Caring for Patients After Bariatric Surgery

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Bariatric surgery leads to sustainable long-term weight loss and may be curative for such obesity-related comorbidities as diabetes and obstructive sleep apnea in severely obese patients. The Rouxen-Y gastric bypass has become the most common procedure for patients undergoing bariatric surgery.




The procedure carries a mortality risk of up to 1 percent and a serious complication risk of up to 10 percent. Indications include body mass index of 40 kg per m2 or greater, or 35 kg per m2 or greater with serious obesity-related comorbidities (e.g., diabetes, obstructive sleep apnea, coronary artery disease, debilitating arthritis). Pulmonary emboli, anastomotic leaks, and respiratory failure account for 80 percent of all deaths 30 days after bariatric surgery; therefore, appropriate prophylaxis for venous thromboembolism (including, in most cases, low-molecular-weight heparin) and awareness of the symptoms of common complications are important. Some of the common short-term complications of bariatric surgery are wound infection, stomal stenosis, marginal ulceration, and constipation. Symptomatic cholelithiasis, dumping syndrome, persistent vomiting, and nutritional deficiencies may present as long-term complications.Bariatric surgery leads to sustainable long-term weight loss and may be curative for such obesity-related comorbidities as diabetes and obstructive sleep apnea in severely obese patients. The Rouxen-Y gastric bypass has become the most common procedure for patients undergoing bariatric surgery.




The procedure carries a mortality risk of up to 1 percent and a serious complication risk of up to 10 percent. Indications include body mass index of 40 kg per m2 or greater, or 35 kg per m2 or greater with serious obesity-related comorbidities (e.g., diabetes, obstructive sleep apnea, coronary artery disease, debilitating arthritis). Pulmonary emboli, anastomotic leaks, and respiratory failure account for 80 percent of all deaths 30 days after bariatric surgery; therefore, appropriate prophylaxis for venous thromboembolism (including, in most cases, low-molecular-weight heparin) and awareness of the symptoms of common complications are important. Some of the common short-term complications of bariatric surgery are wound infection, stomal stenosis, marginal ulceration, and constipation. Symptomatic cholelithiasis, dumping syndrome, persistent vomiting, and nutritional deficiencies may present as long-term complications.

Sixty-seven percent of Americans are obese or overweight, resulting in combined direct and indirect health care costs estimated to be $117 billion per year.1,2  Common obesity-related comorbidities include coronary artery disease, diabetes, obstructive sleep apnea, osteoarthritis, chronic infections, and psychological disorders (Table 1). The combination of highly available, energy-dense food and the reduction of required daily energy expenditure from the use of modern-day conveniences (e.g., automobiles, elevators, remote controls) most likely contributes to the obesity epidemic.

SORT: KEY RECOMMENDATIONS FOR PRACTICECLINICAL RECOMMENDATION EVIDENCERATING REFERENCEBariatric surgery leads to sustainable long-term weight loss and may reduce obesity-related comorbidities such as diabetes mellitus and obstructive sleep apnea.
A
5
Patients should undergo multispecialty preoperative evaluation by a team with medical, surgical, psychological, and nutritional experience before bariatric surgery.
C
7
Prophylaxis to prevent venous thromboembolism using low-molecular-weight heparin is indicated for most patients.
A
17
TABLE 1Obesity-Related ComorbiditiesSYSTEM COMORBIDITIESCardiovascular
Hypertension, hyperlipidemia, cardiomyopathy, long QT syndrome, atrial fibrillation
Pulmonary
Reactive airway disease, obstructive sleep apnea, restrictive lung disease
Musculoskeletal
Debilitating osteoarthritis, chronic low back pain, immobility
Psychological
Binge-eating disorder, depression, body dysmorphic disorder
Dermatologic
Intertrigo, venous stasis, decubitus ulcer, acanthosis nigricans
Endocrine
Diabetes mellitus, hypoandrogenemia, metabolic syndrome, polycystic ovarian syndrome
Genitourinary
Ovarian cancer, uterine cancer, breast cancer, renal cell cancer, dysfunctional uterine bleeding
Gastrointestinal
Irritable bowel syndrome, nonalcoholic fatty liver disease, gastroesophageal reflux, esophageal cancer, colon cancer
Neurologic
Ischemic stroke, meralgia paresthetica



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