Practical Recommendations for the Post Bariatric Surgery Medical Management… · 2019-08-16 ·...
Transcript of Practical Recommendations for the Post Bariatric Surgery Medical Management… · 2019-08-16 ·...
![Page 1: Practical Recommendations for the Post Bariatric Surgery Medical Management… · 2019-08-16 · •The Bariatric/Metabolic World we are living in •Challenges –Post Operative](https://reader034.fdocuments.us/reader034/viewer/2022042923/5f7151530dce200ce0685737/html5/thumbnails/1.jpg)
Practical Recommendations for the Post Bariatric
Surgery Medical Management. Obesity Management
Task Force of the European Association for the
Study of Obesity
Dror Dicker MD, Internal Medicine D & Obesity Clinic Hasharon Hospital-Rabin Medical Center
Sackler School Of Medicine Tel Aviv University, Israel.
Co-Chair Obesity Management Task Force, EASO
Luca Busetto MD Department of Internal Medicine, University of Padova, Italy
Co-Chair Obesity Management Task Force, EASO
![Page 2: Practical Recommendations for the Post Bariatric Surgery Medical Management… · 2019-08-16 · •The Bariatric/Metabolic World we are living in •Challenges –Post Operative](https://reader034.fdocuments.us/reader034/viewer/2022042923/5f7151530dce200ce0685737/html5/thumbnails/2.jpg)
OUTLINE
• The Bariatric/Metabolic World we are living in • Challenges
– Post Operative Follow-up Adherence. – Post Operative Readmissions.
• Need for Guidance – Nutritional management. – Management of comorbidities. – Pharmacotherapy after bariatric surgery – Psychological aspects. – Pregnancy after bariatric surgery. – Weight regain prevention.
![Page 3: Practical Recommendations for the Post Bariatric Surgery Medical Management… · 2019-08-16 · •The Bariatric/Metabolic World we are living in •Challenges –Post Operative](https://reader034.fdocuments.us/reader034/viewer/2022042923/5f7151530dce200ce0685737/html5/thumbnails/3.jpg)
OUTLINE
• The Bariatric/Metabolic World we are living in
![Page 4: Practical Recommendations for the Post Bariatric Surgery Medical Management… · 2019-08-16 · •The Bariatric/Metabolic World we are living in •Challenges –Post Operative](https://reader034.fdocuments.us/reader034/viewer/2022042923/5f7151530dce200ce0685737/html5/thumbnails/4.jpg)
Bariatric/Metabolic Surgery
Rubino F, Diabetes Care 2016
![Page 5: Practical Recommendations for the Post Bariatric Surgery Medical Management… · 2019-08-16 · •The Bariatric/Metabolic World we are living in •Challenges –Post Operative](https://reader034.fdocuments.us/reader034/viewer/2022042923/5f7151530dce200ce0685737/html5/thumbnails/5.jpg)
IFSO Global Registry 2016: Number of operation records submitted (n=142,748)
Second IFSO Global Registry Report 2016
![Page 6: Practical Recommendations for the Post Bariatric Surgery Medical Management… · 2019-08-16 · •The Bariatric/Metabolic World we are living in •Challenges –Post Operative](https://reader034.fdocuments.us/reader034/viewer/2022042923/5f7151530dce200ce0685737/html5/thumbnails/6.jpg)
Primary surgery: Patients’ BMI before surgery; calendar years 2013-2015 (n=50,835)
Second IFSO Global Registry Report 2016
![Page 7: Practical Recommendations for the Post Bariatric Surgery Medical Management… · 2019-08-16 · •The Bariatric/Metabolic World we are living in •Challenges –Post Operative](https://reader034.fdocuments.us/reader034/viewer/2022042923/5f7151530dce200ce0685737/html5/thumbnails/7.jpg)
Primary surgery: Example BMI distributions for three selected contributor countries; calendar years 2013-2015
Second IFSO Global Registry Report 2016
![Page 8: Practical Recommendations for the Post Bariatric Surgery Medical Management… · 2019-08-16 · •The Bariatric/Metabolic World we are living in •Challenges –Post Operative](https://reader034.fdocuments.us/reader034/viewer/2022042923/5f7151530dce200ce0685737/html5/thumbnails/8.jpg)
