FAQ's
There is an indication for bariatric surgery when there is severe obesity (35-39,9 kg/m2) and diseases likely to improve accompany it. Also, in the case of morbid obesity (40 kg/m2 or more) even without associated diseases.
When you have reached morbid obesity, dietary treatments with or without medication or psychological support tend to be insufficient. Only bariatric surgery can guarantee good results in the long term.
Metabolic surgery relates to a diabetes improvement long before a significant loss weight exists. The action of surgery on diabetes is known as stomach surgery and currently there is a reason to find this effect in diabetic patients that don’t have a good response to medical treatment.
It has been observed that after surgery, there is a weight loss that goes with an improvement of accompanying diseases, such as hypertension or sleep apnea.
Metabolic surgery prolongs patients’ survival because it reduces the risk and mortality of cardiovascular and cerebrovascular events, among others, and improves your quality of life.
There is an indication for surgery when there is diabetes mellitus type difficult to control with the standard medical treatment and it is associated with a severe obesity (35-39,9 kg/m2) or more, morbid obesity (40 kg/m2 or more). When diabetes mellitus and dietetic treatments with a medication support fail in maintaining normal ranges of blood glucose and glycated hemoglobin.
All benefits are derivative from the metabolic control of your disease. Your diabetes will improve and it will probably require less treatment. If there are other concomitant diseases, they can improve at the same time as diabetes. If you suffer from dyslipemia (cholesterol or triglycerides), it can also improve. Your arterial hypertension may require less treatment. So it is with most diseases that often go with overweight and diabetes. All of this supposes a significant improvement in your quality of life.
The main objective of metabolic surgery is the resolution of your chronic disease and, therefore, the increase of your life expectancy and your survival.
Yes. Currently, the laparoscopic approach is preferred in most abdominal procedures and, therefore, the surgical approach is always by this technique. We can perform any type of technique by laparoscopy.
The laparoscopic approach consists in avoiding major incisions. Surgery is performed trough some tubes placed through small wounds (of 5 mm or 12 mm). We have at our disposal all the instruments needed for its development, videolaparoscopes, blood vessels sealers to ensure the haemostasis, stapling and cutting machines to join the intestines. Those materials make techniques safe and brief. It is unusual that these procedures last longer than 2 hours.
Those minimal wounds in the abdominal wall make the pain related to the traditional surgery, where considerable wounds were practiced, disappear. There is no pain, so there is a faster recovery, permitting an immediate mobilization and a premature start of the diet. The main benefit is the fast recovery of the patient, allowing an early return home.
Facing the open surgery, it prevents infections, surgical wounds hernias, and prolonged recoveries. In addition, laparoscopic surgery achieves allow aesthetic results by performing small wounds.
At present, we are able to do any technique by laparoscopy. Choosing between one or another technique depends on the patient’s characteristics. The surgeon will recommend the patient to a particular technique considering eating habits, the diabetes degree and the excess weight, and associated diseases that will be able to be improved, etc.
The interventions that offer better results in the long term are the ones in the derivative group, where bridges are performed between the intestines to change the alimentary bolus transit. These techniques have an added value, because they frequently allow the improvement or the cure of diseases that in many occasions converge with diabetes.
Each patient will require a personal evaluation to identify what kind of surgical technique is suited to their dietary characteristics and the possible improvement of the diseases that may have.
Preoperative tests are done prior to the admission. From the day we indicate surgery, a specific respiratory preparation will start, a diet to follow will be established and drugs to be administrated will be indicated.
If you take medication daily, the surgeon will tell you whether you should take it the morning before surgery with a sip of water. If you take aspirin, antiaggregate or arthritis medication, these drugs should be discontinued 5 days before surgery.
You will be hospitalized a few hours before surgery to be prepared for the preoperative procedure. The surgery will take between one and two hours, depending on the indicated technique. The anaesthetic and surgical preparation in the operating room and its exit procedure takes its time, so the patient’s family might have to wait for a while even if the actual time of the surgical procedure is short.
From the first postoperative day, the patient may be transferred to their room. In the first 24 postoperative hours the mobilization on the bed and on the couch will start. Within 48 postoperative hours fluid intake will start. If liquids are tolerated, the patient will be discharged, with precise indications on what should be eaten at home, what medication to take and when to return for a health examination.
During the admission surgeons will take care of you constantly, both in person and by telephone. You and your family will have the surgeon’s phone to ask him any questions or concerns.
