Clinics in Bariatric and Metabolic Surgery Praveen Raj Palanivelu, Siddhartha Bhattacharya, S Saravana Kumar
INDEX
Page numbers followed by f refer to figure, and t refer to table
A
Abdomen
pain 109
pendulous 195, 203
ultrasound of 139, 144
Abdominal drain placement, role of 151
Abdominoplasty 100
Acanthosis nigricans 92f
Acne 90
Acoustic radiation force impulse 66
Adjustable gastric band 5
revisional surgery after 160
Adolescent bariatric team, members of 22, 23f
Adrenal hyperplasia, nonclassic congenital 90
Albright hereditary osteodystrophy 21
Albumin 123
levels 65
Albuminuria, normal 52
Alcohol abuse 228
American Diabetology Association 52
American Society for Metabolic and Bariatric Surgery 36, 73, 237, 238
Amitriptyline 15
Amylase, serum 139
Androgen excess, severe 90
Androstenedione 92
Anemia 85, 114, 118
after bariatric surgery 114
megaloblastic 114
Anesthesia cart 209
Anesthetic precautions 26
Antiandrogens 93
Antibody 41
anti-insulin 57
Antidepressants 15
Antiglutamic acid decarboxylase 41, 62, 85
Antilipemic agents 75
Antilipemic drugs 75
Anti-migratory cuffs, souble layer 146
Antireflux stitch 201f
Apnea-hypopnea index 82
Apolipoprotein B 72
Apollo overstitch 34f
Apple-shaped and pear-shaped distribution 165
Argon plasma photocoagulation 33
Arterial blood gas 78, 82
Arterial disease, peripheral 42
Arthralgia, migratory 4
Artificial reproduction therapy 94
Asia Pacific Metabolic and Bariatric Surgery Society 3436, 237, 238
Asian Bariatric Society Guidelines 34
Asian Consensus Meeting on Metabolic Surgery 35, 36, 237, 238
Asian Diabetes Surgery Summit 35, 36, 237, 238
Aspirin, role of 107
Atracurium 86
B
Balloon dilatation, complications of 137
Band erosion
causes of 161
clinical features of 160
Band slip
classification 162t
types of 162
Bardet-Biedl syndrome 21
Bariatric first approach
advantages of 98
disadvantages of 98
Bariatric procedure 70, 102
primary 157
time of 141
types of 141
Bariatric surgery 13, 14, 17, 22, 25, 26, 30, 39, 47, 56, 58, 63, 65, 69, 72, 73, 75, 76, 85, 8789, 94, 95, 9799, 100, 102, 117119, 126, 127, 139, 141, 142, 167, 168
benefit of 81
bleeding after 109, 110, 110t
concomitant 98
first report of 3
gallstones after 140
history of 3
indications for 11, 237
leaks after 143
primary 158
revisional 158
role of 70, 86, 87
single incision 209
types of 166
weight after 94, 153
Barium swallow 155
Barrett's esophagus 127
development of 155
Bat wings of upper arms 168
Beta stent 148f
Bile duct, common 139
Biliopancreatic diversion 6, 102, 115
Biliopancreatic limb 123
measurement of 186f
obstruction of 136
Binge eating 232
disorder 12
Birth weight 18
Blood
glucose levels 48
investigations 139
sugars, postprandial 40
Body mass index 11, 25, 35, 43, 56, 61, 65, 76, 77, 103, 105, 122, 143
Bone mineral density 119
Bougie placement 178
Bowel obstruction, signs of 134
Boxing championship belt 167
Breasts 166
deformities 168
Breathing disorders, sleep-related 77
Bupropion plus naltrexone 16
Bypass operation 53
C
Cachexia 241
Calcium 95, 120
citrate 119
deficiency after bariatric surgery 114
ionized 122
metabolism 118
supplementation post-bariatric surgery 119
Caprini risk assessment model 103t
Carbohydrates 11
Cardiac disease 77
risk factor for 40
Cardiac failure 122
Carotid Doppler, role of 42
Cavitation injury 204
Centers for Disease Control and Prevention 19
Chemoprophylaxis 106, 107
Cholecystectomy, laparoscopic 7
Cholestasis, chronic 15
Cholesterol, total 72
Circular stapler 219, 222
Cirrhosis 70
Cisatracurium 86
Clozapine 15
Compression, role of 221
Computed tomography 145
contrast-enhanced 160
noncontrast 66
Continuous positive airway pressure
role of 81
