1. OBESITY SURGEONS MÉXICO ADVANCED LAPAROSCOPIC SURGERY FOR OBESITY SLEEVE GASTRECTOMY

2. LAPAROSCOPIC SLEEVE GASTRECTOMY Obesity is an epidemic disease, with an increase patern in most of the contries around world. Obesity is an epidemic disease, with an increase patern in most of the contries around world. World Health Organization said in 2005 that 1,600 million people have overweight and 400 million have morbid obesity around the world. World Health Organization said in 2005 that 1,600 million people have overweight and 400 million have morbid obesity around the world. In 2015, 2,300 million people will have overweight and 750 million will have morbid obesity. In 2015, 2,300 million people will have overweight and 750 million will have morbid obesity.

3. LAPAROSCOPIC SLEEVE GASTRECTOMY This epidemic disease increases the risk to have more than 15 health complications, like: This epidemic disease increases the risk to have more than 15 health complications, like: Mellitus Diabetes Mellitus Diabetes High blood pressure and heart attack High blood pressure and heart attack Sleep apnea Sleep apnea Joint degenerative diseases Joint degenerative diseases And others And others

4. LAPAROSCOPIC SLEEVE GASTRECTOMY

5. Gastric sleeve consists in the removing of the 66% of the stomach, that makes a tube like a shirt sleeve. Gastric sleeve consists in the removing of the 66% of the stomach, that makes a tube like a shirt sleeve. This surgical procedure has less than 10 years, but the medical reports of this technique has a very close relation with the Gastric By Pass results in the weight loose, but with less surgical and nutritional complications. This surgical procedure has less than 10 years, but the medical reports of this technique has a very close relation with the Gastric By Pass results in the weight loose, but with less surgical and nutritional complications.

6. LAPAROSCOPIC SLEEVE GASTRECTOMY The understanding of this surgical procedure is as follows: The understanding of this surgical procedure is as follows: The hunger state depends of the hunger hormons like GRELIN, Leptins and others. The stomach produces all the Grelin in the body, and this hormone is the most efficient stimullus of the hunger zone in the brain. The hunger state depends of the hunger hormons like GRELIN, Leptins and others. The stomach produces all the Grelin in the body, and this hormone is the most efficient stimullus of the hunger zone in the brain.

7. LAPAROSCOPIC SLEEVE GASTRECTOMY When the stomach is full the Grelin levels in the blood decrease and the hunger zone in the brain recognizes that the person does not need more food. When the stomach is full the Grelin levels in the blood decrease and the hunger zone in the brain recognizes that the person does not need more food. When the stomach is empty, the Grelin blood levels are high, the blood Glucose decreases and this strong stimulus makes a call to the brain for food. When the stomach is empty, the Grelin blood levels are high, the blood Glucose decreases and this strong stimulus makes a call to the brain for food. So it’s easy to understand the physiology of the gastric sleeve. If we remove by surgery the 66% of the stomach, the GRELIN production will decrease and the secondary effect of the surgery is that the patient does not feel so much hunger. So it’s easy to understand the physiology of the gastric sleeve. If we remove by surgery the 66% of the stomach, the GRELIN production will decrease and the secondary effect of the surgery is that the patient does not feel so much hunger.

8. LAPAROSCOPIC SLEEVE GASTRECTOMY Remember that 33% of the stomach stays in the normal place in the body at the end of the surgery, but this percent of Grelin is not significant, and the brain understands that the hunger state is not so very important. Remember that 33% of the stomach stays in the normal place in the body at the end of the surgery, but this percent of Grelin is not significant, and the brain understands that the hunger state is not so very important. If we talk about the capacity of the stomach, this will reduce to 66% too. In other words if the patient used to eat 3 hamburgers before the surgery, at the postoperatory period the same patient will have just the capacity for less than half a burger. The capacity of the stomach is 33% after the surgery. If we talk about the capacity of the stomach, this will reduce to 66% too. In other words if the patient used to eat 3 hamburgers before the surgery, at the postoperatory period the same patient will have just the capacity for less than half a burger. The capacity of the stomach is 33% after the surgery.

