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Home arrow Health arrow Bariatric Surgical Practice Guide: Recommendations

Bariatric Surgical Practice Guide: Recommendations


I Selection of a PatientSelection Guidelines for Bariatric Surgery. IntroductionGuidelines RecommendationWestern GuidelinesNational Institute of Health (NIH 1991, Update 2011)Obesity Surgery Society of Australia and New Zealand (OSSANZ: 2008)American Society for Metabolic and Bariatric Surgery (ASMBS: 2013)International Federation for the Surgery of Obesity: European Chapter (IFSO-EC: 2014)Asia-Specific GuidelinesAsia Pacific Metabolic and Bariatric Surgery Society (APMBSS: 2005)Asian Consensus Meeting of Metabolic Surgery (ACMOMS: 2008)International Federation for the Surgery of Obesity: Asia Pacific Chapter (IFSO-APC: 2011)Guidelines from Medical Association/SocietiesThe International Diabetes Federation (IDF: 2011)Diabetes Surgery Summit (DSS 2007)Asian Diabetes Surgery Summit (ADSS: 2010)ConclusionsRecommendationsBariatric Surgery in Adolescents. IntroductionBMI Cut-offs Defining Obesity in ChildrenRationale for InterventionTreatment Options and Patient SelectionLifestyle ModificationsBariatric SurgeryPatient Selection GuidelinesWhy Surgery Should Be Avoided Before Puberty?Adolescent Bariatric TeamSurgical Outcomes and Effect on ComorbiditiesBariatric Surgery and Capacity to ConsentEducation and TrainingConclusionsRecommendationsReferencesSelection of Bariatric Surgery Procedures in Special CircumstancesBariatric Surgery in the Super ObeseBariatric Surgery in ElderlyBariatric Surgery in DyslipidemiaRecommendationsReferencesPreoperative Evaluation and Contraindications to Bariatric SurgeryIntroductionPatient SelectionPreoperative Evaluation of a Bariatric Surgery PatientClinical EvaluationCardiac EvaluationVenous EvaluationPulmonary EvaluationEndocrine EvaluationGastrointestinal EvaluationContraindications to Bariatric SurgerySevere Medical IllnessAbility to Consent/Psychiatric Illness/Substance AbuseBariatric Surgery and PregnancyPraeder Willi Syndrome or Malignant HyperphagiaExtremes of AgeConclusionRecommendationsReferencesII Preoperative Predictors of Outcomes Definition of Outcomes After Bariatric SurgeryIntroductionWeight Loss OutcomesWeight Loss MeasuresPercentile ChartsBody Fat ParametersCo Morbidities OutcomesType 2 DiabetesHypertensionDyslipidemiaOther Co-morbiditiesComplication OutcomesQuality of Life OutcomesClassification of Outcomes According to Duration of Follow-UpRecommendationsReferencesPreoperative Predictors of Weight Loss After Bariatric SurgeryIntroductionPreoperative Weight LossPreoperative BMIEthnicityMarital StatusBinge Eating DisorderPhysical ActivityOut Patient AttendanceSmokingGeneticsDiabetesConclusionRecommendationsReferencesPreoperative Predictors of Diabetes Remission Following Bariatric SurgeryIntroductionPre-operative Predictors of Diabetes RemissionC-PeptideBody Mass IndexDuration of T2DMAge of the PatientGlycemic StatusType of ProcedureConclusionsRecommendationsReferencesIII Technical Considerations Standardization of Technique in Sleeve GastrectomyIntroductionSize of the BougieBeginning of the Distal Section of the StomachStaplersProximal Section of the StomachSuture ReinforcementBanding the SleeveRecommendationsReferencesTechnical Considerations of Laparoscopic Gastric Plication with or Without a BandIntroductionLaparoscopic Gastric PlicationSurgical TechniquePostoperative