Learn, in a practical and face-to-face way, the latest techniques in Bariatric Surgery, with the constant accompaniment of specialists of recognized prestige in this clinical area”

The growing concern for personal image and the numerous complications that collaterally affect patients with obesity have led to the development of new surgical procedures as a priority. Therefore, Bariatric Surgery has progressed enormously in recent years, and the specialist who has focused their career in this field or who wishes to get up-to-date has a great opportunity with this Hybrid Master's Degree.

This program has been developed according to the latest scientific evidence in this area, and will allow the physician to learn about the latest innovations in issues such as the management of fistulas after bariatric surgery, revision surgery after adjustable gastric banding, nutritional treatment of patients with complications or the role of gastrointestinal hormones in the resolution of type II diabetes mellitus after bariatric surgery, among many other aspects.

The program is developed in two distinct phases. The first is carried out 100% online, adapting to the personal and professional circumstances of the specialist. In addition, they will be accompanied by a teaching staff of great reputation in this area of specialty, who will update them with the best multimedia resources: case studies, theoretical and practical exercises, master classes, readings and videos of procedures.

During the second stage, the professional will have the opportunity to spend an on-site internship in a prestigious center, where they will be able to put into practice all the new knowledge acquired during the online phase. In this way, this program offers a comprehensive learning process that is adjusted to the latest developments in Bariatric Surgery.

Make the most of this opportunity to surround yourself with expert professionals and learn from their work methodology"

This Hybrid Master's Degree in Update in Bariatric Surgery contains the most complete and up-to-date scientific program on the market. The most important features include: 

• Development of more than 100 clinical cases presented by surgical professionals specialized in Bariatric Surgery
• The graphic, schematic, and practical contents with which they are created, provide scientific and practical information on the disciplines that are essential for professional practice
• Obese patient assessment techniques
• Comprehensive systematized action plans for the main pathologies related to obesity
• Presentation of practical workshops on diagnostic and therapeutic techniques for patients with obesity
• An algorithm-based interactive learning system for decision-making in the clinical situations presented throughout the course
• Practical clinical guides on approaching different pathologies
• With a special emphasis on evidence-based medicine and research methodologies in Bariatric Surgery
• All this will be complemented by theoretical lessons, questions to the expert, debate forums on controversial topics, and individual reflection assignments
• Content that is accessible from any fixed or portable device with an Internet connection
• Additionally, students will be able to carry out a clinical internship in one of the best hospitals in Spain

The latest knowledge in Bariatric Surgery can be found here, presented through the best multimedia resources: videos, case studies, master classes, among others”

This Hybrid Master's Degree program, of a professionalizing nature and hybrid learning modality, is aimed at updating medical professionals who develop their functions in the surgical service. The contents are based on the latest scientific evidence, and oriented in a educational way to integrate theoretical knowledge in the medical practice, and the theoretical-practical elements will facilitate the updating of knowledge and allow decision-making in patient management.

Thanks to the multimedia content, developed with the latest educational technology, medical professionals will benefit from situated and contextual learning, i.e., a simulated environment that will provide immersive learning programmed to train in real situations. This program is designed around Problem-Based Learning, whereby the professional must try to solve the different professional practice situations that arise throughout the program. For this purpose, the student will be assisted by an innovative interactive video system created by renowned experts.

You will delve into issues such as technical considerations in the perioperative management of the morbidly obese patient with associated abdominal wall pathology"

Get up-to-date through the best educational technology, especially designed for working professionals"

This Hybrid Master's Degree in Update in Bariatric Surgery has been designed by internationally renowned specialists, and they have been in charge of integrating all the latest developments in the discipline in a unique qualification. Therefore, through the 10 specific modules that make up the program, the physician will be able to delve into issues such as endoluminal vertical gastroplasty, Roux-en-Y gastric bypass or thromboembolic prophylaxis in bariatric surgery, among many others.

Delve into the most relevant theory in this field, subsequently applying it in a real work environment”

Module 1. General Aspects of Obesity

1.1. Obesity and Overweight

1.1.1. Introduction
1.1.2. Definition of Obesity
1.1.3. Epidemiology
1.1.4. Pathophysiology
1.1.5. Energy Intake
1.1.6. Metabolism and Energy Expenditure
1.1.7. Updated Action Mechanisms in Bariatric Surgery
1.1.8. Etiology: Genetics and Epigenetics of Obesity Syndromes with Dysmorphic Obesity
1.1.9. Initial Evaluation of Obesity

1.1.9.1. Body Mass Index
1.1.9.2. Waist Circumference
1.1.9.3. Body Fat Percentage
1.1.9.4. Other Parameters

1.1.10. Evaluation of Patient Risk

1.2. Major Comorbidities

1.2.1. Definition of Major and Minor Comorbidity
1.2.2. Diabetes Mellitus Type 2

1.2.2.1. Prediabetes and Diabetes: Definition
1.2.2.2. Dietary Treatment
1.2.2.3. Oral Anti-diabetic Treatment
1.2.2.4. Insulin Treatment
1.2.2.5. Target Organ Involvement: Signs and Symptoms

1.2.3. Hyperlipidemia

1.2.3.1. Total Cholesterol
1.2.3.2. HDL and LDL
1.2.3.3. Triglycerides

1.2.4. Cardiovascular

1.2.4.1. Cardiac: Ischemic Heart Disease
1.2.4.2. Vascular

1.2.4.2.1. Venous Stasis with Increased Risk of DVT/PTE
1.2.4.2.2. Arterial Hypertension

1.2.5. Metabolic Syndrome
1.2.6. Respiratory: hypoventilation syndrome and apnea-hypopnea syndrome
1.2.7. Load-bearing Arthropathy: Definition and Common Injuries
1.2.8. Infertility

1.3. Minor Comorbidities

1.3.1. Digestive

1.3.1.1. Hepatic Steatosis, Steatohepatitis and Cirrhosis
1.3.1.2. Colelitiasis, Colecistitis
1.3.1.3. Gastroesophageal Reflux Diseases