therapy 82
Copper 116, 120
deficiency 118
Coronary artery bypass graft 105
C-peptide 43
Crow's feet 196f
Crural stitch
method 214f
technique 213
Cursillo sleeve 209
D
Dabigatran 106
Dalteparin 106
Dapagliflozin 56
Deep vein thrombosis 102, 143
risk for 25, 104t
Delusions 114
Dermolipectomy 167
Diabetes 42, 48, 62, 77
duration of 50, 54
gestational 95
mellitus 20, 23, 26, 30, 35, 40, 43, 45t, 49, 57, 61, 63, 68, 86, 90, 93, 94
profile 92
remission 49
rates of 57
score 46, 46t
surgery summit 3436
treatment of 59
Diabetic
compliance history 40
drug history 40
family history 40
lifestyle history 40
retinopathy 54
non-proliferative 51
proliferative 51
status 85
Dietary management, principles of 42
Diethylpropion 15
Dietician evaluation, role of 154
Direct thrombin inhibitor 106
Dual balloon system 31
Duodenal dissection 204
Duodenal switch 6, 24, 53, 62, 73, 74, 115, 157, 164, 208
role for 54
Duodenojejunal bypass 53, 59, 202, 204f, 208
sleeve 32
Duodenojejunal flexure 187f, 200f
exposure of 199f
identification of 186f, 207f
Duodenojejunostomy 203, 206, 207f
completed anterior layer of 208f
completed posterior layer of 207f
Duodenum
first part of 205f, 206f
posterior aspect of 204
stapler division of first part of 206
Dyslipidemia 72, 73, 93
improvement 73
mechanism of 74
prevalence of 72
severe 74
E
Eating disorder 37, 230
Echelonflex 220f
Elastic stockings 106
Electrolyte
abnormalities 4
serum 85
Endometrial carcinoma, prevention of 92
Endoscope
double-channel 33
single-channel 33
Endoscopic therapies 149
role for 157
Endoscopic weight loss procedures, role of 31
Endoscopy 161
role of 144
End-stage renal disease 87
Enoxaparin 106
dosage of 107
Enterohepatic circulation 74
Enterotomy 200f
suture closure of 200f
Epigastric port 185f
Epworth sleepiness scale 78, 80f
Esophageal sphincter
lower 127, 130, 154
upper 222
Esophagogastric junction 130
Esophagojejunostomy 150
Esophagus 222
Estimated glomerular filtration rate 86
Ethicon circular staplers 223f
Ethicon staplers, color coding of 220t
Euglycemic-hyperinsulinemic clamp 50
F
Familial chylomicronemia syndrome 72
Fasting blood sugars 40
Fat 11
deposition, pattern of 165
soluble vitamins 4
subcutaneous 240
Fatty acid oxidation 67
Final stapler, application of 198f
First horizontal stapler, application of 191f
Fixed dose insulin 54
Fluid retention 241
Folate 95, 120
deficiency 114
Foley's catheter 110
Follicle stimulating hormone 89
Fundoplication, endoscopic 130
Fundus exposing left crus, complete dissection of 178f
G
Gallstones
asymptomatic 141
disease 139
incidence of 141
symptomatic 142
Gastrectomy, total 150
Gastric artery 204
Gastric band 5
Gastric bipartition 5f
Gastric bypass 38, 74, 99, 195f
anastomosis 47, 130, 163, 164, 194
Gastric pouch 188, 191f, 198f, 201f
cobra head shape of 198f
creation of 188, 216
remnant 113
Gastric sleeve 215
Gastrobronchial fistula 151
Gastrocolic fistula 151
Gastroduodenal artery 204
Gastroepiploic
artery 179f
vessels 176
Gastroesophageal
disease 128
junction 181f, 189, 212
reflux disease 126
severe 155
Gastrohepatic omentum 196f
Gastrointestinal
bleeding
lower 112
upper 112
endoscopy, upper 127, 160
staplers, laparoscopic 219
tract 23
Gastrojejunal anastomosis, stricture of 137
Gastrojejunal stricture 134
balloon dilatation of 137
development of 137
diagnose 137
Gastrojejunostomy 192, 218, 219, 222
antecolic-antegastric 135
creation of 192f, 199, 200f, 219
Gastropancreatic attachment
division of 178f
posterior 190
Gastroplasty, vertical banded 6f
Gastrotomy 198, 217, 222
creation of 199f
Giddiness, causes of 114
Glomerular filtration rate 51
Glucagon like peptide-1 agonists 16
Glucose intolerance 90
