Bariatric surgeons

The Importance of Bariatric Surgeons in Public Health

Bariatric surgeons play a fundamental role in combating obesity, a condition that affects millions of people and is associated with various chronic diseases. Beyond individual treatment, these professionals contribute to reducing healthcare system costs. Studies show that each operated patient represents significant savings in treatments for comorbidities such as diabetes, hypertension, and sleep apnea.

Economic Impact on Public Health

The reduction in costs for continuous medications and recurrent hospitalizations represents a tangible benefit for healthcare systems, justifying the initial investment in the surgical procedure and multidisciplinary follow-up.

The Bariatric Patient's Journey

Deciding on bariatric surgery is the beginning of a transformative journey that requires long-term commitment. This journey includes distinct phases: informed decision, preoperative preparation, surgical procedure, immediate recovery, and continuous adaptation. Success depends on adherence to medical recommendations and understanding that surgery is a tool, not a miraculous solution.

Phases of Psychological Adaptation

Patients frequently experience initial euphoria, followed by periods of challenge and adaptation, until they reach a balanced relationship with their new body condition and modified eating habits.

Evaluation for Bariatric Surgery

The pre-surgical evaluation is thorough and involves various specialists. The endocrinologist evaluates metabolic and hormonal conditions, while the cardiologist checks cardiovascular risks. Laboratory and imaging tests are performed to detect possible contraindications. This stage also includes consultations with pulmonologists and gastroenterologists, depending on the patient's medical history.

Essential Preoperative Exams

Endoscopic evaluations of the digestive system, pulmonary function tests, echocardiogram, and complete metabolic exams form the basis of the preparatory medical investigation to ensure safety in the procedure.

Eligibility Criteria for Surgery

To be eligible for bariatric surgery, it is generally necessary to have a BMI above 40 kg/m² or a BMI above 35 kg/m² with obesity-related comorbidities. It is important to have a history of previous weight loss attempts without lasting success. The evaluation also considers factors such as psychological stability and absence of untreated chemical dependencies.

Special Cases for Surgical Indication

Patients with a BMI between 30-35 kg/m² and difficult-to-control diabetes may be considered for specific metabolic procedures, according to recent clinical guidelines based on robust scientific evidence. This expansion of criteria recognizes the positive impact of surgery on glycemic control and the reduction of microvascular complications of diabetes, even in patients with grade I obesity. The Federal Council of Medicine has updated its resolutions to address these specific situations, allowing a more personalized approach based on metabolic benefits beyond weight loss.

Types of Bariatric Surgeries

Roux-en-Y Gastric Bypass

A procedure that combines gastric restriction with moderate malabsorption, creating a small stomach reservoir and altering intestinal transit, resulting in early satiety and beneficial hormonal changes. This technique promotes significant metabolic effects independent of weight loss, with rapid improvement in type 2 diabetes frequently observed within the first days after surgery. Bypass is particularly recommended for patients with gastroesophageal reflux, advanced metabolic syndrome, or compulsive eating behavior for sweets.

Vertical Gastrectomy (Sleeve)

A technique that removes approximately 80% of the stomach, maintaining its natural anatomical continuity, reducing the production of the hunger hormone (ghrelin) and limiting food intake capacity. This procedure is technically less complex than bypass, preserves endoscopic access to the entire digestive tract, and maintains normal nutrient absorption. Due to these characteristics, it has become the most performed technique worldwide in the last decade, ideal for young, physically active patients or those with conditions requiring continuous use of intestinal absorption medications.

Adjustable Gastric Band

A silicone device placed around the upper portion of the stomach, creating a small chamber that restricts food intake, with the possibility of outpatient post-operative adjustments. Although it is the least invasive and completely reversible procedure, it has lost popularity due to less effectiveness in long-term weight loss and higher reoperation rates. It may still be indicated in very specific cases, such as patients with high surgical risk or those who need temporary weight loss before another scheduled medical procedure.

Biliopancreatic Diversion

A more complex procedure indicated for severe obesity, involving partial gastrectomy and extensive intestinal bypass, with greater potential for weight loss and higher risk of nutritional deficiencies. Due to its significant malabsorptive component, it promotes the greatest weight loss among all techniques, potentially reaching up to 85% of excess weight.

It is especially indicated for patients with a BMI above 50 kg/m² or after failure of less radical procedures. It requires strict commitment to nutritional supplementation and more frequent medical follow-up.

Preparation for Surgery

In the weeks leading up to surgery, it is essential to follow a specific diet to reduce liver volume and facilitate the procedure. The practice of light exercises contributes to cardiovascular conditioning. Medications such as anticoagulants and anti-inflammatories should be suspended according to medical guidance, and smoking should be stopped at least one month before.

Preoperative Diet

A low-carbohydrate, high-protein diet in the two weeks preceding surgery significantly reduces liver size and fat, facilitating surgical access and reducing operative risks.

The Crucial Role of Psychological Support

Psychological counseling helps identify pre-existing eating disorders that can compromise results. Techniques such as cognitive-behavioral therapy are used to modify dysfunctional habits and thoughts related to eating. The psychologist also works on issues such as surgical anxiety and realistic expectations regarding aesthetic and functional results.

Therapeutic Support Groups

Participation in regular meetings with other bariatric patients provides valuable exchange of experiences, shared coping strategies, and continuous motivation for maintaining lifestyle changes.

Potential Risks and Complications

Early Complications

Suture dehiscence, fistulas, bleeding, and infections are complications that can occur in the first days or weeks, demanding immediate intervention and, in some cases, surgical revision. Early identification is fundamental and is based on signs such as persistent tachycardia, fever, disproportionate abdominal pain, or intolerance to liquid intake.

