Bariatric surgery primer for the internist:
Gespeichert in:
| Format: | Buch |
|---|---|
| Sprache: | English |
| Veröffentlicht: |
Philadelphia [u.a.]
Saunders
2007
|
| Schriftenreihe: | Medical clinics of North America
91,3 |
| Schlagworte: | |
| Online-Zugang: | Inhaltsverzeichnis |
| Beschreibung: | XVII S., S. 321 - 536 Ill., graph. Darst. |
| ISBN: | 9781416049869 141604986X |
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| 245 | 1 | 0 | |a Bariatric surgery primer for the internist |c guest ed. Nilesh A. Patel ... |
| 264 | 1 | |a Philadelphia [u.a.] |b Saunders |c 2007 | |
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| 650 | 4 | |a Bariatric Surgery | |
| 650 | 4 | |a Gastric bypass | |
| 650 | 4 | |a Obesity |x Surgery | |
| 650 | 4 | |a Obesity, Morbid |x surgery | |
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| adam_text | BARIATRIC SURGERY PRIMER FOR THE INTERNIST
CONTENTS
Preface xv
Nilesh A. Patel and Lisa S. Koche
Dedication xvii
Financial Impact of Obesity and Bariatric Surgery 321
Kinga A. Powers, Scott T. Rehrig, and Daniel B. Jones
Obesity constitutes a major health problem with serious social and
economic consequences worldwide. In North America, nearly one
third of the population is obese, and this figure includes children
and adolescents who are likely to become obese adults. Obesity
carries a great financial impact on society; consequently, treating
morbidly obese patients with surgery may offer substantial
economic savings. This article summarizes the financial burdens
of obesity and the economics of treating obesity in North America.
It addresses the medical effectiveness and cost effectiveness of
bariatric surgery and the new regulations and accreditations for
bariatric surgery programs.
Preoperative Assessment and Perioperative Care of Patients
Undergoing Bariatric Surgery 339
Rajesh Kuruba, Lisa S. Koche, and Michel M. Murr
The prevalence of morbid obesity in the United States and world¬
wide is increasing at an alarming rate. The number of bariatric
surgical procedures also has steadily increased during the past
decade. This article reviews the published literature and current
practice trends for preoperative workup and assessment of patients
undergoing bariatric surgery.
VOLUME 91 • NUMBER 3 • MAY 2007 ix
Bariatric Surgery Primer for the Internist: Keys to the Surgical
Consultation 353
Daniel Leslie, Todd A. Kellogg, and Sayeed Ikramuddin
The increasing prevalence of morbid obesity in North America
combined with the refinement of laparoscopic techniques for the
performing of these operations has contributed to the exponential
growth of bariatric surgery over the last 10 years. There are many
important considerations for the internist who is referring a patient
for bariatric surgery.
Management of the Challenging Bariatric Surgical Patient 383
Kent R. Van Sickle
Despite the continued increase in surgical procedures for weight
loss, the dramatic increase in the prevalence of morbid obesity
far outpaces the treatments to correct it. As a result, the primary
care physician is increasingly more likely to be evaluating patients
who are either candidates for weight loss surgery or who have al¬
ready undergone a weight loss procedure. Unique medical and so¬
cial situations must be considered when evaluating these patients,
and it is anticipated that all physicians will be seeing a greater
number of complex or challenging patients.
Metabolic Aspects of Bariatric Surgery 393
Franco Folli, Antonio E. Pontiroli, and
Wayne H. Schwesinger
Insulin resistance is a nearly universal finding in morbid obesity. It
may be compensated and latent or uncompensated with single or
multiple clinical abnormalities. Although lifestyle interventions
and medical measures alone may control most metabolic problems
in the short term, the ultimate benefits of such an approach are
usually limited by the complexity of available therapeutic regimens
and the difficulty of maintaining full patient compliance. Many stu¬
dies now document that bariatric surgery can effectively and safely
control these complications in the short term and long term or even
prevent their occurrence. Further investigations are needed to
understand better the mechanisms involved and to define more
clearly the appropriate indications and contraindications of the
treatments proposed.
