CSOWM - BARIATRIC SURGERY PROCEDURES & NUTRITION QUESTIONS WITH CORRECT ANSWERS

CSOWM-BARIATRICSURGERYPROCEDURES & v v v v v




NUTRITION QUESTIONS WITH CORRECT v v v v




ANSWERS 2025 v v




Bariatric and Metabolic Surgery Procedures - CORRECT ANSWER --
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Previously known as weight loss surgery
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- Impact the physiological regulation of body weight
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- Improve morbidity and mortality rates among overweight/obese populations
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Combination Procedures - CORRECT ANSWER - v v v v v




Gastric manipulation, causing some restriction and neural/hormonal changes
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Examples: Sleeve Gastrectomy (SG), Roux-en- v v v v




Y Gastric Bypass (RYGB), and Biliopancreatic Diversion (BPD/DS)
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Sleeve Gastrectomy (SG) - CORRECT ANSWER -
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80% of stomach is removed (specifically the fundus, which significantly reduces ghrelin production)
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Sleeve Gastrectomy (SG) Advantages - CORRECT ANSWER --
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performed more quickly which means shorter anesthesia duration and lesser degree of post op syste mic
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response
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- fewer complications v




- decreased risk of micro-nutritional problems v v v v




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decreased risk of long term complications (obstructions, ulcers, dumping syndrome, hypoglycemia, etc
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)

- can be revised/converted
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- allows access to both biliary & pancreatic duct (for upper GI/EGD)
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- favorable change in the gut microbiota. v v v v v




Sleeve Gastrectomy (SG) Disadvantages & Risks - CORRECT ANSWER -- may
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exacerbate GERD due to preservation of acid producing cells
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unknown long term data (10+ years) regarding durability of weight loss and comorbidity improvement s
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contraindicated in patients with severe GERD, lower esophageal sphincter incompetence, and Barrett's
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esophagus
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Roux-en-Y Gastric Bypass (RYGB) - CORRECT ANSWER - v v v v v v v




Step 1 Restriction: The surgeon separates the upper portion of the stomach from the lower portion. Th e
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upper portion (or the "pouch") is then connected to a limb of the small intestine, called the "Roux li mb."
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The new stomach pouch restricts the amount of food you can eat, making you feel full after eati ng only a
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small amount of food.
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Step 2 Malabsorption: The pouch is then connected to the middle of the small intestine (the jejunum)
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- the duodenum and part of the jejunum are bypassed.
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Roux-en-Y Gastric Bypass (RYGB) Mechanisms - CORRECT ANSWER -Ghrelin Suppression
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- nutrient exposure to the intestine is sufficient for food-induced ghrelin suppression
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- it may cause partial vagotomy
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Increases Satiety and Suppresses Appetite v v v v




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accelerates delivery of nutrients into the hindgut (cecum, large colon, small colon and the rectum) wh ich
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increases the secretion of gut hormones (GLP-1, PPY, OXM, CCK) and bile acids
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Roux-en-Y Gastric Bypass (RYGB) Advantages - CORRECT ANSWER -- more
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weight loss than the LAGB and SG
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- better comorbidity outcomes (CAD, T2DM, HTN, OSA, GERD, and cancer)
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lifetime expectancy increased (~7 years) due to significant improvement or remission of comorbidities
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- favorable change in gut microbiota v v v v




Roux-en-Y Gastric Bypass (RYGB) Disadvantages & Risks - CORRECT ANSWER -- obstruction
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(due to hiatal hernia)
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, - adhesions

- ulcers (NSAIDs, tobacco smoking) such as anastomotic ulcers
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- dumping syndrome v




Biliopancreatic Diversion (BPD) / Duodenal Switch (DS) - CORRECT ANSWER - v v v v v v v v v v




80% of stomach is removed (essentially a sleeve gastrectomy is performed) and the gastric pouch is co
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nnected to a very short length of the ileum (bypasses duodenum and jejunum).
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The biliopancreatic loop (portion of the small intestine that was bypassed) is connected to the distal p art of
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the digestive loop (portion of the intestine that remains and that food will travel through) formi ng a
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channel to the colon
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Biliopancreatic Diversion (BPD) / Duodenal Switch (DS) Advantages - CORRECT ANSWER -- greater
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weight loss @ 1 year follow up
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- most effective against diabetes compared to RYGB, SG, and LAGB
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Metabolic Impact v




- decreased ghrelin (which decreases hunger) v v v v




- increased PYY (which increases satiety) v v v v




- increased GLP-1 (which increases satiety) v v v v




Biliopancreatic Diversion (BPD) / Duodenal Switch (DS) Disadvantages - CORRECT ANSWER --
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higher complication rates and mortality
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- requires longer hospital stay v v v




- greater potential for protein and vitamin/mineral deficiencies
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v due to malabsorption and diarrhea
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patient compliance (lots of follow up visits and strict adherence to dietary and lifelong vitamin/minera l
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supplementation)
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