Nursing Presentation regarding the care of bariatric
surgery patients given at Syosset Hospital
Surgical Treatment of Morbid Obesity
Lester Cooperstone, MD, FACS Bariatric Surgery, NSUH at Syosset
Understanding the concept of bariatric surgery
How to manage morbidly obese patients
How to recognize early signs of complications of surgery
Obesity means Excess in body fat
Incidence is rising despite everything currently being done
300,000 annual deaths in USA attributable to poor diet and inactivity (Surgeon
General report Dec. 2001)
“60% of Adults are overweight or obese”
“Losing even 10 pounds can reduce the risk of getting diabetes or heart disease”
Surgery is not for simple obesity but is reserved for patients with extreme
obesity called morbid obesity.
Surgery for Morbid Obesity = Bariatric Surgery
Baros from the Greek meaning weight
Morbid=resulting in morbidity or illness
Indications for surgery
Weight
100 pounds above ideal weight based on life insurance tables (Less if patient is
short)
Body Mass Index (BMI) above 40 if no significant comorbidities
= ( weight (kg)/height (m) ²) Metric
= (Weight in pounds) x (703)/ {height (inches) x height (inches)}
BMI above35 IF significant weight related comorbidities
such as hypertension, diabetes, sleep apnea
Double ideal body weight
Failure to lose weight despite the “usual methods of dieting etc” over a
prolonged time
Acceptable medical risks
Able to understand the procedure and the aftercare needed
Comorbidities sometimes present
diabetes
hypertension
high blood cholesterol and triglycerides
heart disease such as coronary artery disease and CHF
stroke
increased cancer rate (breast, uterine, colon, etc.)
pulmonary disease such as sleep apnea and pulmonary insufficiency
arthritis
Infertility, polycystic ovarian syndrome (PCOS)
phlebitis, deep vein thrombosis , venous ulcers, and venous insufficiency
Pulmonary Emboli
increased rate of injuries and accidents
Non alcoholic steatohepatitis = Fatty Liver (later cirrhosis)
pseudotumor cerebri
premature and sudden death
Be aware of sensitivity issues and use of a“certain 3 letter word
What to watch for post op
Physical exam can be unreliable in very obese patients
Patient may have intraabdominal bleeding , leak of GI contents or infection
without severe abdominal pain or distension
Vital signs are an extremely important way to detect problems!!!!!
Pulse, Temperature, Respiratory Rate, BP
Be suspicious when the post-operative course is not going “as usual”
Morbidly obese patients are at high risk for Deep Venous Thrombosis (DVT) and
Pulmonary Embolus (PE)
The sooner complications are detected and treated, the better the outcome
Re-exploration (surgical) is sometimes safer than a “wait and hope things
improve” philosophy
DVT- (Deep venous thromboses) Calf Pain, Homans Sign, Unilateral foot/leg
swelling
PE (Pulmonary embolus)- Chest Pain, Shortness of Breath, Tachycardia, Tachypnea,
Hypoxia
Intra-abdominal infection-may be caused by a GI Leak.
Tachycardia, Tachypnea, High Fever, Shortness of Breath, Atelectasis, difficulty
using incentive spirometer well, “divergence from the usual post-op course,),
elevation of WBC, poor urine output due to dehydration or sepsis, abdominal pain
(late finding)
Intra-abdominal bleeding
Tachycardia, hypotension, orthostatic hypotension, severe dizziness when
ambulating, low urine output, Fall in Hct(LATE)
GI tract obstruction
Nausea with Vomiting (may be foamy material without bile=Saliva), inability to
tolerate liquids
In addition to the usual post op considerations
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MD, FACS 