Primary surgery: Type of operation; calendar years 2013-2015 (n=51,820)
Second IFSO Global Registry Report 2016
![Page 9: Practical Recommendations for the Post Bariatric Surgery Medical Management… · 2019-08-16 · •The Bariatric/Metabolic World we are living in •Challenges –Post Operative](https://reader034.fdocuments.us/reader034/viewer/2022042923/5f7151530dce200ce0685737/html5/thumbnails/9.jpg)
n engl j med 377;12 nejm.org September 21, 2017
![Page 10: Practical Recommendations for the Post Bariatric Surgery Medical Management… · 2019-08-16 · •The Bariatric/Metabolic World we are living in •Challenges –Post Operative](https://reader034.fdocuments.us/reader034/viewer/2022042923/5f7151530dce200ce0685737/html5/thumbnails/10.jpg)
n engl j med 377;12 nejm.org September 21, 2017
![Page 11: Practical Recommendations for the Post Bariatric Surgery Medical Management… · 2019-08-16 · •The Bariatric/Metabolic World we are living in •Challenges –Post Operative](https://reader034.fdocuments.us/reader034/viewer/2022042923/5f7151530dce200ce0685737/html5/thumbnails/11.jpg)
n engl j med 377;12 nejm.org September 21, 2017
![Page 12: Practical Recommendations for the Post Bariatric Surgery Medical Management… · 2019-08-16 · •The Bariatric/Metabolic World we are living in •Challenges –Post Operative](https://reader034.fdocuments.us/reader034/viewer/2022042923/5f7151530dce200ce0685737/html5/thumbnails/12.jpg)
Obes Facts 2013
![Page 13: Practical Recommendations for the Post Bariatric Surgery Medical Management… · 2019-08-16 · •The Bariatric/Metabolic World we are living in •Challenges –Post Operative](https://reader034.fdocuments.us/reader034/viewer/2022042923/5f7151530dce200ce0685737/html5/thumbnails/13.jpg)
OUTLINE
• The Bariatric/Metabolic World we are living in
• Challenges
– Post Operative Follow-up Adherence.
![Page 14: Practical Recommendations for the Post Bariatric Surgery Medical Management… · 2019-08-16 · •The Bariatric/Metabolic World we are living in •Challenges –Post Operative](https://reader034.fdocuments.us/reader034/viewer/2022042923/5f7151530dce200ce0685737/html5/thumbnails/14.jpg)
Predictors of attrition in a multidisciplinary adult weight management clinic
Demographic characteristics of the study population, n = 1205
Multivariate analyses (logistic regression model) for risk of attrition
Gill PS,Can J Surg 2012,
A total of 1205 patients were treated in the weight management program:
887 in the medical clinic and 318 with surgery and follow-up in a surgical clinic.
Overall, 516 patients left the program or were lost to follow-up (attrition rate
42.8%).The attrition rate was 53.9% in the medical clinic and 11.9% in the
surgical clinic
![Page 15: Practical Recommendations for the Post Bariatric Surgery Medical Management… · 2019-08-16 · •The Bariatric/Metabolic World we are living in •Challenges –Post Operative](https://reader034.fdocuments.us/reader034/viewer/2022042923/5f7151530dce200ce0685737/html5/thumbnails/15.jpg)
What Happens to Patients Who Do Not Follow-Up after Bariatric Surge (48/105 patients)
Success Rates in Group A and Group B
Group A versus Group
HARPE J, THE AMERICAN SURGEON J,2006
We found that a significant number of patients will not comply with regular follow-up
care after laparoscopic gastric bypass unless they are prompted to do so by their
bariatric clinic. These patients have worse clinical outcome (i.e., less weight loss).
![Page 16: Practical Recommendations for the Post Bariatric Surgery Medical Management… · 2019-08-16 · •The Bariatric/Metabolic World we are living in •Challenges –Post Operative](https://reader034.fdocuments.us/reader034/viewer/2022042923/5f7151530dce200ce0685737/html5/thumbnails/16.jpg)
OUTLINE
• The Bariatric/Metabolic World we are living in
• Challenges
– Post Operative Follow-up Adherence.
– Post Operative Readmissions.
