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Surgical symposium 2015 st. valencia shchukin
- 2. Definition of Obesity according to BMI Underweight <18.5 Normal 18.5 – 24.9 Overweight 25-29.9 Obesity >30 moderate 30.0 – 34.9 severe 35.0 – 39.9 morbid >40 BMI = W(kg)/H (m²)
- 3. What Causes Obesity ? Obesity develops when energy intake consistently exceeds energy output Complex disease involving: - genetics - physiology - metabolism - appetite regulation - environmental factors - psychosocial & cultural
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- 5. 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
- 6. 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.
- 7. 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
- 8. Metabolic Syndrome Abdominal obesity Hyperinsulinemia High fasting plasma glucose Impaired glucose tolerance Hypertriglyceridemia Low HDL-cholesterol Hypertension
- 9. Risk of Death and Obesity 0 100 200 300 15 20 25 30 35 40 BMI D E A T H
- 10. Difficulties in daily living 10 • Moving is hard • Tiredness • Dyspnea Problems during transportation Difficulties with hygiene
- 11. Psycho-social problems 11 Negative selfesteem Social isolation Discrimination
- 12. Why Lose Weight ? • Feel Better • Quality of Life • Look Better • Be Healthier • Avoid Discrimination • Live Longer
- 13. Treatment Options • Diets • Exercise • Behavior Modification • Medication • Surgery
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- 15. 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
- 16. 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
- 17. 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
- 18. Preoperative Preparation 1. Cardiac 2. Pulmonary 3. Endocrine 4. Psychiatric 5. Gastro-intestinal 6. Dietician 7. Weight Loss
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- 20. 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
- 21. 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
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- 27. Sleeve gastrectomy 27 Easier operation No dumping Normal uptake of food But… • No long-term studies
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- 34. Risks of sleeve gastrectomy Postoperative complications • Comparable with a cholecystectomy Mortality < 1/2000 34 Early complications Late complications Bleeding Unsatisfactory weightloss Leakage GE-reflux
- 35. Adjustable gastric banding 35 Affect satiety Adjustable Safe Reversible
- 37. 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)
- 38. Patients preop workup Knowledge of procedure Preparation • Weightloss • Stop smoking Quit certain drugs Eating behavior Physical exercise Vitamins 38
- 39. 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
- 40. 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
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