Frequent questions

Bariatric Surgery

Why should you consider bariatric surgery?

  • Obesity is a disease and must be recognized and managed as such. It`s a multifactorial and complex disease that requires a multidimensional approach to its treatment. Fighting it is not necessarily a matter of willpower or character.

  • If you suffer from morbid obesity or diseases associated with it (diabetes mellitus, high blood pressure, high cholesterol and triglycerides, etc.) you should know that bariatric surgery is the most durable and effective treatment that exists to date.

  • Diets, medications and other conservative measures that are commonly used to treat obesity have been shown to be little or not effective in 99% of people with morbid obesity.

  • Morbid obesity is defined as a body mass index greater than 40 kg / m2 (see body mass index calculator).

  • Candidates for bariatric surgery are those patients who have a body mass index greater than 40 kg / m2 or greater than 35 kg / m2 and who have diseases associated with their overweight.

  • In diabetic people, the case should be analyzed individually since bariatric surgery may occasionally be indicated with a body mass indexes less than 35 kg / m2.

What are the results that can be expected from a bariatric procedure?

  • One thought that often comes to mind from people that consider bariatric surgery is how much weight they can lose. The results are discretely variable between people due to their individual characteristics. On average, a person having a gastric bypass can expect to lose about 70% to 80% of their excess weight, although it often goes further. In the case of gastric sleeve, the percentage ranges around 60% to 70%.

  • Practically all the diseases associated with obesity can remit totally or partially after bariatric surgery. An absolute or partial resolution of type 2 diabetes mellitus can be expected in 90% of patients who suffer from it. A similar average resolution or improvement can be observed in diseases such as high blood pressure, high cholesterol, and obstructive sleep apnea, among many others.


Is a bariatric procedure expensive?

Some people have the perception that obesity surgery is very expensive, however, they generally do not take account that:

  • Bariatric surgery is not more expensive than other common operations that are also necessary to regain health

  • Obesity surgery is a great investment! Not only because it dramatically improves the health status and quality of life of the person, but also because it significantly reduces the costs of medications, interventions and potential hospitalizations due to the consequences that develop from obesity and its associated diseases

  • Our center has financing programs and other facilities that allow practically all patients who wish to change their lives through obesity surgery, to do so.

Is lost weight regain after bariatric surgery?

Most patients experience a modest gain between the first and second year after the operation. In general, this gain is not significant and patients remain at the desired weight in subsequent years.

Bariatric surgery, is it dangerous?

- Surgical procedures to treat obesity have shown to be as safe as many other surgeries that are performed frequently and routinely, for example; a knee replacement, gallbladder operation, or laparoscopic appendectomy.

- Mortality has been estimated around 0.1% - 0.4% of all cases depending on the type of surgery and other factors associated with the health status of the person

- It reduces the probability of developing cardiovascular events, such as myocardial (heart) infarcts and cerebral vascular events, commonly known as strokes or embolisms.

- With the advent of laparoscopy, many complications previously considered common have dramatically decreased or practically disappeared.


What other benefits are obtained with obesity surgery?

- Many other diseases directly or indirectly associated with obesity and inflammation can disappear or improve significantly after surgery. These diseases include osteoarthritis, gastroesophageal reflux, depression, urinary incontinence, migraine, asthma, fatty liver, pseudotumor cerebri, and polycystic ovarian syndrome, among others. Some recent studies suggest that bariatric surgery may play an important role in the resolution or improvement of less conventional health problems such as psoriasis, systemic lupus erythematosus, multiple sclerosis and gout, although more evidence is needed to confirm the benefit.
- Most of the patients report a significant improvement in their quality of life, self-perception and mood.

- It has been estimated that on average, a person that undergoes surgery gains up to 10 years in their life expectancy.

- It reduces the probability of developing cardiovascular events, such as myocardial (heart) infarcts and cerebral vascular events, commonly known as strokes or embolisms.

- Significant decrease in the development of complications associated with diabetes. Among them retinopathy, nephropathy, neuropathy, dialysis, etc.

- Decreases the probability of developing different types of cancer.

- Improves fertility and sexual life.

Endocrine Surgery

What is Endocrine Surgery?

Endocrine surgery is a medical specialty that focuses on the diagnostic approach and surgical treatment of diseases of the glands that produce hormones that trigger fundamental processes for the proper functioning and well-being of our body.

What is an Endocrine Surgeon?

Endocrine surgeon formation is oriented in the total understanding of the glandular disease process, the broad mastery of the surgical techniques used to treat them and the comprehensive care of the patients who suffer from them.
The endocrine surgeon dedicates his daily practice on treating conditions of the thyroid, parathyroid, adrenal and pancreas glands, which potentially require an operation for their adequate resolution. Endocrine surgeons frequently finds with one foot in the medical world and the other in the surgical world.

What other services are offered at Endobalance?

In addition to endocrine surgery and obesity, we treat patients with gastrointestinal problems and general surgery such as acute appendicitis, gallbladder problems, routine and complex hernias, gastroesophageal reflux, etc.

What other diseases does the endocrine surgeon treat?

Other less frequent glandular diseases include neuroendocrine tumors of other organs not mentioned, genetic syndrome such as Multiple Endocrine Neoplasia, among others.

How are adrenal tumors treated?

Adrenal tumors frequently require surgical resection. In general, these operations can be carried out with minimally invasive techniques, which allow us a quick and early recovery, with minimal pain and associated discomfort. The body usually adequately compensates the hormonal production, with the presence of only one gland.

What are the adrenal glands?

