Tratamiento Quirúrgico de la Obesidad Mórbida - Euskadi.net

SURGICAL TREATMENT FOR MORBID OBESITY
INTRODUCTION
In most so-called developed countries, the
frequency of obesity and, more specifically, morbid
obesity, defined by a IMC> 40 kg/m 2 or IMC>35
kg/m 2 with comorbidities, has become a major
public health concern.
Morbid obesity is associated with an increase in
morbidity and general mortality. It has been
recognised as a risk factor in several diseases.
For several years, several surgical teams have used
a number of different surgical techniques to treat
persons with morbid obesity in this country.
The techniques used in bariatric surgery can be
divided into two large groups: simple or restrictive
(gastric banding and vertical ringed gastroplasty)
and complex or mixed (gastric bypass and
biliopancreatic). In general terms, by definition,
restrictive techniques involve a greater limitation to
ingesta. The mixed techniques act on the stomach
and intestine and associate variable levels of
malabsorption to a restrictive component.
AIMS
1. Analyse the activity and degree of
implementation of bariatric surgical techniques
in the Spanish national health system.
2. Assess its efficiency, effectiveness and safety
while making basic recommendations to
guarantee the quality of the care provided.
METHODS
1. A survey of 88 public and private health centres
that carry out or have carried out bariatric
surgery within the national health system and
search of records and databases on hospital activity
in order to determine the level of implementation of
this technique in Spain.
2. Systematic review of the safety and effectiveness
of surgical techniques for patients with morbid
obesity in terms of weight loss, improvement in
comorbidities, quality of life, mortality and
complications.
The search was electronic and manual in the
following languages: Spanish, English, French and
Italian during the period 1992 to 2002.
Economic analysis: NO
Expert opinion: YES
RESULTS
Of the survey: A total of 88 questionnaires were
sent to health centres that perform bariatric surgery.
67% corresponded to public centres and 33% to
private centres. The overall response rate was
51.1%.
In Spain, this technique has been used since 1977.
Bariatric surgery is applied in 15 autonomous
communities. All the techniques are used, although
gastric bypass is the most widely used technique at
this time and is employed in 82% of health centres.
Of the review: A summary has been made of the
results obtained from 5 systematic reviews (which
include 273 studies) and 29 primary studies.
With regard to reliability, the morbidity attributable
to adjustable gastric banding and vertical banded
gastroplasty (VBG) stands at about 10%, with high
re-operation rates in the medium and long term, due
both to the failure of the technique (effectiveness),
and to complications experienced with this
technique or major repercussions on the quality of
life of the patient.
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TRATAMIENTO QUIRÚRGICO DE LA OBESIDAD MÓRBIDA