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Bariatric Surgery: Three Surgical
Techniques, Patient Care, Risks,
and Outcomes 1.8
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CARRIE A. McGRAW, MSN, RN; DANIEL B. WOOL, MD, FACS
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Purpose/Goal
To provide the learner with knowledge specific to caring for
patients undergoing bariatric surgery.
Objectives
1.
2.
3.
4.
Discuss obesity.
Describe eligibility criteria for bariatric surgery.
Discuss three common bariatric surgery procedures.
Identify risks of bariatric surgery.
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Conflict-of-Interest Disclosures
The behavioral objectives for this program were created by
Helen Starbuck Pashley, MA, BSN, CNOR, clinical editor,
with consultation from Susan Bakewell, MS, RN-BC,
director, Perioperative Education. Ms Starbuck Pashley and
Ms Bakewell have no declared affiliations that could be
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publication of this article.
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http://dx.doi.org/10.1016/j.aorn.2014.11.020
ª AORN, Inc, 2015
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AORN Journal j 141
Bariatric Surgery: Three Surgical
Techniques, Patient Care, Risks,
and Outcomes 1.8
www.aorn.org/CE
CARRIE A. McGRAW, MSN, RN; DANIEL B. WOOL, MD, FACS
ABSTRACT
The prevalence of obesity in the United States is a serious health concern. Bariatric surgery is a
recognized and accepted approach for addressing weight loss and health conditions that occur as a
result of morbid or severe obesity. Lifestyle changes, dietary modifications, and regular exercise are
required for optimal and lasting surgical weight loss. Perioperative care of bariatric patients requires
the use of interventions that differ from those used for nonobese patients, including bariatric-specific
equipment, intraoperative monitoring of blood glucose, and postoperative monitoring for respiratory
compromise. This articles outlines the risks and typical outcomes associated with three common
bariatric proceduresdlaparoscopic adjustable gastric banding, laparoscopic sleeve gastrectomy,
Roux-en-Y gastric bypassdto help perioperative nurses and other health care providers successfully
advise patients and monitor their care for optimal outcomes. AORN J 102 (August 2015) 142-149.
ª AORN, Inc, 2015. http://dx.doi.org/10.1016/j.aorn.2014.11.020
Key words: extreme obesity, bariatric surgery, gastric bypass, Roux-en-Y gastric bypass, gastric band.
O
besity is a significant health problem in the
United States. According to national statistics,
more than one-third of adults are obese.1 This
prevalence of obesity has been described as an epidemic.
Obesity contributes to medical comorbidities such as
hypertension, diabetes, coronary artery disease, dyslipidemia,
hypertriglyceridemia, obstructive sleep apnea, and
osteoarthritis. Obesity may also increase the risk for certain
cancers,
including
endometrial,
cervical,
ovarian,
postmenopausal breast, colorectal, esophageal, pancreatic,
gallbladder, liver, kidney, thyroid, and prostate.1,2
A common way to measure obesity is by calculating body mass
index (BMI; in kilograms per meter squared). Morbid or serious
obesity (class 2) describes a BMI of 35 kg/m2 to 39.9 kg/m2.
Extreme obesity describes a BMI of 40 kg/m2 or greater.3
Bariatric surgery is a recognized and accepted approach for
addressing weight loss and health conditions that occur as a
result of these classes of obesity. Bariatric surgical
interventions cause weight loss by restricting the amount
of food the stomach can hold, causing malabsorption of
nutrients, or by a combination of both gastric restriction and
malabsorption that results in hormonal changes.4 Surgeons,
bariatricians, nurses, dieticians, psychologists, and physical
trainers comprise the health care team that provides care
to patients undergoing bariatric surgery. Most bariatric
surgery centers recommend a multidisciplinary approach to
sustained weight loss after bariatric surgery, which requires
sustained dietary changes, lifestyle modification, and
regular exercise.4
Most bariatric surgeries are performed using minimally invasive techniques (eg, laparoscopic surgery).4 This article reviews
eligibility requirements for bariatric surgery and presents the
risks and typical outcomes associated with three commonly
performed bariatric procedures: laparoscopic adjustable
http://dx.doi.org/10.1016/j.aorn.2014.11.020
ª AORN, Inc, 2015
142 j AORN Journal
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gastric banding, laparoscopic sleeve gastrectomy, and
Roux-en-Y gastric bypass. A case study is also provided.
