medicine for managers
In his regular series, clinical editor PAUL LAMBDEN provides easy to read skills-ups on key clinical areas. This month: weight-loss surgery
DR PAUL LAMBDEN is a practising GP and a qualified dentist. He has been a GP for 35 years, over 20 of which have been in practice. He has previously worked as an NHS trust chief executive, principal of a medical defence organisation, LMC secretary and Parliamentary special adviser. He is a writer and broadcaster.
s obesity reaches epidemic proportions, it is becoming increasingly important to achieve weight loss by any means possible. Surgery for weight loss, known as bariatric surgery, is used in those patients who are grossly obese and in whom other attempts at weight loss have failed. Those patients whose obesity is life threatening with a Body Mass Index (BMI) of greater than 40 (also known as morbid obesity) or who have a BMI of greater than 35 but who have other serious health disorders or diseases may be treated under the NHS. Such disorders may include hypertension, diabetes, hyperlipidaemia and sleep apnoea. However it is not available in all areas and the NHS funds less than half of all procedures. There are two most commonly used types of surgery: gastric banding – where a band is placed to encircle part of the stomach to reduce its capacity – which results in a requirement for
A weighty issue A
less food to feel ‘full’ – and gastric bypass, where the larger part of the stomach is bypassed so that food enters the small bowel, less food is digested and a feeling of fullness occurs quickly. There are, however, many variations of the procedure and all can be done by open operation or, where considered appropriate, laparoscopically. The procedures are not without significant risk. Grossly obese patients or those with other serious medical problems are already at intrinsically greater risk and it is estimated that death occurs in between one in 50 and one in 200 patients depending on the degree of obesity. Other significant risks include internal bleeding and clotting problems such as deep vein thrombosis and pulmonary embolism. Following surgery, persistent vomiting is common as patients come to terms with their dietary restrictions and dehydration may also ensue. Patients who are to undergo
36 february 2013
management
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52