Revisional Bariatric Procedures Essay

Abstract

Obesity is the most common form of malnutrition in developed countries. Prevalence of obesity is rising to an epidemic proportion around the world. Obesity increases the risk of medical illness and premature death and thus imposes an economic burden on the health care system. Many morbidities are underlying causes for the earlier mortality associated with obesity including coronary artery disease, hypertension, impaired cardiac function, adult onset diabetes mellitus, venous stasis and hypercoagulability leading to an increased risk of pulmonary embolism. The most widely accepted measure of obesity is the body mass index (BMI) which equals patient weight in kilograms divided by the square of his or her height in meters, a normal BMI ranges from 18.5-24.5 kg/m2, overweight equals BMI between 25-29.5 kg/m2, obesity equals BMI 30 kg/m2 or higher. Treatment of morbid obesity should begin with simple lifestyle changes, including moderation of diet and initiation of regular exercise such as walking and pharmacological management. The most pronounced weight loss is obtained by bariatric surgery which has different techniques that are divided mainly into two groups: restrictive procedures (include sleeve gastrectomy, vertical banded gastroplasty and adjustable gastric banding) and malabsoptive procedures (include Reux En Y gastric bepass, mini gastric bypass, bilio pancreatic diversion and duodenal switch). In general, restrictive procedures are simpler to perform and are accompanied by less procedural complications than malabsorptive procedures. Open surgery has largely been replaced by a laparoscopic approach. As the number of bariatric procedures performed increases, the number of patients requiring revisional procedures continues to rise. Reoperative bariatric surgery is more challenging than primary procedures and is associated with a higher rate of adverse events. Revision is indicated in patients who present with insufcient weight loss, weight regain, continued co-morbid disease, acute or chronic complications after bariatric surgery. Other indications may be specific to the type of operation, for example, the most common cause of revisional surgery after jejuno-ileal bypass is malabsorption, which can lead to liver failure and death. In VBG (vertical banded gastrlplasty), the cause of revision may be symptomatic