There are classic criteria in this sense, which are somewhat old because they date from the year 1991. These consider candidates for those patients who have what is called morbid obesity, this is a Body Mass Index (BMI) greater than 40. The BMI is a way we have to establish what is the patient's weight situation. This is equal to your weight divided by the size squared.

But there is also a second group of candidates for bariatric surgery, which are those patients with a BMI between 35 and 40 (severe obesity) whose overweight is associated with an important disease that enhances the risks, for example diabetes, coronary heart disease and other .

It should be noted, however, that these criteria have changed markedly over time, at the pace of advances in research, and knowing more and more implications of obesity in terms of future risks for life expectancy. Current techniques are much less invasive, with early recovery, with average hospitalization of 48 hours, with small incisions, and with procedures lasting about one hour. This has led to more and more patients being operated with less extreme degrees of obesity than years ago.

In reality, on the one hand what is valued is the weight of the patient and the magnitude of the disease and, on the other hand, that obesity is not of recent origin. It is important to determine that the disease already has its time of evolution. It is also recommended that the patient have a normal age range -between 18 and 65 years old-. Although surgery can be performed outside this age range, when it is not present; included within these parameters, the case should be analyzed in depth.

When we talk about risks, we should divide them into two categories. On the one hand, there are the risks inherent in a surgical intervention performed under general anesthesia, which are fundamentally based on the substratum of the person who is going to operate: an obese and sick patient. This patient is considered at risk for any surgical procedure, if the necessary precautions are not taken. However, when the bariatric surgery is a programmed procedure, the patient arrives at the surgery very prepared, and with a previous treatment that minimizes the risks.

There is a second category of risks, which have to do with this type of surgery in itself. (Barium), but these are among the lowest in the area of ​​major digestive surgeries & uml ;. As this is a surgery that is done a lot nowadays, the specialists have acquired a great experience, and that reduces the complications. The possible risks are associated with the filtration, the loss of intestinal or intestinal fluid material, the result of a filtration (a "puncture"). The important thing to note is that the chances of death as a result of bariatric surgery are 0.1 to 0.5%, in expert hands and centers of high complexity, a low percentage compared to other complex procedures.

It is also noteworthy that if one compares the risks of mortality due to surgery to the risks of mortality due to the prevalence of obesity – in well-designed population studies, more patients die due to obesity and related diseases, than by surgery.

Undoubtedly the complication rate of bariatric surgery 20 years ago, with traditional technique (open-air surgery), is not the same as today's , based on the knowledge of new less invasive techniques, small incisions, less wound infections, fewer hernias, short surgery times, with early mobilization. The laparoscopic technique requires 4 & oacute; 5 incisions of no more than one centimeter.

When we talk about the success of bariatric surgery, we must divide this into two major points: the weight loss and the reversal of associated diseases that the patient has (comorbidities) .

With regard to weight loss, the way in which we evaluate it is based on the excess weight the patient has, and how much of that excess is lost after surgery. to. First of all, we determine what the ideal weight of the patient would be, and from that data we measure what the degree of overweight is.

The 50% reduction of that excess weight, as a minimum, is the cut-off point to say that the surgery gave results. From that floor you can get good results, very good and excellent. Statistically, the average patient lowers between 50 and 90% of excess weight, and that is achieved between 70% and 80% of patients operated. That is, up to 80% of patients manage to lose at least 50% of excess weight.

The other element that we can measure is from what? way the surgery reduced not only the overweight but also the incidence of diseases associated with obesity.

Within what are the diseases associated with obesity, there are two or three that are potentially the most serious, and in which more impact has weight reduction.

First of all, it's diabetes, which has a global remission rate after surgery (that is, the patient does not require more medication and has a normal glucose level) close to 80%.

Another complex disease that can be solved is the obstructive sleep apnea syndrome, which is a respiratory disorder that also has a very high rate of improvement or cure.

