Гепатология и наука о поджелудочной железе

Preoperative Preparation of Super-obese

Abstract

Sandeep C Mutha

The incidence of obesity is increasing like epidemic. 65%of adults in USA are obese and approximately 5.2-37% in different states India. One out of five children is obese (COED- organisation of economic co-operation and development) and the rate of obese females is three times that of male. We as clinicians and anaesthesiologists have to deal with this problem more and more day by day. Obesity is a major health problem affecting almost all organ systems. Most affected systems are cardiovascular, respiratory, endocrine, airway, OSA, hepatic, renal, musculo-skeletal etc. Obese patients have higher rate of post-operative complications like myocardial infarct, neuropathy, infection, DVT, pulmonary embolism etc. Morbidly obese are with BMI more than 40Kg/sq.m or super-obese with BMI more than 50Kg/sq.m are to be preoperatively prepared for better perioperative outcome. In superobese patients preoperative preparation may require 6-8 weeks of controlled diet, exercises and medical treatment. Preoperative workup aims at controlling systemic diseases, optimising cardio-respiratory status, stabilizing endocrinal abnormalities and improving nutrition, effort tolerance and psychological state of mind of the patient. Minimum of 10% weight reduction preoperatively with improved effort tolerance and cardiorespiratory status decreases perioperative complications and hospital stay and cost. Regular assessment and Psychological support during preoperative optimization prepares the super obese patient physically and mentally to undergo complex bariatric surgery