Resultados del bypass gástrico resectivo en pacientes obesos mórbidos ≤ 18 años y ≥ 65 años / Resection gastric bypass in morbid obese patients aged less than 18 and over 65 years

Background: The incidence of morbid obesity is increasing and gastric bypass is the most effective surgical treatment. Aim: To assess the long term results of resection gastric bypass among morbidly obese patients aged less than 18 and over 65 years in terms of weight loss and correction comorbidities. Material and methods: From August 1999 to December 2006, 712 patients with morbid obesity were subjected to open resection gastric bypass. A group of 12 patients, aged less than 18 years and a second group of 8 patients aged more 65 years were selected to prospectively assess weight loss, complications and correction of associated comorbidities. Results: In the first group body mass índex (BMI) decreased from 45±6.7 kg/m² to 27.7±3.2 kg/m², in a follow-up períod of 22.9±8.4 months. All comorbidities disappeared or improved. A single patient (8.3 percent) had an incisional hernia. Among the second group, BMI decreased from 40.6±5.4 kg/m² to 28.4±4.4 kg/m², in a follow-up períod of 26.6±15.9 months. All obesity comorbidities disappeared. Three patients (37.5 percent) presented incisional hernias. No patient died or had postoperative complications. Conclusions: In both groups resection gastric bypass was safe, obtained an appropriate weight loss and corrected all associated comorbidities to obesity.

Propuesta y fundamentos para una norma de manejo quirúrgico del paciente obeso: Año 2004 / A proposal of guidelines for surgical management of obesity

Obesity is a chronic disease with an increasing prevalence in all groups of age, and is associated to increased general mortality and cardiovascular risk. The multidisciplinary non surgical approach must be the treatment of choice for obese subjects. However, the results of such approach among subjects with severe or morbid obesity, are unsatisfactory. In this group of patients, bariatric surgery and specifically gastric bypass achieves good long term results, maintaining a low body mass index, reducing complications and improving quality of life. Considering the widespread practice of bariatric surgery in Chile, the Nutrition Unit of the Ministry of Health formed a task force to propose update guidelines for the surgical treatment of obesity. These guidelines were proposed after a thorough literature review and discussion with groups that practice bariatric surgery using defined protocols. This document provides a summarized version of the guidelines. The first section discusses the background for bariatric surgery and the second part give specific recommendations for patient management and the formation of reference centers for surgical management of obesity.