9. LAPAROSCOPIC SLEEVE GASTRECTOMY Surgical remove of the 66% of the stomach

10. LAPAROSCOPIC SLEEVE GASTRECTOMY In the surgery we remove the 66% of the stomach, applyng a 3 staple line reinforcing it with surgical stiches outside the staple line. The Sleeve Gastrectomy is by laparoscopic technique or minimal invasive technique.

11. LAPAROSCOPIC SLEEVE GASTRECTOMY The patient stays in hospital for just only two days, and at the third day the patient pass to the hotel or home and the management is outside of the hospital in the medical office. 5 to 7 days before the surgery the patient is ready to come back to light work and in the 10 day we remove the surgical drain in the medical office.

12. OBESITY SURGERIES ADJUSTABLE GASTRIC BAND vs GASTRIC SLEEVE The shadow Is the stomach that we remove in the surgery Adjustable gastric band works like a sand clock The hunger hormone is very high The hunger hormone decreases Pouch or stomach bag

13. OBESITY SURGERIES GASTRIC BY PASS The gastric By Pass is more complex and the surgical and nutritional complications are high

14. OBESITY SURGERIES GASTRIC BY PASS MEDICAL MANAGEMENT AFTER THE FIRST MONTH Ursofalk caps 250 mgs Acido Ursodesoxicolico Ursofalk caps 250 mgs Acido Ursodesoxicolico Take one every 12 hours for 6 months Take one every 12 hours for 6 months Ferrotemp caps Ferrous fumarate 330 mgs/Tiamina 5 mgs. Ferrotemp caps Ferrous fumarate 330 mgs/Tiamina 5 mgs. Take 1 cap every day for 6 months and sometimes for many years Take 1 cap every day for 6 months and sometimes for many years Redoxón – tablets 500 mgs. Vitamin C Redoxón – tablets 500 mgs. Vitamin C Take 1 tablet every day disolved in wather. Take 1 tablet every day disolved in wather. Centrum Junior Multivitamins – chewable tablets Chew 1 every/8 hrs. Centrum Junior Multivitamins – chewable tablets Chew 1 every/8 hrs. Neurobión 1000 B12 vitamin by inyection 2 injections every 3 months Neurobión 1000 B12 vitamin by inyection 2 injections every 3 months Calcium citrate Petit 1 tablet every day. Calcium citrate Petit 1 tablet every day. ALL OF THIS IS IN THE POSTOPERATIVE MANAGEMENT OF THE GASTRIC BY PASS. ALL OF THIS IS IN THE POSTOPERATIVE MANAGEMENT OF THE GASTRIC BY PASS. IN THE LAPAROSCOPIC SLEEVE GASTRECTOMY WE ONLY USE SOME OF THIS VITAMINS IN THE FIRST MONTH. “ THE NUTRITIONAL STATUS IS NOT AFECCTED IN THE GASTRIC SLEEVE” IN THE LAPAROSCOPIC SLEEVE GASTRECTOMY WE ONLY USE SOME OF THIS VITAMINS IN THE FIRST MONTH. “ THE NUTRITIONAL STATUS IS NOT AFECCTED IN THE GASTRIC SLEEVE”

15. LAPAROSCOPIC SLEEVE GASTRECTOMY ADVANTAGES Only the stomach is cut avoiding the small bowel or intestines like in the Gastric By Pass. So this surgery is easier and faster than the Gastric By Pass. Only the stomach is cut avoiding the small bowel or intestines like in the Gastric By Pass. So this surgery is easier and faster than the Gastric By Pass. The gastric capacity is just only one third of the presurgery state. The gastric capacity is just only one third of the presurgery state. After the surgery the physiology of all the gastrointestinal area is normal like all the people. After the surgery the physiology of all the gastrointestinal area is normal like all the people. The Gastric Sleeve does not need adjustements like the adjustable gastric band, because all of the anatomy is normal. The Gastric Sleeve does not need adjustements like the adjustable gastric band, because all of the anatomy is normal.

