Excess weight is responsible for an estimated 500,000 deaths per year in the US. In England and Scotland, an estimated 23% of all deaths are attributed to overweight or obesity. The incidence of class III obesity (body mass index [BMI] of 40 or above) is increasing at a rapid rate, and this has resulted in an increase in bariatric operations worldwide. Bariatric surgery (also referred to as metabolic surgery) has been shown to substantially lower all-cause mortality rates among adults with obesity, compared with nonsurgical obesity management. Studies demonstrate that children and adolescents with class III obesity benefit from weight loss surgery. The mechanism of action of bariatric surgery for obesity is not fully understood but is believed to include gastric volume restriction, malabsorption, and hormonal changes.
Recommendations for the BMI threshold for bariatric surgery differ among guidelines. The American Society of Metabolic and Bariatric Surgery and the International Federation for the Surgery of Obesity and Metabolic Disorders recommend bariatric surgery for individuals who have a BMI of ≥35 kg/m², regardless of comorbidities, or for individuals with a BMI between 30.0 and 34.9 kg/m² who do not achieve durable weight loss and management of comorbidities despite optimal nonsurgical therapy. Bariatric surgery is also a treatment option for patients with type 2 diabetes and a BMI >30 kg/m² who do not achieve durable weight loss and management of comorbidities despite optimal nonsurgical therapy. In Asian individuals the BMI threshold is lower due to differences in body composition and cardiometabolic risk.
After bariatric surgery, patients may present to clinics, emergency departments, or a hospital other than the one where they had the operation. Thus, knowledge of common complications is necessary. The abdomen with central adiposity may be difficult to examine and can mask typical signs of sepsis. Careful attention to vital signs, examination findings, and any deviation from expected postoperative course is essential.
- Types of surgical procedures
- Assessing and preparing patients for surgery
- Expected weight loss
- Gastric bypass: description
- Gastric bypass: early complications
- Gastric bypass: late complications
- Sleeve gastrectomy: description
- Sleeve gastrectomy: complications
- Gastric band: description
- Gastric band: early complications
- Gastric band: late complications
- Biliopancreatic diversion (BPD) with or without duodenal switch: description
- Biliopancreatic diversion (BPD) with or without duodenal switch: complications
- Metabolic and nutritional complications
- Bone and mineral metabolism
- Bariatric surgery and pregnancy
- Weight loss failure or weight regain following bariatric surgery
- Abdominal pain following bariatric surgery
- Nausea and vomiting following bariatric surgery
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