Post on 06-Jul-2018
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CHIRURGIACHIRURGIAOBEZITATIIOBEZITATII
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Chirurgia ObezitatiiChirurgia Obezitatii
>>300 mili300 milioaneoane
USA >50% dintre adulti sunt obeziUSA >50% dintre adulti sunt obezisau supraponderali, 5% obezitatesau supraponderali, 5% obezitate
morbidamorbida
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Consumenergetic
Aportenergetic
CauzeCauze
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CauzeCauze
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MORBIDEMORBIDE
IMC>40kg!"IMC>40kg!" IMCIMC
Normal 20-2,!Normal 20-2,! SuraponderalSuraponderal 25-2!,!25-2!,! "be"bezitatezitate 30-3,!30-3,! "bezitate morbida"bezitate morbida
35-3!,!35-3!,!
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#HO C$a%%i&'ati() #HO C$a%%i&'ati() BMIBMI Ri%k (* DeathRi%k (* Death
Under#ei$tUnder#ei$t &elo# '()5&elo# '()5 *o#*o#
+ealt #ei$t+ealt #ei$t '()5-2)!'()5-2)! Aera$e Aera$e
"er#ei$t .$rade '"er#ei$t .$rade 'obesit/obesit/
25)0-2!)!25)0-2!)! Mild inreaseMild inrease
"bese .$rade 2"bese .$rade 2obesit/obesit/
30)0-3!)030)0-3!)0 Moderate1seeModerate1seerere
Morbid1seereMorbid1seereobesit.$rade 3/obesit.$rade 3/
0)0 and0)0 andaboeaboe
er seere er seere
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Femei
>88 cm (80cm) = risc crescut
Barbati
>102 cm (90cm) = ric crescut
DI+TRIBUTIE GRA+IMIIDI+TRIBUTIE GRA+IMII,A--.E +HA-E/,A--.E +HA-E/
cm
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E*e'te a$e (bezitatiiE*e'te a$e (bezitatii
CardiovascularRespiratory disease
Gall bladder disease
Hormonal abnormalities
gout
Stroke
Diabetes
Osteoarthritis
Cancer
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EECTEEECTE ipertensiuneipertensiune iperlipidemieiperlipidemie
diabetes mellitusdiabetes mellitus
IespIesp
+ipoentilatie prin+ipoentilatie prinobezitateobezitate
Apnee de sommn Apnee de sommn
Astm bronsi Astm bronsi
Cardiomiopatie 4IMCardiomiopatie 4IM
&6&6
7ombo8ebita si7ombo8ebita si
boalaboala
tromboemboliatromboembolia
Aident Aidentardioasulareardioasulare
Inontinenta de e9ortInontinenta de e9ort
Artropatii Artropatii
de$eneratiede$eneratie :ureri spate:ureri spate
Uler ariosUler arios
*itiaza aziulara*itiaza aziulara
Amenoree Amenoree In9ertilitateIn9ertilitate
In9etii in8amatiiIn9etii in8amatii
te$umentarete$umentare
↑↑ aner .uter, sin,aner .uter, sin,olon rostataolon, rostata
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+TATI+TICA 1U MI1TE+TATI+TICA 1U MI1TERUMO+RUMO+
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+TATI+TICA 1U MI1TE+TATI+TICA 1U MI1TERUMO+RUMO+
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+TATI+TICA 1U MI1TE+TATI+TICA 1U MI1TERUMO+RUMO+
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-.A1URI DE 2IITOR -.A1URI DE 2IITOR
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TRATAME1TTRATAME1T
MetodeMetode;; Simbarea stilului de iataSimbarea stilului de iata
7ratament mediamentos7ratament mediamentos
