Obesity surgery

Waitman JA, Aronne LJ. Obesity surgery Pros and cons. J Endocrinol Invest 2002 25 925-928. 

Martin LF, Tan TL, Horn JR, et al. Comparison of the costs associated with medical and surgical treatment of obesity. Surgery 1995 118 599-606. 

Obesity Surgery Complication Rates Higher over lime. Press Release, Agency for Healthcare Research and Quality, Rockville, Maryland, July 24,2006. 

CVS Minute Clinic—minor ailments Social network health forums Hospitals—elective surgery (cosmetic, obesity surgery, etc.)... 

Specialized surgical procedures exist for medical conditions with an endocrine component, such as morbid obesity. Surgery for morbid obesity is known as bariatric surgery. An increasing proportion of... 

Faintuch, J. Horie, L.M. Barbeiro, H.V Barbeiro, D.F. Soriano, F.G. Ishida, R.K. Cecconello, I. Systemic inflammation in morbidly obese subjects Response to oral supplementation with alpha-linolenic acid. Obesity Surgery 2007, 17, 341-347. Ferrucci, L. Cherubini, A. Bandinelli, S. Bartali, B. Corsi, A. Lauretani, F. Martin, A. Andres-Lacueva, C. Senin, U. Guralnik, J.M. Relationship of plasma polyunsaturated fatty acids to circulating inflammatory markers. J Clin Endocrin Metab 2006, 91,439-436. 

Venous stasis Major medical illness (e.g., congestive heart failure) Major surgery (e.g., general anesthesia for greater than 30 minutes) Paralysis (e.g., due to stroke or spinal cord injury) Polycythemia vera Obesity Varicose veins... 

KK is a 69-year-old obese female who fell on her way to church and fractured her right hip. She is hospitalized and will undergo surgery to repair her fractured right hip. 

Surgery is warranted when other treatment attempts have failed in severely obese patients (BMI of 40 kg/m2 or greater or 35 kg/m2 or greater with other obesity-related risk factors). 

Venous stasis is slowed blood flow in the deep veins of the legs resulting from damage to venous valves, vessel obstruction, prolonged periods of immobility, or increased blood viscosity. Conditions associated with venous stasis include major medical illness (e.g., heart failure, myocardial infarction), major surgery, paralysis (e.g., stroke, spinal cord injury), polycythemia vera, obesity, or varicose veins. 

Estrogens have a dose-related effect in the development of venous thromboembolism (VTE) and pulmonary embolism. This is especially true in women with underlying hypercoagulable states or who have acquired conditions (e.g., obesity, pregnancy, immobility, trauma, surgery, and certain malignancies.)... 

Risk factors for developing an SSI after cardiac surgery include obesity, renal insufficiency, connective tissue disease, reexploration for bleeding, and poorly timed administration of antibiotics. 

Successful obesity treatment plans incorporate diet, exercise, behavior modification with or without pharmacologic therapy, and/ or surgery (Fig. 59-1). 

Surgery, which reduces the stomach volume or absorptive surface of the alimentary tract, remains the most effective intervention for obesity. Although modern techniques are safer than older procedures and have an operative mortality of 1%, there are still many potential complications. Therefore, surgery should be reserved for those with BMI greater than 35 or 40 kg/m2 and significant comorbidity. 

The main treatment for obesity involves lifestyle alteration (ie, decreased caloric Intake coupled with increased exercise) however, in severely obese patients, gastric bypass surgery is a viable alternative. 

Brief History. B.W., a 75-year-old woman, fell at home and experienced a sudden sharp pain in her left hip. She was unable to walk and was taken to a nearby hospital where x-ray examination showed an impacted fracture of the left hip. The patient was alert and oriented at the time of admission. She had a history of arteriosclerotic cardiovascular disease and diabetes mellitus, but her medical condition was stable. The patient was relatively obese, and a considerable amount of osteoarthritis was present in both hips. Two days after admission, a total hip arthroplasty was performed under general anesthesia. Meperidine (Demerol) was given intramuscularly as a preoperative sedative. General anesthesia was induced by intravenous administration of thiopental (Pentothal) and sustained by inhalation of halothane (Fluothane). The surgery was completed successfully, and physical therapy was initiated at the patient s bedside on the subsequent day. 

If all else—including diet, exercise, and medication combined—seems to fail, surgery is one more option available to some very obese people. Bariatric surgeries make changes to the digestive system so that less food can comfortably be eaten and/or fewer calories can be... 

Gastrointestinal Surgery for Severe Obesity." Weight Control Information Network, a service of the National Institute of Diabetes and Digestive and Kidney Diseases, December 2004. NIH Publication No. 04-4006. Available online. URL http //win.niddk.nih.gov/publications/gastric. htm issurgfor. Accessed January 3, 2008. 

Adults with GH deficiency tend to have generalized obesity, reduced muscle mass, asthenia, and reduced cardiac output. Adult-onset GH deficiency is usually found in the presence of other pituitary hormone deficiencies, and is usually due to damage to the hypothalamus or pituitary caused by tumor, infection, surgery, or radiation therapy. 

With the early application of stereotaxic surgery to neurological studies in experimental animals, Anand and Brobeck (1951) first reported that bilateral lesions of small nuclei in the hypothalamus could disrupt feeding behavior with medial hypothalamic lesions causing obesity and lateral lesions aphagia. In the latter syndrome, the lesioned animals would completely stop eating to the extent that if not maintained... 

Intravascular coagulation can occur in the deep veins of the leg during long journeys, particularly in cramped conditions. Risk factors for DVT include recent pregnancy and childbirth, dehydration, recent surgery, obesity, oral contraceptives, certain abdominal cancers and family history. 

Fatal pulmonary embolism occurred in a 29-year-old man who was not obese, did not smoke, and had not had recent surgery, after he had taken clozapine 300 mg/day... 

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