1.3.2. Obesity and Cancer: Incidence
1.3.3. Asthma
1.3.4. Hypothyroidism
1.3.5. Incontinence
1.3.6. Psychologucal Alterations (Major or Minor?)
1.3.7. Other Minor Comorbidities

1.4. Dietary and Pharmalogical Treatment

1.4.1. Dietary Treatment

1.4.1.1. Introduction
1.4.1.2. Food plan Dietary Treatment
1.4.1.3. Distribution of Macronutrients in the Diet
1.4.1.4. Modification of Diet Structure
1.4.1.5. General Recommendations for Hypocalorie Diets

1.4.2. Medical treatment

1.4.2.1. Types of Drugs
1.4.2.2. Drugs Which Affect Appetite and Fullness
1.4.2.3. Drugs Which Work on a Gastrointestinal Level
1.4.2.4. Thermogenic Drugs
1.4.2.5. Other Drugs
1.4.2.6. Medication being Researched
1.4.2.7. Therapeutic Algorithms

1.5. Physical Activity

1.5.1. Program Objectives
1.5.2. Types of Exercise
1.5.3. Frequency, Duration and Intensity
1.5.4. Behaviour Modification

1.6. Indications of Endoscopic and Surgical Treatments

1.6.1. According to BMI
1.6.2. According to Previous Surgery
1.6.3. According to Associated Comorbidities
1.6.4. Listening to the Patient
1.6.5. Therapeutic Algorithms

1.7. Pre-Operative Study

1.7.1. Basic Preoperative Process
1.7.2. Study of the Upper Digestive Tract: Endoscopy vs. Rx
1.7.3. Study and Eradication of Helicobacter Pylori: When and How?
1.7.4. ASMBS Micronutrient Survey and Grades of Recommendations
1.7.5. Indications from Other Studies

1.7.5.1. Respiratory: Functional Respiratory Tests and Polysomnography
1.7.5.2. Digestive: Ultrasound and CAT
1.7.5.3. Cardiac: ECG and Stress Test
1.7.5.4. Movement: Antigravity Treadmill Test
1.7.5.5. DMT2. Hb Glycated A1, Pancreatic Reserve, and Pancreatic Antibodies
1.7.5.6. Studies of Venous Circulation in Lower Limbs

1.7.6. Updated Pre-anaesthesia Assessment in Bariatric Surgery

1.8. Pre-surgery Preparation

1.8.1. Pre-surgery Preparation
1.8.2. Duration, Objectives and Scientific Evidence Related to Preparation
1.8.3. Liquid Diet
1.8.4. Physical Activity
1.8.5. Respiratory Physiotherapy and Tobacco Consumption
1.8.6. Study and Control of Arterial Hypertension
1.8.7. Updated Blood Glucose Control in Bariatric Surgery

1.9. Surgical Technique Selection

1.9.1. According to BMI
1.9.2. According to Psychological and Nutritional Profile
1.9.3. According to Associated Comorbidities
1.9.4. Listening to the Patient
1.9.5. Recommended Algorithm

1.10. Indications and Technique Selection in Special Groups

1.10.1. Adolescents and Children

1.10.1.1. Children vs. Adolescents: How to Identify Them
1.10.1.2. Bridge Techniques vs. Definitive Techniques: On Whom and Which Ones?

1.10.2. Over 60 Years Old

1.10.2.1. How to Differentiate between Biological Age and Theoretical Age?
1.10.2.2. Specific Techniques for >60s

1.10.3. BMI 30-35

1.10.3.1. Indication for surgery
1.10.3.2. Surgical Techniques

1.10.4. Other Borderline Patients

1.10.4.1. BMI <30 and DMT2
1.10.4.2. BMI 30-35 and C-peptide=0
1.10.4.3. BMI 30 and 35 and DMT1
1.10.4.4. Children Over the Age of 70
1.10.4.5. HIV Patients
1.10.4.6. Liver Cirrhosis Patients

Module 2. Endoscopic and Percutaneous Treatments in Obesity

2.1. Intragastric balloon (Oballon, ELIPSE)

2.1.1. Definition
2.1.2. Technique
2.1.3. Results
2.1.4. Complications

2.2. Endobarrier

2.2.1. Definition
2.2.2. Technique
2.2.3. Results
2.2.4. Complications

2.3. Vertical Endoluminal Gastroplasty (EndoCinch)

2.3.1. Definition
2.3.2. Technique
2.3.3. Results
2.3.4. Complications

2.4. Transoral Gastroplasty (TOGA)

2.4.1. Definition
2.4.2. Technique
2.4.3. Results
2.4.4. Complications

2.5. POSE

2.5.1. Definition
2.5.2. Technique
2.5.3. Results
2.5.4. Complications

2.6. Endoscopic Plication (Apollo)

2.6.1. Definition
2.6.2. Technique
2.6.3. Results
2.6.4. Complications

2.7. Gastric Electrical Stimulation (Gastric Pacemaker)

2.7.1. Definition
2.7.2. Technique
2.7.3. Results
2.7.4. Complications

2.8. Neurostimulation of the Dermatomes of the Abdomen

2.8.1. Definition
2.8.2. Technique
2.8.3. Results
2.8.4. Complications

2.9. Aspire Method

2.9.1. Definition
2.9.2. Technique
2.9.3. Results
2.9.4. Complications

2.10. Uncommon Methods (Lingual Mesh, Surgiclip)

2.10.1. Definition
2.10.2. Techniques
2.10.3. Results
2.10.4. Complications

Module 3. Surgical Treatment of Morbid Obesity

3.1. History of Surgical Treatment of Morbid Obesity

3.1.1. Historical Background in Ancient Times
3.1.2. Beginning of Obesity Surgery in the Modern Era
3.1.3. Current Use of Bariatric and Metabolic Surgery

