SAGES Manual (eBook)

Preface 5
Contents 6
Contributors 9
I. Essentials of Bariatric Surgery 15
1. The Rationale for Bariatric Surgery 16
A. Introduction 16
B. Treatment Selection and Indications for Surgery 17
C. Surgical Treatment: Benefit and Risk 17
D. Global Credentialing Requirements 19
E. Experience in Bariatric Surgery Required to Train Applicants 20
F. Summary 20
G. Selected References 20
2. Overview of Bariatric Operations 22
A. Overview of Bariatric Surgery 22
B. Purely malabsorptive procedures 22
C. Combined RestrictiveÒ Malabsorptive Procedures 24
D. Purely Restrictive Procedures 28
E. Miscellaneous Procedures 33
F. Summary 33
G. Selected References 34
3. Identification of Comorbidities and Their Management 36
A. Introduction 36
B. Obstructive Sleep Apnea 36
C. Cardiovascular Disease 36
D. Deep Vein Thrombosis 37
E. Type 2 Diabetes 37
F. Liver Disease 37
G. Cholelithiasis 38
H. Selected References 38
4. Definition of Obesity and Indications for Surgery 39
A. Indications 39
B. Indications for Operation 40
C. Selected References 41
5. Preoperative Nutritional Assessment and Postoperative Dietary Guidelines 43
A. Preoperative Nutritional Assessment 43
B. Postoperative Nutritional Guidelines 44
C. Selected References 47
6. Essentials of a Bariatric Program 48
A. Introduction 48
B. Facilities 48
C. Personnel 49
D. Education and Support 51
E. Conclusion 52
F. Selected References 53
7. Psychological Assessment 54
A. Introduction 54
B. Checklists 54
C. Wahler Physical Symptoms Inventory 55
D. Personality Assessment Screen 55
E. Other Assessment Tools 56
F. Formal Interview 56
G. Family Weight 57
H. Daily Food Intake 57
I. Obesity and the Body 58
J. Commercial Weight Loss Systems 58
K. Emotional Ideation: Suicidal Thinking 58
L. Depression 59
M. Substance Abuse 59
N. Physical/Sexual Abuse 59
O. Supportive People 60
P. Obstacles After Surgery 60
Q. Summary 61
R. Selected References 61
8. Preoperative Check List 62
A. Introduction 62
B. Preoperative Testing 62
C. Preoperative Evaluation 62
D. Preoperative Checklist 64
E. Intraoperative Considerations 66
F. Conclusion 67
G. Selected References 67
9. Postoperative Care Pathway 69
A. Rationale for Care Pathways 69
B. General Guidelines for Postoperative Hospitalization and Monitoring 69
C. Postoperative Tubes and Drains 70
D. Deep Vein Thrombosis Prophylaxis 70
E. Use of Bariatric Beds 71
F. Postoperative Diet 71
G. Postoperative Imaging 72
H. Pain Management 73
I. Postoperative Antibiotics 74
J. Consolidation of Postoperative Ordersets in Bariatric Postoperative Ordersets 74
Appendix I. Sample Postlaparoscopic Gastric Bypass Orderset 74
Appendix II. Sample postlaparoscopic adjustable gastric band orderset 75
Selected References 76
10. Long-term Follow-up Protocol of Bariatric Patients 77
A. Introduction 77
B. Vitamin Deficiencies 77
C. Mineral Deficiencies 79
D. Selected References 80
11. An Economic Approach to Opening a Bariatric Practice 84
A. Introduction 84
B. Outline the Business 84
C. Mission Statement 84
D. Competitive Advantages and Priorities 85
E. Environmental Scanning 86
F. The Service Package and Service Process 87
G. Economic Benefits to All 88
H. Quantitative Issues: Forecasting Demand and Determining Capacity 88
I. Location and Supply Chain Issues 89
J. Office Business 89
K. Conclusion 91
L. Selected References 93
II. Techniques 94
12. Roux-en-Y Gastric Bypass 95
A. Indications 95
B. Approach: Open versus Laparoscopic 95
C. Patient Position and Room Setup 96
D. Operative Procedure 97
E. Selected References 107
13. Lap-Band® and Adjustment Schedule 109
A. Indication and Description 109
B. Patient Position and Room Setup 109
C. Trocar Position and Choice of Laparoscope 111
D. Operative Technique 112
E. Advantages 112
F. Disadvantages 112
G. Complications 112
H. Results: US Data 114
I. Lap-Band Adjustments 114
J. Selected References 115
14. Laparoscopic Duodenal Switch 116
A. Introduction 116
B. Indications/Special Preoperative Preparation 116
C. Patient Position and Room Setup (Fig. 14.2) 117
D. Trocar Placement 118
E. Technique 119
F. Alternate Techniques 133
G. Postoperative Care 134
H. Selected References 135
15. Laparoscopic Sleeve Gastrectomy: A Staged Procedure for Super- Super Obese Patients 137
A. Indications and Rationale 137
B. Patient Positioning and Room Setup 138
C. Port Position 138
D. Stage-1. Laparoscopic Sleeve Gastrectomy 140
E. Stage-2. Laparoscopic Roux-en-Y Gastric Bypass or Laparoscopic Biliopancreatic Diversion- Duodenal Switch 141
F. Selected References 141
16. Laparoscopic Staged Roux-en-Y: A Staged Procedure for Super- Super Obese Patients 142
A. Indications 142
