RECENT TRENDS IIN TREATMENT OF MORBIID OBESIITY
Muhammad Abdullah Mobasher Atiya;
Abstract
SUMMARY AND UMMARY AND UMMARY AND UMMARY AND UMMARY AND UMMARY AND UMMARY AND UMMARY AND CONCLUSION ONCLUSIONONCLUSIONONCLUSION ONCLUSION ONCLUSION
besity can be defined as a disease in which excess fat has accumulated, such that health may be adversely affected and mortality increased. The measurement of Body Mass Index (BMI) is the most common way to assess the degree of obesity, which is calculated by dividing the weight per (kg) on height per (M2).
Causes of morbid obesity are unknown but the genetic predisposition to obesity has been reported in several studies and is currently thought to be the most common cause of obesity.
Morbid obesity is associated with a large number of problems as coronary artery disease, hypertension, impaired cardiac ventricular function, adult-onset diabetes mellitus, obesity hypoventilation, sleep apnea syndrome and hypercoagulability. Morbidly obese patients can also die as a result of difficulties in recognizing the signs and symptoms of peritonitis and they have an increased risk for development of colon, prostate, breast, uterine carcinoma.
Medical therapy for severe obesity has limited short-term success and almost nonexistent long-term success. These medical tools available for weight management include diet therapy, a regimen of physical activity, behavior modification, and pharmacotherapy.
O
Summary and Conclusion
225
At present, bariatric surgery is the only therapeutic modality that produces sustained weight loss and resolve comorbidities. This success results from the ability to perform the operation reliably, usually laparoscopically, with low mortality.
Pre-operative assessment of the morbidly obese patient is important. A careful medical history should be taken paying attention to dietary habits. A full cardiological examination is essential. Preoperative investigations should include a detailed endocrine profile, upper gastrointestinal endoscopy, abdominal ultrasound and respiratory function tests.
Patients should meet the following criteria for consideration for bariatric surgery: BMI > 40 kg/m2 or BMI >35 kg/m2 with associated medical comorbidity, failed dietary therapy, psychiatrically stable, knowledgeable about operation and its sequelae, motivated and medical problems do not produce likely survival from surgery.
Bariatric surgery -is contraindicated in patients with psychiatric problems, endocrine pathology, alcohol and drug abuse; gastro-esophageal reflux disease (which is a relative contraindication for gastric banding) and inflammatory disease affecting the digestive system. Also patients who are unable to undergo general anesthesia because of cardiac, pulmonary or hepatic disease, or those who are unwilling or unable to comply with post-operative lifestyle changes, diet, supplementation, or follow up may not undergo these procedures.
Summary and Conclusion
226
The operations currently in use are:
Restrictive procedures, such as:
Adjustable gastric banding.
Vertical banded gastroplasty.
Procedures that interfere with absorption such as
Jejuno-ileal bypass.
Biliopancreatic diversion with or without duodenal switch.
Combination of the two procedures
• (Roux-en- Y gastric bypass)
Complications of bariatric surgery include wound infections, anastmotic leakage and stenosis, splenic capsule tear, gastric stasis, bleeding, pulmonary complication, abdominal wall hernias, cholelithiasis.
Gastric-restriction procedures [adjustable gastric band, vertical banded gastroplasty (VBG)] reduce caloric intake and are well accepted (weight loss up to BMI 28-33 kg/m2 after 5 years), but they are less effective in comparison with techniques, such as duodenal switch, gastric bypass or biliopancreatic diversion which could produce a better weight loss (between 60 and 160 kg or BMI of 2530 kg/m2) with acceptable long-term side effect. However, due to malabsorption, a lack of minerals
Summary and Conclusion
227
and vitamins, even protein, could occur and have dangerous side effects. Technical complications should be avoided, especially band dislocation (2 -12%) or suture leak.
Long-term follow-up is very important because obesity is a chronic disease with a high risk\ of recurrence, even after bariatric surgery.
Roux-en-Y gastric by pass is the commonest operation world wide with 60-70% excess weight loss durable to 15 years, Access for the procedure is increasingly laparoscopic.
Worldwide, gastric bypass comprises two thirds of all bariatric procedures performed.
