NAPLES – Unlike many others, obesity is a pathology that involves the person in a multidimensional way and, for this reason, the bariatric surgeon cannot deal exclusively
of the intervention. Among the leading experts in laparoscopic surgery of the digestive system and obesity, the first to realize (already in 1995) the need for a paradigm shift, Luigi Angrisani, explains that obesity is «a disease of which we know still little, which continues to imply a strong social stigma, but which – with the right approach – can be well managed”. Let’s start from the data: the latest available ISTAT photograph certifies that, in the adult population, the overweight percentage is equal to 36.1% (males 43.9%, females 28.8%), while the obese are 11%, 5% (males 12.3%, females 10.8%), highlighting a constantly growing trend. Overall, therefore, in Italy we can estimate around 4 million obese adults.
Hot, indeed very hot, is the topic of anti-diabetes drugs which have proven to have enormous slimming power. Angrisani, who is also an associate professor in General Surgery at the University of Naples Federico II, recognizes the important role that pharmacological therapies have in the management of obesity, but warns of the possible risks and
from the many unknowns of this new frontier. Today pharmacological therapy allows in many cases to accompany the patient to bariatric surgery and to deal with it
any relapses after some time, given that “obesity is a relapsing and chronic disease”. But the drug should not be seen as the panacea for all ills. «Current therapies – continues the specialist – have a major limitation in the methods of administration: they force patients to undergo continuous intradermal injections, which not everyone agrees to undergo». Furthermore, there is no shortage of side effects. «These drugs
they delay gastric emptying and therefore can promote a sense of nausea or aggravate gastric reflux in patients who, due to their weight, already suffer from this disorder”. Leaving aside any negative consequences favored by current fads, new slimming drugs can be valid allies, together with surgery, for the successful management of obesity, but it remains crucial to rely on a specialist who has a 360-degree vision of the problem and who can identify the best solutions at the most appropriate time. A management concept that Angrisani introduced to Federico, already in 1995, when he created the multidisciplinary team at the service of the then pioneering laparoscopic technique in the Polyclinic. And surgery still remains crucial to deal with the disease today.
THE TECHNIQUES
«Each intervention is planned according to the case, using the most suitable technique».
And among the most effective techniques, explains Angrisani, there is sleeve gastrectomy (or gastrectomy
vertical) born as the first stage of a more complex operation called duodenal switch. «Essentially, the operation consists of vertical resection and removal of the
70-80% of the stomach. In this way, the natural conformation of the viscera is transformed from saccular to tubular. The newly formed gastric tubule can contain 150-200 cubic centimeters of volume and is in direct continuity with the esophagus and duodenum. The removal of the bottom of the stomach causes a decrease in blood levels of ghrelin, a hormone that controls the feeling of hunger. This, together with the decreased filling capacity of the stomach, allows us to reduce caloric intake and therefore cause a loss of body weight.” Vertical gastrectomy is particularly
indicated in diabetic patients, in the super obese, and offers results that are completely comparable to those of gastric bypass in the first three years after surgery. «This operation – concludes Angrisani –, in addition to being considered the first choice in our center, can also be used as a revision operation after the failure of the gastric band».
