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Chapter 27: The Surgical Management of Obesity

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What body mass index (BMI or weight(kg)/height [m2]) definition of obesity serves as the standard indication for bariatric surgery when medical therapy has failed and comorbid conditions exist?

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A. Overweight (BMI 25.0–29.9)

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B. Class I obesity (BMI 30.0–34.9)

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C. Class II obesity (BMI 35.0–39.9)

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D. Class III obesity (BMI 40.0 and greater)

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Answer: C

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A 1991 NIH Consensus Conference recommended that bariatric surgery was indicated for a body mass index (BMI) of 35.0–39.9 when medical therapy has failed and comorbid conditions exist. When no comorbid conditions exist, a BMI of 40 or greater is required. This standard continues to be used by insurers, although recent studies have shown benefit in lower BMI groups. (See Schwartz 10th ed., p. 1100.)

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Which of the following bariatric procedures is primarily intended to induce weight loss through malabsorption of ingested nutrients?

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A. Adjustable gastric band

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B. Sleeve gastrectomy

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C. Roux-en-Y gastric bypass (RYGB)

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D. Duodenal switch

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Answer: D

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Bariatric procedures are classified as restrictive, malabsorptive, or a combination of restrictive and malabsorptive in the mechanism of weight loss that they induce. Restrictive operations include adjustable gastric band and gastric sleeve, malabsorptive operations include duodenal switch and biliopancreatic diversion, and combined restrictive and malabsorptive procedures include the Roux-en-Y gastric bypass (RYGB). (See Schwartz 10th ed., p. 1103.)

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Complications of adjustable gastric banding which have diminished its popularity as a bariatric procedure include all of the following EXCEPT

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A. Mortality risk

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B. Slippage of the band

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C. Failure to lose weight

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D. Port and tubing complications

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Answer: A

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The adjustable gastric band procedure, usually performed laparoscopically, has the lowest cost and mortality risk of all the bariatric procedures, but is the least effective for weight loss. In addition, slippage and erosion of the band and complications related to the maintenance and use of the port for adjusting the size of the band contribute to its loss of popularity. (See Schwartz 10th ed., p. 1112.)

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Early postoperative complications after a RYGB procedure include all of the following EXCEPT

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A. Anastomotic leak from a staple ...

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