![Page 17: Practical Recommendations for the Post Bariatric Surgery Medical Management… · 2019-08-16 · •The Bariatric/Metabolic World we are living in •Challenges –Post Operative](https://reader034.fdocuments.us/reader034/viewer/2022042923/5f7151530dce200ce0685737/html5/thumbnails/17.jpg)
Hospital Admissions Greater Than 30 Days Following Bariatric Surgery : Patient and Procedure Matter
Rate and frequency of hospital admission by bariatric procedure within 2 years of operation
Significant preoperative risk factors for hospital admission following bariatric surgery
Telem DA, Surg Endosc 2014
![Page 18: Practical Recommendations for the Post Bariatric Surgery Medical Management… · 2019-08-16 · •The Bariatric/Metabolic World we are living in •Challenges –Post Operative](https://reader034.fdocuments.us/reader034/viewer/2022042923/5f7151530dce200ce0685737/html5/thumbnails/18.jpg)
Readmissions and Emergency Department Visits after Bariatric Surgery at Saudi Arabian Hospital
Ahme A, Obes Facts 2017
![Page 19: Practical Recommendations for the Post Bariatric Surgery Medical Management… · 2019-08-16 · •The Bariatric/Metabolic World we are living in •Challenges –Post Operative](https://reader034.fdocuments.us/reader034/viewer/2022042923/5f7151530dce200ce0685737/html5/thumbnails/19.jpg)
OUTLINE
• The Bariatric/Metabolic World we are living in
• Challenges
– Post Operative Follow-up Adherence.
– Post Operative Readmissions.
• Need for Guidance
![Page 20: Practical Recommendations for the Post Bariatric Surgery Medical Management… · 2019-08-16 · •The Bariatric/Metabolic World we are living in •Challenges –Post Operative](https://reader034.fdocuments.us/reader034/viewer/2022042923/5f7151530dce200ce0685737/html5/thumbnails/20.jpg)
HM Parretti et.al 2014
Clinical obesity, 2016
![Page 21: Practical Recommendations for the Post Bariatric Surgery Medical Management… · 2019-08-16 · •The Bariatric/Metabolic World we are living in •Challenges –Post Operative](https://reader034.fdocuments.us/reader034/viewer/2022042923/5f7151530dce200ce0685737/html5/thumbnails/21.jpg)
OBESITY FACTS, Accepted
![Page 22: Practical Recommendations for the Post Bariatric Surgery Medical Management… · 2019-08-16 · •The Bariatric/Metabolic World we are living in •Challenges –Post Operative](https://reader034.fdocuments.us/reader034/viewer/2022042923/5f7151530dce200ce0685737/html5/thumbnails/22.jpg)
Levels of evidence, grades of recommendation and good practice points
![Page 23: Practical Recommendations for the Post Bariatric Surgery Medical Management… · 2019-08-16 · •The Bariatric/Metabolic World we are living in •Challenges –Post Operative](https://reader034.fdocuments.us/reader034/viewer/2022042923/5f7151530dce200ce0685737/html5/thumbnails/23.jpg)
OUTLINE
• The Bariatric/Metabolic World we are living in
• Challenges
– Post Operative Follow-up Adherence.
– Post Operative Readmissions.
• Need for Guidance
– Nutritional management.
![Page 24: Practical Recommendations for the Post Bariatric Surgery Medical Management… · 2019-08-16 · •The Bariatric/Metabolic World we are living in •Challenges –Post Operative](https://reader034.fdocuments.us/reader034/viewer/2022042923/5f7151530dce200ce0685737/html5/thumbnails/24.jpg)
Nutritional management
![Page 25: Practical Recommendations for the Post Bariatric Surgery Medical Management… · 2019-08-16 · •The Bariatric/Metabolic World we are living in •Challenges –Post Operative](https://reader034.fdocuments.us/reader034/viewer/2022042923/5f7151530dce200ce0685737/html5/thumbnails/25.jpg)
The role of dietician follow-up in the success of bariatric surgery ( n=1680 )
Multivariate analysis for the prediction of a BMI reduction of at least 5%
Multivariate linear analysis for the association between the number of dietary sessions attended and BMI reduction
Endevelt R, SORD 2013
![Page 26: Practical Recommendations for the Post Bariatric Surgery Medical Management… · 2019-08-16 · •The Bariatric/Metabolic World we are living in •Challenges –Post Operative](https://reader034.fdocuments.us/reader034/viewer/2022042923/5f7151530dce200ce0685737/html5/thumbnails/26.jpg)
Nutritional management
![Page 27: Practical Recommendations for the Post Bariatric Surgery Medical Management… · 2019-08-16 · •The Bariatric/Metabolic World we are living in •Challenges –Post Operative](https://reader034.fdocuments.us/reader034/viewer/2022042923/5f7151530dce200ce0685737/html5/thumbnails/27.jpg)
Common findings
Pouwel S, Obesity Facts 2015
In the majority of reports on exercising in a (future) bariatric population, positive
effects on anthropometrics, cardiovascular risk factors and physical fitness were
described. However, the results were not unanimous, with a wide range of exercise
programs and perioperative timing, therefore hampering adequate practical
guidance.
