Analysis of Gastric Banding: A Scientific Weight Loss Surgical Solution for Severely Obese Patients

Gastric ligation:

This surgery is used to treat obesity exceeding 20% ​​of body weight.

Postoperative management:

1. Patient selection

In 1991, the NIH (National Institutes of Health) Unified Development Conference panel proposed that surgical indications for obese patients include a BMI (Body Mass Index) greater than 40 kg/m², or a BMI greater than 35 kg/m² combined with life-threatening cardiopulmonary problems or severe diabetes. Of course, BMI is not always a prerequisite; if there are severe obesity-related comorbidities, surgical treatment can be considered. Generally, patients are selected based on the following criteria:

① Weight exceeding twice the ideal weight.

② Presence of severe obesity-related comorbidities, such as degenerative joint disease, hypertension, hyperlipidemia, coronary artery disease, type D diabetes, sleep apnea, lower extremity venous lymphatic obstruction, obesity-related pulmonary hypertension, etc.

③ Failure of rigorous non-surgical treatment.

④ No abuse of psychotropic drugs, no psychosis or uncontrolled depression.

⑤ No obesity-related endocrine disorders such as hypothyroidism and Cushing's syndrome.

Additionally, surgical treatment may be considered for obese young patients under 20 years of age with a family history of obesity, even if complications have not yet occurred.

Contraindications for surgery: Active abuse of psychotropic drugs and mental illness are absolute contraindications. Furthermore, patients who cannot correctly understand the surgical procedure and its effects, or who have a history of severe depression or suicidal ideation, are also unsuitable for surgical treatment.

2. Preoperative Evaluation After confirming the patient's eligibility for surgery, the patient must first fully understand the surgical procedure, its effects, and potential complications. Good communication and understanding are essential between the doctor, the patient, and their family.

The patient's diet and medication history should be reviewed. A psychiatrist should conduct psychopathological and psychological testing to rule out mental disorders.

Preoperative examinations include: a comprehensive and detailed physical examination, routine blood, urine, and stool tests, liver and kidney function tests, electrolyte tests, blood lipid tests, glucose tolerance tests, T₃, T4, TSH, electrocardiogram, chest X-ray, pulmonary function tests, and blood gas analysis. In addition, upper gastrointestinal barium meal, fiberoptic endoscopy, echocardiography, and cardiac stress tests may be performed as needed.

3. Preoperative Management After hospitalization, the focus is on treating comorbidities related to obesity, such as cardiopulmonary function, diabetes, and chronic lung infections, to ensure the patient is in a condition that can tolerate surgery. Intravenous antibiotics (such as cephalosporins) are administered two days preoperatively to help prevent postoperative infection. A thorough assessment of airway patency is necessary to determine if mask ventilation or endotracheal intubation difficulties are possible. The use of appetite suppressants (such as amphetamines) should be carefully monitored, paying attention to their interactions with anesthetics.

4. Preoperative Medication Opioids and sedatives can prolong respiratory depression; therefore, preoperative medication should be administered in small doses, such as diazepam 10mg and pethidine 50mg intravenously. Histamine H₂ receptor blockers or antacids (intravenous injection) may also be necessary. Intramuscular administration should be avoided in obese patients as the absorption and distribution are difficult to estimate.