Patient Preparation for Bariatric Surgery

167 Pages·2014·2.988 MB·English

by  Peter N. Benotti (auth.)

Patient Preparation
for Bariatric Surgery
Peter N. Benotti
123
Patient Preparation for Bariatric Surgery

Peter N. Benotti
Patient Preparation
for Bariatric Surgery
Peter N. Benotti
Senior Clinical Investigator ,
Obesity Institute, Geisinger Medical Center ,
Southold , NY , USA
ISBN 978-1-4939-0905-6 ISBN 978-1-4939-0906-3 (eBook)
DOI 10.1007/978-1-4939-0906-3
Springer New York Heidelberg Dordrecht London
Library of Congress Control Number: 2014937398
© Springer Science+Business Media New York 2014
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Foreword
It is my great honor to have been invited to write the Foreword for Patient Preparation
for Bariatric Surgery . This book, edited by a dear friend and mentor, and one of the
forefathers of bariatric surgery, is a comprehensive review of the patient preparation
process for bariatric and metabolic surgery. Numerous journal articles and books
have been published in this ever-growing surgical specialty, but few have focused
specifi cally on the patient preparation process. For those of us working in this fi eld,
we understand and greatly value the importance of ensuring that all three compo-
nents, patient, surgeon, and the Allied Healthcare team in all Centers of Excellence,
are well prepared for this life-changing surgery.
Within the 14 chapters of this book, Dr. Benotti has used his clear vision and
understanding of the bariatric patient in conjunction with his vast knowledge, expe-
rience, and expertise to discuss a wide array of issues related to patient prepared-
ness. These include chapters spanning topics from primary care referrals and the
often-encountered diffi culties that these physicians experience when dealing with
severe obesity to anesthesia considerations for these challenging operative patients.
Specifi cally, in the introductory chapter, Dr. Benotti provides the history and
evolution of bariatric surgery and public awareness of the disease of obesity and its
surgical treatment. Following this, the second chapter discusses the importance of
patient referrals from primary care physicians and the need for specifi c guidelines.
Chapter 3 focuses on the importance of educating the patient regarding the periop-
erative process and realistic expectations from bariatric surgery as well as the
importance of active patient participation in the bariatric program, which should be
reinforced throughout the patient education process. This chapter also addresses the
need for the informed consent.
This aspect of the patient education process is critical for the patient selection
process as well as assessing the patient’s preparation for surgery. Dr. Benotti stresses
the crucial need for patients to make decisions on the basis of relevant information,
which is presented clearly and well understood. Failure to understand the risks and
benefi ts of surgery will contribute to unrealistic patient expectations and potential
litigation.
v
vi Foreword
Chapter 4 addresses the need for a thorough initial medical evaluation. Assessing
functional status and capability for physical activity is emerging as an important
component of the patient evaluation and selection process, Dr. Benotti notes.
Furthermore, a simple functional assessment with metrics should be part of the
initial medical evaluation. Closely related and an equally important component is a
psychological and behavioral evaluation, as discussed in Chap. 5 . Dr. Benotti has
summarized that mental health expertise is crucial for evaluation of candidates suit-
able for bariatric surgery as well as for postoperative management and compliance.
Chapter 6 describes the initial medical evaluation, which should be conducted by a
physician who is familiar with obesity-related comorbid conditions contributing to
surgical risk.
Chapters 7 and 8 focus on proper nutrition, specifi cally protein and vitamins, as
well as minerals, respectively. Changes in the gastrointestinal anatomy after bariat-
ric surgery result in altered absorptive capability for minerals as well as protein and
vitamins. This can result in protein, micronutrient, and mineral defi ciencies, which
are well-known complications after bariatric surgery. Chapter 9 addresses preg-
nancy and the association between obesity and increased reproductive risk.
Chapters 1 0 and 1 1 relate to therapeutic and diagnostic endoscopy. Endoscopy
has emerged as a treatment option for nonoperative management of complications
after bariatric surgery. Therapeutic endoscopy is an emerging fi eld related to endo-
scopic interventions for weight loss.
Chapter 1 2 addresses risk assessment, a critical component in healthcare today,
not just for bariatric surgery but for all aspects of medical care. Large clinical regis-
tries and databases have helped to identify patient factors that predict increased
surgical risk, which help bariatric surgery programs to identify surgical risks.
Chapter 1 3 discusses how to manage high-risk patients once they are identifi ed.
Chapter 1 4, the concluding chapter, is related to anesthesia challenges for bariatric
surgery patients.
I am certain that this comprehensive textbook will become a great resource for
bariatric surgeons and physicians as well as all allied health professionals who care
for patients with extreme obesity. I personally look forward to adding this to my
library.
Weston, FL Raul J. Rosenthal, M.D., F.A.C.S., F.A.S.M.B.S.
Preface
I have had the good fortune to participate in the development of bariatric surgery in
the years before 1991, and in the rapid emergence of this intervention as the pre-
ferred treatment for extreme obesity. Bariatric surgery, hardly recognized by aca-
demic surgical societies as recently as 15 years ago, is now an important service line
at most major medical centers, a major focus at academic surgery meetings, and a
critical component of the surgical training curriculum in foregut surgery. Bariatric
surgery is now widely recognized by medical specialties as a major tool for resolu-
tion of obesity-related metabolic derangements, life-threatening disease, and dis-
ability related to extreme obesity.
T his text is an attempt to review the current literature and best practice recom-
mendations regarding a patient-centered approach to the preparation and selection
of candidates for bariatric surgery. It is my hope that this text will contribute to the
continuing development, expanded use, and improved implementation of this
important and valuable resource.
Southold, NY Peter N. Benotti, M.D.
vii

Acknowledgement
I would like to express my appreciation to all of those teachers who contributed to
my education and training in surgery and metabolism. In many challenging situa-
tions in the practice of gastrointestinal surgery, this has been for me a precious
resource.
This text is dedicated to my bariatric surgery patients, in particular, those who
had the courage to undergo this procedure before 1991. Years in this fi eld have pro-
vided me with a great respect for patients suffering with extreme obesity who have
the courage and determination to undergo bariatric surgery, change their lifestyle,
and enjoy the benefi ts of a healthier life.
In conclusion, I am most grateful for the life-long love and support provided by
my family throughout my career in surgery.
Peter N. Benotti, M.D.
ix