3.2. Adjustable Gastric Band

3.2.1. Introduction
3.2.2. Surgical Technique
3.2.3. Results
3.2.4. Immediate Postoperative Complications

3.3. Vertical Gastrectomy

3.3.1. Introduction
3.3.2. Surgical Technique
3.3.3. Results
3.3.4. Immediate Postoperative Complications

3.4. Gastric Bypass Roux-en-Y

3.4.1. Introduction
3.4.2. Surgical Technique
3.4.3. Results
3.4.4. Immediate Postoperative Complications

3.5. Gastric Bypass of One Anastomosis

3.5.1. Introduction
3.5.2. Surgical Technique
3.5.3. Results
3.5.4. Immediate Postoperative Complications

3.6. Biliopancreatic Diversion

3.6.1. Introduction
3.6.2. Surgical Technique
3.6.3. Results
3.6.4. Immediate Postoperative Complications

3.7. Duodenal Crossover

3.7.1. Introduction
3.7.2. Surgical Technique
3.7.3. Results
3.7.4. Immediate Postoperative Complications

3.8. SADIS

3.8.1. Introduction
3.8.2. Surgical Technique
3.8.3. Results
3.8.4. Immediate Postoperative Complications

3.9. Nissen Sleeve

3.9.1. Introduction
3.9.2. Surgical Technique
3.9.3. Results
3.9.4. Immediate Postoperative Complications

3.10. Other techniques: SAGIS/SASI, Intestinal Bipartition, Gastric Plication, Banding Techniques, etc

3.10.1. Introduction
3.10.2. Surgical Technique
3.10.3. Results
3.10.4. Immediate Postoperative Complications

Module 4. Perioperative Management

4.1. ERAS Program in Bariatric Surgery

4.1.1. Introduction
4.1.2. ERAS Protocol in Bariatric Surgery
4.1.3. Implementation Results
4.1.4. GERM Multidisciplinary Working Group. Protocol Update

4.2. Multidisciplinary Management of the Bariatric Patient

4.2.1. Pre Surgery

4.2.1.1. Endocrinology & Nutrition
4.2.1.2. Dietitian
4.2.1.3. Psychiatry
4.2.1.4. Psychology
4.2.1.5. Pneumology
4.2.1.6. Cardiology
4.2.1.7. Digestive System
4.2.1.8. Radiology
4.2.1.9. Surgery
4.2.1.10. Anaesthesiology
4.2.1.11. Rehabilitation and Physiotherapy

4.2.2. Hospital Admission

4.2.2.1. Pre Surgery
4.2.2.2. Intraoperative
4.2.2.3. Post-Operative

4.2.3. Monitoring

4.2.3.1. Surgery
4.2.3.2. Endocrinology & Nutrition
4.2.3.3. Dietitian
4.2.3.4. Psychiatry and Psychology
4.2.3.5. Pneumology
4.2.3.6. Primary Care

4.3. Patient Information, Objectives and Establishing Realistic Expectations

4.3.1. What is Obesity?
4.3.2. Affectations Arising from Obesity
4.3.3. Obesity in the Current Day
4.3.4. Can it be Modified?
4.3.5. Benefits of Fighting It
4.3.6. Postoperative Results

4.3.6.1. Complications
4.3.6.2. Weight Regain
4.3.6.3. Therapy Options

4.3.7. Monitoring

4.4. Psychological Assessment

4.4.1. Psychological Focus on an Obese Patient in Bariatric Surgery
4.4.2. Emotional State and Quality of Life in Candidates for Bariatric Surgery
4.4.3. Considerations in Preoperative Psychological Assessments
4.4.4. Aspects to be Addressed in the Initial Interviews

4.4.4.1. History of the Start and Evolution of Their Obesity
4.4.4.2. Explore Expectations, Motivation and Goals of the Patient
4.4.4.3. Patient’s Lifestyle
4.4.4.4. Family Circle
4.4.4.5. Patient Coping Strategies

4.4.5. Recommended Evaluation Tools

4.4.5.1. Depression/ Anxiety Scale
4.4.5.2. Decision-Making and Self Control
4.4.5.3. Quality of Life
4.4.5.4. Body image
4.4.5.5. Eating Disorders
4.4.5.6. Personality

4.4.6. Considerations for Interpreting the Information Collected

4.5. Perioperative Nutritional Management for Patients under Bariatric Surgery

4.5.1. Introduction
4.5.2. Benefits of Pre-Surgery Weight Loss in Bariatric Surgery
4.5.3. Preoperative Treatment Guidelines

4.5.3.1. Hypocalorie Diet and Very Low-Calorie Diet
4.5.3.2. Medical treatment
4.5.3.3. Other treatments

4.5.4. Postoperative Nutritional Treatment

4.5.4.1. Dietary Progression in the First Weeks
4.5.4.2. Micronutrient Supplementation Guidelines
4.5.4.3. Special Situations

4.6. Thromboembolic Prophylaxis in Bariatric Surgery Prevention Measures for Surgical Site Infections

4.6.1. Thromboembolic Prophylaxis

4.6.1.1. Introduction
4.6.1.2. Early Mobilization
4.6.1.3. Mechanical Prophylaxis
4.6.1.4. Pharmacological Prophylaxis

4.6.2. Prevention of Surgical Site Infections

4.6.2.1. Introduction
4.6.2.2. Preoperative Phase

4.6.2.2.1. Smoking Control
4.6.2.2.2. Shower and Shaving
4.6.2.2.3. Skin Asepsis and Antisepsis
4.6.2.2.4. Antibiotic Prophylaxis

4.6.2.3. Intra and Perioperative Phase

4.6.2.3.1. Door Opening Control
4.6.2.3.2. Body Temperature and Blood Sugar Level Control
4.6.2.3.3. Tissue Oxygenation
4.6.2.3.4. Wound/Operation Site Irrigation
4.6.2.3.5. Sutures with Antiseptics

4.6.2.4. Postoperative Phase

4.6.2.4.1. Skin Dressings
4.6.2.4.2. Measurement Packages

4.7. Antiemetic Prophylaxis and Goal-Directed Fluid Therapy

4.7.1. Antiemetic Prophylaxis

4.7.1.1. Identification of Patients from Risk of Suffering Post Operative Nausea and Vomiting (PONV) in Bariatric Surgery
4.7.1.2. Detection and Intervention of Factors with Reduce the Basal Risk of PONV
4.7.1.3. Antiemetic Drug Management
4.7.1.4. Establishing a Prophylactic Algorithm to Establish Preventive Strategies in High-Risk Patients
4.7.1.5. Description of Treatment for PONV in Bariatric Surgery

