Kirurški pristupi u terapiji ekstremne debljine

master's thesis

• Title (english): Surgical approaches to the treatment of extreme obesity
• Author: Andrea Vuksanović
• Mentor: Marko Sever (mentor)
• Committee member: Žarko Rašić (predsjednik povjerenstva)
• Committee member: Tomislav Meštrović (član povjerenstva)
• Committee member: Marko Sever (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Surgery); Zagreb
• Defense date and country: 2021-07-16, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Surgery

Abstract

Pretilost i prekomjerna tjelesna masa se definiraju kao abnormalno ili preveliko nakupljanje masnog tkiva koje može imati negativan utjecaj na zdravlje. Postoje mnoge metode mjerenja masnog tkiva, no danas se najčešće koriste indeks tjelesne mase (ITM) i opseg struka. Glavni čimbenici rizika za razvoj debljine su prehrana, sjedilački način života te socioekonomski i genetički čimbenici. Pretilost i centralni tip debljine su povezani s povišenim rizikom oboljenja od brojnih bolesti, a razina rizika raste s ITM-om preko 25 kg/m². Najznačajniji čimbenici rizika su metabolički i kardiovaskularni. Glavni neinvazivni pristupi terapiji debljine su dijetetska terapija, tjelesna aktivnost, psihoterapeutski pristupi te farmakoterapija. Promjena prehrane sa smanjenjem kalorijskog unosa treba biti osnova svakog gubitka tjelesne mase, a tjelesna aktivnost je također veoma važna. Terapija endogastričnim balonom je minimalno invazivan pristup na prijelazu prema kirurškim metodama i sastoji se od privremenog umetanja silikonskog balona u želudac s rezultatom smanjenja apetita. Barijatrijskom kirurgijom nazivamo kirurške postupke u liječenju pretilih osoba, a osnovne indikacije za njih su ekstremna pretilost s ITM-om >40 kg/m² i ITM >35 kg/m² s prisustvom ozbiljnih komplikacija debljine. Barijatrijski zahvati se dijele na restriktivne, malapsortivne i kombinirane zahvate. Podesiva želučana vrpca je restriktivni zahvat u kojemu se oko proksimalnog dijela želuca postavlja silikonska omča, formirajući predželudac smanjenog volumena. Sleeve gastrektomija je restriktivni zahvat u kojemu se uzdužno izrezuje veći dio želuca, a na mršavljenje djeluje i preko promjena lučenja grelina. Roux-en-Y želučana premosnica i biliopankreatična diverzija s isključenjem dvanaesnika su zahvati koji kombiniraju restriktivni i malapsorcijski mehanizam te uključuju smanjivanje želuca i prekrajanje tankog crijeva. Veliki gubitak tjelesne mase nakon barijatrijskih zahvata često za sobom ostavlja značajnu količinu mlohave, rastegnute kože i supkutanog tkiva. 70-90% pacijenata nakon barijatrijske operacije izražava želju za plastičnom kirurgijom. Body contouring se odnosi na niz plastično-rekonsrtuktivnih zahvata cijelog tijela čiji je konačni cilj uklanjanje poteškoća nastalih zbog viška i preklapanja kože te podizanje kvalitete života općenito.

Abstract (english)

Obesity and overweight are defined as abnormal or excessive accumulation of adipose tissue that can have a negative impact on health. Today, the most commonly used methods of measuring adipose tissue are body mass index (BMI) and waist circumference. The main risk factors for the development of obesity are diet and sedentary lifestyle along with socioeconomic and genetic factors. Obesity is associated with an increased risk of a number of diseases, and the level of risk increases with a BMI over 25 kg/m². Among the most significant risk groups are metabolic and cardiovascular risks. The main non-invasive approaches to the therapy of obesity are dietary therapy, physical activity, psychotherapeutic approaches and pharmacotherapy. A change in diet with a reduction in caloric intake should be the basis of any weight loss, and physical activity is also crucial. Intragastric balloon therapy is a minimally invasive approach where a silicone balloon is temporarily inserted into the stomach, which leads to a decrease in appetite. The surgical procedures performed to manage obesity are collectively referred to as bariatric surgery. Criteria for bariatric surgery are BMI over 40 kg/m² or BMI over 35 kg/m² with the presence of comorbidities which are severely endangering the patient’s life. Bariatric procedures are divided into restrictive, malabsorptive and combined procedures. Adjustable gastric banding is a restrictive procedure in which a silicone band is placed around the proximal part of the stomach, forming a pre-stomach of reduced volume. Sleeve gastrectomy is a restrictive procedure in in which the majority of the greater curvature of the stomach is removed and a tubular stomach is created. Weight loss in sleeve gastrectomy is also supported by the changes in the secretion of ghrelin. Roux-en-Y gastric bypass and biliopancreatic diversion with duodenal switch are procedures that combine a restrictive and malabsorption mechanisms and they both involve reduction of stomach volume along with bypassing parts of the small intestine. Excessive weight loss after bariatric procedures often leaves behind a significant amount of flabby, stretched skin and subcutaneous tissue. 70-90% of patients express a desire for plastic surgery after bariatric surgery. Body contouring refers to a series of plastic and reconstructive procedures covering the entire body with the ultimate goal of removing the difficulties caused by excess skin and increasing the quality of life in general.

• Keywords: pretilost; kirurški pristup; barijatrijska kirurgija; body contouring
• Keywords (english): obesity; surgical approach; bariatric surgery; body contouring
• Language: croatian
• URN:NBN: urn:nbn:hr:105:110062
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Public note: Pohranitelj objekta unio ključne riječi.
• Created on: 2022-05-20 09:10:05