Impact of Obesity and Bariatric Surgery on Cardiovascular
Disease 415
Michael A. Mathier and Ramesh C. Ramanathan
Morbid obesity is a growing public health concern with multiple
associated cardiovascular comorbidities. Bariatric surgery has
emerged as a safe and effective treatment for morbidly obese patients
x CONTENTS
at risk for, or already suffering from, cardiovascular disease.
Weight loss induced by the surgery has been shown to improve
cardiovascular risk factors, cardiac structure and function, and
the clinical course of established cardiovascular disease. The role
of adipocyte derived cytokines in mediating cardiovascular patho
physiology in obesity and its modulation after weight loss is under
active investigation.
Pulmonary Considerations in Obesity and the Bariatric
Surgical Patient 433
Garth Davis, Jitesh A. Patel, and Daniel J. Gagne
Severe obesity can be associated with significant alterations in nor¬
mal cardiopulmonary physiology. The pathophysiologic effects of
obesity on a patient s pulmonary function are multiple and com¬
plex. The impact of obesity on morbidity and mortality are often
underestimated. Bariatric surgery has been shown to be the most
effective modality of reliable and durable treatment for severe obe¬
sity. Surgical weight loss improves and, in most cases, completely
resolves the pulmonary health problems associated with obesity.
Management of Gastrointestinal Disorders in the Bariatric
Patient 443
Troy A. Markel and Samer G. Mattar
Morbid obesity continues to grow at an alarming rate. As of 2004,
35% of Americans were considered to have a body mass index
(BMI) over 30. As the number of patients undergoing weight loss
surgery increases, the patient population presenting to primary
care physicians with previous gastric bypass will also increase. Ac¬
cordingly, it will become imperative for primary care physicians to
be familiar and comfortable with the care of these patients. This re¬
view focuses on the management of gastrointestinal disorders in
postoperative gastric bypass patients.
Psychosocial and Behavioral Status of Patients Undergoing
Bariatric Surgery: What to Expect Before and After Surgery 451
Thomas A. Wadden, David B. Sarwer,
Anthony N. Fabricatore, LaShanda Jones,
Rebecca Stack, and Noel S. Williams
Extreme obesity, characterized by a body mass index (BMI) of 40
kg/m2 or greater, is associated with significantly increased mortal¬
ity, principally from cardiovascular disease, type 2 diabetes, and
several cancers. It also is associated with an increased risk of psy¬
chosocial complications, including depression, eating disorders,
and impaired quality of life. This article briefly examines the psy¬
chosocial status of extremely obese individuals who seek bariatric
CONTENTS xi
surgery and describes changes in functioning that can be expected
with surgically induced weight loss. The article combines a review
of the literature with clinical impressions gained from the more
than 2500 candidates for bariatric surgery whom the authors have
evaluated at the Hospital of the University of Pennsylvania.
Outpatient Complications Encountered Following Roux en Y
Gastric Bypass 471
Peter P. Lopez, Nilesh A. Patel, and Lisa S. Koche
Practitioners taking care of postoperative bariatric patients need to
keep in mind all of the complications that this population faces to
prevent unnecessary morbidity. Bariatric patients presenting post
operatively with abdominal pain, tachycardia, vomiting, tachyp
nea, and a sense of impending doom should be worked up
aggressively to find the cause of their symptoms. Because the inci¬
dence of obesity is rising in children and adults, more patients will
have surgery to help with their weight loss. Physicians caring for
these patients must be able to diagnosis and treat their complica¬
tions quickly and efficiently to prevent further complications.
Laparoscopic Gastric Band Complications 485
Jeff W. Allen
Weight loss surgery, also known as bariatric surgery, has evolved
from a specialty dominated by intestinal bypasses and vertical
banded gastroplasty to its current state of a specialty characterized
by minimal access techniques and Centers of Excellence. Bariatric
surgery has remained the only reliably effective option for signifi¬
cant weight loss for the morbidly obese. This article reviews com¬
mon problems occurring after laparoscopic adjustable gastric band
with emphasis on conservative diagnosis and effective treatment.