4.7.2. Goal-Guided Fluid Therapy

4.7.2.1. Different Approaches to Fluid Administration in Obesity Surgery: Liberal vs. . Restrictive Approach

4.7.2.1.1. Liberal Fluid Therapy vs. Restrictive Fluid Therapy
4.7.2.1.2. Preoperative, Intraoperative and Postoperative Periods
4.7.2.1.3. Surgical Factors which Affect the Administration of Fluids

4.7.2.2. Concepts Goal-Guided Fluid Therapy
4.7.2.3. Description of the Parameters that Guide the Administration of Fluids in Bariatric Surgery

4.7.2.3.1. Volume Monitoring
4.7.2.3.2. Functional Hemodynamic Variables

4.7.2.4. Review of Current Monitoring Recommendations in Bariatric Surgery

4.8. Early Mobilization and Reintroduction or Oral Feeding

4.8.1. Early Mobilization

4.8.1.1. Inconveniences Period of Inactivity
4.8.1.2. Benefits of Early Mobilization
4.8.1.3. Early Mobilization Guidelines

4.8.2. Reintroduction of Oral Feeding

4.8.2.1. Benefits of Early Oral Feeding
4.8.2.2. Importance of Protein Supplements
4.8.2.3. Guidelines for Reintroduction of Oral Feeding

4.9. Impact of Physical Training Programs on the Maintenance of Weight Loss Before and After Bariatric Surgery

4.9.1. Impact of Physical Training Programs on the Physical Aptitude of Obese People
4.9.2. Physical Activity in the Preoperative and Postoperative Periods of Bariatric Surgery

4.9.2.1. Preoperative Physical Activity
4.9.2.2. Postoperative Physical Activity

4.9.3. Advice Before Starting a Physical Activity Program After Bariatric Surgery
4.9.4. Planning on Physical Activity after Bariatric Surgery

4.9.4.1. Physical Activity during the First Month
4.9.4.2. Physical Activity between the 2nd and 6th Months
4.9.4.3. Physical Activity After the 6th Month

4.9.5. Types of Routines and Exercises

4.10. Optimization of Comorbidities Prior to Bariatric Surgery

4.10.1. Concept of Multimodal Reahbilitation in Bariatric Surgery
4.10.2. Preanesthetic Consultation in Bariatric Surgery
4.10.3. Study and Detection of the Risk Factors of Corony Heart Disease
4.10.4. Screening for Sleep Apnea-Hypopnea Syndrome
4.10.5. Indications for Preoperative Spirometry in Obese Patients
4.10.6. Description of the Recommended Laboratory Studies on Proposed Patients for Bariatric Surgery
4.10.7. Nutritional Optimization in the Preoperative Period
4.10.8. Respiratory Physiotherapy
4.10.9. Physical Rehabilitation of Bariatric Patients

Module 5. Emergencies of the Bariatric Surgery Patient

5.1. Semiology of Abdominal Pathology and Complementary Explorations in Emergencies in Patients with a History of Bariatric Surgery

5.1.1. Introduction
5.1.2. Medical History
5.1.3. Physical Examination
5.1.4. Complementary Examination Orientation
5.1.5. Blood Analysis
5.1.6. Abdomen Rx
5.1.7. Abdominal ultrasound
5.1.8. Computerised and Axial Tomography
5.1.9. Esophagogram and Upper Intestinal Transit
5.1.10. Upper Digective Endoscopy
5.1.11. Endoscopic Retrograde Cholangiopancreatography
5.1.12. Cholangio Nuclear Magnetic Resonance
5.1.13. Echoendoscopy
5.1.14. Exploratory Laparoscopy

5.2. Complications of Endoscopis Procedures (Intragastric Balloon, POSE, Apollo)

5.2.1. Definition of Techniques
5.2.2. Indication of Techniques
5.2.3. Development of Complications
5.2.4. Solution of Complications

5.3. Fistula Management After Bariatric Surgery

5.3.1. Introduction
5.3.2. Leakage and Postoperative Sepsis
5.3.3. Fistula after Laparoscopic Vertical Gastrectomy

5.3.3.1. Causes
5.3.3.2. How to Avoid Them
5.3.3.3. How to Diagnose Them
5.3.3.4. Management

5.3.4. Fistula after Gastric Bypass

5.3.4.1. Causes
5.3.4.2. How to Avoid Them
5.3.4.3. How to Diagnose Them
5.3.4.4. Management

5.3.5. Fistulas after Malabsorptive Techniques

5.4. Intestinal Obstruction of the Upper and Lower Digestive Tract (bridles, internal hernias, trocars, etc. after Bariatric Surgery

5.4.1. Introduction
5.4.2. Obstruction of Upper Digestive Tract
5.4.3. Causes of Intestinal Obstruction

5.4.3.1. After Open Surgery

5.4.3.1.1. Early Onset
5.4.3.1.2. Late Onset

5.4.3.2. After Laparoscopic Surgery

5.4.3.2.1. Early Onset
5.4.3.2.2. Late Onset

5.4.4. Diagnosis of Intestinal Obstruction
5.4.5. Treatment of Intestinal Obstruction
5.4.6. Additional Material

5.5. Acute Digestive Complications: Marginal Ulcer of Anastomotic, Stenosis, Diarrhea, Proctalgia, etc

5.5.1. Introduction
5.5.2. Anastomotic Fistula
5.5.3. Marginal Ulcer
5.5.4. Anastomic Stenosis
5.5.5. Acute Diarrhea following Bariatric Surgery
5.5.6. Proctalgia following Bariatric Surgery

5.6. Managing Bleeding after Bariatric Surgery (Upper GI Hemorrhage, Hemoperitoneum, etc.)

5.6.1. Upper Gastrointestinal Bleeding

5.6.1.1. Early Onset
5.6.1.2. Late Onset

5.6.2. Lower Gastrointestinal Bleeding
5.6.3. Hemoperitoneum

5.7. Hepato-biliary Complications Secondary to Post-Surgical Intestinal Malabsorption. Bacterial Overgrowth

5.7.1. Hepato-biliary Complications Colelitiasis
5.7.2. Effect of Bacterial Overgrowth on MO
5.7.3. Bacterial overgrowth and NASH