BENEFITS AND SAFETY OF BARIATRIC
SURGERY
Experience suggests that medical therapies for weight loss (eg,
dietary therapy, physical activity, behavior therapy) do not
produce significant or long-term weight loss and that bariatric
surgery together with regular exercise and dietary and lifestyle
changes does. Findings from a prospective controlled Swedish
Obese Subjects study5 of 4,047 patients during the period of
up to 15 years demonstrated an average weight change of less
than 2% in patients receiving medical therapy, whereas
bariatric surgery demonstrated significant and sustained
weight loss: patients who underwent laparoscopic adjustable
gastric banding sustained a 13% average weight change, and
those who underwent a gastric bypass sustained a 27%
average weight change.
When considering patient safety and clinically optimal
outcomes, the advent of bariatric-specific technology and
equipment (eg, laparoscopic staplers, long instruments, highdefinition cameras, bed trapezes) has provided added safety
to bariatric surgery. In addition, surgical fellowships in minimally invasive and bariatric surgery provide surgical graduates
experience in the surgical management of patients with
extreme obesity. In a study conducted by the Longitudinal
Assessment of Bariatric Surgery Consortium, findings
demonstrated a 30-day postoperative mortality rate of 0.3%
for laparoscopic gastric bypass and a 0% rate for laparoscopic
adjustable gastric banding.6
Accreditation standards for bariatric surgery centers also
contribute to the safety of bariatric procedures. In 2012, the
American College of Surgeons partnered with the American
Society for Metabolic and Bariatric Surgery (ASMBS) to create
the Metabolic and Bariatric Surgery Accreditation and Quality
Improvement Program to establish one national accreditation
standard for bariatric surgery centers.7,8 The Metabolic and
Bariatric Surgery Accreditation and Quality Improvement
Program tracks reported outcomes to help advance safe highquality care of bariatric surgical patients. All accredited bariatric surgery centers are required to report their outcomes.
The percentage of excess weight loss (ie, amount of weight loss
divided by the total excess weight) can be used to track weight
loss after bariatric surgery.
INDICATIONS FOR BARIATRIC SURGERY
Eligibility criteria for bariatric surgery were first established at
the 1991 National Institutes of Health Consensus
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Bariatric Surgery: Risks and Outcomes
Development Conference on Gastrointestinal Surgery for
Severe Obesity.9 Attendees of the conference included
surgeons, gastroenterologists, endocrinologists, psychiatrists,
nutritionists, other health care professionals, and members of
the public. Current eligibility criteria for weight loss surgery
state that potential candidates have
a BMI of 40 kg/m2 or greater or a BMI of 35 kg/m2 to 39
kg/m2 (about 100 lb overweight for men and 80 lb overweight for women) with one or more associated medical
comorbidy (eg, diabetes, sleep apnea, hypertension),
acceptable surgical risks,
an ability to participate in treatment and long-term followup, and
an understanding of the surgical procedure and the lifestyle
changes that will need to be made.10
Most insurance companies follow the guidelines listed above
when determining whether an approval for payment will be
provided.11 However, some insurance plans do not cover
bariatric surgery.
RISKS AND BENEFITS OF THREE TYPES
OF BARIATRIC SURGERY
Three types of bariatric surgery are currently performed in the
United States: laparoscopic adjustable gastric banding, laparoscopic sleeve gastrectomy, and Roux-en-Y gastric bypass.
Each procedure has risks and benefits that should be considered when selecting the most suitable bariatric surgical treatment for the patient.
Laparoscopic Adjustable Gastric Banding
The laparoscopic adjustable gastric band is an implantable
device that is placed around the cardia or top of the stomach,
where the contents of the esophagus empty into the stomach
(Figures 1 and 2).12,13 If a hiatal hernia is present, the surgeon
should repair it to limit postoperative gastroesophageal reflux
disease. The repair can usually be accomplished with one or
two interrupted sutures that are placed anteriorly to
the stomach.
