The Department of Surgery
The Department is leaded by Professor Javier Padillo as Consulting Senior. Surgical activity is organized by Dr. Enrique Aycart that acts as Chief of Service.
The Department of Surgery develop all the process related to digestive, endocrine and abdominal wall surgery. Surgeon’s members have accredited high surgical quality in their fields. The Department is organized in specialized Units according to the international recommendations:
- Coloproctology
- HPB (liver, bile duct and pancreas)
- Upper GI (oesophagus, stomach)
- Bariatric and Metabolic Surgery (obesity surgery)
- Abdominal Wall (Hernias)
- Endocrine Surgery (thyroids, parathyroid and adrenal gland)
Most pathologies are evaluated and treated by means of a multidisciplinary approach working together with other Services of the Hospital.
The leader
The Department of Surgery is leaded by Professor Javier Padillo as Senior Consulting. Prof. Padillo is a prestigious specialist in General and Digestive Surgery with deep knowledge and a consolidated professional career in the field of liver and pancreas surgery as well as in liver and pancreas transplantation. He is the author of more than 340 national and international research papers. In addition, he is a figure of great relevance in the field of teaching. He is Full Professor at the University of Seville and the Head of Department of Surgery at University Hospital Virgen del Rocío. His professional career has been highlighted with the granting of internationally renowned awards and recognition.
Selected medical specialties - Procedure:
- Bariatric and metabolic surgery
- Photo doctor ´+ photo Hospital
- Brief Doctor´s CV
Dr. Abdul Razack has operated bariatric surgery since 2001. During these 22 years he worked at University Hospital Virgen del Rocío (Seville) as senior endocrine and bariatric surgeon and simultaneously he works at Fatima Hospital (Seville) as Head of Bariatric and Endocrine Surgery. Since January 2023 also works as Head of International Program of Bariatric and Endocrine Surgery at QuironSalud Hospital (Marbella). Dr. Razack has also worked International Surgical Cooperation Programs.
Name of the doctor who writes the article: Dr. Abdul Razack, Bariatric and Endocrine surgeon. Hospital Quirónsalud Marbella
- Name of procedure to be promoted: Bariatric surgery/Obesity surgery and metabolic surgery
- Short Description of the Procedure (What is the name of the procedure?)
Comprehensive solutions for obesity problems
“Bariatric Surgery” includes surgical procedures making changes to your digestive system to help you lose weight and also avoiding comorbidities associated with this disease, such as hypertension, diabetes or sleep apnea syndrome.
The aim of the “Metabolic Surgery” includes not only weight lose but also to do a proper control of the associated metabolic diseases such as diabetes.
The main surgical approaches included in bariatric surgery are “gastric bypass”, “gastric sleeve”, “gastric band” and gastric plicature”.
Bariatric surgery is done when diet and exercise haven't worked or when you have serious health problems because of your weight.
The main surgical approach for “Metabolic Surgery” is the gastric bypass or sleeve approach.
Therefore, a multidisciplinary team is needed to develop a complete pre and postsurgical follow-up.
How is the procedure performed?
The performance of these techniques are done by Minimally Invasive approaches avoid some complications associated with a large incision and those derived from prolonged immobility. The intervention is carried out through two 5-12 millimeter mini-incisions through laparoscopic surgery tools. The camera allows the surgeon to see the anatomy through an incision. The instruments are inserted through the other incision to reduce the lesion. The surgeon can either remove the stomach at sleeve approach or perfume a gastric bypass.
The risks are low because it is a laparoscopic surgery in which the vision quality of anatomy is high and the new laparoscopic devices are really safety . This surgery has a percentage of good results greater than 90%.
General anesthesia
Duration of surgery: An average of 60 minutes for all approaches.
- Recovery: In case of both gastric bypass and sleeve approach the patient in 2 weeks may be living a normal life.
- Days of Admission: This surgery can be performed with a short hospital stay; within 2 to 4 days of admission.
- Days of Stay in the Country: 1 week
- Aprox Price entre 13.000 y 15.000 Euros
- Doctor experience with the procedure (years):
Dr. Abdul Razack has operated bariatric surgery since 2001. He has performed more 2.000 bariatric or metabolic surgeries and more than 10.000 endocrine operations.
Surgical description
SLEEVE APPROACH. GASTRIC TUBE
With the Gastric Tube we reduce the size of the stomach, leaving it in the form of a sleeve or tube. The stomach preserves all its functions and the gastrointestinal tract remains intact, which allows it to absorb all the nutrients consumed, so there is no anemia or vitamin deficiencies after surgery. That is, there are no side effects to surgery.
