1. METABOLIC SURGERY CENTRO HOSPITALAR DE ENTRE O DOURO E VOUGA GASTRO OBESO CENTER SAO PAULO, BRAZIL BMI AS A PARAMETER TO RECOMMEND METABOLIC SURGERY Almino Ramos, MD Mário Nora, MD Galvao Neto, MD

3. diabetes mellitus type II

4. arterial hypertension Metabolic Syndrome

5. dislipidemia

7. Final comments Pierda de peso 2. Dieta restrictiva

8. DMT2TRATAMIENTO QUIRÚRGICO Mecanismos de acción Hormonal 1a Hipótesis “Grasa visceral” Órgano endocrino Ramos, Almino. Galvão Neto, Manoel. Galvão Manoela. Carlo, Andrey OMENTECTOMIA LAPAROSCÓPICA NA BGA. BGA x ALT METABÓLICAS, ESTUDO PROSPECTIVO VII Congresso Brasileiro de Cirurgia Bariátrica – Florianópolis – Santa Catarina – Brasil, 2005

9. DMT2TRATAMIENTO QUIRÚRGICO Mecanismos de acción Hormonal 2a Hipótesis Grelhina

10. DMT2TRATAMIENTO QUIRÚRGICO Mecanismos de acción Hormonal 3ahipótesis “Hindgut” Estimulación ilealprecose “Ileal break” 100 años Hoy

11. Duodenal-Jejunal Bypass 100cm 100cm

12. GASTRECTOMIA EM MANGA (“SLEEVE”) + INTERPOSIÇÃO ILEAL “ILEAL BREAK”

13. Device – Concept

14. Effect of bariatric procedures on T2DM < <

15. DM>5yrs is not good Resolution (%) of diabetes at six months after sleeve gastrectomy according to diabetes duration. Rosenthal :SOARD Volume 5, Issue 4, Pages 429-434

16. C-Peptide < 3 is not good C-peptide > 3 is the most important predictor for a successful treatment for LSG. WJ Lee; Surgery. 2010 May;147(5):664-9. Epub 2009 Dec 11.

19. DUODENAL-JEJUNAL BYPASSJesus Arguilles – Mexico - 2004

20. Porque pensar en la DMT2 y Tratamiento quirúrgico – Datos en humanos Arguelles – México T2DM patients– “no selection” Duodenal-Jejunal Bypass – open N = 10p Resolution 5p Improvement 2p No results 3p Arguelles - Obesity Surgery. 2007, Latin American IFSO Meeting

21. Porque pensar en la DMT2 y Tratamiento quirúrgico – Datos en humanos Arguelles – México T2DM patients– “no selection” Duodenal-Jejunal Bypass – open N = 10p – 4 years follow up Resolution 0 Improvement 1p No results 9p Arguelles – Mexican National Bariatric Congress - 2009

22. Duodenal-Jejunal bypass Surgical treatment - Human data

23. Duodenal-Jejunal bypass Surgical treatment - Human data

24. Duodenal-Jejunal bypass Surgical treatment - Human data

25. MetabolicgastricBypass GastricPouch 50 cm³ Gastro-jejunostomynotcalibrate? Alimentarylimb 150 cm Biliopancreaticlimb 100 cm Laparotomy - 17 N= 27 December 2010 Laparoscopy - 10

26. MetabolicgastricBypass Gastric Pouch ? Gastro-jejunostomy calibrated 12mm Alimentary limb 150 cm Biliopancreatic limb 50 cm N = 37 February 2006

27. MetabolicgastricBypass Metabolic Bypass , inicial experience with Roux-en-Y Gastric Bypass on tipe II diabetes treatment AlminoC Ramos, Manoel Galvão, Manuela Galvão, AndreyCarlo,EdwinCanseco, Thales D. Galvão, Luis F Evangelista, Alvaro Ferraz e Josemberg L Campos São Paulo and Recife - Brasil GastricPouch “doublesize” Gastro-ileostomynotcalibrate Alimentarylimb 100 – 200 cm Biliopancreaticlimb 200 cm IFSO 2010 IFSO 2010

28. MetabolicgastricBypass October 2007 N=44

29. MetabolicgastricBypass 100 cm 200 cm May 2008 N=20

30. Metabolic gastric Bypass Gastric Pouch 25-30 cm³ Gastro-jejunostomy not calibrate Alimentary limb 150 cm Biliopancreatic limb 50 cm N=15 August 2009

31. MetabolicgastricBypass

32. MetabolicgastricBypass

33. MetabolicgastricBypass LAPAROSCOPIC SURGERY XVIII Mário Nora 2011

34. MetabolicgastricBypass

36. Age

37. DMT2 – Time?

38. Use of insulin

39. C peptide

40. HbA1c

41. ComorbiditiesLAPAROSCOPIC SURGERY XVIII Mário Nora 2011

42. METABOLIC SURGERY CENTRO HOSPITALAR DE ENTRE O DOURO E VOUGA GASTRO OBESO CENTER SAO PAULO, BRAZIL BMI AS A PARAMETER TO RECOMMEND METABOLIC SURGERY Almino Cardoso Ramos ramos.almino@gmail.com Phone55 11 83722322