TR ATA M EN

TU L
O B EZ ITII
M O R B ID E

N O RM AL
Grsimea din
corp

Brbat

15 22 %

Femeie

18 33 %

Circumferina
O B EZ ITATE taliei

> 100 cm
Brbat
Femeie

> 88 cm

IN D IC ELE D E M A SA
GI = Greutatea
C O R P O R A LAideal
( IM C )
GI
____
IMC = 2
I

= nlimea, n
metri

IMC < 35 SUPRAPONDERAL

IMC = 35
RISC

40
OBEZITATE+RISCURI
IMC > 40

G R EU TATEA ID EA LA
I (cm) = nlimea, n
cm

Brbat
Femeie

I 100 (kg)
I 100 10 (kg)

IN D IC AII
IMC > 40
IMC = 35 40, dar cu afeciuni majore:
Artrit
Sterilitate
Esofagit de reflux
Hipertensiune
Diabet
Probleme psihosociale

Vrsta = 18 60 ani
Eecul tratamentului conservator
Pacient cooperant (dup operaie)
Acceptarea riscurilor operaiei

C O N TR A IN D IC AII

IMC < 35
Vrsta < 18 ani
Vrsta > 60 ani
Obezitate de cauz endocrin
Dependen de droguri i alcool
Boli asociate grave:
Hepatopatie grav
Cardiopatie grav
Patologie digestiv

Bariatric Surgery Trends

JAMA, 289(14): 17611762, April 9, 2003

US Bariatric surgeries performed per

year
2001: 47,000
2002: 63,000
2003 (projected): 98,000

Bariatric Surgeries
25000

20000

15000
1998
2002
10000

5000

0
12-17

18-34

35-44

45-54

55-64

>65

Age Group

Source: Health Affairs, July/Aug 2005

Surgery to D ecrease
Food Intake
Gastroplasty
Gastric banding
Vertical banded

gastroplasty

G astric Banding

VerticalBanded G astroplasty

W eight Loss O utcom es of

G astroplasty
80% lose weight
30% achieve normal weight
some regain some of lost

weight
improves obesity related
conditions
success depends on
motivation and behaviors

Risks ofG astroplasty

vomiting
erosion of band, breakdown

of staple line
10-20% require follow-up
operations
1/3 develop gallstones

Surgery to Reduce Food Intake

and N utrient Absorption

Gastric Bypass Surgery

Roux-en-Y Gastric Bypass

Roux-en-Y G astric Bypass

O utcom es ofG astric Bypass

Surgery
produces more weight

loss than gastroplasty

generally lose 2/3rds of
excess weight within 2
years

Risks ofG astric Bypass

Surgery
like gastroplasty
chronic diarrhea
nutritional deficiencies
vitamin B-12
iron
calcium

G astric B ypass Surgery Com plications: 14Year Follow up

Surgical Complications
Number of Patients
Vitamin B12 deficiency 239 39.9
Readmit for various reasons 229 38.2
Incisional hernia 143 23.9
Depression 142 23.7
Staple line failure
90 15.0
Gastritis 79 13.2
Cholecystitis
68 11.4
Anastomotic problems 59
9.8
Dehydration, malnutrition 35 5.8
Dilated pouch 19 3.2
Data derived from source (Pories et al.) and modified based on personal communication.
Source: Pories WJ, Swanson MS, MacDonald KG Jr, et al. Who would have thought it?
An operation proves to be the most effective therapy for adult-onset diabetes mellitus.
Ann Surg. 1995;222:339-350; discussion 350-352.

% of Patients

C O N C LU Z II
Obezitatea morbid este o patologie att
de frecvent nct trebuie s o
recunoatem ca atare

Terapiile conservatoare sunt ineficiente pe

termen
lung

Obezitatea morbid este de resort

chirurgical

Rezolvarea minim invaziv prin

gastroband este o soluie pertinent
pentru cazurile obinuite

C O N C LU Z II
Perspectiva de scdere ponderal este de
25 - 35% din IMC
Gastrobanda poate fi pclit prin regimul
alimentar
Cazurile de obezitate extrem necesit
intervenii de by-pass digestiv

M O R A LA