This technique is performed by laparoscopy with small incisions in the abdomen. Recovery is practically painless and fast (from 18 to 24 hours), which allows a return to normal life in 5-7 days, and even sooner.
In addition, it causes a minimal aesthetic defect, there are hardly any scars since the incisions are minimal.
Partial removal of the stomach causes the patient to secrete less Ghrelin, an appetite-regulating hormone. The latter is only achieved with this Gastric Tube Obesity Technique .
GASTRIC BYPASS
Laparoscopic gastric bypass consists of decreasing and restricting the absorption of food by reducing the size of the stomach. A small stomach of 15 to 30 ml is left. Using laparoscopy, small incisions are made to divide the stomach and create a small reservoir in it that connects directly to the small intestine .
In this way the food bypasses a part of the stomach and small intestine, manipulating the path of the food and shortening digestion. In this way the food skips a large segment of the small intestine and thereby decreases the absorption of calories and nutrients. The caloric absorption of food, especially sugars and fats, is decreased.
In addition, due to the small size of the stomach, the amount of food that can be ingested is reduced, reaching a feeling of satiety earlier, thus reducing appetite.
GASTRIC BAND
The gastric band is performed, like the other techniques, by laparoscopy.
It consists of placing an adjustable silicone band around the pit of the stomach that is placed on top of it, thus creating a small bag. The passage of food from this reservoir to the rest of the stomach is through a small tube that slows down the emptying of food and causes a feeling of early satiety.
When eating, the patient will feel full with small portions, which will allow him to lose weight quickly.
Your doctor will need to fit the band around your stomach by adding a saline solution to your access port, which will inflate the band and make it fit as needed.
GASTRIC PLICATION
The gastric plication consists of reducing the capacity of the stomach by means of a fold maintained with sutures, making it smaller but without stapling or cutting it as in the Bypass or the Sleeve. It is a potentially reversible and minimally invasive procedure since it is performed by laparoscopy, under general anesthesia. Sometimes patients can go home the same day.
Therefore, it can be an outpatient procedure in some cases. The first few days you may feel sick and nauseated, which will disappear after a short time. If these discomforts are well tolerated, the patient will leave the same day. Otherwise, you will have to stay in the hospital overnight. It is a procedure that does not require strict monitoring or adjustments by your doctor.
The Plication works in such a way that the capacity of the stomach decreases (the patient feels full with what fits on a dessert plate), and the stomach loses its ability to distend, avoiding excessive intake. Therefore, it forces the patient to change their habits, eating 5 times a day. With it, the digestive function is normal: everything that is eaten is absorbed and it is not necessary to take food supplements.
Pre and Postoperative Program for bariatric and metabolic surgery
Day 1:
Visits with the Team for Bariatric and Metabolic Surgery.
- 1st Consultation Endocrinology
- 1st Consultation Psychiatry
- 1st General Surgery Consultation
- 1st Consultation Nephrology
- 1st Consultation Pneumology
On these visits the doctors will review your medical history, medical examinations and scans that have done to you and be available and judge if necessary repeat or complete any of these explorations. If so, explorations and visits to see the results will be scheduled. On the last visit before the operation, you must complete the informed consent for the same. Once all results are taken, your operation will be scheduled. You may be prescribed medication to prevent complications during surgery.
The surgeon will inform you about the intervention as well as possible complications, and will ask the signing of two documents:
- Authorization sheet for examination or treatment. This allows the surgeon to perform the procedures indicated therein.
- Authorization Sheet for blood transfusion. This allows the surgeon to perform a blood transfusion if is strictly necessary.
Day 2:
- Preoperative Examination
The most common medical examinations for metabolic surgery are:
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- Blood tests to check your hormonal status in concern to diabetes, and other issues.
- Fibrogastroscopy with sedation and biopsy for Helicobacter Pylori. If it was positive, eradication treatment should be performed prior surgery.
- Upper GI x-ray examination.
- Abdominal ultrasound, to rule out possible gallstone.
- Spirometry to check the state of your lungs
- In some cases polysomnography to check if sleep apneas, that is stop breathing during sleep, occur.
The specific health examination required before interventions consists of the following sections:
- Electrocardiogram
- Chest x-ray if necessary and subject to the recommendations of international societies of anesthesiology.
- Blood tests, with special care in the state of red blood cells (RBCs) and coagulation, as well as other determinations as necessary.
- Health Questionnaire must be completed with the help of the nurse.
- Visit with anesthesiology, where you can find out the type of anesthesia to be used and must complete informed consent.
