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World J Gastrointest Surg. Nov 27, 2014; 6(11): 220-228
Published online Nov 27, 2014. doi: 10.4240/wjgs.v6.i11.220
Medical management of patients after bariatric surgery: Principles and guidelines
Abd Elrazek Mohammad Ali Abd Elrazek, Abduh Elsayed Mohamed Elbanna, Shymaa E Bilasy
Abd Elrazek Mohammad Ali Abd Elrazek, Department of Gatsroenterology and Hepatology, Al-Azhar Faculty of Medicine, Al-Azhar University, Asiut Brach, Asuit 721572, Egypt
Abduh Elsayed Mohamed Elbanna, Department of General, Laparoscopic and Bariatric Surgery-Head of Bariatric; unit (D) - Al Husain university Hospital, Al Azhar University, Darrasa-Cairo 16789, Egypt
Shymaa E Bilasy, Department of Biochemistry, Faculty of Pharmacy, Suez Canal University, Ismailia 41522, Egypt
Author contributions: Abd Elrazek MAA wrote, drafted the manuscript and designed the figures; Elbanna AEM wrote the manuscript and designed figures; Bilasy SE wrote and critical revised the manuscript; all authors approved the final version of this review.
Correspondence to: Dr. Abd Elrazek Mohammad Ali Abd Elrazek, Department of Gatsroenterology and Hepatology, Al-Azhar Faculty of Medicine, King Faisal Area, Al-Azhar University, Asiut 721572, Egypt. ahmadrazek@gmail.com
Telephone: +2-88-2180445 Fax: +2-88-2181194
Received: August 7, 2014
Revised: September 6, 2014
Accepted: October 28, 2014
Published online: November 27, 2014
Processing time: 122 Days and 21.6 Hours
Abstract

Obesity is a major and growing health care concern. Large epidemiologic studies that evaluated the relationship between obesity and mortality, observed that a higher body-mass index (BMI) is associated with increased rate of death from several causes, among them cardiovascular disease; which is particularly true for those with morbid obesity. Being overweight was also associated with decreased survival in several studies. Unfortunately, obese subjects are often exposed to public disapproval because of their fatness which significantly affects their psychosocial behavior. All obese patients (BMI ≥ 30 kg/m2) should receive counseling on diet, lifestyle, exercise and goals for weight management. Individuals with BMI ≥ 40 kg/m2 and those with BMI > 35 kg/m2 with obesity-related comorbidities; who failed diet, exercise, and drug therapy, should be considered for bariatric surgery. In current review article, we will shed light on important medical principles that each surgeon/gastroenterologist needs to know about bariatric surgical procedure, with special concern to the early post operative period. Additionally, we will explain the common complications that usually follow bariatric surgery and elucidate medical guidelines in their management. For the first 24 h after the bariatric surgery, the postoperative priorities include pain management, leakage, nausea and vomiting, intravenous fluid management, pulmonary hygiene, and ambulation. Patients maintain a low calorie liquid diet for the first few postoperative days that is gradually changed to soft solid food diet within two or three weeks following the bariatric surgery. Later, patients should be monitored for postoperative complications. Hypertension, diabetes, dumping syndrome, gastrointestinal and psychosomatic disorders are among the most important medical conditions discussed in this review.

Keywords: Obesity; Bariatric surgery; Postoperative care; Body-mass index; El banna

Core tip: Obesity is a growing health concern worldwide that impacts the life of individuals both physically and psychologically. There are several well-established health hazards associated with obesity. Additionally, obese subjects are often exposed to public disapproval because of their fatness which significantly affects their psychosocial behavior. Bariatric surgery is one of the definite solutions for obesity. In this review, we will briefly discuss the general guidelines that should be considered before bariatric surgery. Also, we discuss the protocols of patients’ postoperative care and the management of medical disorders that must be considered after bariatric surgery.