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Bariatric Surgery
By Sue Gabriel, ARNP, CCRN, MSN
Nursing made Incredibly Easy! January/February 2006
2.5 ANCC/AACN contact hours
Online: www.nursingcenter.com
© 2006 by Lippincott Williams & Wilkins. All world rights reserved.
Obesity Defined

Body mass index (BMI) > 30 kg/m2

Morbidly obese: BMI > 40 kg/m2 or more

Goal of bariatric surgery is weight
reduction
Candidates for Bariatric Surgery

BMI > 40 kg/m2, or more than 35 kg/m2 with a comorbidity of sleep
apnea, diabetes, hypertension, degenerative joint disease, asthma,
or history of stroke

18 years or older

Obese for 5 years or more

Unsuccessfully attempted weight loss using other methods

Able to complete intense screening process, including commitment
to long-term weight loss
Types of Bariatric Surgery

Restrictive-Creates a gastric pouch with a narrow outlet,
so patient “feels full” sooner; examples: gastroplasty,
gastric banding
• Vertical banded gastroplasty: Surgical staples create a
small gastric pouch and a “band” as an outlet for the
pouch
• Circumgastric banding: Adjustable, inflatable band placed
around fundus of stomach
Types, continued

Malabsorptive-Bypasses a significant amount
of small intestine, greatly reducing amount of
calories/nutrients absorbed
• Jejunocolic bypass: Reroutes the jejunum
directly to the colon
• Jejunoileal bypass: Small intestine attached
to the distal ileum
Combination Surgery

Most effective procedures combine restrictive
and malabsorptive types of surgery

Gold standard in the U.S. is the Roux-en-Y
gastric bypass; creates a small stomach pouch
with a connection to the jejunum
• Food ingested bypasses 90% of stomach
• Can be done laparoscopically
Preoperative Teaching

Deep breathing/coughing
exercises to be done post-op

Possible need for abdominal
binder/wound dressings postop

I.V. and drains to be in place
post-op

BP/pulmonary function: Should
be peak pre-op

DVT prophylaxis

Need for reliable birth control
for childbearing-age patients,
especially during post-op
period

Pain management options
post-op

Lifelong commitment to weight
loss
Post-Operative Nursing Care

Frequently monitor patient’s BP, cardiac function, I & O;
tachycardia/hypertension common post-op in this
population

Pain management is a priority

DVT prevention: Early ambulation, sequential
compression devices, anticoagulation

Aggressive pulmonary toilet
A New Diet






NPO immediately post-op
Once bowel sounds return, patient starts small
meals; 600-800 calories/day
Clear liquids progressing to regular diet
Diet rich in protein, low in sugars/fats
Drink liquids separate from meals
Eat slowly/chew food thoroughly
Long-Term Implications

Increased risk for abdominal hernia, gall bladder
disease; dietary supplement containing bile
salts, cholecystectomy may be recommended

Nutritional deficiencies: Recommend daily
vitamin, calcium supplement

Follow-up important both physically and
psychosocially