If Obesity is a serious health problem, the morbid Obesity (O.M.) is a real catastrophe to whom suffers it.

The Morbid and Super Morbid Obesity is a chronic, multifactorial and multiorganic Disease that causes serious, very severe or fatal co-morbidities, incapacitates for life and shortens the life expectancy in 30-40% compared to people with normal weight.

The M.O. is a serious Disease whose devastating effects upon the human health should be compared to cancer’s because both diseases lead to the health disaster and premature death. It doesn’t depend on will-power of people that suffer it, it makes useless all kind of dietetic, medicament, psychotherapeutic and acupuncture treatments and other no surgical measures.

People with M.O. (BMI of 40 Kg / m2 or higher of body area) can suffer multiple co-morbidities such as type II Diabetes; Arterial Hypertension; Hearth Disease; Cerebral or Cardiac Infarction; Respiratory Failure; Sleep Apnoea; Hepatic Disease; Infectious Osteoarthritis; Depression and other Psycho-social disorders; Colon, Prostate and Gynaecological Cancer and others. Their immune system is very affected and its power to response against infections is similar to other malignant tumour sufferers.

The patients that suffer M.O. aren’t suitable for any kind of medical, dietetic, psychotherapeutic, “balloons” treatment or similar ones.

Nowadays all the Scientific Societies of the World agree about that Surgery is the only solution to put a brake on Obesity and eliminate the co-morbidities in those patients with a BMI over 40 or between 35 and 40 with serious associated co-morbidities.

This fact has cased that the number of Surgical Operations performed in USA to treat M.O. goes up from 16,000 in 1992 to 104,000 in 2004 and the same increase has been proportional in Spain and other European countries.

The Obesity Surgery has risks because the patients themselves have a high or very high risk to be operated by using any kind of Surgery Technique; it will be difficult they survive after an Emergency Surgery by any cause and they usually need long periods of careful preoperational preparation.

The Obesity Surgery mustn’t be performed by any surgeon because it requires a high degree of specialization in it, training, qualification, knowledge and special skills that were stipulated by the Convention of Cancun in 1997 of the International Federation of Societies for the Surgery of Obesity ( IFSO ). The last recommendations along those lines are centred on that this Surgery mustn’t be performed by anybody that aren’t with a tutor that has performed at least more than 200 operations and has dedicated at least 5 years to the study and treatment of obese patients. The Bariatric Surgeon must entirely dedicate themselves to the Obesity sufferer, be up to date with knowledge and technology, belong to the National and International Scientific Societies, publish their results and experiences, must regularly attend Conferences and debates and dedicate more than 90%, preferably 100% of his/her time to Surgical performance, must perform it at specially qualified Hospitals, and dedicate themselves to it for life.

The last studies about complications and mortality related to the Obesity Surgery confirm that, in a high percentage, these arise in the learning phase, and the experience degree of the is the decisive factor to make them decrease.

Furthermore, the last study presented at the American College of Surgeons, carried out on 60,600 M.O. patients, 3,300 of them were operated by using Gastric Bypass, shows that, after ten years, the survival of the operated patients was 33% times higher than the not operated ones, and after 15 years it was 45%.

The unstoppable development of the Obesity Surgery is caused by three key factors:

1.- The large experience accumulated for the last 15 years in USA and European and Spanish groups entirely dedicated to the Study and Treatment of this complex Surgery.

2.- The spectacular growth rate of patients with Morbid and Super-morbid Obesity that can be only treated in an effective way by Surgery, and the appearance of Morbid and Super-morbid Obesity in childhood and adolescence.

3.- The use of the Slightest Invasive Surgery, the development of last – generation Laparoscopic Surgery Equipments and, the newest, the use of Robots in Laparoscopic procedures.

This last factor has led to a real “Golden Age” for the Obesity Surgery, because it lets the Surgeons trained in these new technologies perform the most complex imaginable Surgery, without surgical incision, with stays in hospital of 24 hours, without post-operative pain and with a return to the usual daily activity of the patient that, in many cases, is possible in less than a week.

This new procedure of operating these “gigantic bodies” that have multiple risk factors and high technical difficulty because of their large volume and huge presence of fat, has meant the great surgical revolution of the Obesity Surgery that only has been possible to reach for these last years, decreasing as much as possible the appearance of intra and post-operative complications because it is possible to perform very precise and systematic procedures with digital and robotic high resolution pictures, and eliminate the large surgical incision and the serious physical damage that means the traditional “open” Surgery.

Lately, Robotics has been the most complex and newest element applied to the Laparoscopic Surgery. We use a Robot that lets us fix and control the pictures and not depend on Surgeon’s “unstable” hand, which shortens the surgical time and minimizes the tiredness of the Surgical Team, and the precision of the operational procedures is more complete, effective and quicker. The only Robot of this type in Spain, has been bought by Centre of Excellence for the Study and Treatment of the Obesity that works at Campo Grande Hospital in Valladolid, but the way is open to the future of 21st century.

The Social prospects of the Obese patients are usually dramatic. They have to face up to the lack of understanding of the society and, sometimes, their own family, and even health professionals that doesn’t realize the complexity and severity this serious disease
 and the lack of understanding of Health Department that isn’t conscious of the problem and don’t adopt suitable solutions with the Specialists that have accumulated the necessary experiences for it
 only at the end who have accepted for life that staunch commitment of “missionary” for the careful and comprehensive attention of the Obese people, we are completely available, night and day, with the only objective of Studying and Treating the Obesity.
The Obese patient is always difficult, complex and special. Each patient is different from the others and requires a specific treatment and sometimes a different technique according to his/her own food and social habits, age, associated pathologies or psychology. That’s why the Bariatric Surgeon must know all the techniques and have personally tried them out.
The Bariatric Surgery is sometimes extremely difficult and dangerous by the own volume and difficulties of the patient, that’s why it is very necessary the experienced surgeons. However there isn’t such a great personal and professional satisfaction than the felt by the Patient and Surgeon together when all has correctly worked and the Patient with Obesity has got over that disease and his/her health problems, does normal life without social and personal handicaps and has lived in harmony again with his/her “new” body and mentality.

Manager of the Centre of Excellence for the Study and Treatment of the Obesity (C.T.O.)
Founder Fellow of the Spanish Society of Obesity Surgery (SECO)
Membership of the International Federation for the Surgery of Obesity (IFSO)

Manager of Digestive Surgery Service.
Founder Fellow of the Spanish Society of Obesity Surgery (SECO).
Membership of the International Federation for the Surgery of Obesity (IFSO)
President of the Mediterranean & Middle Eastern Laparoscopic Surgery Association. (MMESA)