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Percorso Terapeutico

Nell’iter di  Gestione  del  paziente  Bariatrico  occupa  un ruolo imprescindibile,  la valutazione  pre operatoria, affi-data anch’ essa ad  un  team  interdisciplinare  composto da esperti dedicati,  in particolare  endocrinologo-interni-sta,  chirurgo bariatrico, nutrizionista,  psichiatra, cardio-logo,  pneumologo,  anestesista.  Tale valutazione  non deve essere necessariamente collegiale, nel senso conte-stuale del termine, purché però siano tenuti presenti tutti i pareri espressi dai vari componenti il team multidisciplina-re. Tutti i candidati  devono  essere sottoposti ad uno stu-dio pre operatorio di routine, analogamente ad ogni altro intervento di chirurgia addominale  maggiore   e  ad  una larga  serie  di  counselling  (cardiologica, pneumologica, endocrino metabolica, gastroenterologica, psicologica, nu-trizionale  e  chirurgica)  per  la  valutazione dello stato di salute generale e nutrizionale nonché delle comorbilità, al fine di minimizzare i rischi per gli operatori ed evidenziare eventuali controindicazioni generali alla  chirurgia  o spe-cifiche per un determinato tipo di intervento. Sono necessari, infine, colloqui tesi a spiegare i cambiamenti delle abitudini alimentari inevitabili dopo l’intervento, a  valutare  le motivazioni del paziente e la sua disponibilità ad aderire al programma di follow-up, a garantire che il paziente sia stato informato correttamente sui benefici, sui rischi, sui risultati potenziali e le conseguenze della scelta chirurgica e della necessità di un follow-up a lungo termine, esprimendo a quel punto un consenso libero, informato e consapevole.

 

 

Diagramma-Percorso-Bariatrico-2-189x300  IL PERCORSO BARIATRICO

 Il Percorso Bariatrico comincia con una prima visita che  si  svolge  nell’Am-  bulatorio di Chirurgia Bariatrica o di Chirurgia dell’Obesità. Il paziente viene  generalmente inviato da colleghi specialisti del settore  o  può  direttamente  accedere tramite internet.  Lo scopo principale del primo colloquio  è  quello  di prendere coscienza  delle  corrette informazioni scientifiche sulla chirurgia  bariatrica  e  valutare caso per caso la storia clinica del paziente,  le abitudi-  ni alimentari,  il performance status, al  fine  di  porre  indicazioni  corrette al   trattamento chirurgico  e  selezionare il tipo di intervento chirurgico preferi-  bile.

Successivamente, il paziente viene inviato ai vari specialisti  a seconda delle problematiche  singole legate al quadro clinico. In linea generale, il paziente deve essere valutato, oltre  che  dal  chirurgo bariatrico, dall’endocrinologo-internista, dal nutrizionista, dallo psichiatra. Verranno. quindi. selezionate le indagini pre-operatorie indicate  dal quadro clinico e che comunque preve-dono,  in tutti i casi,  gli esami ematochimici di routine, elettrocardiogramma, esofagogastroscopia o RX digerente prime vie, eventuale ecografia epatica, radiografia del torace ed eventuale spirometria, test  per  i disturbi  del com-portamento alimentare. Alcuni test, come la spirometria e le prove di funzio-nalità respiratoria, la polisonnografia, o altri, possono essere richiesti sulla base del quadro clinico e delle indagini preliminari.

Obiettivo dell’inquadramento diagnostico moderno del paziente obeso  e diabetico è la valutazione globale  eseguita in un solo giorno, in day-hospital, con la presenza di tutti gli specialisti che nello stesso giorno valutano il paziente e lo sottopongono ai vari esami per dimetterlo in serata con la diagnosi corretta e la terapia idonea programmata.

Una volta eseguito tutto l’iter pre-operatorio, il paziente viene nuovamente valutato dal chirurgo bariatrico e viene selezionato e programmato l’intervento chirurgico prescelto.

 

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