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Massive Weight Loss

Preoperative

Authors: Magnus Balslev Avnstorp, MD, Mette Ydo Jacobsen, Med. Stud., Mie Pilegaard Bjarnesen, Med. Stud., Anne Mosebo, Med. Stud. and Emir Hansanbegovic, MD

Patient history

Note the following information concerning the patient’s weight history:

  • Cause of weight loss: bariatric surgery or lifestyle changes
  • Maximum weight and BMI (at any point in life), current weight and BMI, and the decrease in BMI points
  • Number of pregnancies
  • Any mechanical issues during sports or other physical activities

Furthermore a thorough preoperative assessment including prior medical history is fundamental. Go to the chapter “Preoperative assessment” to read more.

Physical examination

Skin overhang, laxity and subcutaneous fat fullness is systematically examined and measured in centimeters throughout the following steps:

Patient in upright position with arms abducted in 90 degrees 

  • Skin overhang above and around the umbilicus
  • Overhang on the horizontal bikini line in cm from right to left side
  • Overhang on the mons
  • Scars on the abdomen following surgery e.g. appendectomy or caesarian section
  • Fullness of subcutaneous fat examined by pinching 

Patient in bend forward position 

  • Skin above and around the umbilicus is examined and overhang determined

Patient in supine position

  • Abdominal wall muscles are examined for signs of rectus diastasis or hernia

Preoperative information

Postoperative scarringLocations
Size
Risk of widening and hypertrophic transformation
Postoperative risksInfection
Hematoma
Rupture of the incision site
Healing complications
Loss of sensation in the affected area
Re-operation in case of complications
Necrosis of the umbilicus
DrainsDrains will be applied during surgery and removal will happen postoperatively
Pressure garmentsPressure garments will be used postoperatively
Excessive skin Inform about the risk of excessive skin returning in cases of fluctuating weight or due to natural aging of the skin

Preoperative preparation

  • Broad blood samples
  • ECG: in patients above 60 years of age or with known heart disease/symptoms of heart disease
  • Anaesthesiological check
  • Stabilize co-morbidities, e.g. diabetes
  • If the patient is taking blood thinning medicine consider the need for pausation, bridging, INR monitoring. Regulations from The Danish Society of Thrombosis and Haemostasis are used in Denmark
    (https://www.dsth.dk/bridging2018/index.html)
  • Assess the venous thromboembolism risk by calculating the Caprini score of the patient: https://www.mdcalc.com/caprini-score-venous-thromboembolism-2005
Contents
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Procedures

Procedures