The preoperative evaluation by other specialists (hematologist, etc.) as well as performing other diagnostic tests in order to reduce potential risks of the operation will be necessary sometimes.
Day 3:
The day of surgery.
If your health advises, you can spend the night before surgery outside the hospital. If so, you should go to the hospital two hours before the intervention.
At home, you must follow the instructions they have given. One is showering, for which you will receive an envelope containing a special antiseptic to reduce the risk of infection.
Do not eat or drink after midnight. Remove makeup, nail polish and metal items carried.
Do not take any medication that doctors will not have prescribed to you. If in doubt, just ask them. In any case, do not take anything after midnight.
You should contact the Admissions area where administrative procedures are formalized. If you have questions, at Reception will indicate where to process it.
If it was necessary to stay in the hospital the night before, the nurse will give you instructions for showering for what you will receive an envelope containing a special antiseptic to reduce the risk of infection.
It will put a subcutaneous injection into the abdomen to prevent clots, which will continue to manage during the next few weeks until you get full mobilization.
Do not eat or drink after midnight. Remove makeup, nail polish and metal items carried.
Do not take any medication that does not provide him or authorized nurse. If in doubt, just ask them. You must sign the prior arrangements sheet, in which you can express all those relevant things to you to be complied with during admission.
The stretcher-bearer will take you to the operating theater
Before enter the operating room
Next you will be accompanied to preoperating room. In this area you should undress in the locker room and the nurse will give to you a gown, hat and foot leggings. You will be accommodated on a stretcher. Your data will be checked again and will place to you a bracelet with your identification data. A vein will be channeled into a forearm and a serum will be placed. You may be given some medication at this time. If you have not previously done so, you must sign the prior arrangements sheet, in which you can express all those relevant things to you to be complied with during admission. Then you will be transferred to the operating room.
In the operating room.
You will be received by the anesthesia nurse anesthesia that starts the process. Then the anesthesiologist will administer the anesthesia. You must follow your instructions and gradually sleep. From that moment you will not notice any pain or manipulation of your body.
Surgical techniques are described in specific file.
These surgeries require hospital admission for a period of three or four days. An ICU room will be reserved only in case it is necessary (in less than 5% of cases).
The intervention is performed under general anesthesia and laparoscopically. Laparoscopy consists of accessing the abdominal cavity with five ports of about 12 mm in diameter, previously blowing air (Carbon Dioxide) to create a space in which to work.
The intervention lasts approximately an hour, the patient then going to the resuscitation room (awakening) where they will remain one more hour under the control of specialized nursing and anesthesia. Less than 5% of patients will require an ICU stay (Conditioned by the degree of Obesity and the associated pathology that the patient has).
24 hours after the intervention, the patient gets up, can walk and begins tolerance to liquids that he will take in a varied way at 48 hours and discharge is assessed on the third day after surgery, without drainage and with a liquid diet that should be keep for another week.
From the tenth day, he will be evaluated in consultation and will start, according to nutrition advice, a more varied diet until he progresses to a normal solid diet in a month and a half.
Day 3: In the recovery zone.
The surgeon will inform your family about the results of the operation in the area for it.
You will have one or more catheters placed in the veins to continue administering fluids and medications to avoid having pain. You will remain for 1 to 3 hours, here we will carry out frequent checks pulse, stress, heart, breathing, etc. You will gradually awakening. If at any time you have pain or are restless, please, tell the nurses. When the care team deems it appropriate, you return to your room or will be transferred to the intensive care unit, depending on your condition.
Day 3: In the Intensive Care Unit
In cases of patients with a prior delicate state of health, if they have other heart, kidney, lungs, etc. diseases, it may be necessary to pass the immediate postoperative period in the Intensive Care Unit. This unit will remain guarded 24 hours. It is an area with restricted visits, so relatives must abide by visiting hours. This stay is usually not more than one day, but according to tour case may be further prolonged. Your relatives will be informed at least once a day and as often as necessary.
Days from 4 to 6: In the room
You will have blood tests to check that your state. After anesthesia, may have urinating difficulty. If necessary we will place a sterile tube called a catheter, which is inserted into the bladder to get the urine out and removed as soon as possible. You can resume meals, starting with liquid until well tolerated, when he will retire serum, progressing in the diet as much as your condition will allow.
About 3-4 days after surgery you can go home. At discharge, doctors will recommend a number of drugs, including a subcutaneous injection into the abdomen to prevent clots and will indicate the time that must receive it. Also they will prescribe pain medication if necessary. You will be given a sheet with recommendations to follow.
You will be given an appointment to visit outpatient clinics for control.