When implanting the band, the surgeon plicates a portion of
the stomach to itself over the band to help secure the band and
prevent slippage. The band is a reservoir that can be filled with
saline solution. This reservoir is connected to tubing, which
also connects to a subcutaneous port. A needle is used to access
the port to add or remove fluid. The fluid in the band decreases the functional size of the stomach and slows the flow of
food through it, which helps to create satiety. Initially, the
band is placed without fluid in it and approximately six weeks
after surgery, the surgeon uses a needle to access the port and
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Figure 2. Patient undergoing laparoscopic adjustable
gastric banding. Courtesy of Daniel B. Wool, MD,
FACS.
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In a telephone conversation on May 13, 2015, with
Daniel Wool, MD, FACS, bariatric surgeon, he stated that
some surgeons report lower rates of weight loss and that
comorbidity improvement or resolution mirrors weight loss
and may take two to three years to achieve.
Risks associated with laparoscopic adjustable gastric
banding
Figure 1. Diagram of the adjustable gastric band.
Copyrightª 2005 American Society for Metabolic and
Bariatric Surgery. Reproduced with permission.
add fluid. Fluid can also be removed in this manner. The
adjustable gastric band surgery can be performed as an
outpatient procedure, and most patients return home the day
of surgery.
Successful weight loss with adjustable gastric banding requires
frequent patient follow-up. Increasing the amount of restriction caused by the band should be done gradually. This may
require office visits every six to eight weeks to assess the patient’s weight loss and satiety. The band can hold up to 12 mL
of fluid. Initially, the surgeon places 3 mL of saline solution in
the band. Subsequent fluid additions or removals are usually in
increments of 0.5 mL to 1.0 mL.
Outcomes of laparoscopic adjustable gastric banding
Reported rates of excess weight loss after this procedure
can be 50% to 56% two to three years after surgery.12,13
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Risks associated with this procedure include slippage, gastric
erosion, gastroesophageal reflux disease, and lack of weight
loss.5 Results from one study involving 60 consecutive patients
after a 14-year follow-up demonstrated a 63% reoperation rate
and a 48% band-removal rate.13 Such high removal and
reoperation rates have caused some bariatric surgeons to
reexamine the long-term efficacy of the adjustable
gastric band.
Laparoscopic Sleeve Gastrectomy
The laparoscopic sleeve gastrectomy is accomplished by
removing 75% to 80% of the stomach (Figures 3 to 5).14 The
surgeon mobilizes the stomach 2 cm to 6 cm from the pylorus
along the greater curvature up to the left esophageal crura and
then divides the short gastric vessels and posterior gastric
attachments. The lesser curvature is left intact to function as
the blood supply for the sleeve. The surgeon should repair a
hiatal hernia, if present, to limit postoperative
gastroesophageal reflux disease. Most hiatal hernias can be
repaired with the adjustable gastric band (as discussed
earlier). The new gastric sleeve becomes a high-pressure
system because the surgery reduces the volume and can
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Figure 4. Patient undergoing laparoscopic sleeve
gastrectomy: gastric sleeve next to divided greater
curvature. Courtesy of Daniel B. Wool, MD, FACS.
Figure 3. Diagram of the laparoscopic sleeve
gastrectomy. Copyrightª 2005 American Society for
Metabolic and Bariatric Surgery. Reproduced with
permission.
contribute to gastroesophageal reflux. The high pressure also
results in accelerated gastric emptying. An accepted size for
the gastric sleeve is 32 Fr to 36 Fr.15 Laparoscopic stapling
is performed next to the sizing tube (32-Fr to 36-Fr sizing
tube inserted in the esophagus to gauge the size of the
gastric sleeve), and the surgeon removes the greater
curvature of the stomach and the fundus of the stomach.
The sleeve gastrectomy may be preferred for patients with a
BMI greater than 60 kg/m2. Because there is typically less
visceral fat in the upper abdomen of these patients, most large
livers can be adequately retracted. These patients usually have
a large omentum from the visceral fat lower in the abdomen,
which can be avoided during sleeve gastrectomy. However, the
omentum is still a surgical factor with the gastric bypass
because of the need to perform a jejunojejunostomy (ie,
jejunum to jejunum anastomosis). The sleeve gastrectomy can
be converted to a gastric bypass as a staged procedure after the
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Outcomes of laparoscopic sleeve gastrectomy
The removal of the greater curvature and fundus of the
stomach produces hormonal changes that lower the levels of
ghrelin, an appetite stimulant, thereby inhibiting insulin
secretion and acting on the hypothalamus to regulate hunger.
