Bariatric Surgery is the surgical procedure that causes weight loss through several mechanisms: restriction (decreased stomach capacity), malabsorption (decreased ability to use food) or both; which also cause hormonal changes that explain the consequent improvement or remission of comorbidities associated with obesity, such as: diabetes mellitus type 2, high blood pressure, cholesterol and high triglycerides, high single acid, among others.
There are several types of Bariatric Surgery, approved by the American Bariatric and Metabolic Surgery Association (ASMBS). These types are: restrictive or that diminish the gastric capacity, among which are the Sleeve and Gastric Band; and the mixed ones, which are restrictive and malabsorptive, such as the gastric bypass.
The approach to the realization of these procedures at present is through laparoscopy, a surgery for small incisions whose results -as demonstrated- include less postoperative pain, lower risk of wound infection, lower risk of post-incisional hernia and rapid reintegration to regular activities .
Who are candidates?
According to the ASMBS (American Association of Bariatric and Metabolic Surgery), the ADA (American Diabetes Society) and the American Association of Clinical Endocrinologists, Bariatric Surgery is indicated to: All patients with a Body Mass Index (BMI) greater than or equal to to 35 and at least one associated comorbidity (dyslipidemia, hyperuricemia, diabetes mellitus type 2, degenerative osteoarthritis, hypertension, sleep apnea, among others) or all patients with BMI greater than or equal to 40.
The BMI (Body Mass Index) is calculated by dividing the weight in kilos and the height in meters squared.
Every patient who wants Bariatric Surgery must undergo a series of studies and evaluation by a multidisciplinary team, which includes:
• Bariatric Surgeon: is the one who performs an initial evaluation and together with the multidisciplinary team determine the indication of surgery, which surgery is the best individualizing the cases, performing the surgical procedure and the follow-up.
• Nutritionist: emphasis on education and promotion of a healthy diet, its intervention is fundamental in the preoperative, perioperative, postoperative and long-term follow-up.
• Psychiatrist / Psychologist: in search of disorders associated with food, the patient's mental health that allows him to understand the entire process and the changes of Bariatric Surgery, with intervention throughout the preparation and follow-up process.
• Physiatrist: capture the patient with all their background to advise on the incorporation of physical activity, which also plays an essential role in obtaining the best results.
• Internal Medicine / Endocrinology: the detection, evaluation and compensation of comorbidities prior to surgery to reduce risks is paramount, as is subsequent follow-up.
The benefits of Bariatric Surgery have been demonstrated in scientific studies published in journals of high clinical impact: improving gastroesophageal reflux, hypertension, type 2 diabetes, dyslipidemia, hyperuricemia, infertility, polycystic ovary syndrome, sleep apnea, joint problems, reduces risk of various types of cancer associated with obesity such as cancer of the colon and rectum, endometrium, breast in postmenopausal women, pancreas, liver, gallbladder; better quality of life, reduction of expenses in health problems as a direct consequence of obesity, among many others.
Obesity is a chronic controllable disease as well as the diseases associated with it. So far there is no cure for diabetes; however, the effectiveness of surgery in the improvement of type 2 diabetes has been demonstrated. Therefore, we insist on the adoption of healthy lifestyles.
Bariatric surgery is effective and safe when performed by surgeons with formal training.