The Skinny on Bariatric Surgery. Kim A. Noble, Ph.D., RN, CPAN SCAPAN Fall Conference November 15 th, 2014

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1 The Skinny on Bariatric Surgery Kim A. Noble, Ph.D., RN, CPAN SCAPAN Fall Conference November 15 th, 2014

2 The Skinny on Bariatric Surgery Objectives Following the completion of this presentation, the learner will be able to:! Describe the incidence of worldwide obesity.! Describe the rationale for Bariatric surgery.! Compare & contrast the different surgical techniques for Bariatric surgery, rationale and positive and negative aspects for each.! List the patient care priorities for the care of the Bariatric surgery patient.

3 What is Bariatric Surgery? n Treatment for morbid obesity. n > 50 years old n 1998: 25,000 n 2004: 140,000

4 Bariatric Surgery in the USA n 65% Americans overweight. n as compared to : obesity doubled in USA. n 33% of children in US are overweight; 5-25% obese.

5 Global Obesity & Bariatric Surgery n Overweight %: n US 60% n Russia, UK & Germany 50% n Columbia, Brazil, Italy, Austria & Switzerland 20% n China 10% n Australia 41% " 23% # n Morbid obesity 20% of overweight population. n Most Bariatric procedures in US & Canada (103,000).

6 Bariatric Surgery Worldwide Argentina (88) Australia (60) 68 2,750 Austria (73) 38 1,396 Belgium (70) 200 6,000 Brazil (73) 510 4,000 Czech Rep (83) Egypt (96) 12 2,750 France (84) ,000 Germany (75) 54 1,100 Greece (78) Hungary (99) 1 30 Israel (78) 50 1,000 Italy (73) 200 3, Survey data IFSO (Buchwald & Williams, 2004) Japan (82) Mexico (71) 200 2,500 Netherlands (73) Panama (89) 5 60 Poland (74) Russia (69) Spain (77) 160 2,000 Sweden (70) Switzerland (70) Turkey (90) Ukraine (78) UK (55) USA/Canada (53) ,000

7 In-patient Bariatric Surgery

8 Patient Selection: BMI n Body mass index: n Divide weight (kg) by height (meters squared) n BMI > 25: overweight n BMI > 30: obese n BMI > 40: morbid obesity.

9 Choices for Bariatric Surgery

10 Gastric Bypass 1966: Dr. Edward Mason n Mid 1970 s: Evolution of the surgical procedure.

11 Jejunoileal Bypass (M) n Used 1954~1980. n 35 cm jejunum to distal ileum. n +: Weight loss n -: Replaced by gastric bypass due to risk of liver & renal failure.

12 Roux-en-Y Gastric Bypass n First: 1967; Now #1; n 3 parts: n +: n Gastric pouch; n jejunum attached &. n risk, = wt loss; laparoscopic use. n Complications.

13 Biliopancreatic Diversion (M) n Appeared in n 3 parts: Gastric resection; jejunum attached &. n +: Saves secretion(s). n -: dumping into large intestine; protein.

14 Duodenal Switch (M) n Similar to BPD. n 3 parts: Gastric resection; jejunum attached &. n +: less protein. n -: dumping. article/healthwise/popup/zm2670

15 Very Long Limb RYGB n Evolved in : Easier to perform. -: Negligible improvement in dumping.

16 Gastric Banding n 1976 for open, 1993 laparoscope. n Early technique involved resection external banding. n Vertical banding Vsadjustable banding +: Easy, can radius. -: Catheter failure.

17 Gastric Pacing n Emerging technology; FDA trials in US. n Mimics satiety +: Laparoscope. -: Rare; leakage along electrode.

