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Obesità, la chirurgia mette a posto il metabolismo

Articolo del 16.03.2014 dal quotidiano IL TEMPO

Costringe lo stomaco ad assumere meno cibo. E ne modifica il meccanismo di assorbimento

Sono circa sei milioni gli italiani obesi. Un dato allarmante, in costante crescita, dichiarato in occasione di un recente congresso della Sicob (Società Italiana di chirurgia dell’obesità e malattie metaboliche). I chili di troppo compromettono seriamente salute e qualità di vita, e incidono, di conseguenza, sulle risorse economiche del Servizio Sanitario Nazionale. Per prevenire l’obesità, l’arma più efficace resta, una corretta educazione alimentare, associata a uno stile di vita dinamico, in cui sia favorita l’attività fisica sin dai primi anni di scuola. Tuttavia, non sempre la combinazione di adeguate regole alimentari e movimento può risultare sufficiente per contrastare i casi di obesità di grado importante, dai valori di BMI di 35 kg/m2 (Body Mass Index, Indice di Massa Corporea) in su: quando questi approcci risultano fallimentari, l’unica possibile soluzione è costituita dalla chirurgia bariatrica.
Negli ultimi decenni, grazie all’introduzione delle procedure laparoscopiche mininvasive, è diventata più sicura e meno invasiva. Queste tecniche chirurgiche puntano, ove possibile, a ridurre il trauma chirurgico, minimizzando l’accesso o gli accessi addominali. Inoltre, si sta superando il concetto di “chirurgia bariatrica” e si parla sempre più di “chirurgia metabolica”, intesa come l’insieme di tutti gli interventi che agiscono sul metabolismo, restringendo la capacità dello stomaco di assumere cibo o modificando il meccanismo di assorbimento del cibo introdotto. Con questo tipo di interventi, molti pazienti obesi riescono a controllare anche i valori del diabete, o a mantenere la pressione entro valori accettabili.
Tuttavia, esiste in Italia un problema di ridotta accessibilità ai trattamenti di chirurgia bariatrica: sono solo 7.000 infatti i pazienti che nel nostro Paese ogni anno riescono ad essere operati. Ciò è dovuto a più cause: se da una parte c’è una coscienza piuttosto diffusa relativa all’efficacia dell’intervento chirurgico per ridurre il peso, le malattie associate e quindi migliorare la qualità e l’aspettativa di vita, dall’altra mancano le risorse e l’organizzazione per aumentare il numero degli interventi. Nel Policlinico di Tor Vergata, da molti anni ci dedichiamo a questa malattia e siamo adesso uno dei maggiori centri specializzati in Italia, con circa 200 interventi l’anno dal 2010, ma le liste d’attesa sono ancora molto lunghe.
Ricordiamo che l’impatto globale dell’obesità è molto critico: i pazienti con obesità dai 18 ai 65 anni, infatti, spesso presentano un quadro clinico complicato dal diabete e dall’ipertensione, patologie associate che incidono gravemente sulla vita privata e sul lavoro. Inoltre devono spesso prendere farmaci a carico del Servizio Sanitario Nazionale, chiedere ore di permesso lavorativo per visite specialistiche o per ricoveri ospedalieri. Tutti costi diretti e indiretti, che potrebbero essere ridotti se l’accesso alle procedure chirurgiche fosse maggiore.
L’utilizzo delle tecniche di chirurgia mininvasiva, infatti, permette un recupero e reinserimento lavorativo più rapidi. È dimostrato da molteplici studi che l’intervento chirurgico è associato a un migliore controllo delle malattie, a un migliore controllo del peso corporeo e quindi, a lungo termine, a una sopravvivenza maggiore rispetto alla semplice dietoterapia.
* Responsabile
dell’Unità Operativa
di Chirurgia dell’Obesità
del Policlinico
Tor Vergata di Roma
Paolo Gentileschi *

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