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Surgery is necessary in patients with morbid obesity
because the other treatments fail.
A patient with morbid obesity who tries a non-surgical treatment
regain all the weight that has lost or gain even more
2 years after the surgery.
So, the surgery is very important
not to lose weight
also to maintain the weight lose along in time.
Is there where another non-surgical treatments fail.
We know when a patient is a candidate or not to Bariatric Surgery
by several pre-surgical evaluations we make.
However, what the patient is freshest and it's more clear to know if he has a surgical indication
is how much it weighs.
We measure how obese or not a patient by a formula called the Body Mass Index (BMI)
The BMI is calculated by dividing weight by height squared and this gives a number.
When that number is over 40 BMI that patient has an indication for surgery.
In absolute terms, overweight between 35 and 40 kgs. has an indication of surgery.
In our Bariatric Surgery Program we perform all possible bariatric techniques.
There are many surgical techniques for loss weight, at least 15 or 20 different.
The most used in the world are 3:
Adjustable Gastric Band, Sleeve Gastrectomy
or Roux-en-Y Gastric Bypass
Of all surgical techniques, the most tested, which has proved to be more efficient
and also more secure long-term, is the Roux-en-Y Gastric Bypass
that's what the Americans call the Gold Standard in Bariatric Surgery
It's the gold standard with which we measure all other
the results, complications and the effectiveness of other surgical treatments.
We choose the technique and adapt ourselves to the requirements of each patient.
It's very important that we will perform to the patient the surgery the patient needs.
and not what we like more or are more used to or we do best perform.
Is very important a very good indication of surgery and depending on the patient,
we will choose a Roux-en-Y Gastric Bypass or Gastric Band or Sleeve Gastrectomy
The risks of this surgery, of any of them (Roux-en-Y Gastric Bypass or Gastric Band or Sleeve Gastrectomy)
are the same as have any procedure.
There may be hemorrhage, may have infections, there may be problems with anesthesia.
The obese patient has a particular risk and is not a risk for the rest of the patients
which is the risk of deep vein thrombosis and pulmonary embolism.
All surgical procedures, whatever,
we are talking about bariatric surgical techniques, ie weight loss
or even any other surgical procedure, has risks.
Who gives a patient a safe surgery, basically what he's doing
is to deceive this patient. It doesn't exist Non-Risks surgery.
Moreover, an obese patient is a high risk patient, is a chronically ill patient
with the immune system, cardiovascular, respiratory altered
is a patient who is using its spare capacity to live every day.
All this in the context of an Obesity Program where the clinician, surgeon, anesthesiologists
where all the doctors involved in the treatment of these patients
are specially trained in performing Bariatric Surgery
risks still exist but are low.
Each of these surgical procedures has certain risks of this surgery.
For example: Roux-en-Y Gastric Bypass or Sleeve Gastrectomy has fistula risks.
Fistulas are losses for unions, we make anastomosis between the intestine and stomach.
The Gastric Band has the risk of gastric perforation by placing the Band
or has some risks like slipping away or erosion of the Band.
My mom was operated 3 years ago. Hace 3 años mi mamá se operó
It changed her life, she lose 37 kgs.
Today she weighs 56 kgs ... it's wonderful !! my mom is 56 years old
It's a preventive method for me I don't want to weigh over than 100 kgs at age of 50
Please make the necessary effort and diet and whatever to reach the operation.
The surgery is going to change your lives. I had the surgery 6 months ago, I've lost 30 kgs.
and I changed not only the body but also my life.
I'm a new person, I'm better, I can walk, I can do gym
and lots of things I couldn't do before
because obesity is unfortunately a limitation.
After 7 days, when the doctor take off the drain, you can move better.
You can exercise ... I'm walking now 6 kms. per day
It's the last diet of your life, you will not feel hunger in your life.
Actually I'm very happy. It changes your life, you want get out.
Before surgery I ate a dozen pies, now 2 or 3 and I feel the same satisfaction.
The first 2 months I had doubts
After the first 2 months I think it's the best decision I made in my life.
I think not only should support this before, but also after.
You can not be an island because it is a disease of all.
My husband was operated in OCMI
When he was operated he weighed 190 kgs. more or less
If everything goes well, within the next day I would have to be operating. I'm ready.
By a man who also had surgery three years ago and got 52 kgs. less
And I liked it, the truth is I want to change these habits that I have, I want to change.
I came to OCMI because we knew a person that had come here
and had done quite well and had seen as a comment.
I came to talk, then I had the consultation with Oscar and here I am ...happy.
We have a lot of consultation of patients having some other procedure performed.
For example: Adjustable Gastric Band, and they consult us to make another surgical procedure
or because the Band has failed or because it has had some complications
basically 2 for which we have already discussed: the erosion and slippage of the band.
In this case, what we do is a surgery called "conversion" from By Pass to a Band.
The band is removed surgically and in the same time or on a delayed surgery, as the patient,
is performed a Roux-en-Y Gastric Bypass.