Cirur$ieCirur$ie
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De 'e 3i%'uta! 'hirurgiaDe 'e 3i%'uta! 'hirurgiabariatri'abariatri'a
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Cre%tere e56()e)tia$aCre%tere e56()e)tia$a
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Be)e&'ii 3ire'te a %'a3eriiBe)e&'ii 3ire'te a %'a3erii708 a !a%ei '(r6(ra$e708 a !a%ei '(r6(ra$e
MortalitateMortalitate >20% sadere mortalitate>20% sadere mortalitate$lobala$lobala
>30% sadere mortalitate>30% sadere mortalitatele$ata :< >0% saderele$ata :< >0% saderemortalitate le$ata demortalitate le$ata deobezitateobezitate
=resiune arteriala=resiune arteriala Sadere u '0% a sistoliei siSadere u '0% a sistoliei sidiastoilieidiastoiliei
:iabet:iabet 50% sadere a $liemiei a50% sadere a $liemiei a
eun eun
=ro?l lipidi=ro?l lipidi '0% sadere Col total'0% sadere Col total
'5% sadere *:*'5% sadere *:*
30% sadere 730% sadere 7
(% restere +:*(% restere +:*
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TRATAME1TTRATAME1T
M(3i&'area %ti$u$ui 3e 9iataM(3i&'area %ti$u$ui 3e 9iata :ieta ipo-aloria:ieta ipo-aloria .(00-'200 @al1.(00-'200 @al1zizi//; sop; sop
(% pierdere in $reutate in luni .prin(% pierdere in $reutate in luni .prin
saderea tesutului adipos/saderea tesutului adipos/
E5er'itii &zi'eE5er'itii &zi'e, 3-B, 3-B sesiunisesiuni11sapt timp desapt timp de
30-0 min30-0 min) Sop 2-3% sadere in $reutate) Sop 2-3% sadere in $reutate
M(3i&'ari '(!6(rta!e)ta$e:M(3i&'ari '(!6(rta!e)ta$e: identi?areidenti?arestimuli, autoealuare, $rupuri de suport/stimuli, autoealuare, $rupuri de suport/
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TRATAME1TTRATAME1T
Me3i'atieMe3i'atie Cind modi?arile stilului de iata nuCind modi?arile stilului de iata nu
autaauta
sibutramine,sibutramine, iniba reabsorbtia deiniba reabsorbtia deserotoninserotoninaa
orlistat,orlistat, iniba lipaza panreatiainiba lipaza panreatia
-'0%-'0%
sadere in $reutate in ' an .rebound/sadere in $reutate in ' an .rebound/
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ChirurgieChirurgie I)3i'aI)3i'atiitii
IMC>0IMC>0 IMC>35IMC>35 u omorbiditatiu omorbiditati
:upa un an de tratament medial:upa un an de tratament medial
"bezitate stabila sau a$raata in ultimii 5 ani"bezitate stabila sau a$raata in ultimii 5 ani
C()trai)3i'aC()trai)3i'atiitii
=robleme psiiatrie=robleme psiiatrie =robleme tiroidiene sau suprarenale=robleme tiroidiene sau suprarenale
=atolo$ie in8amatorie a tratului di$esti=atolo$ie in8amatorie a tratului di$esti
:ependenta de alool sau dro$uri de ris:ependenta de alool sau dro$uri de ris
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CHIRURGIECHIRURGIE A; A; -r('e3uri re%tri'ti9e-r('e3uri re%tri'ti9e SC"=; saderea olumului rezeroruluiSC"=; saderea olumului rezerorului
$astri la$astri la '5-20 ml'5-20 ml *imiteaza apaitatea de in$estie S"*I:6*imiteaza apaitatea de in$estie S"*I:6
Senzatie preoitate de Dstoma plinESenzatie preoitate de Dstoma plinE Sade senzata de 9oameSade senzata de 9oame
=roeduri=roeduri