ManagementResultsLaparoscopic Adjustable Gastric Band PlicationIndicationsContraindicationSurgical TechniquePost-operative CourseComplicationsConclusionRecommendationReferencesStandardization of Technique in Roux-en-Y Gastric BypassIntroductionPouch CreationStomaLimb LengthDefect ClosureBandLeak TestRecommendationsReferencesTechnical Considerations of Duodenal Switch and Its VariantsIntroductionTechnical Considerations of Duodenal Switch and Its VariantsStandardized Biliopancreatic Diversion with Duodenal Switch (BPD/DS)Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy" (SADI-S)Sleeve Gastrectomy with Duodeno-Jejunal Bypass (Sleeve DJB)Sleeve Gastrectomy with Loop Duodeno-Jejunal Bypass (Sleeve with Loop DJB)Key Operative Steps of Duodenal Switch and Its VariantsSleeve Gastrectomy with Dissection and Division of the DuodenumEntero-EnterostomyDuodenojejunostomy/DuodenoileostomyConclusionRecommendationsReferencesIV Specific Situations in Bariatric SurgeryGastroesophageal Reflux and Bariatric SurgeryIntroductionGERD and ObesityGERD and Laparoscopic Sleeve Gastrectomy (LSG)GERD and LRYGBConclusionRecommendationReferencesVentral Hernia Repair in the Morbidly ObeseIntroductionTwo Stage ProceduresFirst Perform the Bariatric Surgery and Postpone the Ventral Hernia Repair Until Weight LossFirst Perform the Ventral Hernia Repair and Postpone the Bariatric Surgery Until RecoveryConcomitant Bariatric Surgery with Ventral Hernia RepairPrimary RepairConcomitant Mesh RepairRecommendationsReferencesGallstone Disease Before and After Bariatric SurgeryIntroductionCholelithiasis in ObesityCholelithiasis After Bariatric SurgeryCholecystectomy in Obese PatientsProphylactic ApproachElective/Selective ApproachConventional ApproachUDCA After Bariatric SurgeryManagement of Choledocholithiasis After RYGBRecommendationsReferencesPolycystic Ovarian Syndrome, Pregnancy and Bariatric SurgeryIntroductionDefinition of PCOSPathophysiologyEvaluationBariatric Surgery and PCOSBariatric Surgery and Artificial Reproductive Techniques (ART)Timing of Pregnancy After Bariatric SurgeryObesity and PregnancyBariatric Surgery and PregnancyNutrition in Post Bariatric Patients with PregnancyRecommendationsReferencesNon-alcoholic Fatty Liver Disease and the Effects of Bariatric SurgeryIntroductionPathogenesisTreatment of NAFLDEffects of Bariatric Surgery on NAFLDMechanism of Bariatric Surgery Causing Improvement or WorseningBariatric Surgery in Established CirrhosisRecommendationsReferencesOutcomes of Diabetic Microvascular Complications After Bariatric SurgeryIntroductionImprovement in Diabetic Kidney Disease (DKD) After Bariatric SurgeryImprovement in Diabetic Retinopathy After Bariatric SurgeryImprovement in Diabetic Peripheral Neuropathy After Bariatric SurgeryConclusionRecommendationsReferencesRole of Bariatric Surgery in End-Stage Organ FailureIntroductionBariatric Surgery for Morbid Obesity in End-Stage Renal DiseaseBariatric Surgery for Morbid Obesity in Post-transplant End-Stage Renal DiseaseBariatric Surgery in Cirrhotic or Pre-transplant PatientsBariatric Surgery During Liver Transplant in Cirrhotic PatientsBariatric Surgery After Liver Transplant in Cirrhotic PatientsBariatric Surgery Before Heart Transplant in Advanced Heart FailureRecommendationsReferencesV Postoperative Pathways Perioperative Venous Thromboembolism Prophylaxis After Bariatric SurgeryIntroductionVTE Prevention with Pharmacologic