Nutritional Consequences of Weight Loss Surgery 499
Olga N. Tucker, Samuel Szomstein, and Raul J. Rosenthal
Nutritional deficiencies are already present in many morbidly ob¬
ese patients before weight loss surgery. Appropriate preoperative
detection and correction is essential. The severity and pattern of de¬
ficiencies is dependent on the presence of preoperative uncorrected
deficiency, the type of procedure performed varying with the de¬
gree of restriction or the length of bypassed small intestine, the
modification of eating behavior, the development of complications,
compliance with oral multivitamin and mineral supplementation,
and compliance with follow up. Rigorous control of fluids and
electrolytes with establishment of adequate oral nutrition is impor¬
tant in the immediate postoperative period. Regular follow up of
the metabolic and nutritional status or the patient is essential, with
life long multivitamin and mineral supplementation.
xji CONTENTS
Improvement in Infertility and Pregnancy Outcomes
after Weight Loss Surgery 515
Jitesh A. Patel, Joseph J. Colella, Emmanuel Esaka,
Nilesh A. Patel, and Ronald L. Thomas
The majority of bariatric surgical procedures are performed in
young women. There is a concern about safety and outcomes of
pregnancies after weight loss surgery. Pregnancy after weight loss
surgery is not only safe, but is associated with more favorable out¬
comes in comparison to obese populations who do not undergo
weight loss surgery. An interval of 2 years is recommended from
surgery to pregnancy. This delay helps avoid most of the potential
nutritional complications. Optimal patient care is achieved in an
experienced, multidisciplinary center. Early involvement of the bar¬
iatric surgeon in evaluating abdominal pain is critical because the
underlying pathology may relate to the previous weight loss sur¬
gery. Although infertility is improved after weight loss surgery, re¬
liable modes of contraception may be limited in this population.
Index 529
CONTENTS xiii
|
| adam_txt |
BARIATRIC SURGERY PRIMER FOR THE INTERNIST
CONTENTS
Preface xv
Nilesh A. Patel and Lisa S. Koche
Dedication xvii
Financial Impact of Obesity and Bariatric Surgery 321
Kinga A. Powers, Scott T. Rehrig, and Daniel B. Jones
Obesity constitutes a major health problem with serious social and
economic consequences worldwide. In North America, nearly one
third of the population is obese, and this figure includes children
and adolescents who are likely to become obese adults. Obesity
carries a great financial impact on society; consequently, treating
morbidly obese patients with surgery may offer substantial
economic savings. This article summarizes the financial burdens
of obesity and the economics of treating obesity in North America.
It addresses the medical effectiveness and cost effectiveness of
bariatric surgery and the new regulations and accreditations for
bariatric surgery programs.
Preoperative Assessment and Perioperative Care of Patients
Undergoing Bariatric Surgery 339
Rajesh Kuruba, Lisa S. Koche, and Michel M. Murr
The prevalence of morbid obesity in the United States and world¬
wide is increasing at an alarming rate. The number of bariatric
surgical procedures also has steadily increased during the past
decade. This article reviews the published literature and current
practice trends for preoperative workup and assessment of patients
undergoing bariatric surgery.
VOLUME 91 • NUMBER 3 • MAY 2007 ix
Bariatric Surgery Primer for the Internist: Keys to the Surgical
Consultation 353
Daniel Leslie, Todd A. Kellogg, and Sayeed Ikramuddin
The increasing prevalence of morbid obesity in North America
combined with the refinement of laparoscopic techniques for the
performing of these operations has contributed to the exponential
growth of bariatric surgery over the last 10 years. There are many
important considerations for the internist who is referring a patient
for bariatric surgery.
Management of the Challenging Bariatric Surgical Patient 383
Kent R. Van Sickle
Despite the continued increase in surgical procedures for weight
loss, the dramatic increase in the prevalence of morbid obesity
far outpaces the treatments to correct it. As a result, the primary
care physician is increasingly more likely to be evaluating patients
who are either candidates for weight loss surgery or who have al¬
ready undergone a weight loss procedure. Unique medical and so¬
cial situations must be considered when evaluating these patients,
and it is anticipated that all physicians will be seeing a greater
number of complex or challenging patients.
