Bariatric and Cosmetic Surgery

Bariatric Surgery Overview

• Definition: Bariatric surgery involves surgical procedures on the stomach and/or intestines to aid in weight loss for individuals with extreme obesity.

• Purpose: It is currently the only effective treatment demonstrating sustained weight loss for individuals with extreme obesity.

Criteria for Surgery

• Body Mass Index (BMI):

  • BMI of 40 kg/m² or more.

  • Alternatively, a BMI of 35 kg/m² or more with weight-related comorbidities such as:

    • Type 2 diabetes

    • Hypertension

    • Sleep apnea

    • Heart failure

    • Liver failure

Benefits of Bariatric Surgery

• Quality of Life Improvements:

  • Weight loss enhances overall quality of life.

• Medical Outcomes:

  • Improved glucose control and diabetes management.

  • Normalization of blood pressure (BP).

  • Reduced levels of total cholesterol and triglycerides.

  • Decreased instances of gastroesophageal reflux disease (GERD) and sleep apnea.

Contraindications for Surgery

• Insurance Issues:

  • Insurance coverage varies and often requires participation in a supervised weight loss program and psychological evaluation.

• Screening for Psychological and Physical Issues:

  • Mood disorders, binge-eating disorders, substance abuse, and other psychiatric conditions can negatively affect surgical outcomes.

• Health Conditions:

  • Severe illnesses like advanced cancer, end-stage organ diseases, and unmanageable medical conditions are contraindications.

Types of Bariatric Surgery

• Categories: Bariatric surgeries can be classified as:

  • Restrictive

  • Malabsorptive

  • Combination of both

Restrictive Surgeries

1. Adjustable Gastric Banding (AGB)

   • Inflatable band creates a pouch of approximately 30 mL capacity, adjustable for physiological needs.

   • Advantages: Reversible, normal digestion, low complication rates.

   • Disadvantages: Possible nausea, vomiting, food intolerance, and limited weight loss.

2. Sleeve Gastrectomy

   • Removal of 75% of stomach, forming a sleeve-shaped organ.

   • Faster weight loss but not reversible, with potential complications including leakage and nutritional issues.

3. Gastric Plication

   • A modified version of sleeve gastrectomy, the stomach is sutured rather than removed.

   • Requires a shorter hospital stay but common nausea and risks of leakage.

4. Intragastric Balloon

   • Balloon fills stomach space to promote satiety; outpatient procedure but may present nausea and discomfort.

Malabsorptive Surgery

1. Biliopancreatic Diversion (BPD)

   • Significant portion of stomach removed with reduced nutrient absorption.

   • Pros: Larger meals and rapid weight loss.

   • Cons: Common bloating, numerous bowel movements, and nutritional deficiencies.

Combination Procedures

1. Roux-en-Y Gastric Bypass (RYGB)

   • Small pouch created by bypassing the larger portion of the stomach and intestine.

   • Pros: Effective weight loss and improved comorbidities.

   • Cons: Risk of tension leaks, anemia, and dumping syndrome.

Less Invasive Option

1. Gastric Pacemaker

   • Electrical device implanted to stimulate satiety signals to the brain.

   • Minimal invasiveness with side effects including nausea and heartburn.

Nursing Considerations for Bariatric Surgery

Preoperative Care

• Assess physical limitations, mobility issues, and vital signs.

• Familiarize with correct medical and nutritional techniques, including VTE precautions and proper hospital equipment for body size.

Postoperative Care

• Monitor vital signs and wounds; teach deep breathing and early ambulation.

• Nutrition management starts with clear liquids and gradual transition to a soft diet.

Long-Term Patient Care

• Emphasize the need for follow-up care due to risk for nutritional deficiencies, psychological challenges, and ongoing support for healthy lifestyle integration.

Psychological Considerations

• Help patients navigate self-image issues after significant weight loss.

• Address societal pressures and encourage counseling if needed.

Considerations for Women Considering Pregnancy Post-Surgery

• Women's fertility may return post-surgery but advise postponing pregnancy for 12-18 months to avoid complications.

Metabolic Syndrome Overview

• Importance: Group of metabolic risk factors increasing cardiovascular disease (CVD), stroke, and diabetes risk.

• Criteria for Diagnosis: At least three of five measures must be present (waist circumference, triglyceride levels, HDL cholesterol levels, BP, and fasting glucose).

Etiology and Pathophysiology of Metabolic Syndrome

• Insulin resistance is the main risk factor linked to excess visceral fat.

• Increased risk of coronary artery disease and associated medical complications if left unmanaged.