![Page 28: Practical Recommendations for the Post Bariatric Surgery Medical Management… · 2019-08-16 · •The Bariatric/Metabolic World we are living in •Challenges –Post Operative](https://reader034.fdocuments.us/reader034/viewer/2022042923/5f7151530dce200ce0685737/html5/thumbnails/28.jpg)
Analysis of VO2peak and total duration on CPX in different periods of evaluation
Onofre T, Obes Surg 2017
![Page 29: Practical Recommendations for the Post Bariatric Surgery Medical Management… · 2019-08-16 · •The Bariatric/Metabolic World we are living in •Challenges –Post Operative](https://reader034.fdocuments.us/reader034/viewer/2022042923/5f7151530dce200ce0685737/html5/thumbnails/29.jpg)
Components of a weight maintenance lifestyle intervention programme of proven efficacy in clinical trials
Exercise
• High levels of physical activity: achieve
≥175 min week and advance to ≥200 min week.
• Physical activity for weight maintenance after weight loss:
200–300 min week.
• Self-monitoring of physical activity
Soleymani T, Obesity Reviews 2015
![Page 30: Practical Recommendations for the Post Bariatric Surgery Medical Management… · 2019-08-16 · •The Bariatric/Metabolic World we are living in •Challenges –Post Operative](https://reader034.fdocuments.us/reader034/viewer/2022042923/5f7151530dce200ce0685737/html5/thumbnails/30.jpg)
The National Weight Control Registry key patient data
• Registry members lost an average of 30 kg (66 lb) and maintained their reduced
weight for 5.5 years
• 45% lost weight by themselves; 55% lost weight with the help of some type of
programme
• 98% modified their food intake to lose weight
• 94% increased their physical activity – walking being the most frequent activity
• Most kept their weight off by continuing to maintain a low-calorie (1,360 kcal d−1),
low-fat diet (24% of calories from fat) and by high levels of physical activity
(∼2,786 kcal week− 1)
• Most self-monitored their dietary intake and physical activity
• 78% ate breakfast every day
• 75% weighed themselves once-weekly or more frequently
• 62% watched ≤10 h of television per week
• 90% exercised, on average, about 1 h per day of physical activity
National Weight Control Registry. Facts. [WWW document]. URL
http://www.nwcr.ws/Research/default.htm (accessed April2015).
![Page 31: Practical Recommendations for the Post Bariatric Surgery Medical Management… · 2019-08-16 · •The Bariatric/Metabolic World we are living in •Challenges –Post Operative](https://reader034.fdocuments.us/reader034/viewer/2022042923/5f7151530dce200ce0685737/html5/thumbnails/31.jpg)
Nutritional management
![Page 32: Practical Recommendations for the Post Bariatric Surgery Medical Management… · 2019-08-16 · •The Bariatric/Metabolic World we are living in •Challenges –Post Operative](https://reader034.fdocuments.us/reader034/viewer/2022042923/5f7151530dce200ce0685737/html5/thumbnails/32.jpg)
Nutritional management
![Page 33: Practical Recommendations for the Post Bariatric Surgery Medical Management… · 2019-08-16 · •The Bariatric/Metabolic World we are living in •Challenges –Post Operative](https://reader034.fdocuments.us/reader034/viewer/2022042923/5f7151530dce200ce0685737/html5/thumbnails/33.jpg)
Inadequate protein intake after laparoscopic sleeve gastrectomy surgery is associated with a greater fat free mass loss
Changes in FFM Changes FM
Sherf Dagan S, SORD(2017)
![Page 34: Practical Recommendations for the Post Bariatric Surgery Medical Management… · 2019-08-16 · •The Bariatric/Metabolic World we are living in •Challenges –Post Operative](https://reader034.fdocuments.us/reader034/viewer/2022042923/5f7151530dce200ce0685737/html5/thumbnails/34.jpg)
Inadequate protein intake after laparoscopic sleeve gastrectomy surgery is associated with a greater fat free mass loss
Relative FFM loss (mean SE) according to daily protein intake goal of 60 g/d
Percent of patients with clinically significant FFM loss (>10%) by daily protein intake goal of 60 g/d
Sherf Dagan S, SORD(2017)
![Page 35: Practical Recommendations for the Post Bariatric Surgery Medical Management… · 2019-08-16 · •The Bariatric/Metabolic World we are living in •Challenges –Post Operative](https://reader034.fdocuments.us/reader034/viewer/2022042923/5f7151530dce200ce0685737/html5/thumbnails/35.jpg)
Nutritional management
![Page 36: Practical Recommendations for the Post Bariatric Surgery Medical Management… · 2019-08-16 · •The Bariatric/Metabolic World we are living in •Challenges –Post Operative](https://reader034.fdocuments.us/reader034/viewer/2022042923/5f7151530dce200ce0685737/html5/thumbnails/36.jpg)
Dumping syndrome
Amy Kreykes, THE JOURNAL OF FAMILY PRACTICE 2017
• Dumping syndrome is a common complication following BS.
