Not much of response to a poll.
While in residency, I have witnessed a degradation of our bariatric surgery
program from almost weekly VBGs, through a rare monthly gastric bypass into
none bariatric cases. I have participated in the care of the obese patients
and have done both types of procedures. My observations:
1) despite the fact that all the patients were referred from a
special multidisciplinary group which included endocrinologist,
psychiatrist, psychologist and after a certian period of diet trials, most
of the patients were non-copliant, non-cooperative and very difficult to
take care of both in the ICU and on the floor.
2) I can't recall even a single patient whose postop period was
3) Bariatric operations create new problems which sometime
difficult to address. We had a 40 yo lady 12 years s/p VBG who developped a
duodenal ulcer which eventually perforated and was diagnosed with it almost
a week later when presented with a large Rt gutter abscess. There is no way
to visualize duodenum using conventional EGD or upper GI in a patient s/p
VBG or gastric bypass.
4) Whan I was consenting an obese patient for a bariatric procedure
I told him/her that he/she was not going to normally eat and/or enjoy the
food for the rest of the life, that they would be able to drink or eat very
small meals and so on and so forth. I was very uneasy, and I thought that
would scare them. And I still think that this scare may actually push some
of the obese people to start some other programs instaed of going to the OR.
5) Somebody said: You can't treat supratentorial problems with
infratentorial procedures. I agree.
Of note. A very close friend of mine was asking advise regarding her
obesity. Somebody recommended her bariatric surgery. I warned her not to
rush with it. Simple diet and graet determination helped her to get rid of
125 pounds. Now, she is keeping me busy in finding a good plastic surgeon
to reduce her pannus and do some face lifting. I'm glad to help her.