Roux-en-Y gastric bypass for morbid obesity - Home Study Program

AORN Journal,  Oct, 2002  by Cynthia J. Barrow

• E-mail
• Print
• Link

RISKS AND BENEFITS

Surgery on any obese patient has inherent problems. These problems may include respiratory insufficiency (ie, increased risk of developing postoperative pneumonia), increased incidence of venous thrombosis, increased risk of incisional infections, difficulties in proper positioning, and complications resulting from preexisting comorbidities. (46) Additional complications that may occur as a result of Roux-en-Y gastric bypass include

* abdominal hernia;

* breakdown of the staple line;

* stretched stomach outlets;

* gallstones;

* nutritional deficiencies, which may be avoided by maintaining vitamin and mineral intake; and

* stricture of the stoma between the stomach and intestine. (47)

Although complications may appear formidable, benefits of Roux-en-Y gastric bypass far outweigh the risks. Surgery improves most obesity-related conditions, (48) including

* return of blood sugar levels to normal in 90% of patients; (49)

* decreased hypertension (ie, disappearing in two-thirds of patients); (50)

* diminished knee and hip pain; (51)

* disappearance of sleep apnea, often after a weight loss of only 15 kg to 20 kg; (52)

* relief of esophagogastric reflux symptoms, often within 24 hours of surgery; (53)

* improved pulmonary function; (54)

* slower progression of articular cartilage destruction; (55)

* improved serum concentrations of high-density lipoproteins;

* substantial decline in total serum cholesterol and triglyceride levels; (56)

* relief of stress incontinence; (57) and

* the patient becomes a good candidate for joint replacement when he or she previously was too heavy. (58)

There also is a body of evidence supporting improvements in psychosocial functioning after surgery. (59) Testing has demonstrated a marked improvement in quality of life, self-esteem, mood, self-confidence, body image, and activity level. Improvements have been noted in depression, anxiety, irritability, eating pathology, and the expression of psychological problems in physical symptoms. (60)

THE PREOPERATIVE

Mrs M, a 30-year-old patient, is scheduled for Roux-en-Y gastric bypass. Mrs M is 5 ft 6 inches tall and weighs 275 lbs with a BMI of 44. She has type 2 diabetes and suffers chronic knee pain. After multiple failed attempts to lose weight, Mrs M decided on surgery as a means to improve her health. On the morning of surgery, Mrs M is admitted through the same day surgery (SDS) area. She is greeted by the RN assigned to be her caregiver preoperatively. After she changes into a patient gown, the nurse measures Mrs M's temperature, pulse, respirations, and blood pressure.

The anesthesia care provider then interviews Mrs M in the SDS area, assessing the patient's family history and previous surgery and anesthesia experience, and reviews Mrs M's history and the physical examination performed by the surgeon. The anesthesia care provider also reviews the results of Mrs M's laboratory, x-ray, and electrocardiogram (EKG) studies; her current medications; and any allergies. The anesthesia care provider explains that although she will receive a general anesthetic for surgery, an epidural catheter will be placed preoperatively for the purpose of controlling postoperative pain.