• Prevalence ranging from 25% to 75%, depending upon the type of procedure performed.
• There are 2 types: early and late.
• Early dumping syndrome occurs within 30 minutes of eating.
• Symptoms are related to the robust release of gastrointestinal hormones caused by rapid gastric emptying. Symptoms include nausea, abdominal pain, diarrhea, flushing, hypotension, and tachycardia.
![Page 37: Practical Recommendations for the Post Bariatric Surgery Medical Management… · 2019-08-16 · •The Bariatric/Metabolic World we are living in •Challenges –Post Operative](https://reader034.fdocuments.us/reader034/viewer/2022042923/5f7151530dce200ce0685737/html5/thumbnails/37.jpg)
Dumping syndrome
Amy Kreykes, THE JOURNAL OF FAMILY PRACTICE 2017
• Late dumping is characterized as postprandial hypoglycemia occurring one to 3 hours after eating.
– Late dumping is likely caused by a combination of changes within the pancreatic beta cells and abnormal insulin response to glucose Rapid gastric emptying leads to rapid release of glucose in the gut, which, in turn, leads to brisk insulin secretion. Since glucose is absorbed faster than insulin’s half-life, the resulting (relatively) high levels of insulin may cause hypoglycemia
![Page 38: Practical Recommendations for the Post Bariatric Surgery Medical Management… · 2019-08-16 · •The Bariatric/Metabolic World we are living in •Challenges –Post Operative](https://reader034.fdocuments.us/reader034/viewer/2022042923/5f7151530dce200ce0685737/html5/thumbnails/38.jpg)
Sigstad scoring system for dumping syndrome
![Page 39: Practical Recommendations for the Post Bariatric Surgery Medical Management… · 2019-08-16 · •The Bariatric/Metabolic World we are living in •Challenges –Post Operative](https://reader034.fdocuments.us/reader034/viewer/2022042923/5f7151530dce200ce0685737/html5/thumbnails/39.jpg)
Nutritional management
![Page 40: Practical Recommendations for the Post Bariatric Surgery Medical Management… · 2019-08-16 · •The Bariatric/Metabolic World we are living in •Challenges –Post Operative](https://reader034.fdocuments.us/reader034/viewer/2022042923/5f7151530dce200ce0685737/html5/thumbnails/40.jpg)
![Page 41: Practical Recommendations for the Post Bariatric Surgery Medical Management… · 2019-08-16 · •The Bariatric/Metabolic World we are living in •Challenges –Post Operative](https://reader034.fdocuments.us/reader034/viewer/2022042923/5f7151530dce200ce0685737/html5/thumbnails/41.jpg)
Nutritional management
![Page 42: Practical Recommendations for the Post Bariatric Surgery Medical Management… · 2019-08-16 · •The Bariatric/Metabolic World we are living in •Challenges –Post Operative](https://reader034.fdocuments.us/reader034/viewer/2022042923/5f7151530dce200ce0685737/html5/thumbnails/42.jpg)
Major vitamins and minerals deficiencies after bariatric surgery
![Page 43: Practical Recommendations for the Post Bariatric Surgery Medical Management… · 2019-08-16 · •The Bariatric/Metabolic World we are living in •Challenges –Post Operative](https://reader034.fdocuments.us/reader034/viewer/2022042923/5f7151530dce200ce0685737/html5/thumbnails/43.jpg)
Minimal periodic surveillance for nutritional deficiencies after bariatric surgery
![Page 44: Practical Recommendations for the Post Bariatric Surgery Medical Management… · 2019-08-16 · •The Bariatric/Metabolic World we are living in •Challenges –Post Operative](https://reader034.fdocuments.us/reader034/viewer/2022042923/5f7151530dce200ce0685737/html5/thumbnails/44.jpg)
OUTLINE
• The Bariatric/Metabolic World we are living in
• Challenges – Post Operative Follow-up Adherence.