5.8. Medical Complications Related to Bariatric Surgery (Dumping Syndrome, Reactive Hypoglycemia, Cardiopulmonary, Renal)

5.8.1. Dumping Syndrome
5.8.2. Reactive Hypoglycemia
5.8.3. Cardiopulmonary Complications
5.8.4. Renal Complications

5.9. Nutritional or Toxic Deficiency Emergencies

5.9.1. Introduction
5.9.2. Digestive Emergencies
5.9.3. Neurological Emergencies
5.9.4. Cardiac Emergencies
5.9.5. Nephrourological Emergencies
5.9.6. Psychiatric Emergencies

5.10. Chronic Pain After Bariatric Surgery: a Challenge for the Multidisciplinary Team

5.10.1. Introduction
5.10.2. Definition
5.10.3. Etiology
5.10.4. Diagnosis
5.10.5. Non-Invasive Treatment
5.10.6. Invasive Treatment

Module 6. Revision Surgery

6.1. Definition and Indications of Revision Surgery

6.1.1. Definition and Indicators of the Success or Failure of the Bariatric Surgery
6.1.2. Indications of Revision Surgery
6.1.3. General Features of Revision Surgery
6.1.4. Surgical Strategy in Revision Surgery
6.1.5. General Criteria According to the Type of Primary Technique

6.2. Revision Surgery of Techniques No-Longer Used

6.2.1. Introduction. Historical Review
6.2.2. Description of Techniques No-Longer Used
6.2.3. Indications of Revision Surgery
6.2.4. Preoperative Study and Preparation of the Patient
6.2.5. Therapy Options
6.2.6. Conclusions

6.3. Revision Surgery Following Adjustable Gastric Band

6.3.1. Introduction, Indications and Basic Principles When Should We Consider Bandage Revision Surgery?
6.3.2. Revision Surgery Following Adjustable Gastric Band. Technique Analysis of Surgery
6.3.3. Revision Surgery following Adjustable Gastric Band: Results

6.4. Revision Surgery following Vertical Gastrectomy

6.4.1. Reasons and Candidates for Revision Surgery following Vertical Gastrectomy
6.4.2. Revision Surgery due to Insufficient Loss or Weight Regain following Vertical Gastrectomy

6.4.2.1. Duodenal/SADI-S Crossover. Revision or Second Part
6.4.2.2. Gastric Bypass as an Alternative to Duodenal Crossover
6.4.2.3. Other Possible Alternatives

6.4.3. Revision Surgery for GER following Vertical Gastrectomy

6.4.3.1. Gastric Bypass as the Best Option
6.4.3.2. Other Possible Alternatives

6.5. Revision Surgery following Gastric Bypass

6.5.1. Introduction
6.5.2. Indications

6.5.2.1. Insufficient Weight Loss
6.5.2.2. Weight Regain
6.5.2.3. Persistence of Comorbidities
6.5.2.4. Late Complications

6.5.2.4.1. Reservoir Dilatation
6.5.2.4.2. Alterations of the Gastro-Gastric Anastomosis
6.5.2.4.3. Gastroesophageal Reflux
6.5.2.4.5. Internal Hernias
6.5.2.4.6. Malnutrition
6.5.2.4.7. Hypoglycemia

6.5.3. Technical Aspects

6.5.3.1. Reconfection of the Reservoir
6.5.3.2. Reparation of the Gastro-Gastric Anastomosis
6.5.3.3. Modification of Handle Length
6.5.3.4. Conversion of Normal Anatomy

6.5.4. Conclusions

6.6. Revision Surgery after a One Anastomosis Bypass

6.6.1. Introduction
6.6.2. Relevance of a Correct Technique
6.6.3. Indications

6.6.3.1. Weight Loss Weight Regain
6.6.3.2. Persistence of Comorbidities
6.6.3.3. Gastroesophageal Reflux
6.6.3.4. Nutritional Disorders

6.6.4. Technical Aspects
6.6.5. Results
6.6.6. Conclusions

6.7. Revision Surgery following Duodenal Crossover

6.7.1. Revision Surgery following Duodenal Crossover

6.7.1.1. Revision Surgery for Nutritional Complications

6.7.1.1.1. Indications
6.7.1.1.2. Technique Options

6.7.2. Revision Surgery for Insufficient Weight Loss or Weight Regain after Duodenal Crossover

6.7.2.1. Indications
6.7.2.2. Technique Options

6.8. Revision surgery after BPD

6.8.1. Indications of Revision Surgery for Biliopancreatic Diversion
6.8.2. Revision Surgery Due To Insufficient Loss or Weight Regain after Biliopancreatic Diversion
6.8.3. Medical-Surgical Criteria for Revision Surgery For Protein Malabsorption

6.8.3.1. Technique Options in Revision Surgery for Severe Protein Deficiency

6.8.4. Revision Surgery in Ulcerative Complications of Gastrojejunal Anastomosis in Biliopancreatic Diversion

6.9. Revision surgery after SADI-S

6.9.1. Medium and Long-Term Results of SADI-S, Common Problems
6.9.2. Indications of Revision Surgery following SADI-S
6.9.3. Technique Options in Revision Surgery for Severe Protein Deficiency

6.10. Role of Endoscopic Surgery in the Management of Complications and Weight Regain

6.10.1. Introduction
6.10.2. Gastrointestinal Bleeding
6.10.3. Anastomotic Ulcers
6.10.4. Stenosis
6.10.5. Leakages and Fistulas
6.10.6. Pancreatobiliary Pathology
6.10.7. Weight Regain

Module 7. Postoperative Aftercare and Supplementation

7.1. Postoperative Monitoring and Screening for Nutritional Deficiencies

7.1.1. Dietary and Lifestyle Guidelines after Bariatric Surgery
7.1.2. Macronutrient Deficiencies

7.1.2.1. Vitamins
7.1.2.2. Minerals

7.2. Postoperative Supplementation Mineral and Vitamin Supplements

7.2.1. Supplementation in Restrictive Techniques
7.2.2. Supplementation in Malabsorption Techniques
7.2.3. Supplementation in Mixed Techniques

