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COST-EFFECTIVENESS A 2009 Health Technology Assessment report in the UK showed bariatric surgery to be cost-e ff ective compared with non-surgical options. The incremental cost-e ff ectiveness ratio (ICER) compared with no surgery was between £2000 and with BMI ...

Complications The common complications are shown in Table 68.6 In sleeve gastrectomy , a staple line leak at the angle of His usually presents any time after discharge up to 30 days, and patients can also deteriorate rapidly with sepsis. Urgent - computed tom...

ELIGIBILITY Eligibility criteria were first proposed by the US National Institutes of Health in 1991, when the obesity epidemic was first recognised. All bariatric surgery was done by open lapa rotomy , and the safety profile was very di ff erent. The National In...

FURTHER READING Adams TD, Gress RE, Smith SC et al . Long-term mortality after gas - tric bypass surgery . N Engl J Med 2007; 357 : 753–61. Mingrone G, Panunzi S, De Gaetano A et al . Bariatric–metabolic sur - gery versus conventional medical treatment in obes...

FUTURE CHALLENGES Patients with obesity su ff er from widespread prejudice. Under standing that the obesity epidemic currently experienced in di ff erent parts of the world is driven by a change in the environment towards becoming ‘obesogenic’ and not a lack of...

Follow-up and a shared care model of chronic disease Shared care arrangements with surgeons/physicians and primary care need to be in place so that diabetes and hyper tension medications and dosage can be appropriately reduced as weight is lost. Every patient ...

INTRODUCTION Obesity is becoming the plague of the twenty-first century . With overweight becoming the norm in most Western countries and developing countries, two-thirds of adults su ff er from over weight or obesity ( Table 68.1 ). Every clinician and definit...

Laparoscopic surgery and enhanced recovery Bariatric surgery has been transformed by its amenability to laparoscopic techniques, including intracorporeal suturing and modern laparoscopic stapling devices. Probably equally important is the adoption of enhanced...

Learning objectives To know and understand: How to treat obesity as a disease • Rationale for surgery and the concept of metabolic • surgery Eligibility and NICE guidelines •

METABOLIC SURGERY The phrases ‘metabolic’ or ‘diabetes’ surgery are increasingly being used in conjunction with, or instead of, ‘bariatric surgery’ owing to the highly e ff ective way that surgery improves the metabolic syndrome, with weight loss being a welcom...

Outcomes reported There is wide variation in how surgeons report the results of surgery , which means that it is often di ffi cult to compare studies. There is a need to standardise clinician-reported outcomes and patient-reported outcome measures (PROMs) into ...

PRINCIPLES OF SETTING UP A BARIATRIC/METABOLIC SURGERY SERVICE As for gastrointestinal cancer surgery where a number of di ff erent specialists routinely work together, it is now agreed that ‘bariatric physicians/internists’, dieticians, mental health professio...

RATIONALE Bariatric surgery leads to weight loss of 25–35% of body weight (usually at least 15 /uni00A0 kg) after 1 year, and sustained weight loss maintenance at 15–25% after 20 years. Additional benefits are that most or all of the obesity-related diseases...

Randomised controlled trial evidence for the different types of surgery Some evidence suggests that weight loss is more with a Roux en-Y gastric bypass than sleeve gastrectomy . However, bariatric surgery needs more RCTs comparing di ff erent procedures with lo...

Rationale for surgery Owing to the tendency for basal metabolic rate to decrease with dietary calorie restriction most people will regain all their weight, returning to the previous homeostatic set point. Bariatric surgery appears to alter this mechanism and ‘...

The common operations According to the IFSO Global Registry , in 2018 sleeve gastrec - tomy constituted 46%, gastric bypass 38%, one-anastomosis gastric bypass procedures 7.6% and gastric banding 5% of procedures. Other procedures include the biliopancreatic d...

ACUTE AND CHRONIC LIVER DISEASE Liver blood tests The liver performs a myriad of biochemical, metabolic and immunological functions. Anhepatic humans survive for 24–48 hours. It is the only organ in the body that regenerates. Awareness of currently available...

ANATOMY OF THE LIVER Embryology Liver development begins at 3–4 weeks’ gestation when a hepatic foregut diverticulum buds into the ventral wall of the primitive midgut. This diverticulum is the anlage for the liver, extrahepatic biliary ducts, gallbladder and...