– Post Operative Readmissions.
• Need for Guidance – Nutritional management.
– Management of comorbidities.
![Page 45: Practical Recommendations for the Post Bariatric Surgery Medical Management… · 2019-08-16 · •The Bariatric/Metabolic World we are living in •Challenges –Post Operative](https://reader034.fdocuments.us/reader034/viewer/2022042923/5f7151530dce200ce0685737/html5/thumbnails/45.jpg)
The advanced-DiaRem score improves prediction of diabetes remission 1 year post-Roux-en-Y gastric bypass
DiaRem
Advanced-DiaRem
Aron-Wisnewsky J..Dicker D. Diabetologia (2017)
![Page 46: Practical Recommendations for the Post Bariatric Surgery Medical Management… · 2019-08-16 · •The Bariatric/Metabolic World we are living in •Challenges –Post Operative](https://reader034.fdocuments.us/reader034/viewer/2022042923/5f7151530dce200ce0685737/html5/thumbnails/46.jpg)
The advanced-DiaRem score improves prediction of diabetes remission 1 year post-Roux-en-Y gastric bypass
Aron-Wisnewsky J..Dicker D. Diabetologia (2017)
![Page 47: Practical Recommendations for the Post Bariatric Surgery Medical Management… · 2019-08-16 · •The Bariatric/Metabolic World we are living in •Challenges –Post Operative](https://reader034.fdocuments.us/reader034/viewer/2022042923/5f7151530dce200ce0685737/html5/thumbnails/47.jpg)
Nomogram for the Individualized Metabolic Surgery (IMS) score
Aminian A, Ann Surg 2017
![Page 48: Practical Recommendations for the Post Bariatric Surgery Medical Management… · 2019-08-16 · •The Bariatric/Metabolic World we are living in •Challenges –Post Operative](https://reader034.fdocuments.us/reader034/viewer/2022042923/5f7151530dce200ce0685737/html5/thumbnails/48.jpg)
Performance of Gastric Bypass (RYGB) and Sleeve Gastrectomy (SG) Within Diabetes Severity Level for Both Training and Validation Datasets
Aminian A, Ann Surg 2017
![Page 49: Practical Recommendations for the Post Bariatric Surgery Medical Management… · 2019-08-16 · •The Bariatric/Metabolic World we are living in •Challenges –Post Operative](https://reader034.fdocuments.us/reader034/viewer/2022042923/5f7151530dce200ce0685737/html5/thumbnails/49.jpg)
Management of comorbidities: Type 2 diabetes
![Page 50: Practical Recommendations for the Post Bariatric Surgery Medical Management… · 2019-08-16 · •The Bariatric/Metabolic World we are living in •Challenges –Post Operative](https://reader034.fdocuments.us/reader034/viewer/2022042923/5f7151530dce200ce0685737/html5/thumbnails/50.jpg)
Management of comorbidities: Type 2 diabetes
![Page 51: Practical Recommendations for the Post Bariatric Surgery Medical Management… · 2019-08-16 · •The Bariatric/Metabolic World we are living in •Challenges –Post Operative](https://reader034.fdocuments.us/reader034/viewer/2022042923/5f7151530dce200ce0685737/html5/thumbnails/51.jpg)
A simple scheme for basal insulin prescription at discharge after bariatric surgery.
