Patología Psiquiátrica Y Cirugía Bariátrica

Abstract

bariatric surgery and mental disordersMedical treatments have shown poor outcomes, bariatric surgery has become a frequent treatment alternative for obesity. Obese patients seeking treatment have higher psychiatric comorbidity than not consulting ones. Bariatric surgery has allowed a reduction in medical comorbidity and some improvement in pre surgery psychopathology. Recent evidence reports a decrease in depressive disorders rate, improvement in self-esteem and life quality, in direct association with weight reduction, with no significant anxiety changes. Although weight decrease should help to have a better social life, important difficulties in adapting to the new environment can emerge. An increase in suicides and problematic alcohol use has been observed, as well as a decrease in binge eating disorder with further appearance of compensatory behavior, distorted body image, and marital problems. Pre surgery personality disorder could be a risk factor for a negative outcome. In this context a rigorous post surgery follow up is desirable, in order to optimize mental health benefits of massive weight reduction.Key words: Morbid Obesity, bariatric surgery, psychopathology, mental disorders. resumenLos tratamientos médicos de la obesidad han demostrado baja efectividad, lo que ha llevado a que la cirugía bariátrica se haya establecido como una alternativa de tratamiento cada vez más frecuente. Las personas obesas que buscan tratamiento presentan tasas significativamente elevadas de comorbilidades psiquiátricas en comparación con las personas obesas que no consultan. La cirugía bariátrica ha permitido una reducción de las comorbilidades médicas y una mejoría de las patologías psiquiátricas presentes antes de la cirugía. Publicaciones recientes reportan una disminución de los trastornos depresivos, mejoría de la autoestima y de la calidad de vida, directamente asociados a la reducción de peso, sin variaciones significativas en los niveles de ansiedad. Si bien la pérdida de peso debería ayudar al mejoramiento de la vida social del paciente, pueden surgir importantes dificultades para adaptarse al nuevo entorno. Se ha visto un aumento de la tasa de suicidios y del uso problemático de alcohol, disminución precoz del trastorno por atracones con Rev Chil Cir. Vol 67 -nº 4, Agosto; pág. 441-447 artículO de reVisiÓn *Recibido el 5 de noviembre de 2014 y aceptado para publicación el 29 de diciembre de 2014. Conflictos de Interés: ninguno.Correspondencia: Dr.

Gastric Sleeve analysis as a surgical treatment for obesity

“…In addition to reducing excess weight, it achieves a high rate of improvement and remission of metabolic comorbidities, which improves the quality and life expectancy of the operated patients [7]. The GS is a relatively new procedure and has become one of the bariatric procedures of choice for treating obesity [7,8,10].…”

“…The main cause relies on changing the lifestyle of modern society, which has generated a huge unbalance between the consumption and use of energy, the development of large quantity and variety of industrial foods with a high caloric density, the enormous increase of sedentary lifestyle and less physical activity [7]. Obesity currently represents a major public health issue that has a serious impact on several countries' economy, it is associated with premature mortality, chronic morbidity, an increased use of health services, life quality deterioration and social stigmatization [2,8,9]; It has become a true epidemic of the 21st century and integrates what is known as the civilization syndrome, so the World Health Organization now considers obesity as a global epidemic [1,10,11]. The prevalence of obese patients has severely increased becoming a serious public health issue [7].…”

“…Fat is a toxic factor which increases the fragility of these patients [12]; Obese people suffer from an increased risk of presenting multiple comorbidities such as high blood pressure, diabetes mellitus, dyslipidemia, heart failure, venous insufficiency, stroke, gout, COPD, coronary heart disease, obstructive sleep apnea, osteoarthritis, development of insulin resistance , osteoarticular diseases, mood disorders, substance abuse, depression, anxiety, reproductive disorders and cancer, which diminishes the quality and life expectancy [4,6,8,10,13].…”

“…The effectiveness of dietary, pharmacological and behavioral treatment in morbid obesity is limited, so bariatric surgery emerges as an option for these patients [8,14]. Sincé it is proven that this treatment can loss up to 83% of the weight within of the first year in addition to reducing comorbidities in 40% in 10 years (56% of myocardial infarction, 92% for diabetes and 60% for cancer) [13,15,16].…”

“…Laparoscopic vertical gastrectomy, or GS, is the most recent bariatric surgical procedure for obesity control and stands out for being fast and safe [2,[17][18][19][20]. In 2012, the American Society for Bariatric and Metabolic Surgery published a consensus in which it affirms that a GS is a valid alternative to a Gastric Bypass, and has now demonstrated its effectiveness as an independent procedure for the treatment of morbid obesity [8,21,22]. The Vertical Sleeve Gastrectomy was first described in 1988 by Dr. Scopinaro [11,17].…”