This may contribute to increased weight loss and improvement or resolution of diabetes after sleeve gastrectomy.15-17
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patient achieves some weight loss. Conversion to gastric bypass
may result in further weight loss; however, in patients with a
BMI greater than 60 kg/m2, the sleeve is preferred as the
primary procedure because of the ease of its technical aspects,
good weight loss, and comorbidity resolution or improvement.
In the phone conversation referenced above, Wool stated that
current data suggest that the sleeve gastrectomy is performed
more often than laparoscopic adjustable banding in the
United States.
Figure 5. Patient undergoing laparoscopic sleeve
gastrectomy: explanted greater curvature of the
stomach. Courtesy of Daniel B. Wool, MD, FACS.
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difficult to repair because of the high pressure within the
sleeve.18
Roux-en-Y Gastric Bypass
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The Roux-en-Y gastric bypass has two main components
(Figures 6 to 9). The first component is restrictive and involves
the creation of a gastric pouch with staples near the cardia of
the stomach. The pouch is usually 30 mL in size. The second
component involves bypassing the stomach. The jejunum is
usually divided 40 cm from the ligament of Treitz, which is a
fixed point where the duodenum ends and the jejunum begins
and is usually located below the transverse colon. The proximal
aspect of this division is the biliopancreatic limb, and it is in
continuity with the duodenum and stomach and continues to
receive bile, pancreatic enzymes, and gastric secretions. After
the surgeon divides the jejunum, the bowel is then measured
distally (or forward) anywhere from 100 cm to 150 cm. The
surgeon anastomoses the measured point on the jejunum to
the biliopancreatic limb. Closing the mesenteric defect helps
prevent an internal hernia. The remaining distal end of the
previous division is then anastomosed to the gastric pouch (ie,
the Roux limb). The gastrojejunostomy may be performed
with a stapler and sewn laparoscopically or robotically. The
Roux limb is usually brought over the colon (antecolic) and
connected to the anterior aspect of the pouch (antegastric).
The omentum should be split to reduce tension on the
anastomosis. After this procedure, ingested food will bypass the
stomach. In addition, there is a component of malabsorption
because there is now less intestinal area for absorption. The
ingested food travels down the Roux limb, and digestion
begins where the biliopancreatic limb meets the Roux limb.
Figure 6. Diagram of the Roux-en-Y gastric bypass.
Copyrightª 2005 American Society for Metabolic and
Bariatric Surgery. Reproduced with permission.
The average excess weight loss for patients is about 65% in the
first six months after undergoing the procedure.16
The hormonal changes that occur after gastric bypass are not
completely understood. The bypass of food from the duodenum and beginning of the jejunum reduces the secretion of
ghrelin and glucose-dependent insulinotropic peptide (GIP).
The reduction in ghrelin reduces appetite while the reduction
of GIP may reduce weight gain. Increased nutrient delivery to
the distal ileum after a gastric bypass may enhance the secretion of glucagon-like peptide 1 (GLP-1) and peptide YY
(PYY). Glucose-dependent insulinotropic peptide 1 is secreted
by the distal ileum and increases satiety and may also improve
insulin sensitivity. Secretion of PYY is also known to increase
satiety and decrease food intake.16
Outcomes of gastric bypass
Risks of laparoscopic sleeve gastrectomy
Risks of the sleeve include gastroesophageal reflux (12%),
stricture (0.35%), and leakage (1.06%).14 A leak can be
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Weight loss is achieved by an increase in malabsorption
because there is less intestinal area for absorption. The average
weight loss for an individual who undergoes gastric bypass is
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Figure 7. Patient undergoing Roux-en-Y gastric
bypass: gastric pouch. Courtesy of Daniel B. Wool,
MD, FACS.
Figure 9. Patient undergoing Roux-en-Y
bypass: jejunojejunostomy. Courtesy of
B. Wool, MD, FACS.
75% of excess weight loss in the first six months. The average
percentage of excess weight loss after two years may approach
62%, and comorbidity resolution may occur within weeks and
up to several months after surgery.
type 2 diabetes. The BMI of one-third of the patients was
less than 35 kg/m2 (ie, class 1 obesity). At the one-year
follow-up and subsequent to 12 months of medical therapy,
the patients in the medical group averaged a 12-lb weight
loss compared with an average 64-lb weight loss for the
patients who underwent gastric bypass and an average 55-lb
weight loss for the patients who underwent sleeve
gastrectomy. Discontinuation of lipid-lowering medications
occurred at one year for 61% of the patients who
underwent gastric bypass and for 39% of the patients who
underwent sleeve gastrectomy, compared with 0% of the
patients who underwent medical therapy alone.
