Caring

1st surgical CS

First surgical consultation for obesity (take rdv online)

You arrive at the surgical consultation, addressed by your attending physician, a medical specialist or spontaneously..

  • The first consultation aims to know you and to listen to you. It makes it possible to evaluate your waitings and your capacity of adhesion to the follow-up.
  • The surgeon must inform you and determine, during this first maintenance, if the request for surgical assumption of responsibility appears justified.
  • One will establish the history of your weight, the maximum duration of the modes carried out, the got results. thus us will be able to evaluate your capacity to be subjected to you to dietetic rules and of hygiene of life. .

 

Obesity is the first noninfectious world epidemic!!!
Increase amongst obese people in Montpellier

 

Première Cs chirurgicale obésité dr Vincenzo Salsano mise à jour novembre 2016

 

Multidisciplinary evaluation

CONSULTATION BARIATRIC SURGERY MONTPELLIER TAKE ONLINE APPOINTMENT WITH TEAM DR. SALSANO (click)

 

This consultation will be of principle long. 

A summary mail of this maintenance will be written and sends in copy to your general doctor and all to the members of the multidisciplinary team..

  • Example of card first consultation
  • Name  and Surname  ; Date of birth ;

  • ♦telephone  portable ; email ; mother/father of family 

  • ♦ Profession   Physical-activity related to the profession 

  • physical ♦Activity: sport/leisure
    ♦Estimation of the impact of obesity on quality of life:  1) even estimate self 2) physical-activity 3) social life 4) life professional 5) sex life
     
    ♦Hygiene of life: possible tobacco addiction.

  • ♦Food habitudes:
     
    Salted Hyperphagie/Tachyphagie/Nibbling, Nibbling sweetened – sweat eaters – concept of assumption of great quantities of sodas and drinks sweetened, concept of emotional Kilos or emotional refuge towards food; antecedents of true anorexia/bulimia
     
    ♦Tentatives and failure of the modes.
    ♦Verification of food knowledges 

     

  • Detailed analysis of the allergies, surgical and medical antecedents

  • ♦Control of the presence of possible comorbidities related to obesity or worsened by obesity (relation causes/effect):
    Syndrome of apnea of the sleep, dyslipidemy, diabetes, steatohépatite – Nash syndrome, arterial hypertension, discopathy or articular repercussion multiple, invalidating osteoarthritis, required to lose weight before orthopedic surgery

     

  • One will record your parameters:

    the weight (kg),       ;   the size (m),   ;    the ideal weight,   ; the excess of weight to be lost
    the index of body mass IMC (Kg/m ²)   ;   the excess of the IMC to lose to expect one IMC normal of 24 kg /m2

  •  

    ♦Finalement, we will decide if a more complete multidisciplinary evaluation is legitimate for a possible bariatric operation.

  • EVALUATION AND MULTIDISCIPLINARY PREPARATION

  • Endocrinologist= Dr. SARDINOUX; Dr. PRIEUR; Dr. CHALANÇON; Dr. DUTERTRE; Dr. SAJAS; Dr. ROUQUETTE

    Endocrinal and metabolic assessment
    Cortisol, thyroid hormones, insulin with jeun
    Glycemia with jeun, HbA1: glyquée haemoglobin
    Cholesterol: total, HDL, LDL; Triglycerides
    Uric acid
    Hepatic assessment
    Nutritional assessment
    Hb, Fe, ferritin, transferrine, proteins, albumin, TP
    Vitamins D, parathormone, calcium
    Vitamins B1, B6, B9 and B12
    Mg, Zn, Followed Selenium by the possible deficiencies • Nutritional assessment in 3,6,12 months

 

  • Dietician =Mr. WILCZENTY; Mrs. KLEINER; Mrs. FRANK-MICLO

  • Investigation into the mode of food of the patient
    To check: quantities, time of the meal, hunger and desire for eating.
    To identify the sources of caloric intakes liquid: alcohol and sweetened drinks.
    Analysis and correction of the made mistakes (food compulsions, nibbling sweetened: sweet eaters, hyperphagic food).
    The dietetic Councils and preoperative modes

    Post-operative regular follow-up: to reiterate the dietetic advices, adapted mode.
    To detect the deficiencies.

  • PSYCHIATRIST : dr MELLA ,dr MUTOMBO ; dr HANNOIR

  • PSYCHOLOGIST : Mme GAERTNER 

  • ♦Identify Absolute psychiatric counter-indications • Severe mental disorders.
    Dependence with alcohol and/or drugs.

  • ♦Identify Relative psychiatric counter-indications • Latent depression.
    Magic waiting screw has screw of the bariatric surgery.
    Balance of couple fragile, absence of socio-family support.

