RESUMEN
The articles presented in this symposium on treatment of clinically severe obesity cover most of the topics related to obesity surgery, from basic research about genetic causes of obesity to surgical techniques and clinical results on the severely obese patient. The most striking feature of those results observed after bariatric surgery for the clinically severe obese is not the remarkable weight loss and normalization of the body mass index but the amelioration of some of the metabolic and physiologic abnormalities related to obesity. In fact, carbohydrate and lipid metabolism show improvement, as do cardiac and pulmonary function. These observations justify all efforts devoted to the design and improvement of sound bariatric surgical techniques. Moreover, surgeons seek the well-being of the ex-obese patient, and in doing so they face special discriminatory attitudes from colleges, patients' families, and the society, mainly because of negative stereotypes related to the obese individuals and the lack of information on the real benefits of bariatric procedures. Bariatric surgeons will reach their goal only when an informed society, educated physicians, and properly oriented obese patients together give to bariatric surgery its real dimension. The objective of any surgeon is the wellness of his or her patient. This is important in bariatric surgery as well; beyond excess weight loss and normalization of biochemical parameters, the ex-obese patient should be able to live a normal, productive, happy life. Approaching this goal is a task that takes months or even years. Bariatric surgeons are committed to support and help their patients until they reach wellness after obesity surgery.
Asunto(s)
Obesidad Mórbida/cirugía , Estado de Salud , Humanos , Obesidad Mórbida/fisiopatología , Obesidad Mórbida/psicologíaRESUMEN
Reluctance or open opposition to new surgical techniques or surgical approaches are common both with medical and non-medical groups, and they are mainly due to lack of proper knowledge of the possibilities and limitations of these procedures. In Mexico, there is a lag between medical and surgical progress and the medical and lay information about them. The purpose of this study was to assess the magnitude of this situation. The 238 physicians interviewed comprised 137 internists and 101 surgeons. 787 patients were also interviewed; all of them were asked about obesity surgery, information on medical and non-medical publications, advice about obesity surgery In a special case or patient, and type of surgery performed. Among the physicians, none of the internists would advise obesity surgery to any patient, and most of them only recall intestinal bypass as the current procedure for obesity; only 3% had read about obesity surgery. Surgeons, on the contrary, had more precise information about surgery, 25% had read about techniques and results, and 20% would advise surgery for their patients. The general population had a very vague idea of obesity surgery, with confusion between liposuction and intestinal surgery; most of the individuals interviewed had magic or miraculous conceptions about surgeons and their powers' to eliminate fat. It is concluded that medical and non-medical groups lack the adequate knowledge and comprehension of obesity surgical procedures, and this is one of the problems obesity surgeons face in everyday practice.
RESUMEN
In order to evaluate the short- and long-term complications of obesity surgery, a review was done on 452 cases of morbidly obese patients who met the basic guidelines for obesity surgery and were operated upon; gastric bypass was performed in all of them. There were seven major complications: one myocardial infarction, two pulmonary embolisms, two gastric fistulas, one sepals from bowel infection and one acute thrombocytopenia purpura. Five of the patients died. It is important to note, in those patients with abdominal complications, the absence of classical signs and symptoms of peritonitis, and the need to act immediately in order to solve the postoperative problem. As in other series, minor complications were also present: subcutaneous infection in 18 cases, hernia in four, peptic syndrome in three, mild anemia in 28 and hypovitaminosis A and B in 58; all received medical treatment without problem. It is concluded that obesity surgery, like all major surgery in high-risk patients, may have complications, and therefore It is necessary to recognize them in order to prevent them, and if they emerge, diagnose and treat properly.
RESUMEN
Any incision should give exposure to the organs to be operated; any incision should also ensure correct healing, and last, but not least, the incision should leave an aesthetic scar. The most widely used abdominal incision for obesity surgery is vertical midline, which causes some pain and has an incidence of hernia. Transverse incisions are good, but do not give good exposure to the field as an obese patient is operated. The oblique sub-costal incision is easy to perform, gives an excellent view of the upper abdominal organs, and does not cause much pain in the postoperative period. In 452 patients, 72 were operated with vertical midline incision and 380 with left oblique incision. Gastric bypass was the operation done in all cases. Immediate postoperative ventilation was good in most patients, but seven of the first (vertical) group required a ventilator for 12-36 h. Patients of the second (oblique) group did not require the ventilator, except for one case with Pickwickian syndrome. Three patients with vertical incisions developed a hernia, and only one in the second group (oblique). It appears that the oblique incision is better than vertical incision for obesity surgery.
RESUMEN
A simple auto-evaluation sheet is presented for the proper assessment of the patient's condition after surgery. Stress is put not only on the weight loss, but on other important factors as well.
Asunto(s)
Cirugía General/educación , Educación Médica , Hospitales Generales , México , Seguridad SocialRESUMEN
In order to evaluate the efficacy of Caerulein in the postoperative stage of abdominal surgery, 25 patients received 0.3 mcg/kg intravenously every 4 hours. Bowel Movements, passage of gases, first evacuation and general improvement were compared to 25 patients in similar conditions who didn't receive the drug. The study group showed an earlier appearance of intestinal motility as compared to the control group. This contributed in a relevant matter to an earlier discharge from the hospital. The differences with the control group were statistically significative. The benefits of the drug in the management of the postoperative stage of abdominal surgery are discussed.