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

  1. 1. METABOLIC SURGERY<br />CENTRO HOSPITALAR DE ENTRE O DOURO E VOUGA<br />GASTRO OBESO CENTER<br />SAO PAULO, BRAZIL<br />BMI<br />AS A PARAMETER TO RECOMMEND <br />METABOLIC SURGERY<br />Almino Ramos, MD<br />Mário Nora, MD<br />Galvao Neto, MD<br />
  2. 2. Bypass gástrico metabólico<br />MetabolicSurgery<br /><ul><li>Any anatomic change in digestive tract that will improves metabolic conditions
  3. 3. diabetes mellitus type II
  4. 4. arterial hypertension Metabolic Syndrome
  5. 5. dislipidemia
  6. 6. sleep apnea</li></li></ul><li>
  7. 7. Final comments <br />Pierda de peso<br />2. Dieta restrictiva<br />
  8. 8. DMT2TRATAMIENTO QUIRÚRGICO<br />Mecanismos de acción<br />Hormonal<br />1a Hipótesis<br />“Grasa visceral”<br />Órgano endocrino<br />Ramos, Almino. Galvão Neto, Manoel. Galvão Manoela. Carlo, Andrey <br />OMENTECTOMIA LAPAROSCÓPICA NA BGA. BGA x ALT METABÓLICAS, ESTUDO PROSPECTIVO<br />VII Congresso Brasileiro de Cirurgia Bariátrica – Florianópolis – Santa Catarina – Brasil, 2005<br />
  9. 9. DMT2TRATAMIENTO QUIRÚRGICO<br />Mecanismos de acción<br />Hormonal<br />2a Hipótesis<br />Grelhina<br />
  10. 10. DMT2TRATAMIENTO QUIRÚRGICO<br />Mecanismos de acción<br />Hormonal<br />3ahipótesis <br />“Hindgut”<br />Estimulación ilealprecose<br />“Ileal break”<br />100 años<br />Hoy <br />
  11. 11. Duodenal-Jejunal Bypass <br />100cm<br />100cm<br />
  12. 12. GASTRECTOMIA EM MANGA (“SLEEVE”) + INTERPOSIÇÃO ILEAL “ILEAL BREAK” <br />
  13. 13. Device – Concept<br />
  14. 14. Effect of bariatric procedures on T2DM<br /><<br /><<br />
  15. 15. DM>5yrs is not good<br />Resolution (%) of diabetes at six months after sleeve gastrectomy according to diabetes duration. <br />Rosenthal :SOARD Volume 5, Issue 4, Pages 429-434<br />
  16. 16. C-Peptide < 3 is not good<br />C-peptide > 3 is the most important predictor for a successful treatment for LSG.<br />WJ Lee; Surgery. 2010 May;147(5):664-9. Epub 2009 Dec 11. <br />
  17. 17.
  18. 18.
  19. 19. DUODENAL-JEJUNAL BYPASSJesus Arguilles – Mexico - 2004<br />
  20. 20. Porque pensar en la DMT2 y Tratamiento quirúrgico – Datos en humanos<br />Arguelles – México<br />T2DM patients– “no selection”<br />Duodenal-Jejunal Bypass – open <br />N = 10p<br />Resolution 5p<br />Improvement 2p<br />No results 3p<br />Arguelles - Obesity Surgery. 2007, Latin American IFSO Meeting<br />
  21. 21. Porque pensar en la DMT2 y Tratamiento quirúrgico – Datos en humanos<br />Arguelles – México<br />T2DM patients– “no selection”<br />Duodenal-Jejunal Bypass – open <br />N = 10p – 4 years follow up<br />Resolution 0<br />Improvement 1p<br />No results 9p<br />Arguelles – Mexican National Bariatric Congress - 2009<br />
  22. 22. Duodenal-Jejunal bypass Surgical treatment - Human data<br />
  23. 23. Duodenal-Jejunal bypass Surgical treatment - Human data<br />
  24. 24. Duodenal-Jejunal bypass Surgical treatment - Human data<br />
  25. 25. MetabolicgastricBypass<br />GastricPouch 50 cm³<br />Gastro-jejunostomynotcalibrate?<br />Alimentarylimb 150 cm<br />Biliopancreaticlimb 100 cm<br />Laparotomy - 17<br />N= 27<br />December 2010<br />Laparoscopy - 10<br />
  26. 26. MetabolicgastricBypass<br />Gastric Pouch ?<br />Gastro-jejunostomy calibrated 12mm<br />Alimentary limb 150 cm<br />Biliopancreatic limb 50 cm<br />N = 37<br />February 2006<br />
  27. 27. MetabolicgastricBypass<br />Metabolic Bypass , inicial experience with Roux-en-Y<br />Gastric Bypass on tipe II diabetes treatment<br />AlminoC Ramos, Manoel Galvão, Manuela Galvão, AndreyCarlo,EdwinCanseco, Thales D. Galvão, Luis F Evangelista, Alvaro Ferraz e Josemberg L Campos<br />São Paulo and Recife - Brasil<br />GastricPouch “doublesize”<br />Gastro-ileostomynotcalibrate<br />Alimentarylimb 100 – 200 cm<br />Biliopancreaticlimb 200 cm<br />IFSO 2010<br />IFSO 2010<br />
  28. 28. MetabolicgastricBypass<br />October 2007<br />N=44<br />
  29. 29. MetabolicgastricBypass<br />100 cm<br />200 cm<br />May 2008<br />N=20<br />
  30. 30. Metabolic gastric Bypass<br />Gastric Pouch 25-30 cm³<br />Gastro-jejunostomy not calibrate<br />Alimentary limb 150 cm<br />Biliopancreatic limb 50 cm<br />N=15<br />August 2009<br />
  31. 31. MetabolicgastricBypass<br />
  32. 32. MetabolicgastricBypass<br />
  33. 33. MetabolicgastricBypass<br />LAPAROSCOPIC SURGERY XVIII<br />Mário Nora 2011<br />
  34. 34. MetabolicgastricBypass<br />
  35. 35. MetabolicgastricBypass<br />Inclusion criteria:<br /><ul><li>BMI
  36. 36. Age
  37. 37. DMT2 – Time?
  38. 38. Use of insulin
  39. 39. C peptide
  40. 40. HbA1c
  41. 41. Comorbidities</li></ul>LAPAROSCOPIC SURGERY XVIII<br />Mário Nora 2011<br />
  42. 42. METABOLIC SURGERY<br />CENTRO HOSPITALAR DE ENTRE O DOURO E VOUGA<br />GASTRO OBESO CENTER<br />SAO PAULO, BRAZIL<br />BMI<br />AS A PARAMETER TO RECOMMEND <br />METABOLIC SURGERY<br />Almino Cardoso Ramos<br />ramos.almino@gmail.com<br />Phone55 11 83722322<br />

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