ABSTRACT
Resumen La obesidad es reconocida como "la gran epidemia" del siglo XXI. Los primeros tratamientos fueron enfocados en el manejo médico, sin lograr los resultados esperados, por lo cual surge la cirugía bariátrica (CB) como la mejor alternativa. Inicialmente la obesidad se concibe como una figura de poder en el imperio egipcio, luego como enfermedad por Galeno e Hipócrates, reapareciendo más tarde como símbolo de fecundidad en Europa. Las primeras técnicas fueron el bypass yeyuno-colónico por Payne y De Wind modificado luego por Scopinaro, consolidándose más tarde como el bypass actual por Mason, Wittgrove e Higa. Por su parte, la gastrectomía en manga fue concebida por Gagner como puente de la derivación biliopancreática, pero dado sus excelentes resultados se consolida como técnica por sí sola. A su vez, la CB evidencia efectos metabólicos inesperados, posicionándose en la actualidad como el mejor tratamiento tanto para la obesidad como para el síndrome metabólico. En Chile la CB se inicia en 1986 con González del Hospital Van Buren con la experiencia en bypass yeyuno-ileal, continuando con Awad y Loehnert del Hospital San Juan de Dios. Luego se consolida con el desarrollo de la CB moderna tanto en la Universidad Católica como en la Universidad de Chile, llegando en la actualidad a ser un procedimiento ampliamente difundido en todo el país. El objetivo principal de la siguiente revisión es analizar el concepto de obesidad en la historia y la evolución de la CB en Chile y el mundo, rememorando sus inicios y destacando su constante desarrollo.
Obesity is recognized as "the great epidemic" of the 21st century. The first treatments were focused on medical management, failing to achieve the expected results, which is why bariatric surgery (BC) emerges as the best alternative. Obesity was initially conceived as a power figure in the Egyptian empire, later as a disease by Galen and Hippocrates, later reappearing as a symbol of fertility in Europe. The first techniques were the jejuno-colonic bypass by Payne and De Wind, later modified by Scopinaro, to finally consolidate as the current bypass by Mason, Wittgrove and Higa. For its part, sleeve gastrectomy was conceived by Gagner as a bridge for biliopancreatic diversion, but given its excellent results, it is consolidated as a technique by itself. In turn, BC shows unexpected metabolic effects, currently positioning itself as the best treatment for both obesity and metabolic syndrome. In Chile, BC started in 1986 with González at the Van Buren Hospital with his experience in jejuno-ileal bypass, continuing with Awad and Loehnert at the San Juan de Dios Hospital. Later, it was consolidated with the development of modern BC both at the Catholic University and at the University of Chile, currently becoming a widely disseminated procedure throughout the country. The main objective of the following review is to analyze the concept of obesity in history and the evolution of BC in Chile and the world, recalling its beginnings and highlighting its continuous development.
Subject(s)
Humans , Bariatric Surgery/methods , Metabolism/physiology , Obesity, Morbid/surgery , Gastric Bypass/methods , Chile , Bariatric Surgery/history , Bariatric Medicine/historyABSTRACT
La obesidad es considerada una epidemia en la actualidad. Es definida por la OMS como un índice de masa corporal (IMC) mayor o igual a 30. Se han realizado numerosos esfuerzos para determinar distintos tratamientos que permitan disminuir tanto la prevalencia de dicha enfermedad como las complicaciones asociadas a la misma.La cirugía bariátrica marca el inicio de una nueva era, en la que es posible reducir la morbi-mortalidad asociada a la obesidad. Específicamente se ha demostrado remisión en algunos casos de diabetes, tendencia a la mejoría en pacientes con NAFLD, NASH y reflujo gastroesofágico, así como franca mejoría a nivel cardiovascular. El propósito principal de este artículo es discutir el impacto de la cirugía bariátrica sobre dichas comorbilidades y sobre mortalidad, además las técnicas quirúrgicas, complicaciones y criterios de selección, con el fin de definir cuáles pacientes se benefician de este abordaje.
Obesity is defined as a body mass index greater or equal to 30, nowadays it is considered an epidemic. Numerous efforts have been carried on in order to define treatments that will effectively reduce the prevalence and complications of this condition. Bariatric surgery came to mark the beginning to a new era in this field; it demonstrated a reduction in morbi-mortality in patients with obesity. It has proven to induce remission in patients with diabetes, to improve NAFLD, NASH and GERD, and to be associated to a definite cardiovascular benefit. The main purpose of this article is to discuss the impact that bariatric surgery has over these comorbidities as well as on mortality. Surgical techniques, complications, and selection criteria are also addressed with the objective of defining which patients will benefit from this intervention.