Discontinuation of blood pressure medications occurred at
one year for 47% of the patients who underwent gastric
bypass and for 41% of the patients who underwent sleeve
gastrectomy, compared with 2% of the patients who
received medical therapies.20
Evidence suggests that the gastric bypass has favorable comorbidity resolution or improvement. The researchers of a
systematic review of patients who underwent gastric bypass
found a diabetes resolution rate of 84%, a hypertension resolution rate of 75%, and a sleep apnea resolution rate of
87%.19 In a randomized, nonblinded, single-center trial that
examined 150 patients with diabetes, the researchers
evaluated the efficacy of intensive medical therapy alone
versus medical therapy plus Roux-en-Y gastric bypass or
sleeve gastrectomy in 150 obese patients with uncontrolled
gastric
Daniel
Risks associated with gastric bypass
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The risks associated with this procedure include anastomotic
leak, bleeding, anastomotic ulcer, internal hernia, and anastomotic stricture.19 An internal hernia can result in bowel
ischemia or small-bowel volvulus, which may mandate
immediate emergency surgery. Other complications include
vitamin deficiencies, and it can result in anemia,
osteoporosis, paralysis, and psychosis. It is important that
patients with a gastric bypass take daily vitamins and have
vitamin levels checked annually.
Figure 8. Patient undergoing Roux-en-Y
bypass: gastrojejunostomy. Courtesy of
B. Wool, MD, FACS.
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gastric
Daniel
CARE CONSIDERATIONS
Preoperatively, some patients may need cardiac risk stratification. This is especially applicable to patients who have a
AORN Journal j 147
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long history of hypertension, diabetes, or coronary artery
disease. Patients must also meet with the bariatric nutritionist preoperatively. Regular nutritional visits typically are
scheduled for one, three, six, and 12 months after surgery.
Patients are placed on a clear liquid diet the day before
surgery. Beta-blockers should be continued if previously
prescribed. All patients are also given 5,000 units of heparin
subcutaneously before surgery to help with deep vein
thrombosis (DVT) prophylaxis. Laboratory tests should be
performed preoperatively and may be repeated in six
months and annually thereafter. These tests include a
comprehensive metabolic profile; complete blood chemistry;
international normalized ratio (INR); partial thromboplastin time; vitamin D3, vitamin B1 (thiamine), vitamin
B12, and folic acid levels; hemoglobin A1c; iron panel;
thyroid-stimulating hormone (TSH); lipid panel; and highsensitivity C-reactive protein. The dosing of some preoperative prophylactic antibiotics may need to be adjusted
according to the patient’s weight.
Laparoscopic adjustable gastric banding may take 30 minutes
to 1.5 hours and laparoscopic sleeve gastrectomy and gastric
bypass may take one to three hours to perform. Adequate time
should be scheduled. Intraoperative care considerations
include the following:
Securing a bariatric-qualified OR bed is essential.
Use of footboards should occur when the patient is in the
reverse Trendelenburg position.
Some surgeons may require a split-leg table.
Arms may be left on arm boards and extended less than 90
degrees.
Long laparoscopic instruments, trocars, and staplers may be
needed because of the size of the patients.
A patient warming system may be needed to maintain patient normothermia.
Sequential compression devices should be available to be
prepared to respond to DVT prophylaxis.
Foley catheters may be needed to monitor urine output.
Patients with diabetes may require intraoperative glucose
monitoring.
Postoperative care considerations include the following:
Pulse oximetry must be applied and monitored because most
patients have obstructive sleep apnea.
Narcotics should be monitored as some patients have an
element of respiratory compromise.
Incentive spirometry should be encouraged at least 10 times
per hour while the patient is awake.
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Blood glucose monitoring should be continued for patients
with diabetes.
Beta-blockers should be continued if utilized preoperatively.
Heparin or low-molecular-weight heparin (enoxaparin)
should be continued, as well as surgical compression devices
for DVT prophylaxis; however, early ambulation after surgery is the best prophylaxis.
Patients may begin a sugar-free clear liquid diet after surgery.