StrategiesUnfractionated HeparinLow Molecular Weight HeparinEnoxaparinOther Low Molecular Weight HeparinsFondaparinuxDuration of Venous Thromboprophylaxis'VTE Prevention with Mechanical StrategiesMechanical MethodsInferior Vena Cava FiltersRecommendationsReferencesPerioperative Management of Medical Comorbidities After Bariatric SurgeryIntroductionPostoperative Management of Diabetes MellitusChallenges in Post-operative Diabetic CareCurrently Used Anti-diabetic Medications and Use in Relationship to Bariatric Surgery (Kashyap et al.)BiguanidesThiazolidinedionesSulfonyl UreasInsulinGLP-1 Analogues/DPP4 InhibitorsOthers [16]Current Literature on Post-operative T2DM ManagementRole of Weight Loss in T2DM ManagementManagement of Non-remission/RelapsePostoperative Management of HypertensionObesity and HypertensionCurrently Used Antihypertensive AgentsCurrent Literature on Post-operative Hypertension ManagementPostoperative Management of DyslipidemiaObesity and DyslipidemiaCurrently Used Dyslipidemic AgentsCurrent Literature on Post-operative Dyslipidemia ManagementRecommendationsReferencesPerioperative Management of Obstructive Sleep Apnea After Bariatric SurgeryIntroductionPathophysiology of OSADiagnosis of OSATreatment of OSAScreening, Evaluation and Optimization of OSA in a Bariatric Surgical PatientPerioperative Care of the Bariatric Patient with OSAUse of CPAP in the Postoperative PeriodRecommendationsReferencesEnhanced Recovery After Bariatric SurgeryIntroductionPrinciples of ERASDesigning an ERAS ProgramPre-operative PathwaysPre-operative Investigations and TreatmentsPre-operative Optimization DietPatient Counseling on the Recovery ProcessIntra Operative ProtocolsMinimally Invasive TechniquesUltra Short Acting Volatile Anesthetic Agents and Muscle RelaxantsIntraoperative Prophylaxis for Nausea and VomitingIntraoperative DexamethasoneIntraoperative Intermittent Calf CompressionPrevention of HypothermiaSparing Use of IV FluidsNo NG Tubes, Catheters, Epidurals, Drains or Oxygen TubesPeritoneal and Gastric WashoutPost-operative PathwayNon-narcotic AnalgesiaIncentive SpirometryEarly MobilizationRoutine Anti-emeticsEarly NutritionEarly Discharge from HospitalHour Helpline to the Specialist Bariatric Nurse or Resident DoctorAdvantages of ERAS ProgramsLimitations of ERAS ProgramsConclusionsRecommendationsReferencesVI Surgical Complications After Bariatric Surgery Management of Leaks After Sleeve GastrectomyIntroductionDiagnosis of Sleeve LeaksClassification of Sleeve LeaksClinical ClassificationRadiological ClassificationEndoscopic ClassificationManagement OptionsManagement of Early or Intermediate LeaksManagement of Late LeaksEndoscopic Exclusion of the FistulaEndobiliary Drainage with Enteral NutritionDefinitive Surgical OptionsComplex Sleeve FistulaeGastro-colic FistulaeRecommendationsReferencesDetection and Management of Internal HerniasIntroductionDiagnosisMesenteric Closure and Relationship to Internal HerniaManagement of Patients with Suspected/Proven IHRecommendationsReferencesPrevention and Management of Marginal UlcersPathogenesis and Risk FactorsSurgical FactorsNon-surgical Risk FactorsSmokingNSAID UsageHelicobacter Pylori InfectionOther FactorsProphylactic PPI UseTreatment of Primary MUTreatment of Refractory/Recurrent MUTreatment of MU PerforationRecommendationsReferencesPrevention and Management of Gastro-Jejunostomy Anastomotic StricturesIntroductionPredisposing FactorsLinear Stapled(LSA) Versus