How is the preoperative of bariatric surgery
Bariatric and metabolic operations have been increasingly indicated for the treatment of obesity and its associated diseases, the main driver of which is type 2 diabetes. Its indications, contained in the Resolution of the Federal Council of Medicine (RESOLUTION CFM No. 1942/2010) are based on fragile and very old scientific evidence of 1991.
This is not unique to Brazil, since almost all countries follow the indication for surgery based only on the patient's body mass index (BMI). The current indications are: patients with a Body Mass Index (BMI) above 40 kg / m2 and patients with a BMI greater than 35 kg / m2 who present with comorbidities (diseases aggravated by obesity and that improve when it is treated effectively) such as type 2 diabetes, sleep apnea, hypertension, dyslipidemia, coronary disease, osteoarthritis, and others.
The Brazilian Society of Bariatric and Metabolic Surgery, in conjunction with the Brazilian Diabetes and Endocrinology are looking for ways to submit to CFM new alternatives for operative indication based on patient severity and not just on BMI. This is based on several national and international studies that have shown greater benefit of bariatric and metabolic surgeries in relation to clinical treatments.
How is the preoperative of those who will undergo bariatric and metabolic operations? Weight loss before surgery is controversial. A comparative benefit study has not yet been demonstrated if there is any weight loss in the period prior to surgery. The food in this period must be balanced and without exaggeration. Most multidisciplinary teams caring for bariatric patients require patients to maintain a net diet 24 hours prior to surgery.
Ideally, smokers should stop about 30 days before surgery to decrease the chances of post-operative pulmonary complications operative. But sometimes this is hard to achieve. We therefore ask patients to at least reduce the number of cigarettes smoked and plan to intensify care with respiratory physiotherapy soon after surgery.
One of the great advances in surgery of the digestive system, mainly of bariatric surgery, is access by videolaparoscopy, this it is, through small incisions, which brings many advantages such as less postoperative pain and less pulmonary involvement.
Prior to the operations, the patient should be guided about his postoperative, talk to the nutritionist and other professionals involved in the Bariatric and Metabolic Surgery, when well indicated, is the best option for treating the devastating diseases associated with the major global epidemic of the 21st century, which is the obesity.
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