Glutamic-oxaloacetic transaminase levels, serum 65
Glutamic-pyruvic transaminase, serum 65
Glycemic control 57
Glycosylated hemoglobin 92
levels 44
Gold stapler 220
Greater curvature 177f
Greater omentum, division of 176, 177f, 178, 179f
caudal aspect of 179
Gripping surface technology 222
Guillain-Barré syndrome 115
H
Hair loss 119
Harmonic scalpel 192
Harris-Benedict equation 125
Helicobacter pylori 127
Hematocrit levels 110
Hemoclips, application of 182f
Hepatic cells 68
Hepatic duct, common 139
Hepatic fibrosis 69
Hepatoduodenal ligament 205f
Hernia
advantages of 98
disadvantages of 98
recurrence, chances of 100
repair, laparoscopic 98
surgery 98
treatment of 98
Hiatus hernia 127
High triglyceride levels 72
Hirsutism 90, 94
Home sleep apnea test 79
Homeostatic model assessment for insulin resistance index 50
Homocysteine, total 116
Hormonal disturbances 91
Hormone releasing hormone 89
Hurricane eye 134
Hyperandrogenism, signs of 90
Hypercarbia 78, 82
Hyperglycemia, postprandial 40
Hyperoxaluria 4
Hypertension, pulmonary 76
Hypertriglyceridemia 65
severe 74
Hypertrophy, tonsillar 76
Hypoalbuminemia 125
Hypopharyngeal nerve injury 222
Hypotension 109
Hypoxia 82
I
Incision 209
closure of 216
Incisura angularis 177f
Individualized metabolic surgery score 45, 46f
Inferior vena cava filters 107
Insulin 56
autoantibodies 41
deficiency 62
levels, serum 41, 43
long-acting 48
resistance 50, 61, 68, 92
assessment of 51
assists 67
calculated 50
secretion, incretin-mediated 49
usage 44
Insulinoma antigen 41
Intensive insulin therapy 61
Intermittent pneumatic compression 105, 106
Internal hernia 134, 136
and stricture 134
diagnose 134
International Diabetic Federation 35, 36, 237, 238
International Federation for Surgery of Obesity and Metabolic Disorders Asia Pacific Chapter 35, 36, 237, 238
Intragastric balloon 23, 31
Intraluminal bleeding 111
Intraperitoneal onlay mesh repair 99
Intrauterine growth restriction 95
Iron 120
deficiency anemia 114, 117
development of 117
malabsorption 4
Islet cell antibodies 62
J
Jejunocolic shunt 4
Jejunoileal bypass 3, 3f
procedures 3
Jejunojejunostomy 183, 185, 218
creation of 188f
enterotomy, hand-sewn closure of 188f
Jejunum 198
antemesenteric border of 200f
initiate measurement of 207f
proximal 32
stapler division of 186f, 187f
K
Ketosis 4
Kidney disease, chronic 85
Knee-elbow position 134
L
Laparoscopic adjustable gastric
banding 23
bypass 73
Laparoscopy 161
Laparotomy 161
Lateral traction, application of 217f
Lesser omentum, division of 190f
Linear cutting staplers 219
Linx device 130, 131f
Lipase, serum 139
Liver
evaluation 30
failure 122
histology, mechanism of 69
left lobe of 175, 195, 203
retraction 175, 176f, 185, 185f, 195, 203, 212, 214f
ports for 183
suspension tube technique 212, 214f
Long gastric pouch, creation of 196
Lorcaserin 15
Low-carbohydrate high-protein diet 14
Lower trunk region 167
Low-high-density lipoprotein levels 68
Low-molecular weight heparin 106, 110
Luteinizing hormone 89
levels 91
Lymphocytes 67
M
Macroalbuminuria 52
Macroglossia 76
Magenstrasse and Mill operation 7f
Magnesium 119
Magnetic resonance
cholangiopancreatography 139
imaging 66
Malabsorption 15
Malabsorptive procedures 74
Malnutrition, chances of 58
Marginal ulcers, intractable 113
Maryland forceps 185
Mason's gastric bypass 4f
Medical therapy, role for 42
Medtronics staplers 219
Memory loss 114
Menstrual disturbances 90
Menstrual irregularities 89
Mesenteric artery, superior 135
Mesenteric defect closure 187, 189f
Mesenteric hernia 135
Mesenteric vein, inferior 186f
Mesentery, vertical division of 187f
Metabolic surgery 75, 238
contemplating 57
