Bariatric Surgery (Weight Loss Surgery)

 1. Definition

It is a surgical procedure performed on the stomach or intestines to induce weight loss. It is usually the last resort for patients who have failed to lose weight through diet and exercise.

2. Criteria for Surgery (Who is eligible?)

BMI > 40: Morbid obesity (with or without other diseases).

BMI > 35: Severe obesity associated with comorbidities (like Type 2 Diabetes, Hypertension, Sleep Apnea).

Note: The patient must be mentally stable and willing to commit to lifelong lifestyle changes.

3. Common Types of Procedures

A. Restrictive Surgeries (Limits how much you can eat):

Sleeve Gastrectomy: About 80% of the stomach is removed, leaving a banana-shaped "sleeve." This restricts food intake and reduces the hunger hormone (Ghrelin).

Adjustable Gastric Banding (Lap-Band): An inflatable band is placed around the upper part of the stomach. It creates a small pouch. It is reversible.

B. Malabsorptive Surgeries (Limits calorie absorption):

Biliopancreatic Diversion: Bypasses a large part of the small intestine so fewer calories are absorbed.

C. Combination (Restrictive + Malabsorptive):

Roux-en-Y Gastric Bypass (RYGB): considered the "Gold Standard." The surgeon creates a small stomach pouch and connects it directly to the jejunum (bypassing the duodenum).

4. Pre-Operative Nursing Care

Assessment: Check baseline vitals, weight, and BMI.

Equipment: Ensure bariatric-sized equipment is available (extra-wide bed, large BP cuff, appropriate wheelchair).

Diet: Patient is often put on a liquid diet pre-op to shrink the liver (makes surgery safer).

Education: Teach about using the Incentive Spirometer (very important due to high risk of respiratory issues in obese patients).

5. Post-Operative Nursing Care (Crucial)

Airway & Breathing: This is the priority. Obese patients retain CO2 easily. Keep the head of the bed elevated (Semi-Fowler’s position) to help lung expansion.

Pain Management: PCA (Patient Controlled Analgesia) is often used.

Skin Care: Check skin folds for breakdown or infection.

Early Ambulation: Get the patient moving as soon as possible (same day) to prevent DVT (Deep Vein Thrombosis) and pneumonia.

Anastomotic Leak: Most dangerous complication. Watch for tachycardia (rapid heart rate), fever, and severe abdominal pain radiating to the shoulder/back. This is a medical emergency.

6. Dietary Guidelines (The "New Normal")

Progression: Clear Liquids → Full Liquids → Pureed/Soft Food → Solids.

6 Small Meals: The stomach is now tiny (30ml to 60ml capacity).

No Fluids with Meals: Patients must not drink water during meals. Drink 30 mins before or 30 mins after. Drinking with food flushes food out too fast and causes Dumping Syndrome.

High Protein, Low Carbs: Focus on nutrient-dense food.

Chew Thoroughly: Food must be chewed to a paste to prevent blockage.

7. Major Complication: Dumping Syndrome

What is it? Rapid emptying of gastric contents into the small intestine. Usually caused by eating high-sugar or high-carb foods.

Symptoms:

Sweating, dizziness, tachycardia (palpitations).

Abdominal cramping and diarrhea.

Occurs 15-30 minutes after eating.

Nursing Management:

Lie down (Low Fowler’s) after eating to slow down digestion.

Avoid sugary foods and fluids with meals.

Small, frequent meals.

8. Long-Term Considerations

Vitamin Deficiencies: Because part of the intestine is bypassed, absorption is poor.

Supplements Needed: Vitamin B12 (lifelong injections or sublingual), Calcium, Iron, and Multivitamins.

Excess Skin: After massive weight loss, patients may need plastic surgery for loose skin.