OBESITY SURGEONS MÉXICO ADVANCED LAPAROSCOPIC SURGERY FOR OBESITY

OBESITY SURGEONS MÉXICOOBESITY SURGEONS MÉXICOADVANCED LAPAROSCOPIC SURGERY FOR ADVANCED LAPAROSCOPIC SURGERY FOR

OBESITYOBESITY

SLEEVE SLEEVE GASTRECTOMYGASTRECTOMY

LAPAROSCOPIC LAPAROSCOPIC SLEEVE GASTRECTOMYSLEEVE GASTRECTOMY

Obesity is an epidemic disease, with an Obesity is an epidemic disease, with an increase patern in most of the contries increase patern in most of the contries around world.around world.

World Health Organization said in 2005 World Health Organization said in 2005 that 1,600 million people have that 1,600 million people have overweight and 400 million have morbid overweight and 400 million have morbid obesity around the world.obesity around the world.

In 2015, 2,300 million people will have In 2015, 2,300 million people will have overweight and 750 million will have overweight and 750 million will have morbid obesity.morbid obesity.


This epidemic disease increases the This epidemic disease increases the risk to have more than 15 health risk to have more than 15 health complications, like:complications, like:

Mellitus Diabetes Mellitus Diabetes High blood pressure and heart attack High blood pressure and heart attack Sleep apnea Sleep apnea Joint degenerative diseasesJoint degenerative diseases And othersAnd others


Gastric sleeve consists in the removing of the Gastric sleeve consists in the removing of the 66% of the stomach, that makes a tube like a 66% of the stomach, that makes a tube like a shirt sleeve.shirt sleeve.

This surgical procedure has less than 10 This surgical procedure has less than 10 years, but the medical reports of this years, but the medical reports of this technique has a very close relation with the technique has a very close relation with the Gastric By Pass results in the weight loose, Gastric By Pass results in the weight loose, but with less surgical and nutritional but with less surgical and nutritional complications.complications.


The understanding of this surgical The understanding of this surgical procedure is as follows:procedure is as follows:

The hunger state depends of the The hunger state depends of the hunger hormons like GRELIN, Leptins hunger hormons like GRELIN, Leptins and others. The stomach produces all and others. The stomach produces all the Grelin in the body, and this the Grelin in the body, and this hormone is the most efficient stimullus hormone is the most efficient stimullus of the hunger zone in the brain. of the hunger zone in the brain.


When the stomach is full the Grelin levels in the When the stomach is full the Grelin levels in the blood decrease and the hunger zone in the brain blood decrease and the hunger zone in the brain recognizes that the person does not need more recognizes that the person does not need more food. food.

When the stomach is empty, the Grelin blood levels When the stomach is empty, the Grelin blood levels are high, the blood Glucose decreases and this are high, the blood Glucose decreases and this strong stimulus makes a call to the brain for food. strong stimulus makes a call to the brain for food.

So it’s easy to understand the physiology of the So it’s easy to understand the physiology of the gastric sleeve. If we remove by surgery the 66% of gastric sleeve. If we remove by surgery the 66% of the stomach, the GRELIN production will decrease the stomach, the GRELIN production will decrease and the secondary effect of the surgery is that the and the secondary effect of the surgery is that the patient does not feel so much hunger. patient does not feel so much hunger.


Remember that 33% of the stomach stays in the Remember that 33% of the stomach stays in the normal place in the body at the end of the surgery, normal place in the body at the end of the surgery, but this percent of Grelin is not significant, and the but this percent of Grelin is not significant, and the brain understands that the hunger state is not so brain understands that the hunger state is not so very important.very important.

If we talk about the capacity of the stomach, this If we talk about the capacity of the stomach, this will reduce to 66% too. In other words if the patient will reduce to 66% too. In other words if the patient used to eat 3 hamburgers before the surgery, at the used to eat 3 hamburgers before the surgery, at the postoperatory period the same patient will have just postoperatory period the same patient will have just the capacity for less than half a burger. the capacity for less than half a burger. The The capacity of the stomach is 33% after the capacity of the stomach is 33% after the surgery.surgery.


Surgical remove of the 66% of the stomach


In the surgery we In the surgery we remove the 66% of the remove the 66% of the stomach, applyng a 3 stomach, applyng a 3 staple line reinforcing staple line reinforcing it with surgical stiches it with surgical stiches outside the staple line.outside the staple line.

The Sleeve The Sleeve Gastrectomy is by Gastrectomy is by laparoscopic technique laparoscopic technique or minimal invasive or minimal invasive technique.technique.


