Results after 3 year of implementation of a bariatric surgery protocol in a second level hospital.
EAES Academy. FLORES FLORES G. 07/05/22; 362962; P005
Dr. GUSTAVO FLORES FLORES
Contributions
Contributions
Abstract
Introduction:
Obesity is an international health problem as in Spain, the number of morbidly obese and overweight patients continues to increase, as do the comorbidities. In our region there was an important problem with the management of the surgical waiting list due to the large volume of patients, so we have jointly proposed the service of general surgery and Endocrinology: starting a bariatric and metabolic surgery program based on the guides of the Spanish society of obesity surgery and in the protocols of the IFSO. Resulting in the constitution of a multidisciplinary bariatric and metabolic surgery committee, who together have developed the protocol as well as the way of care for obese patients.
Material and methods: We conducted a prospective observational study during 3 year of evolution, in our first 100 cases, with an evolutionary control of them, in percentage of weight loss, improvement of comorbidities, evolution in body mass index, and the rate of complications.
Results:
Of the total of 100 patients in 44% we have performed Bypass, when they presented comorbidities such as DM2, HTA or dyslipidemia, and the remaining 66% have performed sleeve, were obese patients without comorbidities except for obstructive sleep apnea syndrome, which analyzed within our committee they would be subsidiaries of a pure and restrictive bariatric technique. 80% of our patients 6 months after surgery have achieved 70% of expected weight loss, with excellent monitoring by the endocrinology and nutrition service. 3 years are a little time to evaluate our metabolic results, there is a 100% diabetes mellitus control rate. As for arterial hypertension, we have only had a control of the disease in 45% of patients since the rest continue with medical treatment. In dyslipidemia there is a low response rate in Sleeve with a higher control rate in gastric bypasses. As acute complications in Sleeve, we had only 1, who was the eighth intervened patient, 21 years old, non-smoker, with a His-angled fistula at 96 hours after surgery, with a normal contrasted gastro-duodenal esophageal series.
In late sleeve complications at 9 weeks after the intervention, patient number 40 has presented abdominal pain, with imaging tests suggestive of acute diverticulitis, we made a laparoscopic approach, we identified a secondary hemoperitoneum; strangulated hernia of 12 mm trocar of jejunum, which has required intestinal resection and anastomosis. In the gastric bypass group, we have presented a case with hemoperitoneum in the candy cane cut line, secondary to an arterial branch.
which we have resolved by means of exploratory laparoscopy, washing and aspiration of the hematoma and a hem or lok in the problem area.
Conclusion:
Bariatric and metabolic surgery is increasingly a procedure that will be required to perform in second level hospitals, because obesity is a disease that is increasing and the number of patients and health expenses, is increasing exponentially. It is necessary that during the implementation of a bariatric surgery protocol, strict inclusion criteria are implemented, to try to obtain the best possible results.
Obesity is an international health problem as in Spain, the number of morbidly obese and overweight patients continues to increase, as do the comorbidities. In our region there was an important problem with the management of the surgical waiting list due to the large volume of patients, so we have jointly proposed the service of general surgery and Endocrinology: starting a bariatric and metabolic surgery program based on the guides of the Spanish society of obesity surgery and in the protocols of the IFSO. Resulting in the constitution of a multidisciplinary bariatric and metabolic surgery committee, who together have developed the protocol as well as the way of care for obese patients.
Material and methods: We conducted a prospective observational study during 3 year of evolution, in our first 100 cases, with an evolutionary control of them, in percentage of weight loss, improvement of comorbidities, evolution in body mass index, and the rate of complications.
Results:
Of the total of 100 patients in 44% we have performed Bypass, when they presented comorbidities such as DM2, HTA or dyslipidemia, and the remaining 66% have performed sleeve, were obese patients without comorbidities except for obstructive sleep apnea syndrome, which analyzed within our committee they would be subsidiaries of a pure and restrictive bariatric technique. 80% of our patients 6 months after surgery have achieved 70% of expected weight loss, with excellent monitoring by the endocrinology and nutrition service. 3 years are a little time to evaluate our metabolic results, there is a 100% diabetes mellitus control rate. As for arterial hypertension, we have only had a control of the disease in 45% of patients since the rest continue with medical treatment. In dyslipidemia there is a low response rate in Sleeve with a higher control rate in gastric bypasses. As acute complications in Sleeve, we had only 1, who was the eighth intervened patient, 21 years old, non-smoker, with a His-angled fistula at 96 hours after surgery, with a normal contrasted gastro-duodenal esophageal series.
In late sleeve complications at 9 weeks after the intervention, patient number 40 has presented abdominal pain, with imaging tests suggestive of acute diverticulitis, we made a laparoscopic approach, we identified a secondary hemoperitoneum; strangulated hernia of 12 mm trocar of jejunum, which has required intestinal resection and anastomosis. In the gastric bypass group, we have presented a case with hemoperitoneum in the candy cane cut line, secondary to an arterial branch.
which we have resolved by means of exploratory laparoscopy, washing and aspiration of the hematoma and a hem or lok in the problem area.
Conclusion:
Bariatric and metabolic surgery is increasingly a procedure that will be required to perform in second level hospitals, because obesity is a disease that is increasing and the number of patients and health expenses, is increasing exponentially. It is necessary that during the implementation of a bariatric surgery protocol, strict inclusion criteria are implemented, to try to obtain the best possible results.
