Obesity Surgery

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Obesity Surgery

It is defined as an intervention that repairs or modifies a surgical procedure for weight loss.

Can be:

  • Patients who had successful weight loss with the previous procedure
  • Patients successfully, but with reganancia
  • Patients with successful weight loss, but with complications.

It can be classified:

  • Converting a bariatric surgical procedure to another
  • Review of a procedure without conversion
  • Revert surgery
  • Exploration.

Candidates for bariatric surgery patients review:

VBG, gastric plication, sleeve gastrectomy, gastric bypass or gastric band without success in weight loss or weight gain. Complications of primary surgery: gastric reflux, slide / erosion of gastric banding, gastric pouch dilation, leaks, obstruction, ulcers.
It is estimated that 10-20% of patients undergoing bariatric surgery, surgery merited reganancia weight secondary to primary or complications revision procedure.

The American Surgeon, Volume 71, Number 1, January 2005

The reported incidence of reoperation in bariatric surgery ranges from 5-57%, but the quality and integrity of what is reported is sometimes questioned
Spyropoulos C, Kehagias I, Panagiotopoulos S, Mead N, Kalfarentzos F (2010) Revisional bariatric surgery: 13-year experience from a tertiary Institution. Arch Surg 145: 173-177.
Buckwalter JA, Herbst CA Jr, Khouri RK (1985) Morbid obesity: second gastric operations for poor weight loss. Ann Surg 51: 208-211.

revisional bariatric surgery is often quoted as having a complication rate of between 10-50%

van Gemert WG, van Wersch MM, Greve JW, Soeters PB (1998) Revisional surgery after failed vertical banded gastroplasty: restoration of vertical banded gastroplasty or conversion to gastric bypass. Obes Surg 8: 21-28.
Nesset EM, Kendrick ML, Houghton SG, Mai JL, Thompson GB, et al. (2007) A two-decade spectrum of revisional bariatric surgery at a tertiary referral center. Surg Obes Relat Dis 3: 25-30.

 

Failure of weight loss in bariatric surgery:
When the patient does not achieve> 50% loss of excess weight and / or the patient is unable to reach a BMI
No resolution or restitution of associated comorbid hypertension, diabetes, back pain and bone and joint, among others.

Patient assessment before revision surgery:
If possible determine the reason for failure.

  • Is the anatomically intact surgery?
  • Is the patient followed the post operative nutritional instructions?

A test radiological imaging (fluoroscopy) is required to assess the anatomical structures and in some cases a study of endoscopy may be necessary to determine the best approach.

The surgeon will inform the patient of the need, risks and benefits involved in revision surgery and the importance of monitoring by the multidisciplinary team.
Since 1998 IFSO (International Federation for the Surgery of Obesity) suggested:

“Bariatric surgery revision is a very complex and demanding area that requires considerable bariatric surgical experience”

It is mandatory that patients requiring revisional bariatric surgery are treated by a multidisciplinary group with surgical experience and a senior center.

Surgery bariatric revision increases morbidity and mortality due to age, weight, body mass index, type of fat distribution, medical conditions, type of previous bariatric surgery, hospital facilities and experience of the surgeon and multidisciplinary team.

Usually done laparoscopically, open surgery may be necessary in case of adhesions from previous bariatric surgery.

With the increased number of weight loss surgeries that are performed each year, an increasing number of people requiring surgía de revisión.

Laparoscopic Surgery for Obesity

Ventajas

Among the advantages of the laparoscopic approach include:

  • Reduced postoperative pain
  • shorter hospital stay
  • Faster return to work
  • improved cosmetic

How is surgery performed?

In a laparoscopic procedure, surgeons use small incisions (¼ to ½ inch that is 6 to 12 mm) to enter the abdomen through cannulas (narrow tubular instruments). The laparoscope, which is connected to a tiny video camera, is inserted through the small cannula. An image is projected to a TV that provides the surgeon a magnified image of the stomach and other internal organs. five to six small incisions and cannulas for use of specialized instruments to perform the operation are located.

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