Medical Management Before Bariatric Surgery

AbstractPurpose of ReviewThe evaluation of patients before bariatric surgery requires identification and optimization of the known comorbidities associated with obesity. Evaluation begins with cardiac and pulmonary assessment for elective noncardiac surgery for patients with severe obesity published inCirculation in 2009 by the AHA.1 The algorithm uses a 5-step approach and evaluation after a comprehensive history and physical exam and lab testing completed.Recent FindingsA standardized preoperative checklist and Clinical Practice Guidelines were updated in 2013 by the American Associations of Clinical Endocrinologists (ACCE), The Obesity Society (TOS), and the American Society for Metabolic and Bariatric Surgery (ASMBS). The Clinical Practice Guidelines have 74 recommendations for the preoperative evaluation of the bariatric surgery patient including lab testing, nutritional screening, endocrine evaluation, and the cardiopulmonary evaluation including sleep apnea screening. During the medical evaluation usually within 2 –4 weeks before bariatric surgery, the use of an additional algorithm from the AHA/ACC utilizes a 7-step algorithm to determine a patient’s functional capacity, cardiopulmonary risk, and the need for further cardiac evaluation to include stress testing, cardiology, or pulmonary evaluation.SummaryIn summary, utilization of the AHA science advisory cardiac and pulmonary assessment of the patient with severe obesity before bariatric surgery is e...
Source: Current Cardiovascular Risk Reports - Category: Cardiology Source Type: research

Related Links:

AbstractPurposeBeginning January 1, 2005, bariatric surgery cases were examined with the help of the quality assurance study for operative medicine. All data were registered and analyzed prospectively in cooperation with the Institute of Quality Assurance in Surgery at the Otto-von-Guericke University Magdeburg, Germany. The comparative study focuses on perioperative morbidity, complications, and remission of obesity-associated diseases after gastric bypass (RYGB) and sleeve gastrectomy (SG) at 5-year follow-up.Materials and MethodsData collection includes patients of full age who underwent SG or RYGB surgery between 2005 ...
Source: Obesity Surgery - Category: Surgery Source Type: research
Pediatric obesity is a chronic disease which leads to the development of significant health consequences in childhood, and increased risk of morbidity and premature mortality in adulthood. It is now estimated that 4% of children and 9% of adolescents in the United States have severe obesity (BMI ≥ 120% of the 95th percentile for age). (1) Causal factors for obesity include genetics, environment, medications, and behavior.(2) Severe obesity during childhood and adolescence is associated with the development of significant comorbidities such as cardiovascular disease, type 2 diabetes (T2D), obstructive sleep apnea (OSA), ...
Source: Surgery for Obesity and Related Diseases - Category: Surgery Authors: Source Type: research
We present a video case that individualized procedure of Nissen fundoplication, and SASI bypass (N-SASI) was designed and applied to the patient with class III obesity and severe GERD. This is a 37-year-old man with obesity (BMI: 41.8  kg/m2, categorized as class III obesity) and associated disease of stage 1 hypertension, hyperlipidemia, obstructive sleep apnea syndrome, and non-alcoholic steatohepatitis as well as severe symptoms of GERD. Esophageal-gastro-duodenal scope revealed GERD grade C, hiatal hernia, and duodenal ulcer. He refused RYGB recommended initially due to serious concern about remnant gastric cancer...
Source: Obesity Surgery - Category: Surgery Source Type: research
Obesity, defined as a body mass index> 30kg/m2, is a global challenge with a threefold increase in prevalence since 1975 affecting approximately 13% of adults.1 Obesity is directly and indirectly associated with increased risk and progression of multiple comorbidities, such as coronary artery disease, hypertension, diabetes, hyperlipidemia, atrial fibrillation, venous thromboembolism, and obstructive sleep apnea. Specifically, there is increased risk for atrial fibrillation and venous thromboembolism in obese adults, and oral anticoagulation is frequently prescribed in these patients.
Source: The American Journal of Medicine - Category: General Medicine Authors: Source Type: research
Surg Obes Relat Dis. 2021 Jul 7:S1550-7289(21)00334-8. doi: 10.1016/j.soard.2021.06.021. Online ahead of print.ABSTRACTBACKGROUND: The effects of preoperative weight loss on bariatric surgery outcomes are still unclear, despite the practice being adopted by bariatric centers worldwide. Ongoing studies are needed for routine adoption of this practice given the multiple issues patients face with following difficult preoperative weight loss protocols.OBJECTIVES: The aim of this study was to characterize the prevalence of preoperative weight loss and evaluate its impact on outcomes following elective bariatric surgery.SETTING:...
Source: Surgery for Obesity and Related Diseases : official journal of the American Society for Bariatric Surgery - Category: Surgery Authors: Source Type: research
This study aimed to evaluate nocturnal oximetry approaches in identifying obstructive sleep apnea (OSA) among bariatric surgical candidates.METHODS: This was a cross-sectional study involving adult bariatric patients who were undergoing in-lab polysomnography and who were previously screened with the GOAL questionnaire. OSA severity was established as any OSA, moderate/severe OSA, and severe OSA. Oximetry data were evaluated as oxygen saturation (average and nadir), oxygen desaturation index (ODI) at 3%, and proportion of time spent with oxygen saturation
Source: Obesity - Category: Eating Disorders & Weight Management Authors: Source Type: research
CONCLUSION: Bariatric surgery is feasible in patients with SSO. Revision procedures may increase risk of operative complications.PMID:34248332 | PMC:PMC8241285 | DOI:10.4293/JSLS.2020.00089
Source: JSLS : Journal of the Society of Laparoendoscopic Surgeons - Category: Surgery Authors: Source Type: research
More News: Bariatric Surgery | Cardiology | Cardiovascular | Cardiovascular & Thoracic Surgery | Eating Disorders & Weight Management | Endocrinology | Heart | Nutrition | Obesity | Science | Sleep Apnea | Sleep Disorders | Sleep Medicine