Introduction:
Obesity is an international health problem as in Spain, the number of morbidly obese and overweight patients continues to increase, as do the comorbidities. In our region there was an important problem with the management of the surgical waiting list due to the large volume of patients, so we have jointly proposed the service of general surgery and Endocrinology: starting a bariatric and metabolic surgery program based on the guides of the Spanish society of obesity surgery and in the protocols of the IFSO. Resulting in the constitution of a multidisciplinary bariatric and metabolic surgery committee, who together have developed the protocol as well as the way of care for obese patients.
Material and methods: We conducted a prospective observational study during 3 year of evolution, in our first 100 cases, with an evolutionary control of them, in percentage of weight loss, improvement of comorbidities, evolution in body mass index, and the rate of complications.
Results:
Of the total of 100 patients in 44% we have performed Bypass, when they presented comorbidities such as DM2, HTA or dyslipidemia, and the remaining 66% have performed sleeve, were obese patients without comorbidities except for obstructive sleep apnea syndrome, which analyzed within our committee they would be subsidiaries of a pure and restrictive bariatric technique. 80% of our patients 6 months after surgery have achieved 70% of expected weight loss, with excellent monitoring by the endocrinology and nutrition service. 3 years are a little time to evaluate our metabolic results, there is a 100% diabetes mellitus control rate. As for arterial hypertension, we have only had a control of the disease in 45% of patients since the rest continue with medical treatment. In dyslipidemia there is a low response rate in Sleeve with a higher control rate in gastric bypasses. As acute complications in Sleeve, we had only 1, who was the eighth intervened patient, 21 years old, non-smoker, with a His-angled fistula at 96 hours after surgery, with a normal contrasted gastro-duodenal esophageal series.
In late sleeve complications at 9 weeks after the intervention, patient number 40 has presented abdominal pain, with imaging tests suggestive of acute diverticulitis, we made a laparoscopic approach, we identified a secondary hemoperitoneum; strangulated hernia of 12 mm trocar of jejunum, which has required intestinal resection and anastomosis. In the gastric bypass group, we have presented a case with hemoperitoneum in the candy cane cut line, secondary to an arterial branch.
which we have resolved by means of exploratory laparoscopy, washing and aspiration of the hematoma and a hem or lok in the problem area.
Conclusion:
Bariatric and metabolic surgery is increasingly a procedure that will be required to perform in second level hospitals, because obesity is a disease that is increasing and the number of patients and health expenses, is increasing exponentially. It is necessary that during the implementation of a bariatric surgery protocol, strict inclusion criteria are implemented, to try to obtain the best possible results.
Obesity is an international health problem as in Spain, the number of morbidly obese and overweight patients continues to increase, as do the comorbidities. In our region there was an important problem with the management of the surgical waiting list due to the large volume of patients, so we have jointly proposed the service of general surgery and Endocrinology: starting a bariatric and metabolic surgery program based on the guides of the Spanish society of obesity surgery and in the protocols of the IFSO. Resulting in the constitution of a multidisciplinary bariatric and metabolic surgery committee, who together have developed the protocol as well as the way of care for obese patients.
Material and methods: We conducted a prospective observational study during 3 year of evolution, in our first 100 cases, with an evolutionary control of them, in percentage of weight loss, improvement of comorbidities, evolution in body mass index, and the rate of complications.
Results:
Of the total of 100 patients in 44% we have performed Bypass, when they presented comorbidities such as DM2, HTA or dyslipidemia, and the remaining 66% have performed sleeve, were obese patients without comorbidities except for obstructive sleep apnea syndrome, which analyzed within our committee they would be subsidiaries of a pure and restrictive bariatric technique. 80% of our patients 6 months after surgery have achieved 70% of expected weight loss, with excellent monitoring by the endocrinology and nutrition service. 3 years are a little time to evaluate our metabolic results, there is a 100% diabetes mellitus control rate. As for arterial hypertension, we have only had a control of the disease in 45% of patients since the rest continue with medical treatment. In dyslipidemia there is a low response rate in Sleeve with a higher control rate in gastric bypasses. As acute complications in Sleeve, we had only 1, who was the eighth intervened patient, 21 years old, non-smoker, with a His-angled fistula at 96 hours after surgery, with a normal contrasted gastro-duodenal esophageal series.
In late sleeve complications at 9 weeks after the intervention, patient number 40 has presented abdominal pain, with imaging tests suggestive of acute diverticulitis, we made a laparoscopic approach, we identified a secondary hemoperitoneum; strangulated hernia of 12 mm trocar of jejunum, which has required intestinal resection and anastomosis. In the gastric bypass group, we have presented a case with hemoperitoneum in the candy cane cut line, secondary to an arterial branch.
which we have resolved by means of exploratory laparoscopy, washing and aspiration of the hematoma and a hem or lok in the problem area.
Conclusion:
Bariatric and metabolic surgery is increasingly a procedure that will be required to perform in second level hospitals, because obesity is a disease that is increasing and the number of patients and health expenses, is increasing exponentially. It is necessary that during the implementation of a bariatric surgery protocol, strict inclusion criteria are implemented, to try to obtain the best possible results.
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