Thirty mL of fluid can be given orally every 30 minutes. Some
patients have postoperative nausea and require intermittent
ondansetron and metoclopramide. Sustained tachycardia, fever, or increased abdominal pain may be a sign of a postoperative anastomotic leak or staple line leak. Most
anastomotic leaks require return to the OR for repair. Proton
pump inhibitors are initiated and continued for six months
after surgery. Patients may be discharged home on a bariatric
full-liquid diet. Patients should consume at least 60 g of
protein and 60 oz to 80 oz of liquid per day. Vitamin
supplementation is required after surgery. A pureed diet is
usually started after one week, and a soft diet, after four weeks.
Some patients may not require all their preoperative medications, and medication reconciliation must be performed.
CASE STUDY
A 46-year-old female patient with a BMI of 42 kg/m2
undergoes gastric bypass. Her preoperative weight is 257 lb.
Her comorbidities includes diabetes, hypertension, sleep
apnea, dyslipidemia, gastroesophageal reflux disease, and stress
urinary incontinence. Preoperatively, she was taking six
medications. After surgery, her diabetes resolves at two weeks.
Her sleep apnea, reflux, and high blood pressure resolves at
three months. The dyslipidemia resolves at one year. At the
one-year follow-up, the patient has lost 86 lb, or an 88%
excess weight loss, and her prescribed medications are only
bariatric vitamins.
CONCLUSION
Bariatric surgery is the only proven method of effective and
enduring weight loss combined with lifestyle and diet changes.
Common operations include laparoscopic adjustable gastric
banding, gastric bypass, and sleeve gastrectomy. Each operation is unique, and there is no perfect operation. A patient’s
age, comorbidities, and weight should help determine which
bariatric operation is most suitable. Successful outcomes after
bariatric surgery require a multidisciplinary approach and
extensive patient education, especially related to lifestyle
modification.
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Bariatric Surgery: Risks and Outcomes
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Carrie A. McGraw, MSN, RN, is a quality improvement specialist-NSQIP surgical clinical reviewer at
Advocate Good Shepherd Hospital, Barrington, IL.
Ms McGraw has no declared affiliation that could be
perceived as posing a potential conflict of interest
in the publication of this article.
Daniel B. Wool, MD, FACS, is a bariatric surgeon
at Advocate Good Shepherd Hospital, Barrington, IL.
Dr Wool has no declared affiliation that could be
perceived as posing a potential conflict of interest
in the publication of this article.
AORN Journal j 149
EXAMINATION
Continuing Education:
Bariatric Surgery: Three Surgical
Techniques, Patient Care, Risks,
and Outcomes 1.8
www.aorn.org/CE
PURPOSE/GOAL
To provide the learner with knowledge specific to caring for patients undergoing bariatric surgery.
OBJECTIVES
1.
2.
3.
4.
Discuss obesity.
Describe eligibility criteria for bariatric surgery.
Discuss three common bariatric surgery procedures.
Identify risks of bariatric surgery.
The Examination and Learner Evaluation are printed here for your convenience. To receive
continuing education credit, you must complete the online Examination and Learner Evaluation
at http://www.aorn.org/CE.
QUESTIONS
1. Obesity contributes to medical comorbidities such as
1. hypertension.
2. diabetes.
3. dyslipidemia.
4. hypertriglyceridemia.
5. obstructive sleep apnea.
6. osteoarthritis.
a. 1, 3, and 5
b. 2, 4, and 6
c. 2, 3, 5, and 6
d. 1, 2, 3, 4, 5, and 6
2. Some of the cancers for which obesity can increase risk include
1. ovarian.
2. pancreatic.
3. postmenopausal breast.
4. oral.
5. colorectal.
6. liver.
a. 1, 3, and 5
b. 2, 4, and 6
c. 1, 2, 3, 5, and 6 d. 1, 2, 3, 4, 5, and 6
150 j AORN Journal
3. Serious obesity is defined as a body mass index (BMI)
greater than or equal to
a. 25 kg/m2.
b. 35 kg/m2.
2
d. 50 kg/m2.
c. 40 kg/m .
4. Candidates for bariatric surgery are individuals who
1. have a BMI of 40 kg/m2 or greater.
2. are more than 200 lb in excess of ideal body weight.
