About 15% of patients who undergo bariatric surgery after five years can not maintain the results obtained with weight reduction, a process known as obesity recurrence. The reasons – technical, metabolic and psychological – that lead this large volume of people to regain weight was the theme of the course “Understanding and Treating Recurrence of Obesity”, which opened on Wednesday (04.10) the XVIII Brazilian Congress of Bariatric and Metabolic Surgery , which takes place until Saturday (07), in Florianópolis and is promoted by the Brazilian Society of Bariatric and Metabolic Surgery (SBCBM). The number of procedures is growing year after year in Brazil: in 2016, about 100 thousand bariatric surgeries were performed in the country, an increase of 7.5% compared to 2015, according to data provided by SBCBM.
One of the biggest names in the area of minimally invasive surgery, dr. Michel Gagner detailed to the physicians present a series of studies and results obtained with the vertical gastrectomy (also known as sleeve), a technique that removes about two-thirds of the stomach without gutting – Gagner’s specialty. According to him, there is a worldwide trend of patients to ask for this procedure: “In the United States, the volume of this procedure is 30% is three times greater than that of gastric bypass, which was dominant in the country a few years ago,” explained Gagner.
Gagner has been a frequent visitor in Brazil since 1992 and closely follows the evolution of procedures in the country. “I see that doctors in Brazil are still very conservative about choosing sleeve surgery, but that should evolve in the coming years, as the volume of people who need bariatric surgery has reached epidemic levels and we need a procedure that can be made faster and brings less risk, “he says. Recognized for his contributions in the field of Minimally Invasive Surgery, Gagner was co-surgeon for the world’s first transatlantic robotic cholecystectomy between New York and Strasbourg (France). “From a technical point of view, I see more and more excellence in procedures performed in Brazil, which is reaching an international level. And this is also due to events such as the Congress of the Society of Bariatric Surgery, which show the work of the professionals – and we are following what is happening in Brazil.”
Brazilian Society of Bariatric and Metabolic Surgery Opinion
The president of the Brazilian Society of Bariatric and Metabolic Surgery, Caetano Marchesini, disagrees with Gagner’s opinion regarding vertical gastrectomy. “Brazil has always been attentive and ahead of the advances of bariatric surgery in the world. When the US began to make the gastric band, believing that it was the great new procedure, Brazil, for example, had already stopped using this technique, “says Marceheini. According to him, the same movement is happening with vertical gastrectomy. “The most recent studies indicate that one of the effects of vertical gastrectomy is the recurrence of obesity, the theme of this panel. We are not conservative, but we are attentive to the results, “added Marchesini.
Treatment should be multidisciplinary
Several researchers who presented studies in the course were emphatic in defending the performance of the multidisciplinary – endocrinologists, surgeons, psychiatrists, nutritionists – to follow up patients. “The problem of relapse is part of the disease. And this is what we need to understand: the procedure is not a cure, since a portion of the patients treated will not respond adequately and will require complementary therapy, such as drugs, endoscopic procedures, psychological support and possibly new surgery. We have to mobilize together and offer the best set of treatment measures, “says Dr. Maurício Emmanuel Gonçalves Vieira.
For the psychiatrist Hélio Tonelli, the ideal postoperative follow-up is to mix pharmacotherapy and psychological counseling: “In 10 years working in the area, I learned the complexity of the subject: several behavioral factors are responsible for the recurrence of obesity, such as loss of control in the feeding, poor quality of life and lack of postoperative follow-up”. Patient personality traits are essential to understanding the best treatment, as some people naturally have a harder time adhering to physical activity routines, “what we do know is that self-monitoring of activities and control over impulse and eating habits helps maintain loss of weight after surgery”.
The physical educator, Cristina Aquino Machado, pointed out the need for a technical and physical follow-up after the surgery: “not doing physical exercise and having sedentary behavior is fattening. The advantage of physical activity goes much further: it has an impact on metabolic parameters. But physical exercise has to be planned, repetitive and with realistic goals, because the best workout is the one the patient actually does”. Cristina recommends that all work involving exercises be followed up by other professionals, such as nutritionists and endocrinologists, because the fact that the patient is sedentary may have other reasons, psychological or even physical.