18 Bariatric Surgery Worldwide in 2003 % Laparoscopic gastric bypass 25.7% Laparoscopic adjustable gastric banding 24.2% Open gastric bypass 23.1% Laparoscopic long-limb gastric bypass 8.9% Open long-limb gastric bypass 7.5% Open vertical banded gastroplasty 4.3% Open duodenal switch 2.0% Laparoscopic vertical banded gastroplasty 1.2% Laparoscopic biliopancreatic diversion 1.1% Open biliopancreatic diversion 0.87% Laparoscopic duodenal switch 0.85% Open adjustable gastric banding 0.17% Laparoscopic gastric pacing 0.15% Laparoscopic nonadjustable gastric banding 0.08% Open jejunoileal bypass 0.07% 2003 Survey data IFSO (Buchwald & Williams, 2004)

19 Perioperative Care n Preoperative evaluation. n Anesthetic technique. n Postoperative: n Airway n CV risk n Fluid replacement n DVT prophylaxis n Peripheral nerve injury

20 Goldberg (2000) Outcomes of Bariatric Surgery n 100% improvement: n Diabetes. n Lipid profiles. n 99% improvement: n Respiratory function. n 95% improvement: n Cardiac function. n Stress incontinence. n hypertension n 85% improvement: n Arthritis.

21 Surgical Returns n Frequent requirement of surgical resection of redundant skin.

22 Future trends of Bariatrics

23 Questions?

24 References n n Association of Perioperative Registered Nurses (2004). AORN Bariatric Surgery Guideline, AORN, 79(5). Barrow, C. J. (2002). Roux-en-Y gastric bypass for morbid obesity. AORN, 76(4). n Buchwald, H. & Williams, S. E. (2004). Bariatric surgery worldwide Obesity Surgery, 14, n n n n Goldberg, S., Rivers, P., Smith, K. & Homan, W. (2000). Vertical banded gastroplasty: A treatment for morbid obesity. AORN, 72(6). Gould, J. C., Garren, M. J. & Gutowski, K. A. (2006). Bariatric surgery. Clinical Obstetrics & Gynecology, 49(2). Haines, K. L., Nelson, L. G., Gonzalez, R., Torella, T., Martin, T., Kandil, A., Dragotti, R., Anderson, W. M., Gallagher, S. F. & Murr, M. M. (2007). Objective evidence that bariatric surgery improves obesity-related obstructive sleep apnea. Surgery, 141(3). Hooper, M. M., Stellato, T. A., Hallowell, P. T., Seitz, B. A. & Moskowitz, R. W. (2007). Musculoskeletal findings in obease subjects before and after weight loss following bariatric surgery. International Journal of Obesity, 31.

25 References (con t) n n n n Jazet, I. M., Groot, G. H., Tuijnebreyer, W. E., Fogteloo, A. J., Vandenbroucke, J. P & Meinders, A. E. (2007). European Journal of Internal Medicine, 18. Daniels, J. (2006). Obesity: America s epidemic: What goes up does not always come down. Is there a solution? American Journal of Nursing, 106(1). Livingston, E. H. & Langert, J. (2006). The impact of age and medicare status on bariatric surgical outcomes. Archives of Surgery, 141, McGlinch, B. P., Que, F. G., Nelson, J. L., Wrobleski, D. M., Grant, J. E. & Collazo-Clavell, M. L. (2006). Perioperative care of patients undergoing bariatric surgery. Mayo Clinic Proceedings, 81(10), S25-S33. n McNatt, S. S., Longhi, J. J., Goldman, C. D. & McFadden, D. W. (2007) Surgery for obesity: A review of the current state of the art and future directions. Journal of Gastrointestinal Surgery, 11, n Murray, D. (2003). Morbid obesity-psychosocial aspects and surgical interventions. AORN, 78(6).

26 References (con t) n n n Shore, S. A. & Fredberg, J. J. (2005). Obesity, smooth muscle and airway hyperresponsiveness. Journal of Allergy & Clinical Immunology, 115(5). Steinbrook, R. (2004). Surgery for severe obesity. The New England Journal of medicine, 350. Woodard, C. B. (2004). Pregnancy following bariatric surgery. The Journal of Perinatal Neonatal Nursing, 18(4).

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