Obesity is a global epidemic. The number of obese people grows exponentially every year. This is explained by the easy access to all types of foods, besides the inactivity of people, increasingly involved in their obligations and less willing to spend the energy they consume. The result is that, besides an increase in the number of obese people, there is also an increase in the degree of obesity. A person is considered morbid obese when he is at least 40 kg above what would be considered his normal weight. The weight, however, is not the only villain. Some organisms are less tolerant to excess and show signs of wear even when below 40 kg. These signs go from Diabetes Mellitus II to arterial hypertension and Sleep Apnea. The IJP team has more than 15 years of experience in bariatric surgery. Soon after the beginning of this activity in Brazil, we were already performing this treatment with the highest degree of professionalism. Our team has been to the best training centers, especially for laparoscopic techniques. The team composed by the surgeons Marcelo Loureiro and Daniellson Dimbarre, by the endocrinologist Luciane Bolcato, the psychologist Juceane de Mattos and the nutritionist Ana Forcellini has performed in these 15 years more than 2,500 surgeries and presents one of the best results in Brazil and the world in this treatment. What can be considered an excellent result? Firstly, many patients must be better prepared before their surgeries. This makes us invest in information and, in some cases, preventively counter indicate the surgery. Secondly, low indexes of serious complications. Our team presents, undoubtedly, one of the highest indexes of success in this matter. Ongoing training, respect for the patient, adequate preparation and without haste of the patients, surgeries performed directly by the surgeons. The presence of the surgeon in the pre-operatory visits as well as in the post-operatory ones is indispensable for our team. Besides, bariatric surgeries are large surgeries many times of high risk. Keeping the quality also means not operating many patients in one day. The care is proportional to the concentration and attention given to the patient. When those details are not observed as they should, the complications are usually more frequent. Thirdly, frequent follow up in the first year after the surgery. This period is the most important for weight loss. Our team is available to face the possible difficulties of this period. It is one of the few in Brazil with two very experienced surgeons. If one of them cannot be present, the team is still complete for eventual difficulties. Another important factor is teaching. Our center of excellence, being part of the Instituto Jacques Perissat, has been involved in the teaching of the obesity surgery for 15 years. We have already trained more than 350 surgeons in Brazil, Latin America and the USA in the art of the well done bariatric surgery. Gastro-Intestinal Metabolic Surgery: “the diabetes surgery” The study, during the years of the results of the bariatric treatment (surgeries for weight loss) has shown the benefits of the weight loss. The evidences that some bariatric procedures generate metabolic changes that cannot be attributed solely to decreasing of body weight have strengthened the term “metabolic surgery”, or as commonly known, the “diabetes surgery”, exactly due to the substantial benefic effects in the glycemic control. While the bariatric procedure is based on the body mass index (BMI) to indicate the treatment and the technique to be used, the metabolic surgery uses clinical parameters of dysfunctions of the metabolism to define and individualize the most adequate surgical option for each case. The metabolic procedure may qualify people to the surgical treatment due to the difficulty in controlling the cholesterol, the arterial pressure and the blood sugar, having good results even in specific situations of kidney failure, which would not be obtained by the simple evaluation of the BMI. Concluding, the gastrointestinal metabolic surgery uses an approach with good results in patients with morbid obesity, but especially in the ones exposed to a discrete obesity and metabolic dysfunctions of difficult control such as the one in the patients with type 2 diabetes.

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