Every year in Italy around 30 thousand people undergo bariatric surgery which, according to experts, is confirmed as the most powerful and lasting weapon in the fight against obesity. “Of these 30 thousand operations, 23,500 are those registered in 2022 by the register of the Italian Society of Obesity Surgery. These are increasingly safer, effective and minimally invasive operations.” This is what Giuseppe Navarra, president of the Italian Society of Surgery, told time.news Salute. of obesity (Sicob), today on the occasion of the second National Bariatric Surgery Day, takes stock of the techniques used to combat obesity in an operating room.
“Bariatric surgery operations can be divided into two categories – explains Navarra who is also responsible for the oncology general surgery department of the Messina Polyclinic -: restrictive operations, in which the volume of the stomach is reduced: I eat less because I feel satiated first and therefore obviously I take in fewer calories and lose weight; and malabsorptive or mixed interventions”, procedures which involve a reduction in the size of the stomach but above all cause the food to ‘jump’ through a section of the intestine which is therefore not passed through and cannot be absorbed nutrients” in such a way as to reduce the quantity of food absorbed and consequently the calories consumed in a single meal. “About 50% of the operations performed in Italy and around the world – underlines the expert – are of a restrictive type such as sleeve gastrectomy, a vertical gastrectomy. With this technique we reduce the volume of the stomach, from a container with a capacity of approximately one and a half liters into a tube of 120-130 ml”.
Another restrictive operation is the “bandage”, the famous ring, whose popularity has decreased over the years and with it the number of operations has reduced to around 10-11% of all bariatric surgery operations in Italy. Therefore, mixed techniques, including the family of gastric bypasses, a bariatric surgery procedure that creates a small 40 ml pocket at stomach level, separated from the rest of the organ and connected directly to the small intestine, of which ‘just a small portion. Finally, pure malabsorptive techniques such as bilio-pancreatic diversion, Ds, Sadi which lead to greater weight loss which however comes at the cost of a greater incidence of deficiency syndromes.
Navarra has no doubts about the possibility of an adverse event, such as death, occurring following these operations: “Obviously there are patients who do not survive the operation. For this reason, in order to guarantee the highest possible quality, guidelines must be followed. Sicob has published guidelines on the website of the Higher Institute of Health with the establishment of diagnostic-therapeutic paths which are validated by individual companies, also at regional level. In Italy there are two obesity care networks, in Veneto and Sicily, and accreditation systems for the surgeon and the structure. In this, Sicob has taken charge of extending a whole series of requirements that characterize a center of excellence and other accredited reference centers and verifying the same requirements in order to try as far as possible to guarantee maximum safety for patients” he concludes.
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