Bariatric Surgery and Procedures Flashcards

Which bariatric procedure involves removing approximately 80% of the stomach along the greater curvature, leaving a tubular pouch?

Answer: Sleeve gastrectomy

Sleeve gastrectomy removes about 80% of the stomach along the greater curvature, creating a banana-shaped tubular pouch.

In Roux-en-Y gastric bypass, what is the approximate size of the newly created gastric pouch?

Answer: About 15-30 mL

The Roux-en-Y gastric pouch is typically 15-30 mL, roughly the size of an egg, which sharply restricts intake.

Which mechanism primarily explains why sleeve gastrectomy reduces hunger beyond simple restriction?

Answer: Removal of the ghrelin-producing gastric fundus

The gastric fundus is the main site of ghrelin production, so its removal lowers levels of this hunger hormone.

A patient with a BMI of 37 and type 2 diabetes asks whether they qualify for bariatric surgery under the 2022 ASMBS/IFSO guidelines. What is the most accurate response?

Answer: Yes, surgery is recommended for BMI ≥35 regardless of comorbidities

The 2022 ASMBS/IFSO guidelines recommend bariatric surgery for BMI ≥35 regardless of comorbidities and consider it for BMI 30-34.9 with metabolic disease.

Which bariatric procedure is fully reversible and involves no cutting or stapling of the stomach or intestines?

Answer: Adjustable gastric banding

Adjustable gastric banding places a removable silicone band around the upper stomach without cutting or stapling, making it reversible.

Which procedure combines a sleeve gastrectomy with a long intestinal bypass and produces the greatest average weight loss?

Answer: Biliopancreatic diversion with duodenal switch

The duodenal switch pairs a sleeve gastrectomy with a substantial intestinal bypass, yielding the greatest weight loss but the highest malabsorption risk.

Why is laparoscopic surgery generally preferred over open surgery for bariatric procedures?

Answer: It reduces wound complications, pain, and recovery time

Laparoscopic approaches use small incisions, lowering wound complications, postoperative pain, and hospital stay compared with open surgery.

Two weeks after gastric bypass, a patient reports dizziness, sweating, and cramping shortly after eating a sugary dessert. What is the most likely cause?

Answer: Early dumping syndrome

Early dumping syndrome occurs 15-30 minutes after eating high-sugar foods when hyperosmolar contents rapidly enter the small intestine.

Which postoperative complication after bariatric surgery is a life-threatening emergency typically presenting with tachycardia, fever, and abdominal pain in the first week?

Answer: Anastomotic or staple-line leak

A leak from the anastomosis or staple line allows gastric contents into the abdomen, and persistent tachycardia is often the earliest sign.

A gastric bypass patient develops burning epigastric pain and is found to have an ulcer at the connection between the pouch and small intestine. Which behavior most increases this risk?

Answer: Smoking and NSAID use

Marginal ulcers at the gastrojejunal anastomosis are strongly associated with smoking and NSAID use, both of which impair mucosal healing.

Years after Roux-en-Y gastric bypass, a patient presents with intermittent severe abdominal pain. Which delayed surgical complication should the counselor recognize as unique to bypass anatomy?

Answer: Internal hernia through a mesenteric defect

Rerouted bowel in Roux-en-Y anatomy creates mesenteric defects through which intestine can herniate and twist, sometimes years later.

Which complication is most specifically associated with adjustable gastric banding?

Answer: Band slippage or erosion into the stomach

Gastric bands can slip out of position or erode through the stomach wall, which are leading reasons for band removal.

A sleeve gastrectomy patient reports new or worsening heartburn after surgery. Why is this a recognized issue with this procedure?

Answer: The high-pressure sleeve can worsen or cause gastroesophageal reflux

The narrow, high-pressure sleeve can increase reflux, and severe GERD may require conversion to gastric bypass.

Why does rapid weight loss after bariatric surgery increase the risk of gallstones?

Answer: Rapid fat mobilization increases cholesterol saturation of bile

Rapid weight loss raises cholesterol concentration in bile and reduces gallbladder motility, promoting stone formation.

Which vitamin deficiency is most critical to prevent after gastric bypass because the procedure bypasses the primary site of intrinsic factor-mediated absorption?

Answer: Vitamin B12

Bypassing much of the stomach reduces intrinsic factor and acid needed for B12 absorption, so lifelong supplementation is required.

A counselor advises a post-bypass patient on calcium supplementation. Which form is preferred and why?

Answer: Calcium citrate, because it does not require stomach acid for absorption

Calcium citrate is preferred after bariatric surgery because it absorbs well without stomach acid, unlike calcium carbonate.

Which eating guideline is standard during the first weeks after bariatric surgery?

Answer: Progress gradually from clear liquids to pureed foods to soft foods

Patients advance through staged textures — clear liquids, full liquids, purees, then soft foods — to protect the healing pouch.

Why are patients told to avoid drinking fluids within 30 minutes of meals after bariatric surgery?

Answer: Fluids can flush food through the pouch, reducing satiety and risking discomfort

Drinking with meals washes food rapidly through the small pouch, reducing fullness and potentially causing dumping or overeating.

What daily protein intake is generally recommended for adults after bariatric surgery to preserve lean body mass?

Answer: At least 60-80 grams per day

Most guidelines recommend a minimum of 60-80 grams of protein daily after bariatric surgery to prevent muscle loss.

A post-surgical patient develops confusion, unsteady gait, and eye movement abnormalities after weeks of persistent vomiting. Which deficiency must be treated urgently?

Answer: Thiamine (vitamin B1)

Persistent vomiting can deplete thiamine within weeks, causing Wernicke encephalopathy, which requires immediate thiamine replacement.