Today our 2nd surgical option is not the Adjustable Gastric Banding, is the Sleeve Gastrectomy
We operate few cases of Gastric Band. only the selected.
when we think that the patient actually has much indication of this procedure.
This procedure has a high failure rate, of weighing gain, complications,
erosion and slippage of the band.
When we do Sleeve Gastrectomy select a very specific group of patients.
I would say The main inconvenience that today we find with Sleeve Gastrectomy
is that we do not have long-term follow up with Sleeve Gastrectomy.
We don't know which will be the results of long-term of Sleeve Gastrectomy
Conceptually, any type of surgery, whether Gastric Band , either Bypass or Sleeve Gastrectomy
it's for life. This is the concept and it is very important that the patient understands.
A patient who is planning to having surgery to remove it if he repents or not like surgery,
is a patient who shouldn't have indication for surgery and shouldn't be operated.
One fact it is real: many bands are removed - not reversed any By Pass.
The only really irreversible surgery, technically impossible to reverse, is the Sleeve Gastrectomy
because in the Sleeve Gastrectomy removes a portion of the stomach
and that can not be put back into the abdomen.
However, it is very important that the patient understands the concept of surgery,
regardless of the surgical technique, is for life.
Surgery should always be a last recourse of treatment.
Regardless of whether you are very overweight to lose, for us is very important that the patient
when he consult us, he consult after trying many treatments previously
and failed in them. In fact the large majority of patients who consult us
even when they are very young, have tried not 2 or 3, have tried 10 or 15 times and many treatments
serious treatments and very consistent, with doctors, nutritionists, with dietary changes.
The patients with overweight should try a good diet plan and a good exercise plan to lose weight.
We measure the effectiveness of any surgical procedure, not what happens in the 1st year,
but what happens the 2, 5, 10, 15, 25 years after surgery.
This is where we really evaluate if the procedure has been effective.
It is very important that the patient is conscious and know that surgery is not magic.
Surgery is an essential and indispensable tool without which the patient will not lose weight, but not it's magic.
After the first year of post-operative where everything seems easy and where you lose weight very easily
is very important that after 1 year the patient can keep good eating habits,
make regular physical activity. This is what will allow a very good weight loss maintenance over time.
The patient is admitted and is operated today, i.e. the patient was admitted the same day of the surgery
The surgery takes about 2 to 3 hours.
However, among the patient leaves the room and leaves to see his family until he returns to the room, spend a longer time,
at least 4 or 5 hours.
Part of the post-surgery is the walk very precocious, this to prevent a post-surgery complications
that is deep vein thrombosis with pulmonary embolism, it is very important.
There is very little post-surgery pain, we will specifically charge that there is not too much pain.
The day after the surgery begins with the intake of fluids, with a particular progression with very small sips of water.
In 2 or 3 days or so, the patient go home.
At home the patient can do whatever he wants, except take the ailing and get into bed.
I mean you can go out, you can walk, you can go to the square, you can go to visit friends, you can take the train but it shouldn't stay in bed
because in this way, as I say, we avoid deep vein thrombosis.
Restrictive surgery is that in which the patient weight loss because eats less food.
Malabsorptive surgery is that in which the patient loses weight irrespective of the amount of food he eats
because everything he eats, absorbs only a very small part.
We don't do this surgery, except for a few and rare exceptions. Why ?
Surgery is very effective in achieving weight loss, the patient lose the 100, the 110, the 120, the 130% of excess weight
i.e. the patient lose weight even even more weight than we would like that the patient lose
but has collaterals effects that are important and which are sometimes very difficult to manage.
This surgery can cause diarrhea and flatulences very important
that produces nutritional deficits that sometimes make it necessary to hospitalize a patient 2, 3, 4 or 5 times a year
for intravenous replenishment of nutrients, minerals, vitamins, proteins.
And mixed procedures which combines the two previous procedures, ie in this case
the patient loses weight because they eat less food and also because here you create a small malabsorption syndrome.
i.e. in this surgery, avery little portion you eat is absorbed
In this surgery, is absorbed almost all they eat.
This is enough to optimize weight loss, doesn't cause serious nutritional problems or difficulties in treatment.
The prototype of restrictive surgery is Adjustable Gastric Band.
The prototype is mixed procedure is
No doubt, the surgery is by definition the Bypass and currently performed laparoscopically.
The most effective, not only short, especially long term, is surgery. The surgery is not indicated in all patients.
is indicated in patients who are very overweight and in patients who have failed other treatments, especially diet.
¿Por qué se llama By Pass Gástrico? Porque estamos, si se me permite el término, bypasseando gran parte del estómago.
Then the patient will lose weight because his stomach will be very small, he will eat less
and because there will be a small portion of food that this man going to eat that will not absorb.
We're going to see before we will see during operation and we will see later.
- Hi - How are you? step on the scale, Is this your maximum weight?
- No, the maximum was 260 kg. - 126,600 kgs.
I think the surgery recommended for you is the Bypass
Of course has risks in addition to benefits we've talked too,
cardiovascular, respiratory, fistulas, hemorrhage and even the risk of death.