Bariatric Course

 

What is bariatric surgery?


The term βάρος (baros) derives from the Greek meaning weight. The bariatric surgery is therefore the surgery that deals with body weight.

Who can benefit from it?


In France as in Italy, for the moment it is reserved for adults and in some rare cases even for teenagers. To be operated you must have an evaluation of the BMI (body mass index). It is a mathematical formula conceived by a Belgian physicist Adolphe Quetelet, which gives an initial assessment of the type of obesity you suffer from.

Calculate your BMI

In the case of a BMI between 35 kg / m2 and 40 kg / m2, this is a second degree obesity. If the BMI is higher than 40 kg / m2 it is called severe third degree obesity.

In the first case, one can benefit from an operation if there is an obesity-related comorbidity that could improve thanks to the intervention (diabetes, metabolic syndrome, arterial hypertension, sleep apnea syndrome, joint problems, polycystic ovary). Those with second-degree obesity fall completely within the criteria except for some contrindications such as addiction to drugs, serious mental problems.

Bariatric surgery can also be performed in patients who have already undergone bariatric surgery, without achieving optimal and lasting results.

In France, the HAS recommendations (Haute autorité de Santé) also require that the patient has already tried to lose weight for a minimum period of 6 months, adequately followed by a specialized team (dietician, sports coach, psychologist).
 

Whom to contact in the case included in the criteria?


The first thing to do and look for a specialized center, in Italy you have a certification of the SICOB (Italian Society of Obesity Surgery and Metabolic Diseases) when the center operates more than 50 cases a year, we speak instead of center of excellence if the hospital and its team perform more than 100 procedures per year. Search for yourself: https://www.sicob.org/area_03_pazienti/10_centri_sicob.aspx For Italian patients, the Bariatric Surgery Unit of the Madonna della Salute Hospital in Porto Viro will be the Center of Excellence for the year 2019.

In France SOFFCO (SOcieté Française Francophone of the Chirurgie de l'Obesité), proposes a recognition to the centers structured in multidisciplinary teams that have an activity of at least 50 procedures a year, for at least 3 years and with different types of intervention proposed. https://soffcomm.org/trouver-un-chirurgien-0 For French patients, the Surgical Center de l'Obésité in Toulon will have SOFFCO recognition for the year 2019.

It is important that you talk about it to your primary care physician and that he is guiding you towards a reference center made up of a multidisciplinary team.

What is a surgery?


The principle of bariatric surgery allows to modify the gastrointestinal tract to make sure that the feeling of satiety comes early (restriction interventions) or that part of the ingested food is not absorbed (malabsorptive interventions).

RESTRICTIVE INTERVENTIONS
They aim is to decrease the amount of food ingested and then give a feeling of early satiety. We distinguish:
  • Adjustable gastric ring
  • Longitudinal gastroectomy or SLEEVE
  • Gastrectomy vertical calibrate


MIXED OR RESTRICTIVE-MALASSORBITIVE INTERVENTIONS
These procedures combine a restriction of the stomach with a decrease in the absorption of food from the gut. Among them:
  • By pass Greek Y/li>
  • By pass omega
  • Duodenal addition
  • Sadi-S
All these procedures contain advantages and disadvantages and only a surgeon experienced in obesity can advise you in the best account of the different comorbidities related to your health.
 
 

PREOPEARATIVE PHASE


The pre-operative time is fundamental to get ready for surgery both from a medical point of view and from a psychological point of view.

I argue that as motherhood lasts nine months and serves the fetus to grow and the mother to get used to the idea of becoming a mother, so in the same way the preoperative phase serves the doctor to fully prepare the patient, but above all on changing bad habits and to understand if the patient will be ready to face a life with a bariatric intervention.

In this phase you will see the nutritionist doctor, the cardiologist, the sleep doctor, the psychologist, the dietician, you will carry out radiographic and blood tests. All this procedure (rather long and investigating, I admit) aims to prepare the patient in an optimal manner.

THE SURGERY


In most centers, this type of procedure is performed laparoscopically. It lasts about 2 hours and the stay varies from 2 to 4 days.
At least 2 weeks of rest are recommended in the post-operative period.
 
 

AND THEN?


Once operated, it will be necessary to begin to increase in a suitable way, most of the centers foresee a protocol divided roughly into 4 weeks:
  • 1st week: liquid diet
  • 2nd week: velvety consistency
  • 3rd week: mashed consistency
  • 4th week: consistency in small bits

THE 10 key tips AFTER THE OPERATION


  1. FOLLOW UP: Making you operate in a bariatric surgery center, establish an indissoluble bond with the structure. Trust your team and be guided by professionals. Scientific work demonstrates a relationship between adherence to controls and the result of the intervention. So, do not be lazy and be followed by professionals who know how to identify problems related to the intervention as soon as possible.


  2. RESET THE PORTIONS: Either with a sleeve or with a bypass, the quantity of the meal decreases drastically. Combine your 2 fists and you will understand the maximum amount that with time your stomach will accept. Focus on quality and not on quantity.


  3. EAT IN MIND-FULLNESS: Abandon any kind of distraction (visual or auditory) and concentrate on your meal. It will allow you to eat, savoring and thus satisfying a fundamental aspect of our daily life: pleasure.


  4. WATER OR FOOD: Given the small size of the stomach there will be space for one or the other; drink between meals and do not put your glass on the table.


  5. COOKING: During our visit we talked about always putting a plate with a portion of protein, one of carbohydrates (better if integral) and one of vegetables. Do not look for shortcuts to food already prepared, necessarily contain more fat and stored in order not to perish. Put yourself in the kitchen and cook simple things, with love.


  6. STOP GAS: avoid the carbonated and sugary drinks like the bubonic plague; the first dilate the stomach that your surgeon sewed with a lot of love the second give a slap to the pancreas that finally begins to breathe.
 
 
  1. GUT: A good body weight is secondary to a good GUT flora. Since many years in your belly grow pro-obesity bacteria, ask for a good quality probiotic.


  2. MOVE YOUR BOTTOM: What we have done so far will not do any good unless you start a regular and regular physical activity, remember half an hour a day or two and a half hours during the week.


  3. VITAMINS: Your intestines no longer absorb vitamins and micro-nutrients as before; get help from your nutritionist and take vitamin supplements scrupulously.


  4. ENJOY THE JOURNEY: You have finally turned an important page in the diary of your life; do not deny the past but enjoy this new phase of change. If you can note your daily emotions, it will help you in metamorphosis and above all to understand what you are feeling, it is an exercise that requires dedication but very effective.


  5. I add an eleventh commandment dedicated only to my patients:

  6. The TEAM: In the Center de l'Obésité (CCO, TOULON) where I have the privilege of working, we all row in the same direction, or help you to achieve a stable physical form, an optimal state of health and why not, a little more happiness. In English we say "you shine, I shine", your result is our greatest satisfaction. So, do not skimp and come to the center, for a word of comfort, to solve a doubt or just because you need a little motivation. We are a team, your team.


https://cco-stmichel.fr
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