (September–December 2019) 97