Surgical treatment of obesity
When obesity and associated diseases threaten the lives of individuals, professionals make use of all surgical procedures called “stomach reduction. This type of surgery is complex but the results, in most cases, are excellent and represent a new opportunity for patients.
1. Bariatric surgery as a last resort
Operation. With this type of intervention will minimize the cavity, so that the patient feels satisfied with less food.
When there trying to fix the endocrine obesity through diet and exercise, but if it does not go to the surgeon is recommended in obesity or digestive specialist to find the right technique to the problem, depending on the type of obesity and its habits.
In general it is generally recommended for patients with a body mass index (BMI) of 40 or higher is considered morbidly obese and people over 35 and suffering from any serious illness (diabetes, hypertension, arthritis disabling for overweight … ). Already exceeded a BMI of 35 could presage the rapid changes in the problem.
It is not aesthetic but bariatric surgery and is a radical change of habits because it alters completely the process of digestion and absorption of food.
The capacity of the stomach of a morbidly obese individual is much greater than that of a normal person. With this type of intervention will minimize the cavity, so that the patient feels satisfied with less food.
Although recent years have made great strides in this area, particularly with regard to safety, the operation is not without risks and there is still a small mortality rate (between 1 and 2%).
In order to improve technique and reduce complications, bariatric physicians in collaboration with the Medical College of Barcelona, prepare a protocol for obesity surgery will be completed in coming months and to establish patterns of action to which should benefit all professionals.
Among his plans are fundamental requirements that interventions can be undertaken only by surgeons with experience and greater control immediate postoperative period, with comprehensive measures of surveillance.
2. Techniques for reducing stomach
The Spanish Society of Obesity Surgery (SECO), the organization concerning bariatric surgery, distinguishes various techniques that can be applied to patients with clinically severe obesity.
It’s the doctor who decides the most appropriate intervention gastric patient to lose weight. However, patients should be informed of the options presented and the risk they entail.
These partnerships are of the following:
2.1. Adjustable Ring
Ring is placed at the entrance of the stomach in order to prevent the patient to eat food in bulk. It can be done by opening the stomach but also by laparoscopy, in which there is no need to open which makes it less painful, with little scarring and does not require too much recovery time.
The stomach is not altered and can be studied by endoscopy or radiology. The diameter of the ring can be regulated after the operation but adjustments may be too uncomfortable for the patient.
Weight losses are not very high, are located around 50-60%. They are effective in 60% of cases. But it is possible to get patients to gain some weight.
Although the ring restricts and obstructs the intake, the method is not very effective in those patients superobese and greedy as they can sabotage if you eat candy or cream, preventing them lose weight, and even winning the lost.
2.2. Gastric Bypass
It is the oldest operation (1966) and highlights the significant reduction of stomach gets. It is a low risk intervention (compared with other interventions) that causes severe weight loss without altering the nutritional status only.
By laparoscopy creates a stomach pouch with a small portion of the stomach that binds directly to the small intestine. In this way, you get a smaller stomach that is satisfied with less quantity and a decrease in caloric absorption, which helps you lose weight.
2.3. Gastric Bypass with ring
This is a combined intervention (Vertical Banded Gastroplasty and Gastric Bypass) that can be used in all obese and offers very good long term results.
2.4. Pancreatic-biliary
It is the most complex, is a joint intervention in which there is a restriction on the amount of food eaten and also has a component of malabsorption for fat is not absorbed from the intestine.
It is the most effective operation, with losses of 70-85% overweight, offers a good quality of life and is very good for superobese. No wonder that it has increased the number of surgeons who practice in the USA and Spain.
The drawbacks can be highlighted which can affect the absorption of certain vitamins (A, K, D. ..), minerals (calcium and iron) and proteins. Also need analytical checks required during the first three years.
2.5. Vertical Banded Gastroplasty
Further intervention has been practiced in Europe to operate morbid obesity. This reduction can stomach that underwent open or laparoscopic, is closing the upper stomach stapled vertically and adding a silicone ring to restrict the new stomach that is formed.
It has little operative risk but a high rate of reoperation for failures in the healing of the staple line. In addition, patients may gain weight because as in the case of the adjustable ring is easy to sabotage.
2.6. Duodenal
It is a variant of biliary-pancreatic derivations. Very effective in weight loss and quality of life. Loss is maintained for many years but no less complex and needs analytical checks every 3 months during the first year and every year for life.
2.7. Tubular laparoscopic gastrectomy
This technique of gastric restriction very young (2003) as do not know its long-term outcome. Includes the removal of 80% of the stomach and is indicated for superobese very high risk, patients with other serious medical problems, patients with low BMI (35-43), patients who have failed them gastric banding and teenagers who do not wants to be aggressive surgery as the Duodenal Switch.
It is performed laparoscopically and uses the patient’s own material. It takes time and is easy operative recovery. No serious side effects to (their own operations with laparoscopy).
All these techniques make possible a better quality of life for patients
that after recovery can go out without problems, may exercise, normal clothing, grooming properly without help from another person?
3. Treatment for weight maintenance
Both before and after bariatric intervention is advisable for the patient to undergo physical and psychological treatment. A balanced diet, controlled by a specialist and psychological monitoring of the individual, improving the outcome of the operation and promote recovery.
A re-education that includes food habits that can change the style of diet, change patterns of physical activity and establish stimulus control strategies, increase self-esteem and to motivate patients to improve their quality of life.
4. Postbariática Surgery
After weight loss with stomach reduction surgery, the skin is stranded, especially the belly, and breasts empty. To solve the problem cosmetic surgeons removed the area to readjust the abdominal apron, climb the breasts in female patients and reshape the breast. Also try the skin on the legs and arms.
With this type of intervention are scars, but patients come very satisfied because they get better quality of life and may return to your day more comfortable.
In people who have lost so much weight is not indicated this cosmetic surgery in her arms, legs, breasts and abdomen at the same time and is conducted by parties with an interval of 6 months from one to another intervention.
The Spanish Society of Plastic, Reconstructive and Aesthetic advises patients to put in professional hands holding the title Spatial Aesthetic Plastic and Reconstructive Surgery, issued by the Ministry of Education and Science.
The entity considers any surgical practice even with associated aesthetic purpose involves a degree of risk, derived not only from the procedure itself, but the possible complications. To minimize the danger, it is better to be carried out by trained professionals in centers with appropriate means.
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