Obesity Surgery

The obesity is considered an epidemic global health, with continued growth in the number of new cases each year in developed countries and developing.

On the other hand, it is described that weight loss induces the cure of most of the health problems related to overweight (type II diabetes, sleep apnea syndrome, hypertension or arthritis).

The Swedish obesity study , the largest in terms of bariatric surgery, has not only shown the difference in results (in absolute terms of weight loss) when comparing bariatric surgery with non-operative measures, but it is also associated with a maintenance (10 years) of 14% -25% in weight reduction.

In the same way, bariatric surgery induces a protective effect on mortality in the obese patient, with a 24% reduction in the risk of death.

Classification of Obesity according to the Body Mass Index

According to the Body Mass Index, the following classification is recognized:

  • <18.5 Extreme thinness
  • 5-24.9 Normal weight
  • 0-29.9 Overweight
  • 0-34.9 Obesity type I
  • 0-39.9 Type II Obesity (Morbid Obesity)
  • Above 40 Obesity type III

Candidates for Obesity Surgery (bariatric)

There is no international consensus (usually national) to define with absolute precision which patients are candidates for obesity surgery.

The most commonly accepted criterion is based on the BMI (BMI in English) and the existence of comorbidities):

  • BMI of 40 kg / m2.
  • And also those patients with a BMI of 35 kg / m2, added to the presence of comorbidities attributable to excess weight.

Comorbidities associated with excess weight

Hypertension, depression, heart failure, anxiety, pulmonary embolism, hypercholesterolemia, eating behavior disorders, agoraphobia and other social anxieties, type II diabetes, suicidal ideation, arthritis, low back pain, infertility, fatty liver, joint pain, esophageal reflux, etc.

Intragastric balloon

Installed endoscopically, it consists of filling a balloon in the gastric fundus for a period of 6 months.

The weight loss obtained is moderate compared to other procedures (10-15 Kg) and in general terms, there is a gain after the removal of the balloon.

Therefore, it is useful as a preoperative adjuvant in superobeses.

Gastric bypass

Considered the gold standard, it is the most commonly performed procedure.

The weight loss is 60-70% at 3 years (similar to tubular gastrectomy), with a mortality lower than 0.25%. It combines the restrictive action and the malabsorptive action.

It is the technique of choice in the so-called “gummy patients”, with a marked tendency to ingest fluids and hypercaloric substances (such as sweets).

Tubular Gastric

It is a procedure recently integrated into the surgical repertoire of bariatric surgery techniques.

It consists of the almost total (and longitudinal) removal of the stomach, leaving a tubular gastric reservoir (on the slope of the lesser curvature), on an orogastric probe that serves as a guide, usually calibrated on a 34 Fr-36 Fr (divide by 3 to obtain the caliber in mm, ie between 12 mm in diameter approx).

This gastric tube (tubular or sleeve) acts as a restrictive operation initially, limiting the volume ingested.

Although the suture line may show leaks and occasionally stenoses have been detected that require endoscopic dilatations after surgery, there are few complications associated with the long-term procedure.

It is the preferred technique in patients who have undergone surgery of another type previously, since adhesions sometimes make it difficult to perform traditional gastric bypass.

The loss of excess weight that induces tubular gastrectomy, in the long term, is similar to that obtained with the bypass, reaching 84.5% at 3 years and 45% -60% at 5 years.

By definition, tubular gastrectomy does not generate a malabsorptive syndrome (occasionally vitamin B12 deficiency due to a decrease in the secretion of intrinsic factor), and therefore an important level of commitment on the part of the patient is essential, since after surgery, it can be ingested ease of alcohol and hypercaloric liquids, which limit and make difficult the maintenance of weight loss.

Conclusions

  1. Obesity surgery reduces the complications associated with obesity and increases the survival of patients.
  2. Bariatric surgery induces a protective effect on mortality in the obese patient, with a reduction in the risk of death of 24%.
  3. The sleeve (tubular gastric) offers similar results to the gastric bypass.
  4. The surgery is safe and viable. Optimal alternative to life changes aimed at weight loss, which have been unsuccessful.
  5. A multidisciplinary approach is necessary.
  6. Obesity surgery should be considered a valid option for patients who need to lose weight to reduce the morbidities associated with being overweight.