The patient stays in The patient stays in hospital for just only two hospital for just only two days, and at the third day days, and at the third day the patient pass to the the patient pass to the hotel or home and the hotel or home and the management is outside of management is outside of the hospital in the medical the hospital in the medical office.office.

5 to 7 days before the 5 to 7 days before the surgery the patient is surgery the patient is ready to come back to ready to come back to light work and in the 10 light work and in the 10 day we remove the day we remove the surgical drain in the surgical drain in the medical office.medical office.

OBESITY SURGERIES OBESITY SURGERIES

ADJUSTABLE GASTRIC BAND vs GASTRIC SLEEVE

The shadow

Is the stomach that we remove in the surgeryAdjustabl

e gastric band works like a sand clock

The hunger hormone is very high

The hunger hormone decreases

Pouch or stomach bag

OBESITY SURGERIESOBESITY SURGERIES

GASTRIC BY PASS

The gastric By Pass is more complex and the surgical and nutritional complications are high

OBESITY SURGERIESOBESITY SURGERIESGASTRIC BY PASS MEDICAL GASTRIC BY PASS MEDICAL

MANAGEMENT AFTER THE FIRST MANAGEMENT AFTER THE FIRST MONTHMONTH

Ursofalk caps 250 mgs Acido UrsodesoxicolicoUrsofalk caps 250 mgs Acido Ursodesoxicolico Take one every 12 hours for 6 monthsTake one every 12 hours for 6 months

Ferrotemp caps Ferrous fumarate 330 mgs/Tiamina 5 mgs.Ferrotemp caps Ferrous fumarate 330 mgs/Tiamina 5 mgs. Take 1 cap every day for 6 months and sometimes for many yearsTake 1 cap every day for 6 months and sometimes for many years

Redoxón – tablets 500 mgs. Vitamin CRedoxón – tablets 500 mgs. Vitamin C Take 1 tablet every day disolved in wather.Take 1 tablet every day disolved in wather.

Centrum JuniorCentrum Junior Multivitamins – chewable tablets Chew Multivitamins – chewable tablets Chew 1 every/8 hrs.1 every/8 hrs.

Neurobión 1000Neurobión 1000 B12 vitamin by inyection 2 B12 vitamin by inyection 2 injections every 3 months injections every 3 months

Calcium citrate PetitCalcium citrate Petit 1 tablet every day. 1 tablet every day.

ALL OF THIS IS IN THE POSTOPERATIVE MANAGEMENT OF THE GASTRIC BY ALL OF THIS IS IN THE POSTOPERATIVE MANAGEMENT OF THE GASTRIC BY PASS.PASS.

IN THE LAPAROSCOPIC SLEEVE GASTRECTOMY WE ONLY USE SOME OF IN THE LAPAROSCOPIC SLEEVE GASTRECTOMY WE ONLY USE SOME OF THIS VITAMINS IN THE FIRST MONTH. THIS VITAMINS IN THE FIRST MONTH. “ THE NUTRITIONAL STATUS IS “ THE NUTRITIONAL STATUS IS NOT AFECCTED IN THE GASTRIC SLEEVE”NOT AFECCTED IN THE GASTRIC SLEEVE”


ADVANTAGESADVANTAGES Only the stomach is cut avoiding Only the stomach is cut avoiding

the small bowel or intestines like the small bowel or intestines like in the Gastric By Pass. So this in the Gastric By Pass. So this surgery is easier and faster than surgery is easier and faster than the Gastric By Pass.the Gastric By Pass.

The gastric capacity is just only The gastric capacity is just only one third of the presurgery one third of the presurgery state. state.

After the surgery the physiology After the surgery the physiology of all the gastrointestinal area is of all the gastrointestinal area is normal like all the people.normal like all the people.

The Gastric Sleeve does not The Gastric Sleeve does not need adjustements like the need adjustements like the adjustable gastric band, because adjustable gastric band, because all of the anatomy is normal.all of the anatomy is normal.


AdvantagesAdvantages

The Grelin falls down in 66% The Grelin falls down in 66% and the hunger sensation and the hunger sensation decreases too.decreases too.

This surgical procedure does This surgical procedure does not present Dummping not present Dummping complications like in the complications like in the Gastric By Pass.Gastric By Pass.

The Gastric Sleeve does not The Gastric Sleeve does not

present nutritional present nutritional complications.complications.

The natural sphinters of the The natural sphinters of the stomach are preserved.stomach are preserved.


