who is intended?
For a patient to undergo surgical treatment for obesity, we take into account some indicators and one of the main ones is the result of the Body Mass Index (BMI).
When the BMI is between 35 and 39.9, the patient must have some other disease (comorbidity) associated with obesity (for example, type II diabetes, altered cholesterol, high blood pressure, etc.). When the BMI result is greater than or equal to 40, the patient is morbidly obese and, in this case, already has an indication for surgical treatment, regardless of having or not other diseases associated with obesity.
Before deciding which treatment to choose, consult a doctor you trust to help clarify all your doubts.
Indications
The Federal Council of Medicine created a resolution (CFM Nº1.766/2005 or 1.942/2010) that regulates the indication and types of bariatric surgeries that can be used in Brazil:
- Patients with BMI (body mass index) above 40 kg/square meter;
- Patients with a BMI > 35 kg/m2 and affected by potentially fatal diseases (aggravated by obesity and which improve when effectively treated) such as type 2 diabetes, sleep apnea, high blood pressure, blood fat and others;
- People over 18 years old, elderly people and young people between 16 and 18 years old can be operated on, but they require special care, and the risk/benefit must be carefully analyzed: established obesity, according to the above criteria, with
- unsatisfactory previous treatment of at least two years;
- The patient must not use illicit drugs or alcoholism;
- Absence of severe or moderate psychosis or dementia;
- Understanding, by the patient and family, of the risks and changes in habits inherent to a major surgery of the digestive system and the need for postoperative follow-up with a multidisciplinary team.
Font: CFM RESOLUTION No. 1.942/2010 (Published in the D.O.U. of February 12, 2010, Section I, p. 72)
contraindications
Patients with untreated depression or psychosis, eating disorder, current drug use or alcohol abuse, severe heart disease, prohibitive anesthetic risk, any serious blood clotting disorder (coagulopathy) or inability to meet nutritional needs are contraindications for bariatric surgery.
Some associated diseases like diabetes and hypertension need to be controlled first. Women who intend to have children must wait at least two years after surgery to become pregnant. Pregnancy close to the bariatric surgical procedure is contraindicated.
The presence of portal hypertension with esophagogastric collateral circulation should be considered considerably as it may be a contraindication as there may be a very high risk of massive bleeding during the operation.
preoperative
The evaluations with the team are carried out days before the surgery, where all the necessary information and clarification of the patient’s doubts will be passed on.
The preoperative preparation of the patient is essential to reduce the risks and complications in the surgical act and in the immediate and late postoperative period.
For the success of the procedure, the integral performance of the multidisciplinary team is important, informing and guiding the patient in the preoperative period. Many of these candidates for bariatric surgery are looking for miraculous solutions to morbid obesity. At this stage, information and care are paramount.
It is in the correct assessment of relevant comorbidities in the preoperative period that the best surgical result is obtained.
postoperative
After the BYPASS surgery, the patient will be hospitalized for 02 to 03 days. After hospitalization, the patient will be instructed by the doctor who operated on him and by the multidisciplinary team to strictly follow the established schedule. This schedule contains relevant information about rest, the medications to be used and also about the importance of returning to the doctor and the multidisciplinary team.
It is important to always make it clear to the patient that the doctor who operated on him must carry out periodic follow-up to guarantee the success of the results to be obtained.