Metabolic Aspects of Bariatric Surgery 393
Franco Folli, Antonio E. Pontiroli, and
Wayne H. Schwesinger
Insulin resistance is a nearly universal finding in morbid obesity. It
may be compensated and latent or uncompensated with single or
multiple clinical abnormalities. Although lifestyle interventions
and medical measures alone may control most metabolic problems
in the short term, the ultimate benefits of such an approach are
usually limited by the complexity of available therapeutic regimens
and the difficulty of maintaining full patient compliance. Many stu¬
dies now document that bariatric surgery can effectively and safely
control these complications in the short term and long term or even
prevent their occurrence. Further investigations are needed to
understand better the mechanisms involved and to define more
clearly the appropriate indications and contraindications of the
treatments proposed.
Impact of Obesity and Bariatric Surgery on Cardiovascular
Disease 415
Michael A. Mathier and Ramesh C. Ramanathan
Morbid obesity is a growing public health concern with multiple
associated cardiovascular comorbidities. Bariatric surgery has
emerged as a safe and effective treatment for morbidly obese patients
x CONTENTS
at risk for, or already suffering from, cardiovascular disease.
Weight loss induced by the surgery has been shown to improve
cardiovascular risk factors, cardiac structure and function, and
the clinical course of established cardiovascular disease. The role
of adipocyte derived cytokines in mediating cardiovascular patho
physiology in obesity and its modulation after weight loss is under
active investigation.
Pulmonary Considerations in Obesity and the Bariatric
Surgical Patient 433
Garth Davis, Jitesh A. Patel, and Daniel J. Gagne
Severe obesity can be associated with significant alterations in nor¬
mal cardiopulmonary physiology. The pathophysiologic effects of
obesity on a patient's pulmonary function are multiple and com¬
plex. The impact of obesity on morbidity and mortality are often
underestimated. Bariatric surgery has been shown to be the most
effective modality of reliable and durable treatment for severe obe¬
sity. Surgical weight loss improves and, in most cases, completely
resolves the pulmonary health problems associated with obesity.
Management of Gastrointestinal Disorders in the Bariatric
Patient 443
Troy A. Markel and Samer G. Mattar
Morbid obesity continues to grow at an alarming rate. As of 2004,
35% of Americans were considered to have a body mass index
(BMI) over 30. As the number of patients undergoing weight loss
surgery increases, the patient population presenting to primary
care physicians with previous gastric bypass will also increase. Ac¬
cordingly, it will become imperative for primary care physicians to
be familiar and comfortable with the care of these patients. This re¬
view focuses on the management of gastrointestinal disorders in
postoperative gastric bypass patients.
Psychosocial and Behavioral Status of Patients Undergoing
Bariatric Surgery: What to Expect Before and After Surgery 451
Thomas A. Wadden, David B. Sarwer,
Anthony N. Fabricatore, LaShanda Jones,
Rebecca Stack, and Noel S. Williams
Extreme obesity, characterized by a body mass index (BMI) of 40
kg/m2 or greater, is associated with significantly increased mortal¬
ity, principally from cardiovascular disease, type 2 diabetes, and
several cancers. It also is associated with an increased risk of psy¬
chosocial complications, including depression, eating disorders,
and impaired quality of life. This article briefly examines the psy¬
chosocial status of extremely obese individuals who seek bariatric
CONTENTS xi
surgery and describes changes in functioning that can be expected
with surgically induced weight loss. The article combines a review
of the literature with clinical impressions gained from the more
than 2500 candidates for bariatric surgery whom the authors have
evaluated at the Hospital of the University of Pennsylvania.
Outpatient Complications Encountered Following Roux en Y
Gastric Bypass 471
Peter P. Lopez, Nilesh A. Patel, and Lisa S. Koche
Practitioners taking care of postoperative bariatric patients need to
keep in mind all of the complications that this population faces to
prevent unnecessary morbidity. Bariatric patients presenting post
operatively with abdominal pain, tachycardia, vomiting, tachyp
nea, and a sense of impending doom should be worked up
aggressively to find the cause of their symptoms. Because the inci¬
dence of obesity is rising in children and adults, more patients will
have surgery to help with their weight loss. Physicians caring for
these patients must be able to diagnosis and treat their complica¬
tions quickly and efficiently to prevent further complications.