7.3. Nutritional Recommendations after Restrictive Techniques

7.3.1. Nutritional Recommendations in Patients Undergoing Restrictive Techniques
7.3.2. Post- Surgery Complications and Nutritional Problems

7.4. Nutritional Recommendations after Mixed Techniques

7.4.1. Introduction
7.4.2. Nutritional Objectives
7.4.3. Dietary Progression after Surgery

7.4.3.1. Clear Liquid Diet

7.5. Nutritional Recommendations after Malabsorptive Techniques

7.5.1. Introduction
7.5.2. Preoperative Evaluation and Supplementation
7.5.3. Postoperative Diet and Supplementation

7.5.3.1. Proteins
7.5.3.2. Micronutrients

7.5.4. Gastrointestinal Symptoms
7.5.5. Long-Term Monitoring
7.5.6. Conclusions

7.6. Nutritional Management of Patients Suffering from Complications (Critical Patients)

7.6.1.  Nutritional Assessment for Critically Ill Patients
7.6.2.  Therapeutic Approach for Patients with Complications

7.7. Specific Nutritional Requirements in Children and Adolescents

7.7.1. Introduction
7.7.2. Nutritional Recommendations
7.7.3. Assessment of Nutritional Status
7.7.4. Nutritional Education
7.7.5. Nutritional Needs
7.7.6. Monitoring of Nutritional Status

7.8. Special Nutritional Requirements in the Elderly

7.8.1. Preoperative Age-Focused Assessment
7.8.2. Age-related Physiological Changes that Alter Supplementation
7.8.3. Special Supplementation and Monitoring

7.9. Special Nutritional Requirements in Women (Pregnancy, Breastfeeding and Menopause)

7.9.1. Introduction
7.9.2. Obesity and Reproductive Function in Women
7.9.3. Bariatric Surgery, Pregnancy and Breastfeeding

7.9.3.1. Dietary Recommendations
7.9.3.2. Nutritional Supplements
7.9.3.3. Gestational Diabetes
7.9.3.4. Pregnancy Complications following Bariatric Surgery
7.9.3.5. Neonatal Care
7.9.3.6. Nursing

7.9.4. Bariatric Surgery and Menopause

7.10. Postoperative Management of Specific Complications: Anemia, Protein Malnutrition and Neurological Disorders

7.10.1. Introduction
7.10.2. Anaemia
7.10.3. Protein Deficiency
7.10.4. Neurological Complications

Module 8. Basics of Metabolic Surgery

8.1. Metabolic Syndrome and Mediators of Inflammation

8.1.1. Bariatric Surgery vs. Metabolic Surgery. Anatomophysiological Basis of Metabolic Surgery
8.1.2. Control Mechanisms for Various Obesity Comorbidities
8.1.3. Future Perspectives of Metabolic Surgery

8.2. Pathophysiology of Diabetes Medical and Dietary Treatment of Diabetes

8.2.1. Insulin and Alteration in its Cellular Response
8.2.2. Hyperglycemia, Hyperlipidemia and Tissue Damage
8.2.3. Energetic Metabolism Alterations
8.2.4. Associated Phenomena: Inflammation, Apoptosis, Steatosis and Cellular Fibrosis

8.3. Role of Gastrointestinal Hormones in the Resolution of Type 2 Diabetes Mellitus after Bariatric Surgery

8.3.1. Introduction
8.3.2. Gastointestinal Hormones Involved in the Metabolism of Glucose

8.3.2.1. Incretinic Effect

8.3.3. Pathphysiology and Etipathogenesis of Type 2 Diabetes in Obese Patients

8.3.3.1. Role of Gastrintestinal Hormones in Resistance to Insulin

8.3.4. Contribution of Bariatric Surgery to the Resolution of Type 2 Diabetes

8.3.4.1. Weight Loss
8.3.4.2. Modification of Nutrients and Microbiota
8.3.4.3. Effect of Gastrointestinal Hormones: Proximal and Distal Gut Theory

8.3.5. Evidence of Bariatric Surgery in Type 2 Diabetes

8.3.5.1. Short and Long Term Impact of Bariatric Surgery in Regulating Glucose Metabolism
8.3.5.2. Surgical Treatment vs. Doctor
8.3.5.3. BPGL vs. GV

8.4. Concept of Metabolic Surgery, Concept and Scientific Evidence

8.4.1. Introduction: History of Metabolic Surgery
8.4.2. Concepts of Metabolic Surgery

8.4.2.1. General Concepts: Obesity Surgery and Metabolic Complications
8.4.2.2. Specific Concept: Diabetes Surgery

8.4.3. Indications of Metabolic Surgery

8.4.3.1. Indications in Diabetic Patients with Morbid Obesity
8.4.3.2. Indications in Type 2 Diabetic Patients with BMI 35-40
8.4.3.3. Indiciations in Diabetic Patients with BMI< 30

8.4.4. Surgical Techniques

8.4.4.1. Tradicional Techniques: (Gastric Banding, Vertical Gastrectomy, Gastric Bypass and Biliopancreatic Bypass)
8.4.4.2. New Techniques: BAGUA SADI-S, Gastroileal Bypass of One Anastomosis, and Others

8.4.5. Current Scientific Evidence on Metabolic Surgery
8.4.4. Ethical and Deontological Aspects of Metabolic Surgery

8.5. Importance of Loop Lengths in Bariatric Surgery

8.5.1. Determining Cutting Points
8.5.2. Patient Monitoring
8.5.3. Comorbidity Remission

8.6. Influence of the Microbiota in Bariatric Surgery

8.6.1. Microbiome: basic concepts
8.6.2. Microbiome and Obesity
8.6.3. Changes in Microbiome after Bariatric Surgery

8.7. Obesity and NASH Role of the Liver as Metabolism Regulator

8.7.1. Role of the Liver as Metabolism Regulator
8.7.2. Obesity and Non-Alcoholic Fatty Liver Disease
8.7.3. Bariatric Surgery and Non-Alcoholic Fatty Liver Disease