The stitches will be removed in the consultation, 10 days after surgery.
From the intervention day until the first examination, liquid diet with nutritional complements will be taken. On the first examination in the consultation, the diet will be changed.
The examinations will be within 10 days, one month, three months, and every three months during the first year, and every six months during the second year. They will be alternated with surgeons, endocrinologists, and nutritionists depending on the needs of each patient.
In the successive check-ups, protocolled analytical controls will be performed, and nutritional advice appropriate to their characteristics will be given, exercises and skin care will be recommended to supplement surgery with a change in your lifestyle.
Laparoscopic surgery, despite being well tolerated, may be accompanied by some pain, nausea and vomiting. Most cases do not present any of these symptoms, being controlled to the maximum with medication. Once liquids are tolerated, patients leave the hospital in a day or two.
Physical activity depends on how the patient feels. Patients can remove dressings and shower the day after surgery. Exercises in bed are recommended from the moment the patient wakes up. We suggest walking the first postoperative week. During the second week you will be able to walk, do some physical activity such as driving, climbing stairs or lifting light objects, and carry out jobs that do not require physical effort. They will probably be able to return to normal activities within two weeks.
Most of the patients can go back to work within fifteen days after the laparoscopic procedure. Of course, this depends on the nature of their employment. Patients with administrative or desk jobs usually return in a few days, while those with physical work or jobs that involve lifting heavy objects may take longer.
Although the laparoscopic approach is always indicated and the intervention initiated, in a small number of patients the laparoscopic method is not possible because of the inability to visualize or handle the organs properly.
When the surgeon decides to convert a laparoscopic surgery to open surgery, it should not be understood as it is initiated to avoid complications. The decision to convert to any open procedure is strictly based on the patient’s safety.
The factors that increase the risk of conversion to open surgery include history of previous abdominal surgery that cause dense scars, or bleeding during surgery.
Yes, in all procedures there are risks. Obviously, these are related to the type of operation performed. The vast majority of patients who have received laparoscopic surgery experience few or no complications, and they go back quickly to their normal activities.
It is important to remember that before undergoing any type of surgery (either laparoscopic or open), you have to ask your surgeon about his experience and training. The risks of metabolic surgery performed by laparoscopic approach are much smaller than leaving a chronic disease without an adequate response to medical treatment.
The complications of metabolic surgery by laparoscopic are infrequent (less than 10%), but they can include bleeding, wound infection, urinary tract infection, pneumonia, clots of blood, embolism or cardiorespiratory problems. The most specific, but uncommon (less than 2%) complication of the surgery is the leakage of contents into the abdomen through the new joints (anastomosis) created between two small intestine portions or between the small intestine and the stomach.
Mortality is less than 1% but may be mainly due to pulmonary embolism.
If there was overweight, when you lose weight there may be excess skin in some parts of your body, mainly in the abdomen. This is usually visible after the first six months. It is from the next eighteen months when an abdominoplasty, or another body contouring surgery depending on each particular case, should be contemplated. For women, depending on their aesthetic requests, they may require a breast reconstruction. Nevertheless, these are the minor aspects, since the main goal of obesity surgery is gaining health.
After surgery there is an improvement in hormone levels and you can get pregnant. But it is important that the patient knows that she must not do it until she has achieved the complete weight loss, and this means having to delay pregnancy at least for a year after surgery. After obesity surgery you can have a normal pregnancy, but it is important to accomplish rigorous health checks to ensure that at all times the levels of iron, calcium, vitamins, etc. are normal.
Our team will answer this question. The endocrinologist will define your chronic disease and the consequences of having a medical treatment without a good response. Afterwards, the whole team will study your case in order to define your best line of treatment and, if it was surgical, it will be specifically assessed by metabolic surgeons to determine which surgical technique is the most appropriate for you.
You can get in contact with the team of Dr. Alberto Pagán in three ways:
Sending an e-mail requesting an appointment for your first consultation: consulta@doctopagan.es
Calling the number 971 21 32 62
Filling and sending the form in the Contact section
To perform a metabolic surgery is more accessible than you think. Many international studies show that these procedures are paid for themselves after two years. The patient improves their disease significantly, and this is translated into savings in the costs associated with treatment, into a more productive and better quality of life.
Our team has been concerned about keeping as a first priority patient safety. In order to maintain these high standards, we have organized a surgery “package” including the necessary costs, using the best technology available at the moment.