Laparoscopic Gastric Band Complications 485
Jeff W. Allen
Weight loss surgery, also known as bariatric surgery, has evolved
from a specialty dominated by intestinal bypasses and vertical
banded gastroplasty to its current state of a specialty characterized
by minimal access techniques and Centers of Excellence. Bariatric
surgery has remained the only reliably effective option for signifi¬
cant weight loss for the morbidly obese. This article reviews com¬
mon problems occurring after laparoscopic adjustable gastric band
with emphasis on conservative diagnosis and effective treatment.
Nutritional Consequences of Weight Loss Surgery 499
Olga N. Tucker, Samuel Szomstein, and Raul J. Rosenthal
Nutritional deficiencies are already present in many morbidly ob¬
ese patients before weight loss surgery. Appropriate preoperative
detection and correction is essential. The severity and pattern of de¬
ficiencies is dependent on the presence of preoperative uncorrected
deficiency, the type of procedure performed varying with the de¬
gree of restriction or the length of bypassed small intestine, the
modification of eating behavior, the development of complications,
compliance with oral multivitamin and mineral supplementation,
and compliance with follow up. Rigorous control of fluids and
electrolytes with establishment of adequate oral nutrition is impor¬
tant in the immediate postoperative period. Regular follow up of
the metabolic and nutritional status or the patient is essential, with
life long multivitamin and mineral supplementation.
xji CONTENTS
Improvement in Infertility and Pregnancy Outcomes
after Weight Loss Surgery 515
Jitesh A. Patel, Joseph J. Colella, Emmanuel Esaka,
Nilesh A. Patel, and Ronald L. Thomas
The majority of bariatric surgical procedures are performed in
young women. There is a concern about safety and outcomes of
pregnancies after weight loss surgery. Pregnancy after weight loss
surgery is not only safe, but is associated with more favorable out¬
comes in comparison to obese populations who do not undergo
weight loss surgery. An interval of 2 years is recommended from
surgery to pregnancy. This delay helps avoid most of the potential
nutritional complications. Optimal patient care is achieved in an
experienced, multidisciplinary center. Early involvement of the bar¬
iatric surgeon in evaluating abdominal pain is critical because the
underlying pathology may relate to the previous weight loss sur¬
gery. Although infertility is improved after weight loss surgery, re¬
liable modes of contraception may be limited in this population.
Index 529
CONTENTS xiii |
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| series2 | Medical clinics of North America |
| spelling | Bariatric surgery primer for the internist guest ed. Nilesh A. Patel ... Philadelphia [u.a.] Saunders 2007 XVII S., S. 321 - 536 Ill., graph. Darst. txt rdacontent n rdamedia nc rdacarrier Medical clinics of North America 91,3 Bariatric Surgery Gastric bypass Obesity Surgery Obesity, Morbid surgery Patel, Nilesh A. Sonstige oth Medical clinics of North America 91,3 (DE-604)BV000003310 91,3 HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=015685543&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
| spellingShingle | Bariatric surgery primer for the internist Medical clinics of North America Bariatric Surgery Gastric bypass Obesity Surgery Obesity, Morbid surgery |
| title | Bariatric surgery primer for the internist |
| title_auth | Bariatric surgery primer for the internist |
| title_exact_search | Bariatric surgery primer for the internist |
| title_exact_search_txtP | Bariatric surgery primer for the internist |
| title_full | Bariatric surgery primer for the internist guest ed. Nilesh A. Patel ... |
| title_fullStr | Bariatric surgery primer for the internist guest ed. Nilesh A. Patel ... |
| title_full_unstemmed | Bariatric surgery primer for the internist guest ed. Nilesh A. Patel ... |
| title_short | Bariatric surgery primer for the internist |
| title_sort | bariatric surgery primer for the internist |
| topic | Bariatric Surgery Gastric bypass Obesity Surgery Obesity, Morbid surgery |
| topic_facet | Bariatric Surgery Gastric bypass Obesity Surgery Obesity, Morbid surgery |
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