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New Bariatric Surgery Guidelines are Out!

>> Saturday, April 20, 2013






It's been an exciting few weeks - not only are the Canadian Diabetes Association 2013 guidelines out, but so too have the Clinical Practice Guidelines for Bariatric Surgery been updated!

These guidelines, published as a joint effort by the American Association of Clinical Endocrinologists, The Obesity Society, and the American Society for Metabolic & Bariatric Surgery, have some exciting new updates and features.

The guidelines address 7 key questions:

1.  Which patients should be offered bariatric surgery? 

2.  Whic bariatric surgical procedure should be offered? 

3.  How should potential candidates for bariatric surgery be managaed preoperatively? 

4.  What are the elements of medical clearance for bariatric surgery? 

5.  How can early postoperative care be optimized? 

6.  How can optimal follow-up of bariatric surgery be achieved? 

7.  What are the criteria for hospital admission after bariatric surgery?


A few headliners that caught my eye:

1.  Sleeve gastrectomy is no longer considered to be investigational; it is now considered to be a mainstream bariatric procedure. (though it has been 'unofficially' considered to be mainstream for some time already)

2.  Emerging data to suggest that bariatric surgery could be offered to patients with a BMI between 30-34.9 with diabetes or the metabolic syndrome, though the current evidence is limited by the small number of patients studied, and the lack of long term outcomes (so far).   See my previous comments on this issue here.

3.  There are excellent preoperative and postoperative checklists to help guide health care providers in terms of what needs to be asked about, checked for, and monitored.

The guidelines are a must-read for anyone involved in the care of bariatric patients.

Dr Sue Pedersen www.drsue.ca © 2013 

Follow me on Twitter for daily tips! @drsuepedersen

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Sex Drive, Fertility, and Bariatric Surgery

>> Wednesday, April 17, 2013





It is a well known fact that obesity is a risk factor for female infertility, and that fertility is often seen to improve after obesity surgery.  While it has been generally thought that improvements in various hormones after surgery are the reason for the improvement in fertility, a recent study suggests that it is not just about the physiology, but also the psychology.

The study, by Dr Legro and colleagues, included 29 women having gastric bypass surgery.  They looked at ovulation rates before and up to 2 years after gastric bypass surgery, and they also looked at responses to a questionnaire designed to assess sexual function.

Interestingly, they found that despite half of these women reporting irregular periods before surgery, 90% were actually ovulating before surgery.  While they did see some improvements in the hormonal parameters of the menstrual cycle after surgery, what was most impressive was the marked improvement in the sexual function questionnaire scores, with the biggest improvements seen in sexual desire and arousal.

It's important to note is that the group in this study was comprised of women who were relatively healthy obese women, so the ovulation rate may have been unusually high in this group.  However, the Bottom Line of the study is that improvements in sex drive and enjoyment may be a major factor in the improvement in fertility seen after gastric bypass surgery.

The most important thing to point out is that pregnancy MUST be avoided for 1-2 years after bariatric surgery (exact recommendation varies by clinic and country), due to concerns for fetal undernutrition and poor fetal growth as well as potential nutritional deficiencies.  Furthermore, there are concerns that the birth control pill may not be absorbed properly after bariatric surgery, and therefore, the pill MUST NOT be relied on for contraception.    Therefore, be sure to speak to your doctor about these issues before surgery, such that appropriate plans can be made to avoid pregnancy until it's safe to proceed.

Dr Sue Pedersen www.drsue.ca © 2013 

Follow me on Twitter for daily tips! @drsuepedersen

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