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¿Qué saber antes de optar por una bariátrica?

When listening to the testimony of someone close to them who has performed a bariatric surgery, it is understood that it can be beneficial to treat obesity, known as the great epidemic of this century. This method of weight loss is the most effective and the most sustainable over time.

By Dr. Pablo García / specialist in weight surgery

Obesity is considered a disease on its own. It is the second cause of preventable death, after smoking. It is directly related to diabetes, hypertension, cerebral accidents, sleep apnea, joint diseases, cancer, venous insufficiency, depression, infertility, gout, low self-esteem and gastroesophageal reflux. All this without mentioning the social and labor limitations that arise.

Bariatric surgery is any procedure that is used to lose weight. At a general level, the new indications determine that the patients who apply are those with a body mass index (BMI) greater than 30 kg / m2 and who suffer from a disease directly related to obesity such as diabetes or hypertension or who have a BMI. over 35 without other conditions. Patients between the ages of 16 and 70 are accepted, so programs for adolescents and adults have been devised. The truth is that each case must be identified with the specialist doctor, who has the final say and determines whether or not he is a candidate. According to the type of diet, weight, diseases and lifestyle, this will indicate which procedure is the most appropriate, will answer your questions based always on scientific and statistical facts.

Specialists involved in the process

A bariatric surgeon must have a multidisciplinary team and have several specialists to treat the different aspects of obesity. These are: the surgeon himself, who is the one who performs the surgery once approved by the other colleagues; a nutritionist or endocrinologist, who traces the feeding guidelines before, during and after surgery and also evaluates and regulates metabolic imbalances such as diabetes or thyroid. In addition to these, a cardiologist, regardless of age, due to the cardiovascular changes of the patient and the predisposition to problems due to obesity; a specialist in pulmonology intervenes due to the respiratory restriction caused by obesity, sleep apnea or asthmatic history; a gastroenterologist performs and evaluates through a high endoscopy the state of the stomach before surgery, the presence of some hiatal hernia or reflux.

Given these changes, mental health also plays an important role, so a psychologist or psychiatrist assists the patient as emotional support. However, the attention of other specialists may arise according to the particular medical conditions of the person.

Medical exams

Many laboratory tests are required, such as blood count, blood chemistry, protein measurement, lipid profile, urine, coprological and metabolic tests for thyroid, cortisol and diabetes, which will predict the possibility of remission and improvement of them.

Regarding routine studies, in addition to upper digestive endoscopy, should be performed: chest x-ray, spirometry (lung function test), abdominal, thyroid and pelvic sonography (mainly in women). This discards other diseases that are related to obesity and determines the possibility of resolving them in the same bariatric surgery, as in the case of gallstones or ovarian cysts.

Undoubtedly, bariatric surgery is a very safe option, with the definitive evidence that there is a greater risk of being obese than being subjected to this treatment option. It is a way of returning the quality of life and fullness, reborn self-love and restoring health. To achieve success after this surgery, the patient is required to modify their feeding practices in order to be sustainable over time.

After the bariatric:

During the first weeks after surgery, recovery is paramount, so there are aspects of daily life that should wait. These are some recommendations to follow after the patient arrives at home:

  • The showers are recommended 48 hours after the operation.
  • Do not lift heavy objects for a month.
  • You can drive and have sex after the third week of recovery.
  • After 4 weeks, physical activity should increase to speed up weight loss. Hikes and indoor cycling are ideal.
  • The feeding is key so that the system adapts. The first days should be based on liquids such as soups and juices, then semi-solids are introduced as purees.

Bariatric surgery techniques:

  • Adjustable Gastric Band: A ring (with adjustable gauge) is placed around the entrance of the stomach to reduce food intake.
  • Vertical gastrectomy: In this surgery approximately 80% of the volume of the stomach is extracted, leaving it in the form of a tube and with a capacity of 150-200 cc.
  • Plicated tubular gastroplasty: The capacity of the volume of the stomach is reduced by folding inward (invagination) of the wall of this organ.
  • Gastric bypass: It is a mixed technique of bariatric surgery, since it has a restrictive component and another malabsorptive (alters digestion, causing incomplete absorption of food). With this surgical procedure, the absorption of food is reduced and restricted, creating a small deposit at the expense of the smaller curvature of the stomach, thus achieving an early satiety.
  • Duodenal crossing: It has two components, first 80% of the stomach is removed and then a crossing occurs in the small intestine at the level of the duodenum to take advantage of approximately 50% of it in the digestion and absorption of food.
  • Biliopancreatic diversion: ¾ parts of the stomach are removed and the small intestine is divided, which reduces food intake and acidity. In addition, an extremity is attached to the gastric pouch to create a food channel, where the food moves with little absorption.

Adjustable Gastric Band: A ring (with adjustable gauge) is placed around the entrance