16. LAPAROSCOPIC SLEEVE GASTRECTOMY Advantages The Grelin falls down in 66% and the hunger sensation decreases too. The Grelin falls down in 66% and the hunger sensation decreases too. This surgical procedure does not present Dummping complications like in the Gastric By Pass. This surgical procedure does not present Dummping complications like in the Gastric By Pass. The Gastric Sleeve does not present nutritional complications. The Gastric Sleeve does not present nutritional complications. The natural sphinters of the stomach are preserved. The natural sphinters of the stomach are preserved.

17. LAPAROSCOPIC SLEEVE GASTRECTOMY ADVANTAGES IN A SHORT PERIOD: In DIABETIC patients the Glucose falls down to a normal state. The blood lipids like triglicerides and cholesterol decreases to normal levels and the good cholesterol has an increase. Uric acid decreases too to a normal levels.

18. LAPAROSCOPIC SLEEVE GASTRECTOMY Weight loss in Sleeve gastrectomy Weight loss in Sleeve gastrectomy *First month: 16 to 26 pounds *First month: 16 to 26 pounds *Second month 11 to 16 pounds *Second month 11 to 16 pounds *Third month 11 to 16 pounds *Third month 11 to 16 pounds *Fourth month 7 to 11pounds *Fourth month 7 to 11pounds *Fifth month 7 to 11 pounds *Fifth month 7 to 11 pounds * Sixth month 7 to 11 pounds * Sixth month 7 to 11 pounds * The next 6 months the weight loss will be the half of the first * The next 6 months the weight loss will be the half of the first six months. six months. Normally within the first 6 months the size reduction is 10 sizes Normally within the first 6 months the size reduction is 10 sizes

19. LAPAROSCOPIC SLEEVE GASTRECTOMY Disadvanteges Needs a surgical cut of one feet line in the stomach. Needs a surgical cut of one feet line in the stomach. This surgical procedure needs the use a surgical drain for 7 to 10 days. This surgical procedure needs the use a surgical drain for 7 to 10 days. This surgery causes nausea but we control it with strong medication. The nausea always dissapears after 12 hours. This surgery causes nausea but we control it with strong medication. The nausea always dissapears after 12 hours. Over the years the stomach bag size could get bigger than the 33%, but never again the size it was before the surgery. Over the years the stomach bag size could get bigger than the 33%, but never again the size it was before the surgery.

20. LAPAROSCOPIC SLEEVE GASTRECTOMY Disadvantages Injection of B12 vitamin in the first month and sometimes after the sixth month if needed. Injection of B12 vitamin in the first month and sometimes after the sixth month if needed. In some people with high Body Mass Index the weigth loss stops at 18 months and needs convertion to Gastric By Pass. This situation sometimes happens in people that needs to loose more than 200 pounds. In some people with high Body Mass Index the weigth loss stops at 18 months and needs convertion to Gastric By Pass. This situation sometimes happens in people that needs to loose more than 200 pounds.

21. SAFE STEPS FOR AN OBESITY SURGERY BeforeAfter www.obesitysurgeons.com.mx 8 months 1 year and 2 months

22. LAPAROSCOPIC SLEEVE GASTRECTOMY Internal Medicine/Anestesiology Internal Medicine/Anestesiology Bariatric/plastic surgeons Patient Sport Medicine Psicology/Nutrition Psicology/Nutrition THE PATIENT IS THE MOST IMPORTANT MEMEBER OF THE TEAM AND IS THE MAIN FACTOR IN THE MANAGEMENT OF THIS DISEASE

23. LAPAROSCOPIC SLEEVE GASTRECTOMY REMEMBER THERE IS NO SURGICAL PROCEDURE THAT WARRANTIES EXCELLENT RESULTS BY ITSELF IF THE PATIENT DOES NOT CHANGE THE BAD HABITS OF FOOD INTAKE AND DOES NOT DO EXCERSISE.

24. LAPAROSCOPIC SLEEVE GASTRECTOMY THANK YOU DR. JUAN CARLOS OLIVARES GONZÁLEZ OBESITY SURGEONS MEXICO CEO ADVANCED LAPAROSCOPIC SURGERY FOR OBESITY www.obesitysurgeons.com.mx