Subject(s)
Humans , Bariatric Medicine , Bariatric Surgery , ObesityABSTRACT
La obesidad es un problema de salud mundial asociado con el desarrollo de enfermedades crónico degenerativas. La cirugía bariátrica es el tratamiento que ha mostrado mayor efectividad para la obesidad severa; el paciente debe modificar su estilo de vida para mantener la pérdida de peso a largo plazo. Se ha visto que las intervenciones cognitivo conductuales han sido efectivas para lograr este cambio en el paciente. El presente estudio busca evaluar la efectividad de una intervención cognitivo conductual grupal en la pérdida de peso y calidad de vida antes de la cirugía. Se incluyeron nueve pacientes con obesidad mórbida candidatos a cirugía bariátrica sin comorbilidades psiquiátricas. Se realizó una evaluación inicial de calidad de vida que medía peso e IMC (Índice de Masa Corporal, por sus siglas en español). Los pacientes fueron sometidos a una intervención grupal con el objetivo de promover la pérdida de peso mediante técnicas cognitivo conductuales. El promedio de pérdida de peso fue de 5.7 kg en las cinco semanas que duró el tratamiento, mostrando significancia estadística de .001; a su vez, con la pérdida de peso disminuyó el IMC con una significancia estadística de .002. En cuanto a calidad de vida, hubo mejoría significativa en la percepción corporal y en la actitud al tratamiento.
Obesity is a global health problem associated with the development of chronic degenerative diseases. Bariatric surgery has proven to be the most effective treatment for severe obesity. Despite surgery, patients must change their lifestyle in order to maintain weight loss in the long term. It has been reported that cognitive behavioral interventions have been effective to promote a lifestyle change and weight loss in obese patients. The aim of this study was to assess the effectiveness of a cognitive behavioral group intervention on weight loss and quality of life before surgery. Participants were nine morbidly obese patients, without psychiatric comorbidities, candidates for bariatric surgery. An initial assessment of quality of life that measured weight and BMI (Body Mass Index, for its English acronym) was performed. Patients underwent a group intervention in order to promote weight loss through cognitive behavioral techniques. The average weight loss was 5.7 kg during the five weeks of treatment, showing statistical significance of .001. In turn, along with weight loss, there was a decrease in BMI, with a statistical significance of .002. Regarding quality of life, there was significant improvement in body perception and attitude toward treatment.
A obesidade é um problema de saúde mundial associado com o desenvolvimento de enfermidades crônico degenerativas. A cirurgia bariátrica é o tratamento que mostrou maior efetividade para a obesidade severa; o paciente deve modificar seu estilo de vida para manter a perda de peso a longo prazo. Observa-se que intervenções cognitivo conductuais têm sido efetivas para conseguir esta mudança no paciente. O presente estudo busca avaliar a efetividade de uma intervenção cognitivo conductual grupal na perda de peso e qualidade de vida antes da cirurgia. Incluíram-se nove pacientes com obesidade mórbida candidatos a cirurgia bariátrica sem co-morbilidades psiquiátricas. Realizou-se uma avaliação inicial de qualidade de vida que media peso e IMC (Índice de Massa Corporal). Os pacientes foram submetidos a uma intervenção grupal com o objetivo de promover a perda de peso mediante técnicas cognitivo conductuais. A média de peso perdido foi de 5.7 kg nas cinco semanas que o tratamento durou, mostrando significância estatística de .001; ao mesmo tempo a perda de peso fez com que o IMC diminuísse com uma significância estatística de .002. Com respeito à qualidade de vida, houve melhoria significativa na percepção corporal e na atitude com respeito ao tratamento.
Subject(s)
Humans , Adult , Quality of Life , Bariatric Medicine , Obesity/psychologyABSTRACT
OBJECTIVES: Questions about reliability of bioimpedance analysis (BIA) in morbidly obese subjects have curtailed its use in this setting, but metabolic implications might reignite the debate. In a prospective study, it was aimed to analyze anthropometric and clinical associations. METHODS: Bariatric candidates (n = 94) with or without metabolic syndrome were consecutively investigated. Age was 34.9 ± 10.4 years (68.1% females), and BMI was 40.8 ± 4.6 kg m(-2) . Methods included single-frequency BIA, anthropometrics, inflammatory indices, and general biochemical profile. RESULTS: Body composition results (water, fat) in females, but not in males, were entirely consistent with the literature. In both genders good association was observed with anthropometrics (BMI, waist circumference), inflammatory indices (ferritin, C-reactive protein) and general biochemical variables. Anthropometric measurements also displayed comparable associations. Multivariate tests including the two sets of measurements indicated no predominance of one method over the other, one complementing the other as metabolic marker. CONCLUSIONS: BIA limitations were mostly relevant for males, not females. Despite such discrepancies, good associations with anthropometry were demonstrated for both genders. Correlations with liver enzymes, and indices of protein, carbohydrate, and lipid metabolism could be demonstrated. BIA deserves more investigations concerning liver steatosis and ongoing inflammation, and it could contribute as well, synergistically with anthropometry, to monitor weight loss, body fat shifts, and metabolic risk.