The experience of the surgeon and the multidisciplinary team is determinant for the recognition and adequate management of these critical situations, highlighting the importance of choosing qualified professionals.

Late Complications

Nutritional deficiencies, intestinal obstructions, internal hernias, and development of gallstones can emerge months or years after the procedure, requiring continuous follow-up and regular monitoring. Marginal ulcers in the gastrojejunal anastomosis region can occur, especially in patients who resume smoking or use of anti-inflammatories.

It is essential to maintain the consultation schedule even when everything seems to be going well, as some complications develop silently and are more easily treatable when detected early.

Dumping Syndrome

This adverse reaction to the ingestion of sugars and simple carbohydrates causes symptoms such as tachycardia, sweating, and diarrhea, functioning as a conditioning mechanism that discourages the consumption of these foods. Although initially uncomfortable, many surgeons consider dumping a therapeutic ally, as it reinforces the need for healthy food choices.

Nutritional strategies such as meal fractionation, appropriate combination of proteins and complex carbohydrates, and hydration between meals can minimize these symptoms, allowing for varied and enjoyable eating even after surgery.

Post-Surgical Follow-up and Adaptation to the New Lifestyle

Postoperative follow-up follows a structured schedule with frequent consultations in the first year. Vitamin supplementation is mandatory and permanent, especially vitamin B12, iron, and calcium. Periodic blood tests monitor nutrient levels and metabolic markers. Food reintroduction occurs in phases, moving from liquids to pureed to solid foods.

Phases of Food Progression

The post-operative dietary evolution begins with clear liquids, progresses to complete liquids, pureed foods, soft foods, and finally solids, in a gradual process that can take up to three months for adaptation of the new digestive system.

Physical Activity After Bariatric Surgery

Regular physical activity is fundamental to preserve muscle mass during rapid weight loss. It is recommended to start with light walks two weeks after surgery, gradually progressing in intensity and duration. Resistance exercises should be incorporated from the second month. Physical training contributes to improving skin tone and preventing the yo-yo effect.

Benefits of Strength Training

Resistance muscle work helps preserve lean mass during rapid catabolism, improves basal metabolism, contributes to bone health, and promotes better skin adaptation to the new body silhouette.

Myths and Truths About Bariatric Surgery

Surgery as a "Magic Solution"

Contrary to popular belief, the procedure is only a tool that requires permanent change in habits for lasting success, not eliminating the need for balanced nutrition and regular physical activity.

Fertility and Pregnancy

Women frequently experience improvement in fertility after weight loss, but pregnancy should preferably be planned after 12-18 months of surgery, when weight loss stabilizes and the nutritional status is adequate.

Regaining Lost Weight

Long-term studies show that approximately 20% of patients may regain a significant part of the weight, generally associated with the return of problematic eating behaviors or abandonment of regular clinical follow-up.

Choosing a Qualified Bariatric Surgeon

When choosing a surgeon, verify their certification by the Brazilian Society of Bariatric and Metabolic Surgery. The volume of surgeries performed annually is an important indicator of experience. Evaluate the available hospital structure, including specialized ICU and complete multidisciplinary team. Seek references from other patients and analyze the professional's complication and reoperation rates.

Relevant Credentials and Experience

Specialization in bariatric surgery, number of procedures performed annually, participation in scientific updates, and complication rates are objective indicators of the surgeon's technical competence.

Expected Long-Term Results

The most pronounced weight loss occurs in the first 18 months after surgery. A loss of 60-80% of excess weight is expected, depending on the technique used. Beyond weight reduction, patients experience significant improvement or remission of comorbidities such as type 2 diabetes, hypertension, and sleep apnea. Quality of life tends to improve in physical, social, and psychological aspects.

Comorbidity Remission Rates

Type 2 diabetes has remission rates of 60-80% after gastric bypass, while arterial hypertension improves in about 70% of cases, and sleep apnea can be resolved in more than 85% of patients.

The Future of Bariatric Surgery

Endoscopic Procedures

Minimally invasive techniques such as the endobarrier, endoscopic gastric plication, and gastric aspiration systems represent the frontier of treatments, offering intermediate options between clinical treatment and traditional surgery.

Personalized Medicine

Preoperative genetic and metabolic analysis is being developed to predict which patients will respond better to certain surgical techniques, optimizing results and minimizing complications through an individualized approach.

Telemedicine in Follow-up

Digital platforms for remote monitoring, nutritional follow-up applications, and virtual consultations are revolutionizing postoperative care, increasing treatment adherence and allowing early interventions when necessary.

Why Choose AvaliaMed for Your Bariatric Journey

Choosing a qualified bariatric surgeon is a decision that will profoundly impact your health and quality of life for many years. AvaliaMed emerges as an essential tool in this process, offering a complete platform where medical specialists register and make available their credentials, experience, and areas of specialization.

By using AvaliaMed to find your bariatric surgeon, you have access to transparent information about academic training, certifications, mastered surgical techniques, and evaluations from other patients. This knowledge allows for an informed choice, based on objective criteria and real experiences.

The platform facilitates not only the initial selection of the professional but also appointment scheduling and continuous postoperative follow-up. With AvaliaMed, you establish a direct link with the entire multidisciplinary team necessary for the success of your bariatric treatment.

In your bariatric journey, you deserve the support of the best professionals available. AvaliaMed connects you to surgeons committed to excellence, facilitating each step from the first consultation to long-term follow-up. Do as thousands of satisfied patients have done: choose AvaliaMed as your ally in the pursuit of health and well-being.