13 July 2020 Author : Natacha Botelho Vieira Morbid obesity is a serious public health problem that affects all socioeconomic classes, adults and children. It has with medical, social, and psychological repercussions, as well as economic impact. For those who have the disease, it means: Deterioration of quality of life; Social exclusion; Increased risk of other diseases; Increased risk of death. Bariatric surgery has been shown to be the most effective procedure for the treatment of morbid obesity and associated diseases. It leads to an effective and lasting weight loss, to the improvement or cure of associated diseases and reduces long-term health costs. Metabolic surgery has sustained favorable effects on blood glucose. Normalizing glycemic control for months or years or greatly improving blood glucose in the long term, even without remission of the disease, provides potential benefits to patients with type 2 diabetes mellitus. Metabolic surgery provides excellent glycemic control and reduces cardiovascular risk factors. Who can have bariatric and metabolic surgery Candidates for bariatric surgery are those who: Have a body mass index (BMI) higher than 40 kg/m 2 ; Have a BMI equal to or higher than 35 kg/m 2 associated with diseases related to obesity (diabetes, high blood pressure, sleep apnea, among others); Are over 18 years old; Have stable obesity for more than 5 years; Have failed medical treatment and a diet longer than 1 year; They are not dependent on alcohol or drugs; Do not have uncontrolled endocrinological or psychiatric pathology; Understand and accept the procedure; Have an acceptable operative risk. Metabolic surgery candidates are those who: Have a BMI between 30 and 35 kg/m 2 associated with difficult to control type 2 diabetes mellitus, diagnosed more than 2 years ago and less than 10 years ago; They are over 30 years old. What are the options for bariatric and metabolic surgery There are three groups of bariatric procedures: Restrictive procedures , in which the volume of the stomach is reduced, with a concomitant decrease in the ability to eat food and consequent early satiety. This group includes calibrated vertical gastrectomy or gastric sleeve or sleeve gastrectomy . Malabsorptive procedures , in which part of the small intestine is excluded from digestion, resulting in less absorption of food, without significantly altering the amounts ingested. This group includes biliopancreatic diversion ( duodenal switch and Scopinaro operation ). Mixed procedures , which combine both above, that is, condition a reduction in the ability to eat food and alter its level of digestion and absorption. Roux-en-Y gastric bypass is part of this group. Of these 3 groups, Roux-en-Y gastric bypass and gastric sleeve are accepted as metabolic surgery . All these surgical procedures are performed at Hospital da Luz by laparoscopy or robotic surgery, an advantage in bariatric and metabolic surgery! How the surgery is decided Since obesity is a multifactorial disease, its approach must be multidisciplinary . In this way, the specialties of general surgeons with bariatric and metabolic aspects, nutrition, psychology, pneumology, endocrinology, gastroenterology, internal medicine and anesthesia are part of the evaluation of the obese patient, where the assessment of BMI, associated diseases, nutritional, psychological is carried out. , operative and anesthetic risk, as well as the patient's ability to follow-up. From the result of this assessment, the most appropriate surgical procedure for each individual patient is decided. Objectives of bariatric and metabolic surgery: Improvement in life expectancy; Improvement in the quality of life; Cure or improvement of associated diseases; Minimal complications. The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
