Comprehensive evaluation of the patient with obesity candidate for bariatric and endocrine metabolic surgery (in Spanish)

Abstract

Currently, obesity is considered a pandemic, the incidence of which has tripled in the last 30 years, and has generated increasing public health problems. Based on the guidelines of the American Association of Endocrinologists (AACE), the Society for Obesity, the American Society for Metabolic and Bariatric Surgery (ASMBS), the Association for Obesity Medicine and the American Association of Anesthesiologists, the present document, in order to become the roadmap that guides the procedure to be followed in patients suffering from this chronic disease and who attend the San Francisco General Hospital. Obesity is recognized as a global disease and is a pathology characterized by the use of various medications due to related comorbidities, such as: cardiovascular disease, type 2 diabetes mellitus, chronic kidney disease, non-alcoholic fatty liver, metabolic syndrome and various types of cancers . This protocol contains the highest level of evidence available to date, in relation to the surgical and non-surgical management of the patient with a diagnosis of obesity, including topics such as the identification of candidate patients for bariatric procedures, type procedures that should be offered, as well as preoperative and intraoperative management and follow-up post-operative care. Since the publication by the American Society for Metabolic and Bariatric Surgey (ASMBS) in 2013 of the guidelines for the management of patients with obesity, there has been a significant increase in publications that support excellent results for the treatment of patients with obesity and type 2 diabetes mellitus by bariatric and metabolic surgery. In 2016, the publication of the Diabetes Surgery Summit (DSS2) marks a difference in the management of patients with type 2 diabetes mellitus, which is why they have grown substantially and the evidence shows that the bariatric metabolic management of these patients is superior to medical management and lifestyle changes when assessing glycemic control and remission of comorbidities. With the prior evaluation of the multidisciplinary team, we will have scientific information of the highest level that allows us to have a patient with optimal recovery applying the criteria of Enhanced Recovery after Bariatric Surgery (ERASb) Obesity in Ecuador has become a public health problem, so in the pediatric population, overweight and obesity have increased since 1986, going from 8% to 26% by 2012 in the 11-year-old group. 19 years old. The prevalence of overweight and obesity in the adult population in Ecuador is 62.8%, according to sex, the prevalence of overweight and obesity is 5.5% higher in women (65.5%) than in men (60%), and the highest rate of obesity and overweight occurs between the fourth and fifth decades of life, with prevalences higher than 73%.