17th July 2023

Bariatric Surgery

Bariatric procedures can be considered for the management of severe obesity and its complications. Surgery is reserved for those with:

• A BMI of 40 kg/m2 or more, or
• Between 35 kg/m2 and 40 kg/m2 with evidence of other significant disease (e.g. type 2 diabetes mellitus or obstructive sleep apnoea) which will improve with weight loss

In these patients, surgery is only considered when all appropriate non-surgical measures have been tried. There are two main surgeries to be aware of for the purposes of the MRCP:

• Roux-en-Y gastric bypass – a small gastric pouch is created, which is anastomosed to the jejunum (restrictive and malabsorptive)
• Sleeve gastrectomy – a partial gastrectomy reducing the volume of the stomach (restrictive)

Complications:

There are many complications for which the following could be tested in the MRCP examination:

• Nutritional deficiencies – malabsorptive procedures are at increased risk of deficiencies. Risk of anaemia and metabolic bone disease.
• Anatomical – Stricture formation, marginal ulcers, small capacity (early satiety)
• Gallstones – because of distorted anatomy, ERCP can be difficult in these patients!
• Short-bowel syndrome
• Dumping syndrome
• Change in bowel habits