indications for 237
role for 56
Metabolic syndrome 68, 168
development of 61
hallmark of 67
Metformin 16, 94
Methylmalonic acid, elevated 116
Microalbuminuria 52
Micrognathia 76
Micronutrient deficiencies 114
Micropouch gastric bypass 219
Mineral deficiencies 24
Mini-gastric bypass 53, 54
Modern surgical staplers 219
Muscle wasting 240
Mushroom sign 134
N
National Institutes of Health 4, 3436, 237, 238
Guidelines 29, 52
Needloscopic method 213, 214f
Nephrolithiasis 4
Nephropathy 51, 62, 85
Neuropathy 52, 62
Night eating syndrome 12, 234
Nonalcoholic fatty liver disease 20, 65, 66, 68, 122
diagnosis of 66
epidemiology of 68
pathogenesis of 67
staging of 66
Nutrition focused physical examination 124
Nutritional deficiencies
incidence of 26
investigations for 31
Nutritional evaluation 86
Nutritional precautions 95
O
Obesity
central 67
childhood 19
endocrine causes of 21
hypoventilation syndrome 77
impact pregnancy 95
in children 19
Surgery Society of Australia and New Zealand 35, 36, 237, 238
Obstructive sleep apnea 20, 29, 30, 7678
clinical features of 76
long-term sequelae of 77
pathophysiology of 77
physical signs of 76
severity of 81, 82
Olanzapine 15
Oligomenorrhea, causes of 92
Oliguria 109
Omentopexy 181f
Oral contraceptive 93
pills 94
Oral contrast study 160
Oral gastrografin, role for 144
Oral thromboprophylactic agents 106
Osteoarthritis 26
Ovarian drilling, role for 94
P
Pancreas 204
Parallel port technique 174
Paranoia 114
Parathyroid hormone 85, 115, 122
Pars flaccida 189
approach 217f
Percutaneous transhepatic instrumentation 140
Petersen's defect 136
Petersen's hernia 135
Pharmacotherapy, role of 21, 29
Phentermine 15
plus topiramate 15
Phrenoesophageal ligament 188
over left crus, dissection of 189f
Pittsburgh rating scale, modified 166
Plasmapheresis, preoperative 74
Platelet count 65
Pneumoperitoneum, creation of 174, 174f, 203
Polycystic ovarian
disease 68, 89
syndrome 89
Polyglycolic acid 222
Polymorphonuclear cells 67
Polyphagia 154
Polysomnography 79, 82
test 79
Ports 174, 183, 195, 203
create mini triangle of manipulation 211f
placement 195f, 209
Positive airway pressure 82
Post-bariatric micronutrient supplementation dosages 120t
Post-bariatric setting 114
Post-renal transplant setting 87
Prader-Willi syndrome 20
Pramlintide 16
Prealbumin 123
Predict weight loss after surgery 36
Prophylactic cholecystectomy, concerns of 141
Prostatic hypertrophy, benign 98
Protein
energy malnutrition 114, 122
grams of 124
Proton pump inhibitors 113
Proximal duodenal staple line, excision of 207f
Psychiatric illness, active severe 14
Psychological evaluation, role of 12
Pylorus 203, 207f
level of 195
position of 206f
R
Rectus muscle 209
Reflux disease 126
Refractory hypoalbuminemia, treatment of 125
Renal dysfunction, postoperative 86
Renal failure 122
Renal function, worsening of 86
Renal transplant 87
setting of 87
Reproductive system abnormalities 89
Respiratory tract infection 143
Retina, detachment of 51
Retinol-binding protein 124
Retinopathy 51, 62
Retrognathia 76
Reverse omega-shaped incision 210f
Robotic Roux-en-Y gastric bypass 192
Rossetti sleeve gastrectomy 132f
Roux limb obstruction 136
Roux-en-Y fistulojejunostomy 150
Roux-en-Y gastric bypass 2325, 28, 38, 44, 46, 53, 57, 74, 112, 114, 115, 127, 128, 163, 183, 209, 219
laparoscopic conversion to 156
ports placement for 184f
score system for 44t
single incision multiport 216
S
Sarcopenia 241
Scopinaro's biliopancreatic diversion 7f
Selenium 120
deficiency 117, 118
Sequential compression device 105
Seromuscular bite, anterior 182f
Serum 17-hydroxyprogesterone 92
Sex hormone binding globulin 89
Shock, stages of 109