Circular Stapled Anastamosis (CSA)Hand-Sewn Anastomosis Versus Circular-Stapler AnastomosisHand-Sewn Versus Linear-Stapler Versus Circular-StaplerWhat sized Circular-Stapler Is Better?Treatment of GJA StricturePerforation Following DilatationRecommendationsReferencesManagement of Leaks After Gastric BypassIntroductionClassification of LeaksTime of Appearance After SurgerySeverity of LeakLocationRisk FactorsDiagnosisManagement of LeakRecommendationsReferencesPrevention and Management of Bleeding After Sleeve Gastrectomy and Gastric BypassIntroductionPost-Operative Bleeding After Laparoscopic Sleeve GastrectomyPresentationDiagnosis and ManagementIntra-Operative Prevention of BleedingConclusionPostoperative Bleeding After Roux-En-Y Gastric Bypass PatientPresentationDiagnosis and ManagementPreventionConclusionRecommendationsReferencesVII Revisional Bariatric SurgeryRevisional Surgical Options After Laparoscopic Adjustable Gastric BandingIntroductionLaparoscopic Roux-en-Y Gastric BypassLaparoscopic Sleeve GastrectomyBiliopancreatic Diversion with Duodenal SwitchRebandingMini Gastric BypassConclusionRecommendationsReferencesRevisional Surgical Options After Laparoscopic Sleeve GastrectomyIntroductionDefinitions of Success or Failure of Bariatric ProceduresEvaluation of Patients with Failure After Sleeve GastrectomyStrategies for Management of Weight Regain or Failure After Sleeve GastrectromyLaparoscopic Revisional Sleeve Gastrectomy (LRSG)Laparoscopic Roux-en-Y Gastric BypassLaparoscopic Bilio-Pancreatic Diversion with Duodenal SwitchOther ProceduresConclusionRecommendationsReferencesRevisional Surgical Options After Laparoscopic Roux-en-Y Gastric BypassIntroductionLaparoscopic Adjustable Gastric BandingPouch or Anastomotic Revision with Surgery or Endoluminal TechniquesLaparoscopic Distal Roux-en-Y Gastric Bypass (LDRYGB)Laparoscopic Biliopancreatic Diversion with Duodenal SwitchRecommendationsReferencesVIII Nutritional Management in Bariatric SurgeryPerioperative Diet Management in Bariatric SurgeryChoice of Pre-operative DietPost Bariatric Surgery DietMacronutritient RequirementsCommon Post-surgery Nutritional ProblemsFoods to Be Avoided After SurgeryConclusionRecommendationsReferencesImportance of Protein After Bariatric SurgeryProtein Energy Malnutrition (PEM) After Bariatric SurgeryDietary Protein Recommendation of After Bariatric SurgeryConclusionRecommendationsReferencesAnemia and Related Deficiencies in Bariatric SurgeryIntroductionImportance of Iron, Folic Acid and B12Etiology of Post-bariatric Surgery AnemiaIdentification and Management of Iron, Vitamin B12 and Folate DeficiencyTreatment and Supplementation for AnemiaRecommendationsReferencesCalcium and Vitamin D Deficiencies in Bariatric SurgeryIntroductionCalcium HomestasisBariatric Surgery and Calcium and Vitamin D MetabolismChoice of Procedure in Patients with Pre-existing DeficiencyCalcium Recommendation in Bariatric SurgeryRecommendationsReferencesOther Micronutrient Deficiencies in Bariatric SurgeryThiamineThiamine Deficiency in Bariatric SurgeryThiamine Recommendation Post-bariatric SurgeryCopperCopper Recommendation After Bariatric SurgerySeleniumSelenium Recommendation After Bariatric SurgeryZincZinc Deficiency and Bariatric SurgeryZinc Recommendation After Bariatric SurgeryVitamin AVitamin EVitamin K in Bariatric SurgeryConclusionRecommendationsReferences
 
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