Bariatric Surgery

The rapidly increasing problem of obesity brings a fresh focus on bariatric surgery. This new interest calls for a sound text covering the multiple and complex aspects of the effective, long-term treatment for obesity.

Bariatric Surgery: A Primer for Your Medical Practice is a user-friendly, practical reference that provides all the necessary information the health care professional needs concerning patient selection and preoperative assessment, medical treatment of obesity, and options for surgical intervention.

Also addressed are recommendations for dealing with complex postoperative care of the bariatric patient, including the problems that a patient may face immediately after surgery and long-term issues such as adjustments in lifestyle and health care management.

Authorities on the multidisciplinary care of bariatric patients, Drs. Francis A. Farraye and R. Armour Forse, are joined by leading medical experts to review what is required of today's practicing physician who will manage the care of patients requiring surgery for their obesity.

Some chapter topics:

• The medical management of obesity
• Types of bariatric surgery
• Medical management of the patient after bariatric surgery
• Nutrition and prevention of nutritional deficiencies
• Psychological support and consequences
• Endoscopic and radiologic imaging of surgically-altered anatomy

Inside the chapters of Bariatric Surgery many crucial elements of the procedure are concisely and logically covered. Numerous tables, images, charts, and an 8-page atlas with 18 figures in full color, support the text and provide further detail on the topics.

Bariatric Surgery is the perfect text for the primary care physician, family practitioner, general internist, endocrinologist, nutritionist, gastroenterologist, radiologist, medical and surgical resident, and medical student.

Contents

Dedication
Acknowledgements
About the Author
About the Editors
Contributing Authors
Preface
Foreword by Robert F. Kushner, MD

Chapter 1: The Obesity Epidemic
John R. Pender, MD and Walter J. Pories, MD

Chapter 2: Medical Treatments of Obesity
Jennifer Rosenblum, MD and Heather K. Stein, MD, MPH

Chapter 3: Choice of Bariatric Procedures
David M. Lambert, MD; Ranjan Sudan, MD; and R. Armour Forse, MD, PhD

Chapter 4: Preoperative Evaluation of the Patient Undergoing Bariatric Surgery
Nawfal Istfan, MD, PhD and Wendy A. Anderson, MS, RD, LDN

Chapter 5: Anesthesia Issues in Patients Undergoing Gastric-Bypass Surgery
Keith P. Lewis, RPh, MD

Chapter 6: Gastric Bypass Surgery in the Pediatric and Elderly Patient
Caroline M. Apovian, MD

Chapter 7: Immediate Postoperative Complications
Donald T. Hess, Jr, MD and R. Armour Forse, MD, PhD

Color Atlas

Chapter 8: Nutritional Consequences Following Bariatric Surgery
Wendy A. Anderson, MS, RD, LDN and Laura Foresta, RD, LDN

Chapter 9: Medical Management of the Patient After Gastric-Bypass Surgery
Marie E. McDonnell, MD; Caroline M. Apovian, MD; and Donald T. Hess, Jr, MD

Chapter 10: Endoscopy After Bariatric Surgery
Christopher S. Huang, MD and Francis A. Farraye, MD, MSc

Chapter 11: Imaging of the Gastrointestinal Tract After Bariatric Surgery
Jose C. Varghese, MD; Brian C. Lucey, MD; and Jorge A. Soto, MD

Chapter 12: Psychological Issues and the Bariatric-Surgery Patient
Linda Lin, PhD and Frank Perna, PhD, EdD

Appendix: Bariatric-Related Abbreviations
Index

"The most common procedures are clearly described and illustrated graphically so the reader can gain a crucial understanding of surgical anatomy. This text, therefore, is an important reference that should be available in the clinical setting, as questions frequently come up when contemplating management, particularly endoscopic management of complications that arise after surgery. . .The chapter on perioperative anesthesia issues was well written, and contains information useful to all team members caring for the obese patient, especially for the endoscopist performing procedures on the obese patient under conscious sedation. Also germane to the endoscopist is the section on radiologic imaging following bariatric surgery, with excellent quality radiographs illustrating common complications such as anastomotic leak, ulcer, and stricture. . . this primer should be considered essential reading and should be retained as a useful reference for GI fellows, and for all involved in the care of the obese patient."

— Stephen C. Pflugfelder, MD, John McCraken, MD, Practical Gastroenterology

About the Editors
Francis A. Farraye, MD, MSc is an Associate Professor of Medicine and Epidemiology at the Boston University School of Medicine in Boston, Mass. He is also the Clinical Director in the Section of Gastroenterology and Co-Director of the Center for Digestive Disorders at Boston Medical Center. After graduating from the State University of New York at Stony Brook, Dr. Farraye earned his medical degree from the Albert Einstein College of Medicine in New York and his master's degree in Epidemiology from the Harvard School of Public Health. He completed an internship and residency in internal medicine, as well as a research and clinical fellowship in gastroenterology at Beth Israel Hospital in Boston.