B. Patient Position and Room Setup 142
C. Trocar Position and Choice of Laparoscope 143
D. Laparoscopic Staged Roux-en-Y (First Stage) 143
E. Laparoscopic Staged Roux-en-Y ( Second Stage) 144
F. Selected References 146
III. Outcomes 147
17. Outcomes of Laparoscopic Gastric Bypass 148
A. Introduction 148
B. Short-Term Outcome 148
C. Long-Term Outcome 150
D. Revisional Surgery 153
E. Selected References 153
18. Outcomes of Laparoscopic Adjustable Gastric Banding 155
A. Introduction 155
B. Perioperative Outcomes 155
C. Late Complications 156
D. Weight Loss 156
E. Comorbidity Resolution 157
F. Conclusions 157
G. Selected References 157
19. Outcomes of Duodenal Switch and Other Malabsorptive Procedures 158
A. Background 158
B. Outcomes 160
C. Selected References 165
20. Outcomes of Bariatric Surgery in Adolescents 167
A. Epidemiologic Trends and Behavioral Weight Management 167
B. Surgical Weight Loss in Adolescents 167
C. Comorbidity 170
D. Mortality and Postoperative Adverse Events 172
E. Which Operation Is Best for Adolescents? 174
F. Selected References 174
21. Which Operation Is Best? 177
A. Introduction 177
B. Risk 178
C. Age 178
D. Superobesity 180
E. Previous Surgery 181
F. Comorbidities 181
G. Transplant 183
H. Other 184
I. Conclusion 185
J. Selected References 186
IV. Complications 191
22. Anastomotic Leaks after Laparoscopic Gastric Bypass 192
A. Background 192
B. Incidence 192
C. Diagnosis 192
D. Management 193
E. Outcome 194
F. Conclusion 194
G. Selected References 194
23. Gastric Bypass: Gastrointestinal Bleeding 197
A. Introduction 197
B. Etiology 197
C. Diagnosis 198
D. Treatment 199
E. Prevention 200
F. Conclusion 201
G. Selected References 201
24. Intestinal Obstruction after Laparoscopic Gastric Bypass 202
A. Background 202
B. Incidence 202
C. Etiology of Intestinal Obstruction 202
D. Diagnosis 202
E. Sequential Intraoperative Prevention of Intestinal Obstruction 203
F. Management 204
G. Outcome 204
H. Conclusion 204
I. Selected References 205
25. Roux-en-Y Gastric Bypass: Stomal Stenosis 207
A. Introduction 207
B. Diagnosis 207
C. Treatment 208
D. Selected References 208
26. Gastric Bypass: Marginal Ulceration 209
A. Introduction 209
B. Etiology 209
C. Clinical Presentation and Diagnosis 210
D. Medical Treatment 210
E. Surgical Treatment 210
F. Conclusions 212
G. Selected References 213
27. Laparoscopic Adjustable Gastric Banding: Infection, Slippage, and Hiatal Hernia 214
A. Introduction 214
B. General Guidelines for Postoperative Follow- up 214
C. Port Infection 216
D. Band Infection 217
E. Gastric Prolapse or “Band Slippage” 217
F. Hiatal Hernia 218
G. Pouch Dilation 219
H. Postoperative Imaging 219
I. Selected References 219
28. Gastric Erosion Following Adjustable Gastric Banding 221
A. Gastric Erosion 221
B. Incidence and Etiology 221
C. Diagnosis 223
D. Treatment and Postoperative Course 224
E. Summary 229
F. Selected References 229
V. Guidelines and Accreditation in Bariatric Surgery 231
29. Society of American Gastrointestinal andEndoscopic Surgeons ( SAGES) Bariatric Credentialing Guidelines 232
A. Introduction 232
B. The SAGES Guidelines for Institutions Granting Bariatric Privileges Utilizing Laparoscopic Techniques 232
C. Minimum Requirements for Privileging of Bariatric Procedures 234
D. Institutional Support 234
E. Maintenance of Privileges 234
F. Selected References 234
30. Reporting of Bariatric Surgery Outcomes 236
A. Introduction 236
B. Outcomes Definitions 236
C. Data Sources 237
D. Center of Excellence Movement 238
E. Ideal Bariatric Surgery Database 238
F. Outcomes: Weight Loss 239
G. Outcomes: Comorbidity Resolution 240
H. Outcomes: Quality of Life 241
I. Outcomes: Cost-Effectiveness 241
J. Outcomes: Survival 241
K. Conclusions 242
L. Selected References 242
31. The Betsy Lehman Center Guidelines for Weight Loss Surgery 245
A. Introduction 245
B. Methodology 245
C. Betsy Lehman I 246
D. Impact of Betsy Lehman I 246
E. Betsy Lehman II 247
F. Conclusion 248
G. Selected References 248
32. American Society for Metabolic and Bariatric Surgery ( ASMBS) Centers of Excellence Program 249
A. Centers of Excellence Concept 249
B. Application Process 250
C. Provisional Status 250
D. Full Approval 251
E. Freestanding Outpatient Bariatric Surgery Center of Excellence 252
F. Selected References 252
33. The American College of Surgeons ( ACS) Bariatric Surgery Center Network 253
A. Introduction 253
B. Guidelines 254
C. Center Levels and Descriptors 255
D. Data Collection 260
E. Special Center Designations 261
F. The Application Process 262
G. Center Obligations 263
H. Summary 264
I. Selected References 264
Index 266