Complications of Bariatric Surgery Samaad Malik MD MSc Surg FRCSC Head Division of General Surgery Clinical Assistant Professor University of British Columbia Victoria General Hospital ID: 1039217
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1. “Losing it is only the beginning…” Complications of Bariatric SurgerySamaad Malik, MD, MSc (Surg), FRCSCHead, Division of General SurgeryClinical Assistant Professor, University of British Columbia, Victoria General Hospital, Victoria, BCwww.victoriasurgery.ca
2. DisclosuresNo disclosures
3. IntroComorbiditiesBariatric SurgeryVariations
4. Etiology GeneticBehavioralPhysiologicalPsychologicalSocialEnvironmentalCulturalMedicationsEndocrine
5. Bariatric SurgeryBPDREY Gastric BypassMini gastric bypassSADISleeve GastrectomyBandDo not cure Morbid Obesity80-100 lb weight loss
6. Predictors of Morbid ObesityAgeGenderSocial inactivityStressEmotional Anxiety
7. Elements of Bariatric CareMorbid Obesity is a real diseaseSurgery is not cureLaparoscopic Best for nowComplication RateMultidisciplinary team involvement
8. Elements of Bariatric CareDiet, Exercise and Behavioral ModificationJournalActive processFamily membersWeight Loss support groupclub
9. Preoperative PathwayProvincial ProgramCentral Intake2 Sites: Victoria and Richmond6 SurgeonsPatient Preparation:EducationProtein Shakes
10. Surgical Options
11. Surgical Options
12. Surgical Options
13. Surgical OptionsREY Gastric BYPASSSleeve Gastrectomy
14. NKOTB
15. ResultsType II DM resolution ratesBPD >90% REY GB up to 80%Sleeve up to 75%
16. ResultsREY Bypass60-80% EWL in 1st year50-60% EWL at 5 yearsSleeveLong term data REFLUXBMI<30 excellent response BMI 30-35 moderate response BMI >35 poor response
17. ComplicationsSurgical MedicalMultiple anastomosesleak/stenosis/obstruction/bleedIncreased procedure specific complications Internal herniationMarginal ulcerationNSAIDs contraindicatedGastric remnant distentionRecurrent hyperinsulinemic hypoglycemia Dumping syndromeNutritional deficienciesUnpredictable medication absorptionQuality of LifebowelsNutritional deficienciesIron deficiency anemia
18. REY GASTRIC BYPASSPainInternal herniation
19. REY GASTRIC BYPASSREY GBMarginal ulceration
20. LEAKREY GBSleeve
21. CBD STONESREY GBSleeve
22. REFLUXREY GBSleeve
23. Weight RegainLong-term weight loss in laparoscopic sleeve gastrectomy.Sepúlveda M1, Alamo M2, Saba J3, Astorga C3, Lynch R3, Guzmán H3.Surg Obes Relat Dis. 2017 Jul 25. pii: S1550-7289(17)30343
24. Bariatric Surgery in VictoriaProgramInfrastructureDietician, patient navigatorBariatric SurgeonsDr Brad AmsonDr Samaad MalikDr Elaine LamSingle WaitlistFirst available surgeon modelTimeline:LongIdeally 6-9 monthN=120 cases/yrSleeves
25. ConclusionsBariatric Surgery is the most effective treatment for patients suffering from obesity related comorbidities: DM, HTN, OSA, lipidsNot CureLap Sleeve GastrectomyComplicationsCannot operate on everyoneNeed a better optionSurgery is best solution now, but far from perfect
26. THANK YOU!www.victoriasurgery.ca