MSCI3009: Clinical Perspectives 2
Dr Louise Dunford
Bariatric Surgery
Learning Outcomes:
After your weight management lectures and doing your own background reading you should be able
to:
Explain what bariatric surgery is, why we use it, and what the benefits and risks are.
Explain the NICE guidelines for bariatric surgery.
Describe and illustrate different types of bariatric surgery
Evaluate the evidence for its success
Compare success to other weight loss methods
Bariatric surgery is weight loss surgery. Reduces size of stomach. Or bypasses part of the stomach.
Rarely makes someone a normal weight. For most people it shifts category from high risk to
progressively lower.
Why do bariatric surgery?
Used as a treatment for people who are very obese. It is used to resolve comorbidities, it can lead
to significant weight loss and help improve and prevent conditions, such as type 2 diabetes or high
blood pressure, muscular skeletal problems - arthritis
Financial and economic benefit for country – individuals take less long-term medications to treat
their obesity-related condition, this is better financially as it saves the individual money.
Personal reasons – to improve self-confidence and self esteem as well as appearance.
To combat stigma with obesity
NICE Guidelines
NICE Guidelines (National Institute for Health and Care Excellence)
Guidance on identification, assessment and, management of obesity.
Need to fulfil ALL the following criteria:
BMI> 40 kg/m² or BMI> 35 kg/m² and comorbidity.
Non-surgical measures (diet, lifestyle changes and programmes or drugs) have been tried
and failed.
The person is fit for anaesthesia and surgery.
The person is committed to long term follow up.
The person will receive intensive management in a tier 3 service (specialist multidisciplinary
team).
, MSCI3009: Clinical Perspectives 2
Dr Louise Dunford
Prior to surgery the consultant needs to discuss the following issues with the patient and family if
appropriate:
Benefits and risks
Surgical complications and perioperative mortality
Long term implications of surgery.
Choose the surgical intervention jointly with the patient, taking into account:
The degree of obesity and comorbidities
The scientific evidence on effectiveness and long term, effects (positive and negative)
The facilities and equipment available at the hospital
The experience of the surgeon.
Provide post- operative dietetic monitoring and support:
The appropriate diet for the bariatric procedure
Micronutrient status monitoring and nutritional supplementation
Information on patient support groups
Support and guidance to achieve long term, weight loss and weight maintenance.
Three main types of bariatric surgery:
1. Gastric band
2. Gastric sleeve
3. Gastric bypass (roux en y)
Gastric Band
Laparoscopic adjustable gastric banding (LAGB)
Least invasive of the surgical methods.
Can be adjusted or reversed.
Weight loss takes longer.
Band can slip – very painful.
Simplest method.
The restriction of the stomach can be created using
a silicone band, this makes you feel full after eating
a small amount of food. The band can be adjusted
by addition or removal of saline through a port
placed just under the skin.
Gastric Sleeve
Weight loss quicker than gastric band but
slower than bypass.
Can do full bypass at later stage.
Less risky than full bypass, but still major
surgery.
Not reversible - because part of stomach is
permanently removed.
Can still stretch stomach back.
Removes part of stomach, stomach shaped as sleeve
and sewn together. Permanent smaller stomach.
Dr Louise Dunford
Bariatric Surgery
Learning Outcomes:
After your weight management lectures and doing your own background reading you should be able
to:
Explain what bariatric surgery is, why we use it, and what the benefits and risks are.
Explain the NICE guidelines for bariatric surgery.
Describe and illustrate different types of bariatric surgery
Evaluate the evidence for its success
Compare success to other weight loss methods
Bariatric surgery is weight loss surgery. Reduces size of stomach. Or bypasses part of the stomach.
Rarely makes someone a normal weight. For most people it shifts category from high risk to
progressively lower.
Why do bariatric surgery?
Used as a treatment for people who are very obese. It is used to resolve comorbidities, it can lead
to significant weight loss and help improve and prevent conditions, such as type 2 diabetes or high
blood pressure, muscular skeletal problems - arthritis
Financial and economic benefit for country – individuals take less long-term medications to treat
their obesity-related condition, this is better financially as it saves the individual money.
Personal reasons – to improve self-confidence and self esteem as well as appearance.
To combat stigma with obesity
NICE Guidelines
NICE Guidelines (National Institute for Health and Care Excellence)
Guidance on identification, assessment and, management of obesity.
Need to fulfil ALL the following criteria:
BMI> 40 kg/m² or BMI> 35 kg/m² and comorbidity.
Non-surgical measures (diet, lifestyle changes and programmes or drugs) have been tried
and failed.
The person is fit for anaesthesia and surgery.
The person is committed to long term follow up.
The person will receive intensive management in a tier 3 service (specialist multidisciplinary
team).
, MSCI3009: Clinical Perspectives 2
Dr Louise Dunford
Prior to surgery the consultant needs to discuss the following issues with the patient and family if
appropriate:
Benefits and risks
Surgical complications and perioperative mortality
Long term implications of surgery.
Choose the surgical intervention jointly with the patient, taking into account:
The degree of obesity and comorbidities
The scientific evidence on effectiveness and long term, effects (positive and negative)
The facilities and equipment available at the hospital
The experience of the surgeon.
Provide post- operative dietetic monitoring and support:
The appropriate diet for the bariatric procedure
Micronutrient status monitoring and nutritional supplementation
Information on patient support groups
Support and guidance to achieve long term, weight loss and weight maintenance.
Three main types of bariatric surgery:
1. Gastric band
2. Gastric sleeve
3. Gastric bypass (roux en y)
Gastric Band
Laparoscopic adjustable gastric banding (LAGB)
Least invasive of the surgical methods.
Can be adjusted or reversed.
Weight loss takes longer.
Band can slip – very painful.
Simplest method.
The restriction of the stomach can be created using
a silicone band, this makes you feel full after eating
a small amount of food. The band can be adjusted
by addition or removal of saline through a port
placed just under the skin.
Gastric Sleeve
Weight loss quicker than gastric band but
slower than bypass.
Can do full bypass at later stage.
Less risky than full bypass, but still major
surgery.
Not reversible - because part of stomach is
permanently removed.
Can still stretch stomach back.
Removes part of stomach, stomach shaped as sleeve
and sewn together. Permanent smaller stomach.
