Obesity & Surgery

fat Man TapeAs a result of the increasing obesity epidemic, there is a frequent presentation of patients requiring surgeries for obesity related medical complications in particular weight loss (bariatric), orthopaedic, general and cardiac surgery (1).

It is well recognized and reported that obese patients experience poorer perioperative (during the surgical procedure) and postoperative outcomes comparted to normal weight patients.

This may be explained by the presence of obesity related co-morbidities (e.g. Type 2 Diabetes Mellitus, Hypertension, Hyperlipidaemia, Obstructive Sleep Apnoea) causing metabolic abnormalities, but also the mechanical demand placed on the body through the presence of “thickened body walls, enlarged, fatty livers, and increased intra-abdominal or thoracic adiposity can make even routine surgery challenging” (2).

The Solution = Pre-operative Weight Loss

Preoperative weight loss prior to surgery is believed to help both in terms of medical improvement of co-morbidities as well as surgical access. Surgical difficulty may be reduced as a result of decreased liver volume; adiposity; and improved exposure to anatomical landmarks (3-6). These physical changes are likely to help surgeons by creating improved access, leading to a more accurate and less time consuming surgery, and lowered morbidity (5,7-9).

Research suggests that as little as 10% of Excess Body Weight improve and control existing medical problems (e.g. Type 2 Diabetes, Hypertension, High Cholesterol, Obstructive Sleep Apnoea) (2). Improvements in these co-morbidities may lead to reduced medical complications in the surgical patient.

Pre-operative weight loss has the following potential benefits:

Benefits for the Surgeon

  • Reduced abdominal adiposity (fat tissue) levels
  • Reduced liver size
  • Improved exposure and view of anatomical landmarks
  • Reduced conversion rate to open surgery
  • Improved safety of surgery

Benefits for the Patient

  • Reduced risk of preioperative complications
  • Reduced length of operation
  • Reduced length of hospital stay
  • Improvement of co-morbid conditions (e.g. blood pressure, diabetes control)
  • Improved post-operative outcomes (e.g. rehabilitation, post-operative weight loss)

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