The third disease also very serious, and which involves a significant cardiovascular risk, is hypertension. In a percentage clearly lower than in the case of diabetes, but in more than 50% of the cases operated on, this condition improves or disappears.

There is practically no Body organ that is saved from obesity. There are other diseases that also accompany it and that although they do not have an impact at the mortality level, yes. they affect the quality of life of the person markedly. These are, for example, the osteoarticular issues: patients who have a structure to support a weight, which is half of what they are carrying on, and that by removing them from overweight they improve their degree of mobility, for example .

It is a myth to think that after the surgery the patient will owe it. feed for life with liquid foods. The goal of a bariatric surgery that d? E; The results that one expects, is that the patient changes habits in terms of the way they eat, the frequency and the quality of the food; but that I can eat absolutely everything in terms of consistency. Also it is important that you are; incorporated in the usual table and that does not suffer any social impediment. S í it can be given that, in the context of a complication (when the surgery is too "adjusted" or when the patient does not adapt well to it), he needs to appeal to liquid foods before the difficulty of achieving proper chewing.

In any bariatric surgery, regardless of the technique used, during the process of significant weight loss is recommended vitamin supplementation to avoid deficits at that time. Then, as the weight is balanced, in the case of sleeve gastrectomy it becomes necessary during the descent. In the case of the gastric bypass the supplements s í they are indicated for life because for more than the patient has a balanced diet, as there is a skipping of the digestive tract there are substances that will not be absorbed.

We must differentiate what is the reincorporación to the daily life of what it is to return to have a full and healthy life. As for labor reincorporation, for example, it will depend. from what? type of activity the patient develops. As we can say that the first two to three days must be at rest. On the seventh day, the patient can already drive vehicles and after the month has already been released for moderate physical activity. After two months you have freedom for all kinds of physical activity, as long as your condition of obesity allows it.

It should be noted, however, that the condition of medical discharge is a bit misleading when we refer to bariatric surgery, because by definition in any chronic disease. only and recurrent the patient is never discharged, since he has to fight for life against this disease that is obesity. Then, the patient should always remain in contact with the team, like any patient who has a chronic control of their disease.

S í, it is possible. What you have to ask yourself is when the time is right. What we recommend to the patients is that they avoid pregnancy during the first two years after the surgery.

After bariatric surgery, not only can you get pregnant, but also that even clearly increase the chances of achieving it because, among other things, obesity is associated with infertility and what is known as high risk pregnancy, a condition that improves after surgery. Then, when the patient loses weight will increase their fertility and their chances of getting pregnant.

Should not be performed in patients who have, for example, primary disorders of the diet, such as bulimia and anorexia. This does not mean that whoever suffers from this disease could not never operate, but you should have a pre-treatment maybe more complex.

Neither should the intervention be performed when the patient has an addiction (alcohol, drug). As in the previous case, it is not that they could never be operated on, but they need to have had a more abstinent time than prudential and an exhaustive medical control.

Thirdly, the Surgery is also not recommended for those suffering from severe psychiatric disorders, such as psychosis, bipolar disorder, among others, who have not been properly treated.

There are classic criteria in this sense, which are somewhat old because they date from the year 1991. These consider candidates for those patients who have what is called morbid obesity, this is a Body Mass Index (BMI) greater than 40. The BMI is a way we have to establish what is the patient's weight situation. This is equal to your weight divided by the size squared.

But there is also a second group of candidates for bariatric surgery, which are those patients with a BMI between 35 and 40 (severe obesity) whose overweight is associated with an important disease that enhances the risks, for example diabetes, coronary heart disease and other .

It should be noted, however, that these criteria have changed markedly over time, at the pace of advances in research, and knowing more and more implications of obesity in terms of future risks for life expectancy. Current techniques are much less invasive, with early recovery, with average hospitalization of 48 hours, with small incisions, and with procedures lasting about one hour. This has led to more and more patients being operated with less extreme degrees of obesity than years ago.

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