Ba$()a% ga%tri'Ba$()a% ga%tri' Ga%tri' ba)3i)gGa%tri' ba)3i)g Ga%tr(6$a%tie 9erti'a$a 3e 'a$ibrareGa%tr(6$a%tie 9erti'a$a 3e 'a$ibrare Reze'tia !arii 'urburi ga%tri'e <ga%tri'Reze'tia !arii 'urburi ga%tri'e <ga%tri'
%$ee9e=%$ee9e=
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Au%tare i)e$ Au%tare i)e$
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C(!6$i'atii ga%tr(ba)3aC(!6$i'atii ga%tr(ba)3a Aluneare .5%/ Aluneare .5%/
einterentieeinterentie 6rosiune .0)'%/6rosiune .0)'%/
Neesita eFtra$ereNeesita eFtra$ere
=er9orare tubulatura=er9orare tubulatura.'%/.'%/ inlouireinlouire
In9etare port .0)5%/In9etare port .0)5%/ Antibiotie Antibiotie
Nu slabeste .5%/Nu slabeste .5%/ 6Ftra$ere si b-pass6Ftra$ere si b-pass
Mortalitate; ' in >3000Mortalitate; ' in >3000
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CHIRURGIECHIRURGIE
B;B; -r('e3ee 'are i)3u'-r('e3ee 'are i)3u'!a$ab%(rbita!a$ab%(rbita Di9er%ie bi$i(6a)'reati'ai)9er%ieDi9er%ie bi$i(6a)'reati'ai)9er%ie
3u(3e)a$a3u(3e)a$a Ab%r(btie $i6i3i'a "?8 Ab%r(btie $i6i3i'a "?8 M(3i&'ari '(!6(rta!e)ta$eM(3i&'ari '(!6(rta!e)ta$e
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B@ 6a%% $a6ar(%'(6i'B@ 6a%% $a6ar(%'(6i'
'!0s :rs Mason and Ito'!0s :rs Mason and Ito
estriti; rezeror $astri mi .'5-estriti; rezeror $astri mi .'5-
20/20/ Modi?are anatomia ;Modi?are anatomia ;
Continutul $astri este diriat B5-Continutul $astri este diriat B5-
'50m distal de li$amentul lui 7reitz )'50m distal de li$amentul lui 7reitz )=reine re8uFul biliopanreati in stoma=reine re8uFul biliopanreati in stoma
69et de malabsorbtie69et de malabsorbtie
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-r(b$e!e-r(b$e!e reu sau imposibil
de reenit
2 anastomoze
'2 mm stoma Suplimentare u
itamine toata iata
69ete aderse; dumpin$,
Stenoze anastomotie
:e?iente de ?er,
aliu et
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CHIRURGIECHIRURGIE
C;C; -r('e3ee '(!bi)ate-r('e3ee '(!bi)ate estritie 4 proedee are induestritie 4 proedee are indu
malabsorbtiemalabsorbtie
Ga%tri' b@6a%% 'u a)%a i)Ga%tri' b@6a%% 'u a)%a i) // GO.D +TA1DARGO.D +TA1DAR in obsitatea morbida)in obsitatea morbida)
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+$ee9e+$ee9e
=roedeu strit=roedeu stritrestritirestriti
Stoma tubularStoma tubular DDNe# Gid on te &lo@ENe# Gid on te &lo@E
Maor pierdereMaor pierdereimportanta ACU7A inimportanta ACU7A in$reutate$reutate
H Supresia $relineiH Supresia $relinei
Nu bpassNu bpass Nu modi?ariNu modi?aridramatie de anatomiedramatie de anatomie
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+$ee9e+$ee9e
'-2% ris de ?stula din linia de'-2% ris de ?stula din linia de
setiunesetiune einterentiieinterentii
:ees:ees Spitalizare prelun$itaSpitalizare prelun$ita
=osibila reinterentia de ompletare=osibila reinterentia de ompletare
astri bpassastri bpass $astrobanda$astrobanda
e-sleeee-sleee
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C(!6$i'atiiC(!6$i'atii =neumonie 7rombo8ebite si
ompliatii
Sin$erare In9etii
=erotinita
?stula .2-3%/
:ees; ' in 200