Machnica K, OBES SURG 2015
![Page 52: Practical Recommendations for the Post Bariatric Surgery Medical Management… · 2019-08-16 · •The Bariatric/Metabolic World we are living in •Challenges –Post Operative](https://reader034.fdocuments.us/reader034/viewer/2022042923/5f7151530dce200ce0685737/html5/thumbnails/52.jpg)
Management of comorbidities: Sleep Apnoea Syndrome
![Page 53: Practical Recommendations for the Post Bariatric Surgery Medical Management… · 2019-08-16 · •The Bariatric/Metabolic World we are living in •Challenges –Post Operative](https://reader034.fdocuments.us/reader034/viewer/2022042923/5f7151530dce200ce0685737/html5/thumbnails/53.jpg)
Management of comorbidities: Dyslipidemia
![Page 54: Practical Recommendations for the Post Bariatric Surgery Medical Management… · 2019-08-16 · •The Bariatric/Metabolic World we are living in •Challenges –Post Operative](https://reader034.fdocuments.us/reader034/viewer/2022042923/5f7151530dce200ce0685737/html5/thumbnails/54.jpg)
Management of comorbidities: Hypertension
![Page 55: Practical Recommendations for the Post Bariatric Surgery Medical Management… · 2019-08-16 · •The Bariatric/Metabolic World we are living in •Challenges –Post Operative](https://reader034.fdocuments.us/reader034/viewer/2022042923/5f7151530dce200ce0685737/html5/thumbnails/55.jpg)
Dose–response analysis of relative risk with reduction in BMI and duration of observation
Ricci C, OBES SURG ( 2015 )
![Page 56: Practical Recommendations for the Post Bariatric Surgery Medical Management… · 2019-08-16 · •The Bariatric/Metabolic World we are living in •Challenges –Post Operative](https://reader034.fdocuments.us/reader034/viewer/2022042923/5f7151530dce200ce0685737/html5/thumbnails/56.jpg)
Changes in systolic (A) and diastolic blood pressure (mm Hg) (B), percentage of excess weight loss (C), and percentage of body mass index loss (D) during follow-up after the bariatric surgical procedure in hypertensive and nonhypertensive patients.
Benaiges D, American Journal of Hypertension 2016
![Page 57: Practical Recommendations for the Post Bariatric Surgery Medical Management… · 2019-08-16 · •The Bariatric/Metabolic World we are living in •Challenges –Post Operative](https://reader034.fdocuments.us/reader034/viewer/2022042923/5f7151530dce200ce0685737/html5/thumbnails/57.jpg)
Predictors of Hypertension Remission and Recurrence After Bariatric Surgery
Changes in percentage of excess weight loss (A) and percentage of BMI loss (B) during follow-up after the bariatric surgery in hypertensive patients with and without hypertension remission at 1 year
Multivariate analysis of predictor factors for 1-year
hypertension remission and 3-year hypertension recurrence after bariatric surgery
Benaiges D, American Journal of Hypertension 2016
![Page 58: Practical Recommendations for the Post Bariatric Surgery Medical Management… · 2019-08-16 · •The Bariatric/Metabolic World we are living in •Challenges –Post Operative](https://reader034.fdocuments.us/reader034/viewer/2022042923/5f7151530dce200ce0685737/html5/thumbnails/58.jpg)
OUTLINE
• The Bariatric/Metabolic World we are living in
• Challenges – Post Operative Follow-up Adherence.
– Post Operative Readmissions.
• Need for Guidance – Nutritional management.
– Management of comorbidities.
– Pharmacotherapy after bariatric surgery
![Page 59: Practical Recommendations for the Post Bariatric Surgery Medical Management… · 2019-08-16 · •The Bariatric/Metabolic World we are living in •Challenges –Post Operative](https://reader034.fdocuments.us/reader034/viewer/2022042923/5f7151530dce200ce0685737/html5/thumbnails/59.jpg)
Pharmacotherapy after bariatric surgery
![Page 60: Practical Recommendations for the Post Bariatric Surgery Medical Management… · 2019-08-16 · •The Bariatric/Metabolic World we are living in •Challenges –Post Operative](https://reader034.fdocuments.us/reader034/viewer/2022042923/5f7151530dce200ce0685737/html5/thumbnails/60.jpg)
OUTLINE
• The Bariatric/Metabolic World we are living in
• Challenges – Post Operative Follow-up Adherence.
– Post Operative Readmissions.
• Need for Guidance – Nutritional management.
– Management of comorbidities.
– Psychological aspects.
![Page 61: Practical Recommendations for the Post Bariatric Surgery Medical Management… · 2019-08-16 · •The Bariatric/Metabolic World we are living in •Challenges –Post Operative](https://reader034.fdocuments.us/reader034/viewer/2022042923/5f7151530dce200ce0685737/html5/thumbnails/61.jpg)
Suicide and Poisoning Deaths with Gastric Bypass Surgery
Adams TD, nejm 2017
![Page 62: Practical Recommendations for the Post Bariatric Surgery Medical Management… · 2019-08-16 · •The Bariatric/Metabolic World we are living in •Challenges –Post Operative](https://reader034.fdocuments.us/reader034/viewer/2022042923/5f7151530dce200ce0685737/html5/thumbnails/62.jpg)
Psychological aspects
![Page 63: Practical Recommendations for the Post Bariatric Surgery Medical Management… · 2019-08-16 · •The Bariatric/Metabolic World we are living in •Challenges –Post Operative](https://reader034.fdocuments.us/reader034/viewer/2022042923/5f7151530dce200ce0685737/html5/thumbnails/63.jpg)
OUTLINE
• The Bariatric/Metabolic World we are living in • Challenges
– Post Operative Follow-up Adherence. – Post Operative Readmissions.
