surgical symposium 2015 st. valencia shchukin
TRANSCRIPT
Overweight Obesity
Surgery?
Definition of Obesity according to BMI
Underweight <18.5Normal 18.5 – 24.9Overweight 25-29.9Obesity >30
moderate 30.0 – 34.9severe 35.0 – 39.9morbid >40
BMI = W(kg)/H (m²)
What Causes Obesity ? Obesity develops when energy intake
consistently exceeds energy output Complex disease involving:
- genetics - physiology- metabolism - appetite regulation - environmental factors
- psychosocial & cultural
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Positive energy balance Genetic component
Chronic sleep loss
Consumption of food, independent of caloric content, cause metabolic changes that incease body fat (processed meat, high sugar etc)
Low intake of fat-fighting foods such as fruits and vegetables
Stress and psychological distress
Many types of medications
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Medical Problems from Obesity
• Many medical problems are caused by or worsened by obesity.
• Most get better or go away with significant weight loss.
• These medical problems are called comorbidities.
Obesity Comorbidities• High Blood
Pressure• Diabetes• High Cholesterol• High Triglycerides• Heart Disease• Joint Pains• Difficulty
Breathing• Sleep Apnea
• Heartburn• Urine Incontinence• Varicose Veins• Difficulty Exercising• Fatty Liver• Increased Cancer Risk• Frequent Headaches• Sex Hormone Problems
Metabolic Syndrome
Abdominal obesityHyperinsulinemiaHigh fasting plasma glucoseImpaired glucose toleranceHypertriglyceridemiaLow HDL-cholesterolHypertension
Risk of Death and Obesity
0
100
200
300
15 20 25 30 35 40
BMI
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E
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Difficulties in daily living10
• Moving is hard• Tiredness• Dyspnea
Problems during transportation
Difficulties with hygiene
Psycho-social problems
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Negative selfesteem Social isolation Discrimination
Why Lose Weight ?
• Feel Better• Quality of Life• Look Better• Be Healthier• Avoid Discrimination• Live Longer
Treatment Options
• Diets• Exercise• Behavior Modification• Medication• Surgery
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Diets Don’t Work !
• Almost anyone can lose weight dieting• Almost no one can maintain long term
weight loss• 97% of patients 100 pounds or more
overweight regain lost weight within 2 years
• Often gain more than was lost
Exercise
• Very important as part of any weight loss program
• Regular exercise causes more weight loss and keeps it off longer
• Length of time is more important than intensity
• Rarely enough as treatment alone
Medications
• Cause only modest weight loss 10-15%• Need to be taken indefinitely• Often cause side effects• Expensive and often not covered by
insurance• Only work well in combination with diet
and exercise
Preoperative Preparation
1. Cardiac 2. Pulmonary3. Endocrine4. Psychiatric 5. Gastro-intestinal6. Dietician 7. Weight Loss
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Indications for Surgery
• BMI > 40 kg/m2• BMI > 35 kg/m2 with co-morbidities
• Comorbidities:– Hypertension– Diabetes– Hyperlipidemia– Sleep apnea– Severe arthrosis NIH Consensus
Conference Ann Intern Med 1991
Indications for Surgery
• Age > 18 or < 60• Failure of diet > 6 months• Obesity history > 5 years • Low risk for surgery• No endocrinological disease• Psychologically sound
NIH Consensus Conference Ann Intern Med 1991
Operations for Obesity22
Laparoscopic technique23
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Biliopancreatic diversion
Sleeve gastrectomy27
Easier operation No dumping Normal uptake of food
But… • No long-term studies
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Risks of sleeve gastrectomyPostoperative complications
• Comparable with a cholecystectomy
Mortality < 1/2000
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Early complications
Late complications
Bleeding Unsatisfactory weightloss
Leakage GE-reflux
Adjustable gastric banding35
Affect satiety Adjustable Safe Reversible
Gastric banding36
Complications
• Band Slippage 3-5%• Band Erosion 1-3%• Tubing Leak 2-3%• Port Infection 1-2%• Stomach Perforation <1%• Esophageal Dilation ?• Death <0.1% (less than 1/1000)
Patients preop workup Knowledge of procedure Preparation
• Weightloss• Stop smoking Quit certain drugs
Eating behavior
Physical exercise
Vitamins
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BARIATRIC SURGERY IN NAIROBI AND KENYA EABC -MEDICAL TREATMENT 57-70
PATIENTS PER YEAR 20 -30 PATIENTS UNDERGO DIFFERENT
SURGERIES PER YEAR THROUGH OUR CLINIC
IN COLLABORATTION WITH MOH ORGANISED FIRST OBESITY SYMPOSIUM
SECOND SYMPOSIUM IN PROGRESS NOW
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CONTINUATION FREQUENT RADIO, NEWSPAPERS, MEDIA
INFORMATION ABOUT OBESITY AND TREATMENT
BARIATRIC TREATMENT IN MOMBASA SEVERAL SURGEONS UNDERWENT
TRAINING TO BE EXPERT IN BARIATRIC SURGERY
NEED OF COOPERATION AMONG ALL SPECIALISTS
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