Shedding Health Risks with Bariatric Weight Loss Surgery

Shedding Health Risks with Bariatric Weight Loss Surgery

By Susan Gallagher Camden, RN, CBN, MSN, PhD

Nursing2009, January 20092.5 ANCC/AACN contact hoursOnline: www.nursingcenter.com

© 2009 by Lippincott Williams & Wilkins. All world rights reserved.

Bariatric weight loss surgery (BWLS)

Patients having BWLS in the U.S. grew 644% from 1995 to 2005

400,000 had the surgery in 2008

One reason is growing awareness of obesity’s effect on morbidity and mortality

How BWLS combats diabetes Obesity is a major independent risk

factor for type 2 diabetes

In the U.S., most people diagnosed with diabetes are overweight

Research shows that 90% of patients who have BWLS no longer need medication for diabetes

Who’s a candidate for BWLS?

National guidelines set forth criteria- body mass index of 40 kg/m2 or more- 35 to 39.9 kg/m2 with severe comorbidities

Insurance reimbursement looks for documentation of 3 unsuccessful attempts at weight-loss programs

Who’s a candidate for BWLS?

Physical exam to include health and weight history

Screening of physical or emotional disorders

Not considered a candidate if: Unstable cardiac or pulmonary condition

Prader-Willi syndrome

Known endocrine disease

Unresolved psychological issues

Typical screening protocol

Preoperative evaluation compromises two main parts:

psychological testing

clinical interview

Psychological testing Typically, Minnesota Multiphasic

Personality Inventory-2

Includes family and social situation

Any eating disorders or psychological issues must be addressed

Patients must be made aware of commitment to weight loss, exercise, changes in eating habits postoperatively

Clinical interview Consists of comprehensive assessment

of patient’s medical, surgical, psychiatric, and psychosocial history

Drug or food allergies

Alcohol and tobacco use and medication history

Sorting out surgical options

Roux-en-Y gastric bypass combines gastric restriction and malabsorption strategies, is most common weight loss procedure performed in U.S.

Surgeon creates small gastric pouch with an anastomosis to the jejunum

Food bypasses 90% of stomach and duodenum so fewer calories are absorbed


When high-calorie foods reach this limb of the small intestine, a feeling of satiety or even discomfort may result, helping curb the appetite

Can be done laparoscopically; reduces consumption and absorption, leading to weight loss


Laparoscopic adjustable gastric banding: stomach size is limited by inflatable band placed around fundus of stomach. Band is connected to SC port and monitored to ensure regulation of stoma size to meet patient’s weight and nutritional needs


Primary advantage is that a reduced amount of well-chewed food enters and passes through the digestive tract in the usual manner

Banding can be performed laparoscopically, making it less invasive and a better choice for some patients


Biliopancreatic diversion (BPD) involves removing 75% of stomach and dividing intestine, with one end attached to the stomach (alimentary limb)

Bile and pancreatic juices move though biliopancreatic limb, which supplies digestive juices to common limb; surgeon is able to adjust length of limb to regulate malabsorptive qualities

Sorting out surgical options Adverse reactions: flatus, loose or foul-

smelling stools, stomal ulcers, and severe malnutrition, especially protein, vitamin, and mineral malnutrition

Adding duodenal switch to traditional BPD procedure results in a BPD/DS procedure, where part of the stomach is resected, creating a smaller stomach pouch

Sorting out surgical options Distal part of small intestine is then

connected to pouch, bypassing duodenum and jejunum

As with any weight loss surgery, protein, vitamin, and mineral supplements become part of patient’s everyday life

Risks for malnutrition are greater with malabsorptive surgeries, especially BPD and BPD/DS

Vertical sleeve gastrectomy

Sometimes called sleeve gastrectomy, greater curvature gastrectomy, parietal gastrectomy, gastric reduction, or vertical gastroplasty

Restrictive form of weight loss surgery; approximately 85% of stomach is removed

Sleeve-shaped stomach that remains has capacity of 60 to 150 mL


In contrast to other forms of bariatric surgery, outlet valve and nerves to stomach remain intact; although stomach is drastically reduced, function is preserved

Because pylorus is retained, problem of dumping is avoided

Not reversible


Greatest advantage: doesn’t include bypass of intestinal tract, avoiding complications (intestinal obstruction, anemia, osteoporosis, vitamin and protein deficiency)

Because new stomach continues to function normally, patients face fewer restrictions on foods they can eat


Removing most of stomach virtually eliminates hormones produced within stomach that stimulate hunger.

Best suited to patients who are either extremely obese or who have medical conditions such as Crohn’s disease that would rule out intestinal bypass surgery


Usually a one-step procedure that can be performed laparoscopically

Doesn’t provide malabsorption so some experience disappointing weight loss or even weight regain

Patients with high body mass index often require follow-up weight loss surgery to achieve goals


Two-procedure option not only produces results that patient wants but may also provide lower overall risk

Because procedure requires stapling of stomach, patients run risk of leakage and other complications directly related to stapling

Patients may experience additional complications (postop bleeding, small-bowel obstruction, pneumonia, death)

Preparing the patient

Patient/family teaching to include:

early ambulation postoperatively spirometry for increased lung expansion pain management wound care nutrition instruction (including frequent

small meals and fluids in between)

Postoperative care Preventing respiratory complications is a

priority

Prevention of increased risk of VTE

Monitor fluid and electrolyte balance

Monitor nutrition

Long-term implications

Patient must commit to lifetime monitoring of height, weight, and nutritional status

Women should not become pregnant up to 18 months after surgery

Encourage patient to join a support group to celebrate and cope with weight loss

Health & Medicine

Shedding Health Risks with Bariatric Weight Loss Surgery