surgical symposium 2015 st. valencia shchukin
TRANSCRIPT
![Page 1: Surgical symposium 2015 st. valencia shchukin](https://reader035.vdocument.in/reader035/viewer/2022070523/58ed02f91a28ab33398b4601/html5/thumbnails/1.jpg)
Overweight Obesity
Surgery?
![Page 2: Surgical symposium 2015 st. valencia shchukin](https://reader035.vdocument.in/reader035/viewer/2022070523/58ed02f91a28ab33398b4601/html5/thumbnails/2.jpg)
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)
![Page 3: Surgical symposium 2015 st. valencia shchukin](https://reader035.vdocument.in/reader035/viewer/2022070523/58ed02f91a28ab33398b4601/html5/thumbnails/3.jpg)
What Causes Obesity ? Obesity develops when energy intake
consistently exceeds energy output Complex disease involving:
- genetics - physiology- metabolism - appetite regulation - environmental factors
- psychosocial & cultural
![Page 4: Surgical symposium 2015 st. valencia shchukin](https://reader035.vdocument.in/reader035/viewer/2022070523/58ed02f91a28ab33398b4601/html5/thumbnails/4.jpg)
4
![Page 5: Surgical symposium 2015 st. valencia shchukin](https://reader035.vdocument.in/reader035/viewer/2022070523/58ed02f91a28ab33398b4601/html5/thumbnails/5.jpg)
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
5
![Page 6: Surgical symposium 2015 st. valencia shchukin](https://reader035.vdocument.in/reader035/viewer/2022070523/58ed02f91a28ab33398b4601/html5/thumbnails/6.jpg)
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.
![Page 7: Surgical symposium 2015 st. valencia shchukin](https://reader035.vdocument.in/reader035/viewer/2022070523/58ed02f91a28ab33398b4601/html5/thumbnails/7.jpg)
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
![Page 8: Surgical symposium 2015 st. valencia shchukin](https://reader035.vdocument.in/reader035/viewer/2022070523/58ed02f91a28ab33398b4601/html5/thumbnails/8.jpg)
Metabolic Syndrome
Abdominal obesityHyperinsulinemiaHigh fasting plasma glucoseImpaired glucose toleranceHypertriglyceridemiaLow HDL-cholesterolHypertension
![Page 9: Surgical symposium 2015 st. valencia shchukin](https://reader035.vdocument.in/reader035/viewer/2022070523/58ed02f91a28ab33398b4601/html5/thumbnails/9.jpg)
Risk of Death and Obesity
0
100
200
300
15 20 25 30 35 40
BMI
D
E
A
T
H
![Page 10: Surgical symposium 2015 st. valencia shchukin](https://reader035.vdocument.in/reader035/viewer/2022070523/58ed02f91a28ab33398b4601/html5/thumbnails/10.jpg)
Difficulties in daily living10
• Moving is hard• Tiredness• Dyspnea
Problems during transportation
Difficulties with hygiene
![Page 11: Surgical symposium 2015 st. valencia shchukin](https://reader035.vdocument.in/reader035/viewer/2022070523/58ed02f91a28ab33398b4601/html5/thumbnails/11.jpg)
Psycho-social problems
11
Negative selfesteem Social isolation Discrimination
![Page 12: Surgical symposium 2015 st. valencia shchukin](https://reader035.vdocument.in/reader035/viewer/2022070523/58ed02f91a28ab33398b4601/html5/thumbnails/12.jpg)
Why Lose Weight ?
• Feel Better• Quality of Life• Look Better• Be Healthier• Avoid Discrimination• Live Longer
![Page 13: Surgical symposium 2015 st. valencia shchukin](https://reader035.vdocument.in/reader035/viewer/2022070523/58ed02f91a28ab33398b4601/html5/thumbnails/13.jpg)
Treatment Options
• Diets• Exercise• Behavior Modification• Medication• Surgery
![Page 14: Surgical symposium 2015 st. valencia shchukin](https://reader035.vdocument.in/reader035/viewer/2022070523/58ed02f91a28ab33398b4601/html5/thumbnails/14.jpg)
14
![Page 15: Surgical symposium 2015 st. valencia shchukin](https://reader035.vdocument.in/reader035/viewer/2022070523/58ed02f91a28ab33398b4601/html5/thumbnails/15.jpg)
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
![Page 16: Surgical symposium 2015 st. valencia shchukin](https://reader035.vdocument.in/reader035/viewer/2022070523/58ed02f91a28ab33398b4601/html5/thumbnails/16.jpg)
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
![Page 17: Surgical symposium 2015 st. valencia shchukin](https://reader035.vdocument.in/reader035/viewer/2022070523/58ed02f91a28ab33398b4601/html5/thumbnails/17.jpg)
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
![Page 18: Surgical symposium 2015 st. valencia shchukin](https://reader035.vdocument.in/reader035/viewer/2022070523/58ed02f91a28ab33398b4601/html5/thumbnails/18.jpg)
Preoperative Preparation
1. Cardiac 2. Pulmonary3. Endocrine4. Psychiatric 5. Gastro-intestinal6. Dietician 7. Weight Loss
![Page 19: Surgical symposium 2015 st. valencia shchukin](https://reader035.vdocument.in/reader035/viewer/2022070523/58ed02f91a28ab33398b4601/html5/thumbnails/19.jpg)
