What body mass index (BMI or weight(kg)/height [m2]) definition of obesity serves as the standard indication for bariatric surgery when medical therapy has failed and com or bid conditions exist?
A 1991 NIH Consensus Conference recommended that bariatric surgery was indicated for a body mass index (BMI) of 35.0-39.9 when medical therapy has failed and comorbid conditions exist. When no comorbid conditions exist, a BMI of 40 or greater is required. This standard continues to be used by insurers, although recent studies have shown benefit in lower BMI groups.
Which of the following bariatric procedures is primarily intended to induce weight loss through malabsorption of ingested nutrients?
Bariatric procedures are classified as restrictive, malabsorptive, or a combination of restrictive and malabsorptive in the mechanism of weight loss that they induce. Restrictive operations include adjustable gastric band and gastric sleeve, malabsorptive operations include duodenal switch and biliopancreatic diversion, and combined restrictive and malabsorptive procedures include the Roux -en-Y gastric bypass (RYGB).
Complications of adjustable gastric banding which have diminished its popularity as a bariatric procedure include all of the following EXCEPT:
The adjustable gastric band procedure, usually performed laparoscopically, has the lowest cost and mortality risk of all the bariatric procedures, but is the least effective for weight loss. In addition, slippage and erosion of the band and complications related to the maintenance and use of the port for adjusting the size of the band contribute to its loss of popularity.
Early postoperative complications after a RYGB procedure include all of the following EXCEPT:
Early postoperative complications after RYGB include anastomotic leak from a staple line, gastric remnant dilation due to downstream obstruction, intra-abdominal bleeding, and pulmonary complications such as atelectasis and pulmonary embolus. Diabetes, if present, usually improves promptly after RYGB and hyperglycemia is unlikely to be problematic.
Small bowel obstruction after RYGB should be treated as an urgent surgical emergency because:
Small bowel obstruction after RYGB is frequently due to an incarcerated internal hernia at the location of the closure, or lack thereof, of the mesenteric defect. This can progress rapidly to strangulation and necrosis of the bowel with subsequent perforation. Adverse outcomes with this complication have resulted in the uniform recommendation that small bowel obstruction in this setting should be regarded as a surgical emergency. Abdominal distention and difficulties with nasogastric intubation are not relevant concerns.
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