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Debe de ser el imc un criterio para la cirugía metabólica
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Debe de ser el imc un criterio para la cirugía metabólica

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Debe de ser el imc un criterio para la cirugía metabólica Debe de ser el imc un criterio para la cirugía metabólica Presentation Transcript

  • METABOLIC SURGERY
    CENTRO HOSPITALAR DE ENTRE O DOURO E VOUGA
    GASTRO OBESO CENTER
    SAO PAULO, BRAZIL
    BMI
    AS A PARAMETER TO RECOMMEND
    METABOLIC SURGERY
    Almino Ramos, MD
    Mário Nora, MD
    Galvao Neto, MD
  • Bypass gástrico metabólico
    MetabolicSurgery
    • Any anatomic change in digestive tract that will improves metabolic conditions
    • diabetes mellitus type II
    • arterial hypertension Metabolic Syndrome
    • dislipidemia
    • sleep apnea
  • Final comments
    Pierda de peso
    2. Dieta restrictiva
  • DMT2TRATAMIENTO QUIRÚRGICO
    Mecanismos de acción
    Hormonal
    1a Hipótesis
    “Grasa visceral”
    Órgano endocrino
    Ramos, Almino. Galvão Neto, Manoel. Galvão Manoela. Carlo, Andrey
    OMENTECTOMIA LAPAROSCÓPICA NA BGA. BGA x ALT METABÓLICAS, ESTUDO PROSPECTIVO
    VII Congresso Brasileiro de Cirurgia Bariátrica – Florianópolis – Santa Catarina – Brasil, 2005
  • DMT2TRATAMIENTO QUIRÚRGICO
    Mecanismos de acción
    Hormonal
    2a Hipótesis
    Grelhina
  • DMT2TRATAMIENTO QUIRÚRGICO
    Mecanismos de acción
    Hormonal
    3ahipótesis
    “Hindgut”
    Estimulación ilealprecose
    “Ileal break”
    100 años
    Hoy
  • Duodenal-Jejunal Bypass
    100cm
    100cm
  • GASTRECTOMIA EM MANGA (“SLEEVE”) + INTERPOSIÇÃO ILEAL “ILEAL BREAK”
  • Device – Concept
  • Effect of bariatric procedures on T2DM
    <
    <
  • DM>5yrs is not good
    Resolution (%) of diabetes at six months after sleeve gastrectomy according to diabetes duration.
    Rosenthal :SOARD Volume 5, Issue 4, Pages 429-434
  • C-Peptide < 3 is not good
    C-peptide > 3 is the most important predictor for a successful treatment for LSG.
    WJ Lee; Surgery. 2010 May;147(5):664-9. Epub 2009 Dec 11.
  • DUODENAL-JEJUNAL BYPASSJesus Arguilles – Mexico - 2004
  • Porque pensar en la DMT2 y Tratamiento quirúrgico – Datos en humanos
    Arguelles – México
    T2DM patients– “no selection”
    Duodenal-Jejunal Bypass – open
    N = 10p
    Resolution 5p
    Improvement 2p
    No results 3p
    Arguelles - Obesity Surgery. 2007, Latin American IFSO Meeting
  • Porque pensar en la DMT2 y Tratamiento quirúrgico – Datos en humanos
    Arguelles – México
    T2DM patients– “no selection”
    Duodenal-Jejunal Bypass – open
    N = 10p – 4 years follow up
    Resolution 0
    Improvement 1p
    No results 9p
    Arguelles – Mexican National Bariatric Congress - 2009
  • Duodenal-Jejunal bypass Surgical treatment - Human data
  • Duodenal-Jejunal bypass Surgical treatment - Human data
  • Duodenal-Jejunal bypass Surgical treatment - Human data
  • MetabolicgastricBypass
    GastricPouch 50 cm³
    Gastro-jejunostomynotcalibrate?
    Alimentarylimb 150 cm
    Biliopancreaticlimb 100 cm
    Laparotomy - 17
    N= 27
    December 2010
    Laparoscopy - 10
  • MetabolicgastricBypass
    Gastric Pouch ?
    Gastro-jejunostomy calibrated 12mm
    Alimentary limb 150 cm
    Biliopancreatic limb 50 cm
    N = 37
    February 2006
  • MetabolicgastricBypass
    Metabolic Bypass , inicial experience with Roux-en-Y
    Gastric Bypass on tipe II diabetes treatment
    AlminoC Ramos, Manoel Galvão, Manuela Galvão, AndreyCarlo,EdwinCanseco, Thales D. Galvão, Luis F Evangelista, Alvaro Ferraz e Josemberg L Campos
    São Paulo and Recife - Brasil
    GastricPouch “doublesize”
    Gastro-ileostomynotcalibrate
    Alimentarylimb 100 – 200 cm
    Biliopancreaticlimb 200 cm
    IFSO 2010
    IFSO 2010
  • MetabolicgastricBypass
    October 2007
    N=44
  • MetabolicgastricBypass
    100 cm
    200 cm
    May 2008
    N=20
  • Metabolic gastric Bypass
    Gastric Pouch 25-30 cm³
    Gastro-jejunostomy not calibrate
    Alimentary limb 150 cm
    Biliopancreatic limb 50 cm
    N=15
    August 2009
  • MetabolicgastricBypass
  • MetabolicgastricBypass
  • MetabolicgastricBypass
    LAPAROSCOPIC SURGERY XVIII
    Mário Nora 2011
  • MetabolicgastricBypass
  • MetabolicgastricBypass
    Inclusion criteria:
    • BMI
    • Age
    • DMT2 – Time?
    • Use of insulin
    • C peptide
    • HbA1c
    • Comorbidities
    LAPAROSCOPIC SURGERY XVIII
    Mário Nora 2011
  • METABOLIC SURGERY
    CENTRO HOSPITALAR DE ENTRE O DOURO E VOUGA
    GASTRO OBESO CENTER
    SAO PAULO, BRAZIL
    BMI
    AS A PARAMETER TO RECOMMEND
    METABOLIC SURGERY
    Almino Cardoso Ramos
    ramos.almino@gmail.com
    Phone55 11 83722322