Short gastric vessels, division of 177f
Single anastomosis duodenoileal bypass with sleeve gastrectomy 208
Single incision
laparoscopic surgery 195, 203
technique 176
multiport technique 210
sleeve gastrectomy, ports placement for 211f
technique 216
Sitagliptin 49
Skin
fat envelope, quality of 166
lesions 120
Sleeve gastrectomy 37, 47, 73, 99, 109111, 173, 175f, 202, 204, 208
failure of 155
laparoscopic revisional 23, 27, 53, 74, 98, 118, 156, 163
revision after 155
role for 129
score system for 44t
single incision 218
multiport 209
Sleeve gastroplasty, endoscopic 33
Sleeve leak 144, 148
complex 151
endoscopic classification of 145
guide management of 147
management of 145, 149
risk factor for 144
site of 144
Sliding scale insulin 54
Small-bowel obstruction 134
Sodium-glucose cotransporter-2 inhibitors 16
Spatz 3 balloon 32f
Spironolactone 93
Splenic artery, direct branch of 178
Staple height and length 219
Staple line reinforcements 222
Stapler
application 175, 179, 200f, 215
sequential firings of 215f
Stapling technology 219
essentials of 219
future advances in 223
Steatohepatitis, nonalcoholic 68
Stent migration 149
Stomach, surface of 203
Stop-bang sleep apnea questionnaire 79f
Stroke 77
Surgery, indications for 35t
Syndromic obesity, causes of 20
T
Tachycardia 109
Taewoong Niti-S megastent 148f
Thiamine 120
deficiency 115
Thromboembolism, venous 102, 103
Thromboprophylaxis 104
Thyroid disease 90
Tissue
stapler interaction 221
subcutaneous 209
Tobacco abuse 228
Total iron binding capacity 116, 122
Total knee replacement 26
Total parenteral nutrition 125
Total testosterone, serum 91
Trendelenburg position, reverse 173, 194, 202
Triangulation technique 174
Triglyceride 67, 72
Trimethylene carbonate 222
Tru-cut liver biopsy 70
Tyrosine phosphatase 41
U
Ulcers, marginal 113, 134
Umbilical tape sling technique 213
Umbilicus 195
ideal position of 203
Unstable medical disease 14
Upper trunk deformities 168
V
Venous thromboembolism, chances of 167
Ventral hernia 97
repair 98
laparoscopic 99
Veress needle 183
Vertical stapler, application of 191f
Visceral fat deposition 67
Vitamin
A 95, 120
deficiency 116, 118
B1 deficiency 115
active 116
deficiency 115, 117
D 119, 120
deficiencies 24
E 120
K 95, 120
W
Weakness, causes of 114
Weight gain, history of 18
Weight loss 14, 26, 28
and regain, history of 153
efforts 227
goals 227
history 227
lifestyle modifications for 30
preoperative 36
Western Bariatric Societies Guidelines 34
X
Xerostomia 15
Xiphisternum 195
Y
Y-Y paradox 17
Z
Zinc 120
×
Chapter Notes

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Clinics in Bariatric and Metabolic Surgery
Clinics in Bariatric and Metabolic Surgery
Praveen Raj Palanivelu MS DNB FA CS PhD Head GEM Obesity and Diabetes Surgery Centre Coimbatore, Tamil Nadu, India Associate Authors Siddhartha Bhattacharya MS DNB FNB MNAMS FMAS FAIS Consultant Bariatric Surgeon GEM Obesity and Diabetes Surgery Centre Chennai, Tamil Nadu, India S Saravana Kumar DNB FMAS Senior Consultant GEM Obesity and Diabetes Surgery Centre Coimbatore, Tamil Nadu, India Foreword Henry Buchwald
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Clinics in Bariatric and Metabolic Surgery
First Edition: 2019
9789352709113
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Foreword