8.8. Influence of Bile Acids

8.8.1. Bile Acid Synthesis and Hepatic Circulation
8.8.2. Regulation of Dietary Fat Availability by Bile Acids
8.8.3. Main Bile Acid Receptors: TGR5 - FXR
8.8.4. Regulation of Metabolism by the Bile Acids
8.8.5. Metabolic Effects of Manipulating Intestinal Bile Acid Availability after Bariatric Surgery

8.9. Influence of Bariatric Surgery on Hypogonadism and Polycystic Ovary Syndrome (POS)

8.9.1. Prevalance of Male Hypogonadism and POS in Bariatric Surgery Candidates
8.9.2. Effects of Bariatric Surgery in the Hormonal Concentrations of Patients with Male Hypogonadism and Semen Quality
8.9.3. Effects of Bariatric Surgery on the Resolution of POS and Female Fertility

8.10. Timing of Metabolic Surgery and Its Effect on the Pancreas

8.10.1. Time as a Predictor of Diabetes Resolution following Metabolic Surgery
8.10.2. Pancreas Remodeling Capacity of the Pancreas in Human vs. Animal Models
8.10.3. Regeneration of the Pancreas and Hyperinsulinism after Bariatric Surgery

Module 9. Transplantation, Abdominal Wall and Special Situations in Bariatric Surgery

9.1. Technical Considerations in the Perioperative Management of the Morbidly Obese Patient with Associated Abdominal Wall Pathology

9.1.1. Preoperative Optimization
9.1.2. Obesity Surgery Before Wall Surgery
9.1.3. Dermolipectomies as an Associated Procedure in Abdominal Wall Reconstruction

9.2. Solid Organ Transplant and Bariatric Surgery

9.2.1. Obesity and Donors
9.2.2. Transplantation and Surgical Technique
9.2.3. Post-Transplant Obesity: Metabolic Syndrome
9.2.4. Bariatric Surgery and Liver or Kidney Transplant

9.3. Obesity and Gastroesophageal Reflux

9.3.1. Pathophysiology of Reflux Diagnostic Tests
9.3.2. GERD in the Context of Obesity
9.3.3. GERD Therapy Focus in Obese Patient

9.3.3.1. Medical Treatment
9.3.3.2. Surgical Management

9.3.4. Monitoring of Patient with GERD

9.4. Management of a Morbidly Obese Patient What is the Ideal Strategy?

9.4.1. Definition of Superobese Patients
9.4.2. Is a Superobese Patient Different to a Simple Obese Patient?
9.4.3. Multidisciplinary Preoperative Management of the Superobese Patient
9.4.4. Role of an Intragastric Balloon in a Superobese Patient
9.4.5. Anesthetic Management and Monitoring of the Superobese Patient
9.4.6. Surgery in Superobese Patients Is There a Technique of Choice?
9.4.7. What Results Can We Expect Following Surgery in Superobese Patients?
9.4.8. Nutritional Monitoring in a Superobese Patient After Surgery

9.5. Surgery in a Patient with BMI <35

9.5.1. Introduction
9.5.2. Impact of Class I Obesity (BMI 30-35kg/ m2) on Health
9.5.3. Non-Surgical Treatment of Class I Obesity
9.5.4. Evidence in the Literature for Bariatric Surgery in BMI 30-35 Kg/M2
9.5.5. Safety in Bariatric Surgery
9.5.6. Cost-Benefit Ratio
9.5.7. Recommendations offered by Different Scientific Societies

9.6. Pregnancy and Bariatric Surgery

9.6.1. Perinatal Risks and Complications in Pregnant Women undergoing Bariatric Surgery
9.6.2. Management of Pregnant Woman Undergoing Bariatric Surgery

9.7. Adolescents and Bariatric Surgery. Technique and Results

9.7.1. Adolescents and Morbid Obesity
9.7.2. Indications and Current Scene
9.7.3. Therapeutic Perspectives and Results

9.8. Effects of Bariatric Surgery on Bone Metabolism

9.8.1. Introduction
9.8.2. Pathophysiological Mechanisms

9.8.2.1. Nutrient Malabsorption
9.8.2.2. Mechanical Disorders
9.8.2.3. Neurohormonal Mechanisms

9.8.3. Effects of Bariatric Surgery on Bone Metabolism

9.8.3.1. Adjustable Gastric Band
9.8.3.2. Gastric Bypass
9.8.3.3. Vertical Gastrectomy
9.8.3.4. Biliopancreatic Diversion and Duodenal Crossover

9.8.4. Fracture Risk
9.8.5. Recommendations in the Preoperative Evaluation and Treatment of Bone Metabolism Alterations after Bariatric Surgery

9.8.5.1. Properative Evaluation
9.8.5.2. Treatment of Bone Metabolism Alterations following Bariatric Surgery

9.9. Other Special Situations in Bariatric Surgery

9.9.1. Inflammatory Bowel Disease
9.9.2. Heart Disease
9.9.3. Kidney Diseases
9.9.5. Neurological Diseases and Mobility Problems
9.9.6. Psychiatric Illness

9.10. Sarcopenia and Loss of Muscle Mass

9.10.1. Body Tissue
9.10.2. Energy Expenditure
9.10.3. Sarcopenia

9.10.3.1. Definition
9.10.3.2. Assessment
9.10.3.3. Sarcopenic Obesity

9.10.4. Changes in Body Composition in Bariatric Patients
9.10.5. Inconveniences of Loss of Fat-Free Mass in Bariatric Patients

Module 10. Innovation, Quality of Life, Training and Clinical Management in Bariatric Surgery

10.1. Innovation, Quality of Life, Training and Clinical Management in Bariatric Surgery

10.1.1. Application of Robotics in Bariatric Surgery

10.1.1.1. Bariatric Procedures: General Aspects (Indications, Contraindications, Advantages and Disadvantages)
10.1.1.2. Restrictive Laparoscopic and Robot-Assisted Procedures

10.1.1.2.1. Gastric Sleeve: Advantages and Disadvantages of Using Robots
10.1.1.2.2. Other Restrictive Procedures: Gastric Banding, Bariclip, Gastroplication, Intragastric Balloon and Endorobotics

