GASTRIC BYPASS SURGERY

The Impact of Gastric Bypass Surgery on Quality of Life

Table of content

Abstract3

Background4

CHAPTER II- LITERATURE REVIEW12

Introduction12

CHAPTER III- METHODOLOGY58

Hypothesis58

Objectives58

Rationale58

Introduction59

Study Design61

Methods for data collection63

Data analysis63

CHAPTER 4 AND 5: ANALYSIS AND CONCLUSION68

Conclusion68

Section: Sexual Life68

Section: Self Esteem76

Section: Public distress85

Section: Work95

Conclusion103

Recommendation104

APPENDIX112

Chapter I- Introduction

Abstract

Morbid obesity has become an epidemic with over 98,000 people undergoing surgery from weight loss in 2003. Unfortunately, this all to prevalent disease causes a decrease in life expectancy compared to the non-obese. The degree of elevation of a patients body mass index (BMI) is directly correlated with an increased mortality. Not only do obese patients die earlier, they are plagued by co-morbid medical conditions such as hypertension, diabetes, obstructive sleep apnea, coronary artery disease and many others at an increased rate. Additionally, the combination of an elevated BMI with multiple medical co-morbidities increases the patient's risk of death. For those patients with extremely high BMI's and multiple co-morbidities, bariatric surgery may be the only effective means of improving their risk of mortality. Bariatric surgery has been shown to have a relative risk reduction in the 5-year mortality rate for the morbidly obese of 89%.

In addition to the co-morbidities which plague this patient population, the morbidly obese are at increased risk of peri-operative pulmonary complications when surgical weight loss procedures are performed. This is mostly attributed to body habitus. As many as 10% of morbidly obese patients can have an extended time on a ventilator. The super-obese are at even greater risk with 14% to 29% of patients developing pulmonary complications. As a direct result of these pulmonary complications, prolonged ventilator times and subsequent tracheostomy are not uncommon in the super-obese patient populations. We present the case of a prophylactic tracheostomy in a morbidly obese patient with poor pulmonary function undergoing Roux-en-Y gastro-intestinal bypass (RYGIB).

Similar to Joe in Charles Dickens' The Pickwick Papers, respiratory difficulties have plagued the obese. This patient suffered from chronic hypoxia from obstructive apnea in addition to her other co-morbid conditions. A tracheostomy, when performed correctly, is a safe and effective means of securing airways for ventilation and oxygenation. Recent advances have allowed for bedside percutaneous tracheostomy, in addition to the standard open flap variety. Tracheostomy in obese patients with obstructive apnea results in improved quality of life and hypertension. Nevertheless, weight loss results in a more profound improvement in obstructive apnea.

Background

The past decade has seen an explosion in popularity for gastric bypass surgery as the rate of morbid obesity (a body mass index, or BMI, of more than 40) grew rapidly. A RAND study found that, from 2000 to 2005, the US obesity rate increased by 24 percent. But the rate of severe obesity increased even faster; the number of people with a BMI over 40 grew by 50 percent, and the number of people with a BMI over 50 grew 75 percent. Surgical therapy for the long-term treatment of obesity— bariatric surgery—in individuals whose body mass index (calculated as weight in kilograms divided by the square of height in meters) is 40 or higher or in ...