ADVANTAGES IN A ADVANTAGES IN A SHORT PERIOD:SHORT PERIOD:

In DIABETIC patients In DIABETIC patients the Glucose falls down the Glucose falls down to a normal state.to a normal state.

The blood lipids like The blood lipids like triglicerides and triglicerides and cholesterol decreases to cholesterol decreases to normal levels and the normal levels and the good cholesterol has an good cholesterol has an increase.increase.

Uric acid decreases too Uric acid decreases too to a normal levels.to a normal levels.


Weight loss in Sleeve gastrectomyWeight loss in Sleeve gastrectomy *First month: 16 to 26 pounds*First month: 16 to 26 pounds *Second month 11 to 16 pounds*Second month 11 to 16 pounds *Third month 11 to 16 pounds*Third month 11 to 16 pounds *Fourth month 7 to 11pounds*Fourth month 7 to 11pounds *Fifth month 7 to 11 pounds*Fifth month 7 to 11 pounds * Sixth month 7 to 11 pounds* Sixth month 7 to 11 pounds * The next 6 months the weight loss will be the half of the * The next 6 months the weight loss will be the half of the

first first six months. six months.

Normally within the first 6 months the size Normally within the first 6 months the size reduction is 10 sizesreduction is 10 sizes

LAPAROSCOPIC LAPAROSCOPIC SLEEVE GASTRECTOMYSLEEVE GASTRECTOMYDisadvantegesDisadvanteges

Needs a surgical cut of one Needs a surgical cut of one feet line in the stomach.feet line in the stomach.

This surgical procedure This surgical procedure needs the use a surgical needs the use a surgical drain for 7 to 10 days.drain for 7 to 10 days.

This surgery causes nausea This surgery causes nausea but we control it with but we control it with strong medication. The strong medication. The nausea always dissapears nausea always dissapears after 12 hours.after 12 hours.

Over the years the stomach Over the years the stomach bag size could get bigger bag size could get bigger than the 33%, but never than the 33%, but never again the size it was before again the size it was before the surgery.the surgery.


DisadvantagesDisadvantages

Injection of B12 vitamin Injection of B12 vitamin in the first month and in the first month and sometimes after the sixth sometimes after the sixth month if needed.month if needed.

In some people with high In some people with high Body Mass Index the Body Mass Index the weigth loss stops at 18 weigth loss stops at 18 months and needs months and needs convertion to Gastric By convertion to Gastric By Pass. This situation Pass. This situation sometimes happens in sometimes happens in people that needs to people that needs to loose more than 200 loose more than 200 pounds.pounds.

SAFE STEPS FOR AN SAFE STEPS FOR AN OBESITY SURGERYOBESITY SURGERY

Before After

www.obesitysurgeons.com.mx

8 months

1 year and 2 months


Internal Medicine/AnestesiologyInternal Medicine/Anestesiology

Bariatric/plastic surgeons Bariatric/plastic surgeons Patient Patient Sport Sport MedicineMedicine

Psicology/NutritionPsicology/Nutrition

THE PATIENT IS THE MOST IMPORTANT THE PATIENT IS THE MOST IMPORTANT MEMEBER OF THE TEAM AND IS THE MEMEBER OF THE TEAM AND IS THE

MAIN FACTOR IN THE MANAGEMENT OF MAIN FACTOR IN THE MANAGEMENT OF THIS DISEASETHIS DISEASE


REMEMBER THERE IS NO SURGICAL REMEMBER THERE IS NO SURGICAL PROCEDURE THAT WARRANTIES PROCEDURE THAT WARRANTIES

EXCELLENT RESULTS BY ITSELF IF EXCELLENT RESULTS BY ITSELF IF THE PATIENT DOES NOT CHANGE THE PATIENT DOES NOT CHANGE

THE BAD HABITS OF FOOD INTAKE THE BAD HABITS OF FOOD INTAKE AND DOES NOT DO EXCERSISE.AND DOES NOT DO EXCERSISE.


THANK YOUTHANK YOU

DR. JUAN CARLOS OLIVARES DR. JUAN CARLOS OLIVARES GONZÁLEZGONZÁLEZ

OBESITY SURGEONS MEXICO CEOOBESITY SURGEONS MEXICO CEOADVANCED LAPAROSCOPIC SURGERY FOR ADVANCED LAPAROSCOPIC SURGERY FOR

OBESITYOBESITY

www.obesitysurgeons.com.mxwww.obesitysurgeons.com.mx

OBESITY SURGEONS MÉXICO ADVANCED LAPAROSCOPIC SURGERY FOR OBESITY

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