Clinics in Bariatric and Metabolic Surgery written by Praveen Raj Palanivelu and his team, is unique among texts in the discipline of metabolic/bariatric surgery for its question and answer format. The tide of bariatric practice is turning to the Asian/Pacific nations, excellently represented in this volume, as the global pandemic of obesity and the metabolic syndrome remain unchecked. For example, one in five adults in India, with a population of over one billion, are now obese, and the prevalence of obesity in India is rapidly increasing. Further, it has been demonstrated that Asian populations are more obese for a given body mass index (BMI) and are therefore more susceptible to the comorbidities of obesity, in particular, type 2 diabetes.
The book is divided into three well-written sections: History, Care Capsules followed by detailed discussions of a topic, and Surgical Techniques. The book is comprehensive and can be read as a textbook in the field. The reader can also use the book to answer questions and review a perspective approach to a specific problem. For some, this book may serve as the starting point for innovative thought, for the elucidation of the mechanisms of action of metabolic bariatric surgery and, perhaps, to consider the etiology of the malignant diseases we are treating.
Metabolic/bariatric surgery is in a constant state of flux. There is no gold standard operation; it is, therefore, incumbent on the practitioners of this discipline to remain current in the field, be aware of what has transpired in the past, what is happening today, and potential directions for the future. The book persuasively provides these essential elements and will serve as a frequently consulted source of information.
Henry Buchwald MD PhD
Professor of Surgery and Biomedical Engineering
Owen H and Sarah Davidson Wangensteen Chair in Experimental Surgery, Emeritus
University of Minnesota, Minnesota, USA
President, American Society for Bariatric Surgery, 1998–1999
President, International Federation for the Surgery of Obesity (IFSO), 2003–2004
Preface
Bariatric surgery has evolved to be the most effective method of treatment for morbid obesity. The number of bariatric procedures being performed each year is growing tremendously, with bariatric surgery now evolving to be a specialty of its own. With obesity and metabolic diseases on the rise, more and more surgeons are now needed to addressing this concern. However, without standardized approaches and guidelines in many areas, surgeons are left with many questions in their day-to-day practice. “Which patient should I select for bariatric surgery?”, “What will be the ideal bariatric procedure?”, “What would be the relevant investigations?”, “How do I manage the nutritional aspect of my patient after surgery?”, “How can I avoid and appropriately manage complications?”, “What procedure do I choose in those who require a redo surgery?”, etc. These questions can be very confusing for the bariatric surgeon, especially at the beginning of his career. However, even with experience, bariatric surgeons still continue to ponder over these questions throughout their entire career. This book follows the success of our previously textbook Bariatric Surgery Practice Guide published in 2017. In this book however, we have attempted a new style of presentation wherein commonly seen case scenarios have been addressed in a question and answer fashion. The cases have been chosen in a manner commonly seen in clinical practice and questions very commonly asked by surgeons in digital platforms and conferences. It is meant to be a quick-reference book that provides easy access information on a day-to-day basis with detailed explanations for the same.
Through this format, a first of its kind, we hope to provide our readers with a thorough understanding of the subject and answers for all practical steps involved in bariatric surgical practice.
Praveen Raj Palanivelu
Siddhartha Bhattacharya
S Saravana Kumar