Bariatric Surgery

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What is obesity?

Obesity is a condition characterized by excessive accumulation of body fat, a condition that causes serious damage to health. It is caused, in most cases, by incorrect lifestyles: a hypercaloric diet and a low energy expenditure due to physical inactivity.

Obesity is therefore a largely preventable condition.

Obesity is one of the major public health problems worldwide, because its prevalence is constantly and worriedly increasing, not only in Western countries, but also in low and medium incomes countries. Obesity is also an important risk factor for various chronic diseases, such as type 2 diabetes mellitus, cardiovascular diseases and cancers.

It is estimated that 44% of type 2 diabetes cases, 23% of ischemic heart disease cases and around 41% of some cancers are attributable to obesity/overweight.

In total, overweight and obesity represent the fifth most important risk factor for global mortality and the deaths attributable to obesity are at least 2.8 million/year in the world.

Consequences of obesity

We can certainly say that there is a close correlation between obesity and the most common diseases.

  • Diabetes
  • Arterial hypertension
  • Respiratory disease (asthma, respiratory failure, night apnoea syndrome)
  • Atherosclerosis

The Bariatric Surgery

Surgery of obesity or Bariatric Surgery is currently the only therapeutic effective means, in the long term, in inducing a satisfactory and definitive weight loss and in the control or reduction of complications of obesity.

Directions to the surgery

  • between 18 and 65 years of age (before the age of 18 and after the age of 65, interventions for obesity can be performed in particularly selected cases)
  • condition of obesity for at least five years
  • highly motivated and collaborative patient
  • BMI greater than 40 or BMI between 35 and 40 with presence of complications due to obesity
  • failure of previous controlled non-surgical therapies

Contraindications to the surgery

  • endocrinological diseases responsible for obesity
  • neoplastic pathologies not controlled
  • chronic inflammatory diseases of the digestive system
  • diseases of the nervous system
  • cardiac and/or respiratory contraindications under general anaesthesia
  • severe psychiatric disorders
  • alcoholism
  • reduced life expectancy
  • important hepatopathies

The most common bariatric interventions

Gastric banding

The gastric banding is a restrictive surgical procedure; the surgery involves the creation, in the upper part of the stomach, of a small pocket that communicates with the rest of the gastric system through a orifice. The gastric pocket, of about 25-30 ml, is obtained by surrounding the upper part of the stomach with a silicon ring, adaptable.

The ring is placed around the stomach and has the particularity of being blown or blown away by the doctor simply by adding or removing sterile physiological solution in the reservoir which is punctured through the skin, changing the diameter of the emptying orifice. The food ingested, by stretching the walls of the neoformed gastric pocket, activate the mechanizers that stimulate the center of appetite at the hypothalamic level, giving the patient a sense of satiety. This is an outpatient procedure. It will be up to the medical team to indicate when to adjust the bandage, based on multiple factors, not least the actual results of weight loss.

Sleeve gastronomy

Gastrectomy laparoscopic sleeve is a restrictive procedure in which the stomach is tubulized. The surgery is performed with laparoscopic technique and involves the removal of a large part of the stomach through a resection, made with the help of mechanical sutures. The remaining part of the stomach has a tubulariform aspect of drastically reduced volume, with a capacity of about 100/150 ml. This procedure is not reversible because a part of the stomach is definitely removed. The nerves of the stomach and the pylori, the“outlet valve”, remain intact preserving gastric function despite the reduced volume. Studies have shown that the portion of the stomach that is removed, the bottom in particular, produces Grelin, one of the hormones responsible for the sense of hunger. The reduction of the levels of this hormone that is observed after the surgical intervention, determines a decrease of the appetite. Loss of excess weight recorded an average reduction of 60 %, with lasting results overtime based on patient compliance.

Bypass gastrico

Gastric bypass (BPG) roux-en-Y laparoscopic is a procedure made both with malabsorptive and restrictive action. Malabsorption allows the body to absorb only a part of the calories ingested. The malabsorptive action generated by BPG is mild and this reduces the deficit of vitamin absorption and diarrhoeal discharges, characteristic of pure malabsorptive interventions such as bilio-pancreatic derivation and duodenal-switch. The restrictive action is guaranteed by the creation of a small gastric pocket capable of containing only limited amounts of food. This type of surgery has proved to be an effective method not only in losing weight, but also in maintaining it, despite several years later some patients, who do not comply with nutritional and behavioural rules, recover part of the weight lost. One BPG limit appears to be the inability to explore the residual stomach endoscopically.

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