RYGB results in significant improvement or resolution of much major obesity-related comorbidity. Degenerative joint disease, hyperlipidemia, gastroesophageal reflux, hypertension, obstructive sleep apnea, depression, stress urinary incontinence, asthma, migraine headaches, venous insufficiency, congestive heart failure, and diabetes improve or resolve in the majority of patients after surgery.
besity can be defined as a disease in which excess fat has accumulated, such that health may be adversely affected and mortality increased. The measurement of Body Mass Index (BMI) is the most common way to assess the degree of obesity, which is calculated by dividing the weight per (kg) on height per (M2).
Causes of morbid obesity are unknown but the genetic predisposition to obesity has been reported in several studies and is currently thought to be the most common cause of obesity.
Morbid obesity is associated with a large number of problems as coronary artery disease, hypertension, impaired cardiac ventricular function, adult-onset diabetes mellitus, obesity hypoventilation, sleep apnea syndrome and hypercoagulability. Morbidly obese patients can also die as a result of difficulties in recognizing the signs and symptoms of peritonitis and they have an increased risk for development of colon, prostate, breast, uterine carcinoma.
Medical therapy for severe obesity has limited short-term success and almost nonexistent long-term success. These medical tools available for weight management include diet therapy, a regimen of physical activity, behavior modification, and pharmacotherapy.
O
Summary and Conclusion
225
At present, bariatric surgery is the only therapeutic modality that produces sustained weight loss and resolve comorbidities. This success results from the ability to perform the operation reliably, usually laparoscopically, with low mortality.
Pre-operative assessment of the morbidly obese patient is important. A careful medical history should be taken paying attention to dietary habits. A full cardiological examination is essential. Preoperative investigations should include a detailed endocrine profile, upper gastrointestinal endoscopy, abdominal ultrasound and respiratory function tests.
Patients should meet the following criteria for consideration for bariatric surgery: BMI > 40 kg/m2 or BMI >35 kg/m2 with associated medical comorbidity, failed dietary therapy, psychiatrically stable, knowledgeable about operation and its sequelae, motivated and medical problems do not produce likely survival from surgery.
Bariatric surgery -is contraindicated in patients with psychiatric problems, endocrine pathology, alcohol and drug abuse; gastro-esophageal reflux disease (which is a relative contraindication for gastric banding) and inflammatory disease affecting the digestive system. Also patients who are unable to undergo general anesthesia because of cardiac, pulmonary or hepatic disease, or those who are unwilling or unable to comply with post-operative lifestyle changes, diet, supplementation, or follow up may not undergo these procedures.
Summary and Conclusion
226
The operations currently in use are:
Restrictive procedures, such as:
Adjustable gastric banding.
Vertical banded gastroplasty.
Procedures that interfere with absorption such as
Jejuno-ileal bypass.
Biliopancreatic diversion with or without duodenal switch.
Combination of the two procedures
• (Roux-en- Y gastric bypass)
Complications of bariatric surgery include wound infections, anastmotic leakage and stenosis, splenic capsule tear, gastric stasis, bleeding, pulmonary complication, abdominal wall hernias, cholelithiasis.
Gastric-restriction procedures [adjustable gastric band, vertical banded gastroplasty (VBG)] reduce caloric intake and are well accepted (weight loss up to BMI 28-33 kg/m2 after 5 years), but they are less effective in comparison with techniques, such as duodenal switch, gastric bypass or biliopancreatic diversion which could produce a better weight loss (between 60 and 160 kg or BMI of 2530 kg/m2) with acceptable long-term side effect. However, due to malabsorption, a lack of minerals
Summary and Conclusion
227
and vitamins, even protein, could occur and have dangerous side effects. Technical complications should be avoided, especially band dislocation (2 -12%) or suture leak.
Long-term follow-up is very important because obesity is a chronic disease with a high risk\ of recurrence, even after bariatric surgery.
Roux-en-Y gastric by pass is the commonest operation world wide with 60-70% excess weight loss durable to 15 years, Access for the procedure is increasingly laparoscopic.
Worldwide, gastric bypass comprises two thirds of all bariatric procedures performed.
RYGB results in significant improvement or resolution of much major obesity-related comorbidity. Degenerative joint disease, hyperlipidemia, gastroesophageal reflux, hypertension, obstructive sleep apnea, depression, stress urinary incontinence, asthma, migraine headaches, venous insufficiency, congestive heart failure, and diabetes improve or resolve in the majority of patients after surgery.
Other data
| Title | RECENT TRENDS IIN TREATMENT OF MORBIID OBESIITY | Other Titles | الطرق الحديثه لعلاج السمنه المرضيه | Authors | Muhammad Abdullah Mobasher Atiya | Issue Date | 2015 |
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