Bariatric surgery - NYSORA

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Bariatric surgery

Learning objectives

  • Define and classify the different types of bariatric surgery
  • Describe the complications that are associated with bariatric surgery
  • Anesthetic management of a patient undergoing bariatric surgery

Definition and classification


  • Adjustable gastric band: Placement of an inflatable silicone band around the top portion of the stomach
  • Gastric bypass surgery (e.g., Roux-en-Y gastric bypass): The stomach is divided into a small upper pouch and a much larger lower “remnant” pouch, and the small intestine is rearranged to connect to both
  • Sleeve gastrectomy or gastric sleeve (irreversible): The stomach is reduced to 15% of its original size via surgical removal of a large portion of the stomach along the greater curvature

Working mechanism

Each procedure exerts its effects through at least one of the three mechanisms → procedures often affect several of these mechanisms

  • Restricting: Restricting food intake (e.g., gastric sleeve)
    • Reduce the size of the stomach that is available to hold a meal
    • Filling the stomach faster enables the individual to feel more full after a smaller meal
  • Blocking: Decreasing nutrient absorption (e.g., Roux-en-Y gastric bypass)
    • Reduce the amount of intestine that the food passes through
    • Reduces the ability of the intestines to absorb nutrients from the food
  • Mixed: Affecting cell signaling pathways
    • Alter hormones responsible for hunger (e.g., ghrelin) and satiety (e.g., leptin)

Patient characteristics



bariatric surgery, management, preoperative, intraoperative, postoperative, anesthesia, coagulation, blood count, chest X-ray, ECG, electrolytes, liver function tests, premedication, antibiotics, gastric acid aspiration, fiberoptic intubation, preoxygenation, propofol, tracheal intubation, desflurane, propofol, TIVA, maintenance, induction, ventilation, analgesia, remifentanil, paracetamol, NSAID, opioids, dexamethasone, 5HT3 inhibitor, local anesthetic infiltration, early recovery, late recovery, fluids, patient-controlled analgesia, epidural, hypoventilation, immobility, atelectasis, deep vein thrombosis, physiotherapy, early mobilization, thromboembolic prophylaxis

See also obesity considerations

Suggested reading

  • Pollard BJ, Kitchen G. Handbook of Clinical Anaesthesia. 4th ed. Taylor & Francis group; 2018. Chapter 10 Abdominal surgery.

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