Roux-en-Y gastric bypass. Image courtesy of Ethicon Endo-Surgery, Inc.
By Sylvia Foley, AJN senior editor
People who are obese (BMI of 30 kg/m2 or greater) are prone to a laundry list of ills. They’re not only at greater risk for diseases such as type 2 diabetes, coronary heart disease, stroke, and osteoarthritis—they’re also more apt to experience discrimination and psychological abuse, and to suffer from anxiety and depression. Many have repeatedly tried to lose weight through diet, exercise, psychotherapy, and pharmacotherapy, to no avail. Until recently, there was little else providers could offer them.
But bariatric surgery, known to be an effective treatment for obesity and obesity-related comorbidities, is becoming an increasingly common option. In 1998, only about 13,000 bariatric procedures were performed in the United States; by 2007 that figure had jumped to 200,000, and it continues to rise. With prevalence rates for overweight and obesity also at record highs in this country, more nurses will likely find themselves caring for patients who have undergone such procedures.
In this month’s CE, “Outcomes and Complications after Bariatric Surgery,” authors Lauren Gagnon and Emily Karwacki Sheff explain the two main types of bariatric surgery and outline five of the most common procedures in the United States:
- Roux-en-Y gastric bypass (RYGB)
- adjustable gastric banding (AGB)
- vertical sleeve gastrectomy (VSG)
- biliopancreatic diversion with duodenal switch
- vertical banded gastroplasty
Gagnon and Sheff then discuss the outcomes and complications of bariatric surgery, noting that although it is “generally safe,” there is always some risk. Depending on the surgery, complications might include “dumping” syndrome, cholelithiasis, pulmonary embolism and deep vein thrombosis, and anastomotic leak, among others. The authors close with detailed nursing implications for pre- and postoperative patient care. For example, with regard to preoperative evaluation and patient teaching, they explain the importance of the following:
- helping patients know what to expect upon awakening from surgery
- discussing postoperative pain control before surgery
- ensuring that patients have realistic weight-loss goals
- preparing patients for certain aesthetic changes
Bariatric surgery has proven to be most effective when patients adhere to postoperative recommendations and attend follow-up visits and support groups. The full article is free online. And if you’ve worked with patients who have undergone bariatric surgery, we’d love to hear about your experiences.
As an RN I’ve seen the results of a LOT of Bariatic surgery, & participated in it in the O.R.
In this area, gastric banding is by far the most common & seems to cause fewer side effects. Many of the people who had the older surgeries either failed badly, or if they kept the weight off, developed serious side effects such as not absorbing vitamins/ minerals, & needing monthly IV injections of meds to reverse this. The IV could take well over an hour, not to speak of the problems w/ starting an IV in a person whose veins had been used over and over for years.
Some surgeons require the pending patient to see a therapist of some kind before surgery. As in plastic surgery, many people expect miraculous changes in their entire life, their happiness, and so on.
For some people it is literally a life saver: especially severe diabetics (type II diabetics can be “cured”) or those at high risk of stroke, heart attack can have their risk lowered dramatically. PRE and POST discussion/ interviews, etc are of the greatest importance, I feel.