• Need for Guidance – Nutritional management. – Management of comorbidities. – Pharmacotherapy after bariatric surgery – Psychological aspects. – Pregnancy after bariatric surgery.
![Page 64: Practical Recommendations for the Post Bariatric Surgery Medical Management… · 2019-08-16 · •The Bariatric/Metabolic World we are living in •Challenges –Post Operative](https://reader034.fdocuments.us/reader034/viewer/2022042923/5f7151530dce200ce0685737/html5/thumbnails/64.jpg)
Pregnancy after bariatric surgery
![Page 65: Practical Recommendations for the Post Bariatric Surgery Medical Management… · 2019-08-16 · •The Bariatric/Metabolic World we are living in •Challenges –Post Operative](https://reader034.fdocuments.us/reader034/viewer/2022042923/5f7151530dce200ce0685737/html5/thumbnails/65.jpg)
Effects of bariatric surgery on maternal and foetal outcomes
![Page 66: Practical Recommendations for the Post Bariatric Surgery Medical Management… · 2019-08-16 · •The Bariatric/Metabolic World we are living in •Challenges –Post Operative](https://reader034.fdocuments.us/reader034/viewer/2022042923/5f7151530dce200ce0685737/html5/thumbnails/66.jpg)
Recommended nutritional screening and supplementation during pregnancy
![Page 67: Practical Recommendations for the Post Bariatric Surgery Medical Management… · 2019-08-16 · •The Bariatric/Metabolic World we are living in •Challenges –Post Operative](https://reader034.fdocuments.us/reader034/viewer/2022042923/5f7151530dce200ce0685737/html5/thumbnails/67.jpg)
OUTLINE
• The Bariatric/Metabolic World we are living in • Challenges
– Post Operative Follow-up Adherence. – Post Operative Readmissions.
• Need for Guidance – Nutritional management. – Management of comorbidities. – Pharmacotherapy after bariatric surgery – Psychological aspects. – Pregnancy after bariatric surgery. – Weight regain prevention.
![Page 68: Practical Recommendations for the Post Bariatric Surgery Medical Management… · 2019-08-16 · •The Bariatric/Metabolic World we are living in •Challenges –Post Operative](https://reader034.fdocuments.us/reader034/viewer/2022042923/5f7151530dce200ce0685737/html5/thumbnails/68.jpg)
Weight regain prevention
![Page 69: Practical Recommendations for the Post Bariatric Surgery Medical Management… · 2019-08-16 · •The Bariatric/Metabolic World we are living in •Challenges –Post Operative](https://reader034.fdocuments.us/reader034/viewer/2022042923/5f7151530dce200ce0685737/html5/thumbnails/69.jpg)
Short-term use of liraglutide in the management of patients with weight regain after bariatric surgery
Result of the short term use of Liraglutide due to poor weight loss or weight regain after bariatric surgery
Clinical data of the patients included in the analysis
PAJECKI D, Rev . Col . Bras . Cir . 2012
![Page 70: Practical Recommendations for the Post Bariatric Surgery Medical Management… · 2019-08-16 · •The Bariatric/Metabolic World we are living in •Challenges –Post Operative](https://reader034.fdocuments.us/reader034/viewer/2022042923/5f7151530dce200ce0685737/html5/thumbnails/70.jpg)
Liraglutide in Type 2 Diabetes after Bariatric Surgery
Changes in body mass index (BMI) after therapy with liraglutide in completers
Changes in glycated hemoglobin after therapy with liraglutide in completers
J. J. Gorgojo-Mart’nez et al. SORD (2016)
![Page 71: Practical Recommendations for the Post Bariatric Surgery Medical Management… · 2019-08-16 · •The Bariatric/Metabolic World we are living in •Challenges –Post Operative](https://reader034.fdocuments.us/reader034/viewer/2022042923/5f7151530dce200ce0685737/html5/thumbnails/71.jpg)
Thank You