Dr. Farraye’s clinical interests are in the care of patients with inflammatory bowel disease, endoscopy in patients after bariatric surgery, and the management of colon polyps and colorectal cancer. He is studying the significance of adenomas found in patients with ulcerative colitis, management and diagnosis of dysplasia and cancer in patients with inflammatory bowel disease, and predictors of pouchitis after ileal pouch anal anastomosis. In the area of colorectal cancer, he is involved in several ongoing research studies, including modifying behavior in patients with colon polyps, identifying barriers to colorectal cancer screening, and gender differences in the tolerability of colon cancer screening with flexible sigmoidoscopy.

A frequent speaker and invited lecturer on topics including the management of inflammatory bowel disease, colorectal cancer screening, and endoscopy in the bariatric surgery patient, Dr. Farraye has authored or coauthored over 150 original scientific manuscripts, chapters, reviews, and abstracts. His work has been published in the American Journal of Gastroenterology, Gastroenterology, Alimentary Pharmacology and Therapeutics, Gastrointestinal Endoscopy, Annals of Internal Medicine, JAMA, and others. In addition, he has developed an interactive teaching DVD on the complications of bariatric surgery and the performance of endoscopy after bariatric surgery.

Dr. Farraye is a Fellow of the American College of Physicians and the American College of Gastroenterology. Nationally, he serves as Chair of the Patient Care Committee, Vice Chair of the Board of Governors, Governor in Massachusetts, and member of the Board of Trustees for the American College of Gastroenterology. He serves as AGA representative on the National Colorectal Cancer Round Table as Co-Chairman of the Standards Committee. He has served as the Chairman of the lower gastrointestinal disorders section of the Annual Scientific Program Committee of the American Society of Gastrointestinal Endoscopy. He is a member of the Chapter Medical Advisory Committee for the New England Crohn’s and Colitis Foundation of America (CCFA) and is its immediate past Chairman. The New England CCFA named Dr. Farraye Humanitarian of the Year in 2003.

R. Armour Forse, MD, PhD is the Dr. & Mrs. Arnold W. Lempka Professor and Chair in the Department of Surgery at Creighton University, Omaha, Neb and the Chief of the Surgical Services at Creighton University Medical Center in Omaha, Neb.

Dr. Forse was previously the Laslo N. Tauber Professor of Surgery at Boston University and the Vice Chairman of Surgery at Boston Medical Center. Dr. Forse received his undergraduate, medical, and post-doctorate degrees from McGill University in Montreal, Quebec, Canada. He completed his surgical internship and residency at Royal Victoria Hospital in Montreal, where he also served as chief surgical resident. His research fellowships include experimental surgery at McGill University and surgical metabolism at Columbia University College of Physicians and Surgeons in New York. Dr. Forse was an Assistant Professor of Surgery at McGill University and later an Associate Professor of Surgery at Harvard Medical School, where he co-founded and directed the Center for Minimally Invasive Surgery and directed the Clowes Laboratory of Surgical Metabolism.

Dr. Forse's clinical interests are in the areas of gastrointestinal surgery including bariatric surgery, minimally invasive surgery, trauma, care of the critically ill patient, and nutrition, including obesity. He has been involved with bariatric surgery for over 25 years and has performed thousands of procedures, including jeujuno-ileal bypass, gastroplasty, gastric bypass, laparoscopic gastric bypass, and revision bariatric surgery. His research interests currently include the development of transluminal surgery, the effectiveness of revision surgery, and the effects on nutrients on various diseases. His basic research interests include adipocyte biology as it applies to cell differentiation and proliferation in obesity, abdominal compartment syndrome in obesity, cell signaling in macrophages and Kuppfer cells, and nutrient-disease interactions.

Dr. Forse is a frequent speaker on topics including bariatric surgery, nutritional support, and the treatment of sepsis. He has authored and coauthored over 380 papers, chapters, and abstracts, and has coedited 4 previous medical books. His publications have appeared in American Journal of Clinical Nutrition, American Journal of Physiology, American Journal of Surgery, Annals of Surgery, Biochemistry Journal, Critical Care Medicine, New England Journal of Medicine, and Obesity Research.

Dr. Forse is a Fellow of the American College of Surgeons, the American College of Critical Care Medicine, and the Royal College of Surgeons in Canada, and he is a member of over 25 surgical societies.