Portfolio – Bariatric Center

Testimonials

miguel ortega — Sun, 29 Apr 2018 22:32:07 +0000

Testimonials

Marcia - Manga gástrica

Paty - Manga gástrica

Rocio - Manga gástrica

Rosa - Bypass gástrico

Sergio - Bypass gástrico

Silvia - Manga gástrica

Denisse - Bypass gástrico

Elia - Manga gástrica

Joel - Bypass gástrico

Micaela - Bypass gástrico

Mily - Manga gástrica

Paco - Bypass gástrico

Diabetes and Obesity?

miguel ortega — Sun, 29 Apr 2018 22:16:37 +0000

Am I Candidate for Obesity Surgery?

miguel ortega — Sun, 29 Apr 2018 22:15:17 +0000

The management of the obese patient at present must be Multidisciplinary, with the main objective of offering our patients a safe and effective surgical procedure tailored to their needs. The initial evaluation is Clinical Nutrition and includes the classification of the patient according to the degree of Obesity through the Body Mass Index.

HOW IS OBESITY CLASSIFIED?

Obesity is classified in degrees according to the Body Mass Index (BMI), which is the Weight (in Lb) divided by the Size (in In²), established by L.A.J. Quetelet in Belgium in 1835, according to Kral (2001). The original publication of Quetelet, published in 1842, has been reproduced in Obesity Research (Quetelet 1994). The World Health Organization (WHO 1997) and the National Institutes of Health (NIH 1998) have adopted the BMI as a parameter of obesity.

Classification of Obesity according to the BMIObesity ClassBMI (lb / in²)

Normal	–	18.5 – 24.9
Overweight	–	25 – 29.9
Obesity	I	30 – 34.9
Morbid obesity	II	35 – 39.5
Obesity	III	more than 40
Super Obesity	–	more than 50
Super Super Obesity	–	more than 60
Triple Obesity	–	more than 65

The risks of comorbidity and mortality associated with these categories are classified as “increased” in the range of 25.0-29.9 lb/in², “moderate” in Class I, “severe” in Class II and “very severe” In Class III (Kral 2001).

• OBESITY SURGERY INDICATIONS:

The Consensus of the National Institutes of Health establishes that patients with a BMI greater than 40 lb/in² (Class IV) should be considered for surgery, and also those with less marked obesity, BMI 35-40 lb/in² (Class III), with concomitant pathologies (comorbidity) of high risk, such as cardiopulmonary disease, sleep apnea, uncontrollable diabetes and hypertension. However, cases with body mass indexes between 30 and 35 in the presence of comorbidity, and a history of nutritional medical management in obesity with poor response, could be analyzed and agreed to undergo Bariatric Surgery.

Indications:

1. Age over 18 years old and under 60 years old.

2. BMI greater than 40.

3. BMI greater than 35 in the presence of comorbidity.

4. Morbid obesity maintained for more than 3 years.

5. BMI between 30 and 35 in the presence of comorbidities and poor response to nutritional medical management. (Previous consensus of the medical group).

6. Ages between 15 and 18 years, with a BMI greater than 40 in the presence of comorbidity or greater than 50 without comorbid. (Previous consensus of the medical group).

7. Ages between 60 and 70 years, with acceptable operational risk. (Previous consensus of the medical group).

Contraindications:

1. Age under 15 years and over 70 years.

2. BMI less than 30.

3. High Operative Risk

4. Drug addiction and alcoholism.

5. Mental Retardation

6. Psychotic disorders without medical control.

7. Bulimia Nervosa.

The Selection of a Patient that is candidate for Obesity Surgery must apart from having these criteria, be submitted to an evaluation and consensus on the part of our medical group according to the following specialties.

• Clinical Nutrition

• Internal Medicine and Medical Sub-specialties such as Pulmonology, Cardiology and Critical Medicine in case of being a High Risk patient.

• Psychology and Behavioral Management

• Anesthesiology

• Obesity surgery

• Plastic surgery

• Physical rehabilitation

Orbera

miguel ortega — Sun, 29 Apr 2018 22:13:59 +0000

Allergan intragastric balloon ®

It is an alternative non-surgical and non-pharmacological system for the treatment of obesity. It is designed to cause a temporary loss of weight in obese patients, by partially filling the stomach and helping them feel a sense of satisfied and fullness.

Short-term treatment is indicated in the following cases:

1. Patients with mild to moderate obesity, with significant risks to their health related to their obesity and who have failed to achieve and maintain a weight loss with other methods or programs supervised by doctors.

2. The BIB system is also usable for the temporary loss of weight in severely obese patients (or super obese with a BMI> 50), to help them reduce the surgical risk in preparation for a more definitive surgery.

3. Obese patients who are candidates for surgery but who are at high risk or who simply reject surgery as the only alternative treatment.

Contraindications:

• Large Hiatal hernia with symptomatic RGE

• Gastric or duodenal ulcer

• Malignancy

• No tolerance

• Not willing to change habits

• Believe in magical effects

• Pregnancy

The intragastric balloon is made of high quality silicone, durable and resistant to stomach acid, is designed to be used in conjunction with a supervised long-term diet and in context with a habit modification program, to help the patient maintain Weight loss once the appliance is removed. The intragastric balloon is introduced into the stomach endoscopically (through the mouth), without the need for surgery, is placed deflated with topical anesthesia in the throat and with deep sedation given by an anesthesiologist, without the need for general anesthesia. The balloon is then filled with saline using a total volume between 400 to 800 ml, mixed with a blue tincture of methylene to detect spontaneous ruptures during treatment. The procedure usually lasts 20 to 30 minutes and does not require an overnight hospital stay in the vast majority of cases. Once filled the balloon is too large to pass to the intestines and will float freely within the stomach.

The orbiting system can be used for 6 months. It is not recommended for longer periods. Over time, acid and stomach bacteria will weaken the balloon material and cause it to deflate. The use of medications that reduce stomach acid during these months is recommended to reduce stomach and balloon damage. If the balloon is deflated or broken prematurely, you will notice a change in urine color, due to the dye that is injected as a safety mechanism inside the balloon.

This technique offers a good possibility to reduce body weight, on average the weight loss is in the range of about 15 to 20 kgs. 5 months after the placement of the balloon. After 6 months the balloon can be deflated and removed endoscopically without difficulty. Consecutive balloons can be placed to extend the treatment if necessary.