  • ♦Treat food behavioral problems • Hyperphagies compulsive eaters (binge eating) Nibbling
     

  • ♦ psychotherapeutic treatment is adapted into preoperative
     

  • ♦ psychotherapeutic post-operative follow up
    To accompany the patient in the psychic refittings related on the surgery and the weight loss.
    .

  • Gastroenterologist = dr CHAZE ; dr FABRE ; dr FONTES ;dr MILLAN ; dr BLANC Christophe; dr ANDREANI ; dr PIERRAGES
  • Gastroscopy
    To check the integrity of the oesophagus and the stomach.
    To detect a hiatal hernia.
    To search and treat a œsophagite, a gastritis or an ulcer.
    To eradicate very possible infection with Helicobacter pylori (obligatory before gastric by-pass)
    Gastroscopy of control to envisage 2 years after the surgery


  • Possible Coloscopie To detect and treat lesions colics at the subject of more than 50 years (obesity is a risk factor independent for the development of digestive cancers;)

  • Hepatic assessment
    ◊Recherche of hepatic steatosis or the stéato nonalcoholic hepatitis (Nash syndrome).

     

  • Hepatic echography
    ◊Estimate the volume of the liver (predictive of technical difficulty during the intervention).
    ◊Search the presence of calculations in the blister
    .

  • Pneumologist =dr CLAVEL ; dr SHBAT ; dr THIBOUT ; dr TARODO
  • Research SAS: syndrome apnea of the sleep (40% of obese) Epworth Score and night oximetry.
    Polysomnography.
  • RHEUMATOLOGIST = dr FERRAZZI ; dr BOURBON ; dr HERVE ; dr TOUZERY
  • Research complications:  discopathy; multiple articular repercussion
  • CARDIOLOGIST =dr SHADFAR; dr NIDALI; dr CAMBON ; dr MASSON
  • Consultation necessary in order to evaluate the operational risk in the case of hypertension, of heart disease or severe arrhythmia and treatment AVK in progress..
  • ANESTHESIOLOGIST
  • Mandatory consultation
  • Basic phisician
  • Essential link between the patient, the surgeon and the other specialists
    It evaluates the knowledge acquired by its patient constraints risks/benefit of the surgery.
    It makes sure that its patient has the intellectual resources and sufficient knowledge to provide an assent lit to the bariatric surgery.
    It adapts posologies of the treatments in progress (for example AVK, hormones thyroid), the malabsorptive surgery can involve a malabsorption of various drugs and requires the adaptation of their posology.

The surgery is only one stage in the multidisciplinary assumption of responsibility for this extremely serious chronic disease.
It is about a long process. The time between the first consultation with the surgeon and the last is at least from three to five months.
The assumption of responsibility is standardized while being individualized to guarantee a strict evaluation and a rigorous selection.

.

 

Multidisciplinary evaluation before surgery obesity Dr. Vincenzo Salsano put at days October 2016

2nd surgical CS

Second Consultation of the Surgeon

If the multidisciplinary evaluation at favorable summer, the surgical assumption of responsibility is then possible.

The goal of this second (sometimes third) surgical consultation is of:

To return in detail of the bariatric surgery and to take the time to explain you in a clear way:

  • objectives to be reached in terms of control of the weight and remission of Co-morbidities,
  • the advantages and the disadvantages of the procedure which was selected in a collegial way because it you is adapted.

To make sure that you understood and accepted:

  • risks of the bariatric intervention and need for a medical monitoring and surgical in the long run.

To dictate to your attending physician a mail your involved..

To communicate information which we exchanged on :

  • The result of the evaluation, surgical strategy suggested, the method of information on the expected benefit, risks of the surgery, imperative character of the regular follow-up.

The surgeon is at your disposal to answer all your questions.

You can request further information to your doctor who collaborates with us and can check that you have well sufficient knowledge to provide an assent lit to the bariatric surgery.

 Recourse to the repairing surgery:

The recourse to the repairing surgery is possible. This one can be realized as soon as possible 12 to 18 months after the bariatric surgery, in the absence of denutrition, with stabilized ponderal loss. 

Second surgical consultation obesity Dr. Vincenzo Salsano put at days November 2016

Pregnancy and obesity

Suggestions concerning pregnancy and obesity

The bariatric surgery is contra-indicated in the pregnant women. After an intervention of bariatric surgery we recommend:

 

In case of pregnancy

  • A nutritional follow-up within the multi-field team during the pregnancy and in postpartum.
  • A supplementation out of iron, folates, B12 vitamins, vitamins D and calcium (in particular after Gastric By-pass: malabsorptive surgery).
  • A loosening of the ring in the event of pregnancy after an installation of ring.

 

In the event of project of pregnancy

  • An evaluation dietetic and nutritional, clinical and biological.
    The supplementation in folates, in accordance with the international recommendations, will have to be installation as of the desire of pregnancy.

 

Conseils en matière de grossesse et obésité dr Vincenzo Salsano mise à jours décembre 2010