10.1.1.3. Robot-Assisted Laparoscopic Roux-en-Y Gastric Bypass

10.1.1.3.1. Pouch Confirmation and Probe Calibration
10.1.1.3.2. Intestinal Loop Length: Alimentary Loop, Biliopancreatic Loop, Common Loop
10.1.1.3.3. Types of Anastomosis: Manual, Linear, Circular, Robotic Grappling (Anterior, Posterior, One Plane, Two Plane)
10.1.1.3.4. Closing Spaces and Gaps
10.1.1.3.5. Intraoperative Tests: Methylene Blue, Pneumatic Test, Endoscopy
10.1.1.3.6. Use of Open and Closed Drains

10.1.1.4. Other Robot-Assisted Mixed Procedures:

10.1.1.4.1. Gastric Bypass of One Anastomosis
10.1.1.4.2. SADI-S
10.1.1.4.3. Duodenal Crossover and Biliopancreatic Diversion
10.1.1.4.4. Intestinal Bipartition

10.1.1.5. Revision Surgery and Robotic Surgery
10.1.1.6. Superobesity and Robotic Surgery
10.1.1.7. Use of New Platforms in Gastrointestinal Surgery
10.1.1.8. How to Reduce Costs in Robotic Surgery without Putting the Patient at Risk?
10.1.1.9. Future of Robotic Surgery in Bariatric Surgery
10.1.1.10. Pandemic and Robotic Surgery
10.1.1.11. Telemedicine and 5G Technology
10.1.1.12. Conclusions

10.2. Application of NOTES and Single Port in Bariatric Surgery

10.2.1. Basics of Access Reduction in Bariatric Surgery
10.2.2. Surgical Techniques
10.2.3. Results

10.3. Quality of Life After Bariatric Surgery

10.3.1. Introduction
10.3.2. Concept of Quality of Life
10.3.3. Questionnaires

10.3.3.1. Generic Questionnaires
10.3.3.2. Specific Questionnaires

10.3.4. Results

10.3.4.1. Surgical Techniques Results

10.3.4.1.1. Short-Term Results

10.3.4.2. Long-Term Results
10.3.4.3. Future Perspectives
10.3.4.4. Conclusions

10.4. Bariatric Surgery Cost-Benefit Studies

10.4.1. Economic Impact of Obesity and Bariatric Surgery

10.4.1.1. Economic Load of Obesity
10.4.1.2. Costs of Bariatric Surgery
10.4.1.3. Benefits of Bariatric Surgery
10.4.1.4. Cost-effective Aspect of Bariatric Surgery

10.4.2. Systems or Mehtods for the Evaluation of the Impact on Health Costs

10.4.2.1. Comparison of Approaches for Measuring Cost Impact

10.4.2.1.1. Cost Minimization Analysis (CMA)
10.4.2.1.2. Cost-Effectiveness Analysis (CEA)
10.4.2.1.3. Cost-Utility Analysis (CUA)
10.4.2.1.4. Cost-Benefit Analysis (CBA)

10.4.2.2. Visualization of Cost-effectiveness Using the Cost-effectiveness Plan

10.4.3. Summary of Current Data on the Economic Benefit of Bariatric Surgery

10.5. Management of Waiting List and Selection of Candidates in Bariatric Surgery

10.5.1. Introduction
10.5.2. Candidate Selection for Bariatric Surgery
10.5.3. Factors Affecting the Waiting List

10.5.3.1. Resources Availability
10.5.3.2. Severity
10.5.3.3. Waiting Capacity

10.5.4. Criteria for Prioritizing Patients on the Waiting List Severity Scales
10.5.5. Conclusions

10.6. Experimental Animal and Cadaver Training Thiel in Bariatric Surgery

10.6.1. Introduction
10.6.2. Learning Curve in Laparoscopic Gastric Bypass
10.6.3. Ex vivo Laparocopic Gastric Bypass Training Strategies

10.6.3.1. Training Models

10.6.3.1.1. Laboratory Models
10.6.3.1.2. Virtual Reality Simulators
10.6.3.1.3. Animal Experimentation Models
10.6.3.1.4. Thiel Human Cadavers

10.6.3.2. Laparoscopic Surgery Workshops

10.7. Bariatric Tourism
10.8. Quality Standards After Bariatric Surgery. What is the Current Evidence?

10.8.1. In Relation to Weight Loss
10.8.2. In Relation to the Resolution of Comorbidities in Revision Surgery
10.8.3. Mortality and Morbidity in Bariatric Procedures Record of Complications
10.8.4. How to Measure Quality of Life in Bariatric Patients? Measuring Systems

10.9. Aesthetic and Body Contouring Surgery

10.9.1. Selection Criteria for Intervention of Morbid Obesity Sequelae Following Bariatric Surgery
10.9.2. Plastic Surgery Techniques for the Intervention of Sequelae

10.9.2.1. Upper Limbs Classification and Techniques

10.9.2.1.1. Horizontal, L, T Brachioplasty
10.9.2.1.2. Posterior Brachioplasty

10.9.2.2. Posterior Brachioplasty

10.9.2.2.1. Horizontal Lifting
10.9.2.2.2. Vertical Lifting
10.9.2.2.3. Complementary Techniques

10.9.2.3. Abdomen Classification and Techniques

10.9.2.3.1. Conventional/ Anchor Abdominoplasty with/ without Rectus Plication, with/ without Umbilical Transposition
10.9.2.3.2. Upper/ Lower Body Lift
10.9.2.3.3. Complementary Techniques: Liposuction

10.9.2.4. Breast Classification and Techniques

10.9.2.4.1. Breast Reduction
10.9.2.4.2. Mastopexy with/without Prosthesis

10.9.3. Intra / Postoperative Management
10.9.4. Complications after Obesity Sequelae Surgery

10.10. Creation of Behavioral Therapy Programs for Maintaining Weight Loss after Surgery

10.10.1. Introduction
10.10.2. Psychological Aspects of Morbidly Obesity Postoperative Patients
10.10.3. Phases in Postoperative Monitoring
10.10.4. Areas to Evaluate in Postoperative Monitoring
10.10.5. Individual Psychological Monitoring

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