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Cirugia para la obesidad
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Cirugia para la obesidad

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 DEFINICIÓN

La cirugía de la obesidad debería plantearse únicamente en casos seleccionados de obesidad mórbida (obesidad patológica grave).

 RIESGOS

El riesgo operatorio de todas las intervenciones es similar. La mortalidad no es elevada, y la causa más frecuente de muerte no está relacionada con la técnica sino con el embolismo pulmonar, otras complicaciones médicas (pulmón, corazón, etc.) y el grado de obesidad.

 EFICACIA

La obesidad mórbida es muy difícil de curar y el tiempo ha demostrado que con medicinas e incluso con la cirugía es una enfermedad muy "resistente" a todos los tratamientos. Generalmente las intervenciones sencillas tienen un alto índice de fracaso a largo plazo. Las intervenciones actuales pueden hacer perder el 50% del sobrepeso, y ayudar mucho al resto, y sus efectos a menudo duran de por vida.
 
 
 
Muchas operaciones, sin embargo, no lo consiguen, y además afectan a la calidad de vida del operado. En algunas operaciones es frecuente tener que reoperar por fallar la técnica en la pérdida de peso.

  TÉCNICAS

La Gastroplastia Vertical Anillada (GVA). A largo plazo supone un índice de reoperaciones entre el 25 y 50 por ciento. La mitad de los fracasos son debidos a la operación y la otra mitad a los propios pacientes, que mantienen ingesta de comidas con alto índice calórico que les hacen ganar peso. La calidad de vida no es buena porque, de por vida, el paciente está condenado a "no disfrutar" de la comida.
La anilla ajustable por laparoscopia. Se puede aplicar por laparoscopia (visión directa del abdomen por tubo de fibra óptica a través de una incisión diminuta), es decir, sin abrir el abdomen, pero no se ha podido demostrar que los resultados a largo plazo sean mejores que la G.V.A.
El Bypass gástrico: Es la operación que más se realiza entre los cirujanos expertos en obesidad. El índice de reoperaciones es muy bajo. Las pérdidas de peso, superiores en todas las estadísticas a la GVA y la anilla ajustable. El "índice de cura" es superior al 80% y el resto de los pacientes, si no se curan, mejoran. Tiene efectos secundarios que hay que vigilar pero que son mínimos y controlables.
El "Cruce duodenal" o Bypass pancreático: Es la operación más efectiva. "Cura" a más del 90-95% de los pacientes, y el resto mejoran. Da la mejor calidad de vida pues pueden ingerir todo tipo de comidas sin restricciones en la mayoría de los casos. El índice de reoperaciones no supera el 2%. Es la más indicada en los pacientes más obesos, pues necesitan perder más peso de forma permanente. Hasta los 3 años pueden perder tanto peso que las posibles complicaciones del hierro, calcio o vitaminas deben ser corregidas.
Indicaciones. No todos los obesos son iguales y, por lo tanto, tampoco se les debe hacer la misma intervención. Los pacientes más obesos (los superobesos) necesitan la operación más agresiva que haga posible, de la forma más efectiva, su vuelta a la normalidad. En los algo menos obesos, el bypass gástrico es la intervención más utilizada, generalmente por laparoscopia.

  RESULTADOS

La pérdida de peso no es inmediata sino lenta y progresiva.

Va a depender del grado de severidad de la obesidad. Cuanto más obeso mas peso se pierde y también mas peso tiene que perder. Puede ser de 5-8 Kilos por mes al principio para irse reduciendo cuando pasan los meses y el peso a perder ya es menor.

Es muy difícil bajar hasta el peso ideal. El mejor resultado con todo tipo de operaciones es cuando el/la paciente queda pesando al menos un 10% por encima del peso ideal. Ningún cirujano puede predecir el peso final con ninguna de las operaciones. Las variaciones individuales son tan grandes que no hay uniformidad ni con el mismo tipo de operación. tuotromedico
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