Weight Loss Surgery

Also called: Bariatric surgery, Bypass surgery, Gastric banding, Obesity surgery

If you're very overweight and can't lose pounds with a healthy diet and exercise, surgery
might be an option for you. The surgery is usually for men who are at least 100 pounds
overweight and women who are at least 80 pounds overweight. If you are somewhat less
overweight, surgery still might be an option if you also have diabetes, heart disease or
sleep apnea.

Weight loss surgery limits the amount of food you can take in. Some operations also
restrict the amount of food you can digest. Many people who have the surgery lose
weight quickly. If you follow diet and exercise recommendations, you can keep most of
the weight off. The surgery has risks and complications, however, including infections,
hernias and blood clots.
Effects of Epidural Anesthesia and Analgesia on Coagulation and Outcome After
Major Vascular Surgery

Abstract

To examine the interaction of epidural anesthesia, coagulation status, and outcome after
lower extremity revascularization, 80 patients with atherosclerotic vascular disease were
prospectively randomized to receive general anesthesia combined with postoperative
epidural analgesia (GEN-EPI) or general anesthesia with on-demand narcotic analgesia
(GEN). Demographics did not differ between groups except that the GEN-EPI group had
a higher incidence of diabetes mellitus and of previous myocardial infarction.
Coagulation status was monitored using thromboelastography. An additional 40
randomly selected patients without atherosclerotic vascular disease undergoing
noncardiovascular procedures served as controls for coagulation status. Vascular surgical
patients were hypercoagulable compared with control patients before operation and on
the first postoperative day. Postoperatively, this hypercoagulability was attenuated in the
GEN-EPI group and was associated with a lower incidence of thrombotic events
(peripheral arterial graft, coronary artery or deep vein thromboses). The rates of
cardiovascular, infectious, and overall postoperative complications, as well as duration of
intensive care unit stay, were significantly reduced in the GEN-EPI group. Stepwise
logistic regression demonstrated that the only significant predictors of postoperative
cardiovascular complications were preoperative congestive heart failure and general
anesthesia without epidural analgesia. We conclude that in patients with atherosclerotic
vascular disease undergoing arterial reconstructive surgery (a) thromboelastographic
evidence of increased platelet-fibrinogen interaction is associated with early
postoperative thrombotic events, and (b) epidural anesthesia and analgesia is associated
with beneficial effects on coagulation status and postoperative outcome compared with
intermittent on-demand opioid analgesia.