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Massive Weight Loss

Preoperative

Authors: Kasper Baasch Nielsen, Med. Stud., Mie Pilegaard Bjarnesen, Med. Stud., Anne Mosebo, Med. Stud. and Magnus Balslev Avnstorp, 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
  • 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

With the patient standing: Inspect the arms, both when abducted 90° with forearms extended, and when adducted close to the body. Pinch the medial part of the arms to inspect excess, laxity, and quality of the skin.

With the patient in supine position: The patient flexes the shoulders and the elbows 90° and the previously drawn markings can be controlled in relation to the expected stress on the skin after the removal of the excess skin.

Preoperative information

Postoperative scarringLocation
Size
Scar might be difficult to hide
Risk of widening and hypertrophic transformation
Postoperative risksInfections
Hematoma
Ruptures of the incision site
Healing complications
Loss of sensation in the affected area
Re-operation in case of complications
Pressure garmentsPressure garments will be used postoperatively
Excessive skinInform 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 or INR monitoring. The regulations from the Danish Society of Thrombosis and Haemostasis is 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