3. have a BMI of 35 kg/m2 to 39 kg/m2 with obesityrelated medical comorbidities.
a. 1 and 2
b. 1 and 3
c. 2 and 3
d. 1, 2, and 3
5. Successful weight loss after laparoscopic band placement
requires
1. the band to be filled gradually over six to eight weeks.
2. prolonged hospitalization.
3. total excess weight loss of 50% to 56%.
4. comorbidity improvement or resolution that mirrors
weight loss.
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August 2015, Vol. 102, No. 2
5. a workout regimen of four hours of exercise per day.
a. 4 and 5
b. 1, 3, and 4
c. 1, 2, 3, and 4
d. 1, 2, 3, 4, and 5
6. Risks associated with the laparoscopic gastric banding
include
1. band slippage.
2. gastric erosion.
3. gastroesophageal reflux disease.
4. lack of weight loss.
5. a 63% reoperation rate.
6. a 48% band removal rate.
a. 1, 3, and 5
b. 2, 4, and 6
c. 2, 3, 5, and 6
d. 1, 2, 3, 4, 5, and 6
7. By removing the greater curvature and fundus of the
stomach during laparoscopic sleeve gastrectomy, hormonal changes occur that lower ghrelin, an appetite
stimulant, which inhibits insulin secretion and acts on the
hypothalamus to regulate hunger, thereby contributing
www.aornjournal.org
Bariatric Surgery: Risks and Outcomes
both to increased weight loss and improvement or
resolution of diabetes after sleeve gastrectomy.
a. true
b. false
8. Risks of laparoscopic sleeve gastrectomy include
1. gastroesophageal reflux.
2. ulcer.
3. stricture.
4. leakage.
a. 1 and 3
b. 2 and 4
c. 1, 2, and 4
d. 1, 2, 3, and 4
9. After a Roux-en-Y procedure, ingested food bypasses the
stomach and weight loss is achieved by an increase in
malabsorption because there is less gastric area for absorption.
a. true
b. false
10. One of the risks associated with Roux-en-Y procedures is an
internal hernia, which may result in bowel ischemia or smallbowel volvulus and require immediate emergency surgery.
a. true
b. false
AORN Journal j 151
LEARNER EVALUATION
Continuing Education:
Bariatric Surgery: Three Surgical
Techniques, Patient Care, Risks,
and Outcomes 1.8
www.aorn.org/CE
T
his evaluation is used to determine the extent to
which this continuing education program met your
learning needs. The evaluation is printed here for
your convenience. To receive continuing education credit, you
must complete the online Examination and Learner Evaluation at
http://www.aorn.org/CE. Rate the items as described below.
8.
Will you change your practice as a result of reading this
article? (If yes, answer question #8A. If no, answer
question #8B.)
8A.
How will you change your practice? (Select all that
apply)
1. I will provide education to my team regarding why
change is needed.
2. I will work with management to change/implement
a policy and procedure.
3. I will plan an informational meeting with physicians
to seek their input and acceptance of the need for
change.
4. I will implement change and evaluate the effect of
the change at regular intervals until the change is
incorporated as best practice.
5. Other: __________________________________
8B.
If you will not change your practice as a result of
reading this article, why? (Select all that apply)
1. The content of the article is not relevant to my
practice.
2. I do not have enough time to teach others about the
purpose of the needed change.
3. I do not have management support to make a
change.
4. Other: __________________________________
9.
Our accrediting body requires that we verify the time
you needed to complete the 1.8 continuing education
contact hour (108-minute) program: _____________
OBJECTIVES
To what extent were the following objectives of this
continuing education program achieved?
1. Discuss obesity.
Low
1.
2.
3.
4.
5.
High
2.
Describe eligibility criteria for bariatric surgery.
Low
1.
2.
3.
4.
5.
High
3.
Discuss three common bariatric surgery procedures.
Low
1.
2.
3.
4.
5.
High
4.
Identify risks of bariatric surgery.
Low
1.
2.
3.
4.
5.
High
CONTENT
5.
To what extent did this article increase your knowledge
of the subject matter?
Low
1.
2.
3.
4.
5.
High
6.
To what extent were your individual objectives met?
Low
1.
2.
3.
4.
5.
High
7.
Will you be able to use the information from this article
in your work setting?
1.
Yes
2.
No
152 j AORN Journal
www.aornjournal.org