19
![Page 20: Surgical symposium 2015 st. valencia shchukin](https://reader035.vdocument.in/reader035/viewer/2022070523/58ed02f91a28ab33398b4601/html5/thumbnails/20.jpg)
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
![Page 21: Surgical symposium 2015 st. valencia shchukin](https://reader035.vdocument.in/reader035/viewer/2022070523/58ed02f91a28ab33398b4601/html5/thumbnails/21.jpg)
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
![Page 22: Surgical symposium 2015 st. valencia shchukin](https://reader035.vdocument.in/reader035/viewer/2022070523/58ed02f91a28ab33398b4601/html5/thumbnails/22.jpg)
Operations for Obesity22
![Page 23: Surgical symposium 2015 st. valencia shchukin](https://reader035.vdocument.in/reader035/viewer/2022070523/58ed02f91a28ab33398b4601/html5/thumbnails/23.jpg)
Laparoscopic technique23
![Page 24: Surgical symposium 2015 st. valencia shchukin](https://reader035.vdocument.in/reader035/viewer/2022070523/58ed02f91a28ab33398b4601/html5/thumbnails/24.jpg)
![Page 25: Surgical symposium 2015 st. valencia shchukin](https://reader035.vdocument.in/reader035/viewer/2022070523/58ed02f91a28ab33398b4601/html5/thumbnails/25.jpg)
25
![Page 26: Surgical symposium 2015 st. valencia shchukin](https://reader035.vdocument.in/reader035/viewer/2022070523/58ed02f91a28ab33398b4601/html5/thumbnails/26.jpg)
Biliopancreatic diversion
![Page 27: Surgical symposium 2015 st. valencia shchukin](https://reader035.vdocument.in/reader035/viewer/2022070523/58ed02f91a28ab33398b4601/html5/thumbnails/27.jpg)
Sleeve gastrectomy27
Easier operation No dumping Normal uptake of food
But… • No long-term studies
![Page 28: Surgical symposium 2015 st. valencia shchukin](https://reader035.vdocument.in/reader035/viewer/2022070523/58ed02f91a28ab33398b4601/html5/thumbnails/28.jpg)
28
![Page 29: Surgical symposium 2015 st. valencia shchukin](https://reader035.vdocument.in/reader035/viewer/2022070523/58ed02f91a28ab33398b4601/html5/thumbnails/29.jpg)
29
![Page 30: Surgical symposium 2015 st. valencia shchukin](https://reader035.vdocument.in/reader035/viewer/2022070523/58ed02f91a28ab33398b4601/html5/thumbnails/30.jpg)
30
![Page 31: Surgical symposium 2015 st. valencia shchukin](https://reader035.vdocument.in/reader035/viewer/2022070523/58ed02f91a28ab33398b4601/html5/thumbnails/31.jpg)
31
![Page 32: Surgical symposium 2015 st. valencia shchukin](https://reader035.vdocument.in/reader035/viewer/2022070523/58ed02f91a28ab33398b4601/html5/thumbnails/32.jpg)
32
![Page 33: Surgical symposium 2015 st. valencia shchukin](https://reader035.vdocument.in/reader035/viewer/2022070523/58ed02f91a28ab33398b4601/html5/thumbnails/33.jpg)
33
![Page 34: Surgical symposium 2015 st. valencia shchukin](https://reader035.vdocument.in/reader035/viewer/2022070523/58ed02f91a28ab33398b4601/html5/thumbnails/34.jpg)
Risks of sleeve gastrectomyPostoperative complications
• Comparable with a cholecystectomy
Mortality < 1/2000
34
Early complications
Late complications
Bleeding Unsatisfactory weightloss
Leakage GE-reflux
![Page 35: Surgical symposium 2015 st. valencia shchukin](https://reader035.vdocument.in/reader035/viewer/2022070523/58ed02f91a28ab33398b4601/html5/thumbnails/35.jpg)
Adjustable gastric banding35
Affect satiety Adjustable Safe Reversible
![Page 36: Surgical symposium 2015 st. valencia shchukin](https://reader035.vdocument.in/reader035/viewer/2022070523/58ed02f91a28ab33398b4601/html5/thumbnails/36.jpg)
Gastric banding36
![Page 37: Surgical symposium 2015 st. valencia shchukin](https://reader035.vdocument.in/reader035/viewer/2022070523/58ed02f91a28ab33398b4601/html5/thumbnails/37.jpg)
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)
![Page 38: Surgical symposium 2015 st. valencia shchukin](https://reader035.vdocument.in/reader035/viewer/2022070523/58ed02f91a28ab33398b4601/html5/thumbnails/38.jpg)
Patients preop workup Knowledge of procedure Preparation
• Weightloss• Stop smoking Quit certain drugs
Eating behavior
Physical exercise
Vitamins
38
![Page 39: Surgical symposium 2015 st. valencia shchukin](https://reader035.vdocument.in/reader035/viewer/2022070523/58ed02f91a28ab33398b4601/html5/thumbnails/39.jpg)
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
39
![Page 40: Surgical symposium 2015 st. valencia shchukin](https://reader035.vdocument.in/reader035/viewer/2022070523/58ed02f91a28ab33398b4601/html5/thumbnails/40.jpg)
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
40
![Page 41: Surgical symposium 2015 st. valencia shchukin](https://reader035.vdocument.in/reader035/viewer/2022070523/58ed02f91a28ab33398b4601/html5/thumbnails/41.jpg)
41