- They are two small glands that are located above each kidney. These organs are responsible of producing some extremely important hormones for the body. The adrenal is divided into two parts: the cortex and the medulla. Cortisol (the hormone with which we respond to stress), aldosterone (which maintains blood pressure), and androgens and estrogens (which control the reproductive system) are synthesized in the cortex. Catecholamines (adrenaline, norepinephrine, and dopamine) are produced in the marrow and are responsible of the mediating “fight or flight” responses. Adrenal tumors often produce an exaggerated amount of these hormones or in some cases it can be malignant (up to 10% of these lesions).

- Due to their presentation and origin, the diagnostic approach to these tumors is complex and must be carried out by a person with extensive knowledge in the area. Before the operation, a period of preparation and temporary pharmacological treatment is required in some cases, with the intention of making the operation and definitive treatment safer and faster.


What if I have persistent or recurrent hyperparathyroidism?

Cases of hyperaparathyroidism that persists after an operation or that returns after 6 months of it requires a complete and awareness re-evaluation, and in most cases, a second operation. At Endobalance, we receive complex cases of hyperparathyroidism.

Are there other forms of hyperparathyroidism?

There are also secondary and tertiary hyperaparathyroidisms that develop from a state of chronic hypocalcemia. Surgical evaluation and treatment is usually a complex and intricate process, so it’s essential to see the specialist indicated to carry out the surgery. Frequently we teamwork with a nephrologist and an endocrinologist.

What is minimally invasive or directed parathyroidectomy?

In most cases of primary hyperparathyroidism that require surgical treatment, it is possible to remove the diseased gland through an incision less than 3 cm. For this, it’s necessary to have concordant localization studies, an intraoperative PTH protocol and a surgeon with adequate training and experience.

What is primary hyperaparathyroidism?

Hyperparathyroidism is a disease in which calcium levels in the blood are above normal values. Usually this happens due to an abnormal growth of one or more of the parathyroid glands. Symptoms include weak bones (osteopenia, osteoporosis), urinary stones or stones, deterioration kidney function, fatigue, memory loss, muscle or bone pain, depression, anxiety, abdominal pain, seizures, arrhythmias, and excessive urination. . The diagnosis is generally made with laboratory studies and localization studies are frequently requested to have a map of where the abnormal gland is located. Not all cases of hyperparathyroidism require surgical treatment that is why it’s important that an expert evaluate each case and its individual characteristics.

What is thyroid surgery under neuromonitoring?

- The recurrent laryngeal nerves are two very small structures that are in intimate contact with the thyroid gland. These nerves are responsible for the integrity of the voice. One of the recognized complications of thyroid surgery is postoperative dysphonia (hoarseness and decreased intensity / quality of voice). Similarly, there are two other structures near the upper pole of the thyroid, called external branches of the superior laryngeal nerves. Damage to these branches results in the inability to reach high tones, swallowing disorders, and a voice that diminishes in quality with use. While it’s true that the experience and care that the surgeon gives during the operations is an irreplaceable preservation instrument, at Endobalance we are committed to excellence. For this reason, we use all the resources within our reach to provide our patients with the best care and the best possible results.

- Intraoperative neuromonitoring is a valuable technological resource that is used as an aid in locating and preserving the integrity of the nerves already described. This is achieved by placing a sensor that remains between the vocal cords for the emission of information towards a module that in turn shows the representation of an electrical conduction curve with amplitude and frequency that allows us to demonstrate the identity of the nerve and its proper functioning. Although it is not a foolproof technology, intraoperative neuromonitoring has shown through serious, high-volume studies:

1. Increase the rate of identification of recurrent laryngeal nerves
2. Decrease the risk of recurrent laryngeal nerve injury
3. Increase the safety of total thyroidectomy selection
4. Helps make thyroid tissue resection more complete

Wajtczak B. et al. Experience with intraoperative neuromonitoring of the recurrent laryngeal nerve improves surgical skills and outcomes of non-monitored thyroidectomy. Langenbecks Arch Surg. 2017; 402(4): 709-717.

I was diagnosed with thyroid cancer. Should I be treated by an oncologist?

Endocrinologists and endocrine surgeons have the greatest experience in the field of glandular tumors (thyroid, parathyroid, adrenal). Glandular tumors are frequently hormone producers and their diagnostic and therapeutic approach requires in-depth knowledge in this area. This is especially important during the disease follow-up after initial treatment. The endocrine surgeon is involved in hundreds of thyroid cancer cases during his training and professional practice. The endocrine surgeon treats glandular cancer in the same way that a neurosurgeon treats brain cancer or an ophthalmologist treats eye cancer.

I was diagnosed with thyroid cancer. What does that mean for me?

If you were diagnosed with thyroid cancer, you shouldn't panic. There are 4 main types of thyroid cancer. The most common type is by far the most indolent as well. This does not mean that the diagnosis should be minimized, however we know that more than 90% of these cases will obtain a complete cure. None of these cases require chemotherapies or treatments of great morbidity or adverse effects. The main column in the management of this diagnosis is surgery.

I have Graves disease (autoimmune hyperthyroidism). Is surgical treatment appropriate for me?

There are several treatment options for Graves' disease, including drug treatment, radioactive iodine, and surgery. All the options have advantages and disadvantages. Surgical treatment is an option in Graves' disease, and it is especially recommended in cases in which the eyes are markedly affected or when other treatments have been ineffective.

I have multinodular goiter. What does that mean?

In simple terms, it means that your thyroid gland is big. Multinodular means that this growth is not irregular but at the expense of numerous confluent nodules. The size of the goiter can become significant and cause compressive symptoms, which is why it sometimes requires surgical removal.

I have a thyroid nodule. Does that mean I have cancer?

Thyroid nodules are common lesions. Fortunately, up to 95% of them are benign. Ultrasound evaluation and fine needle biopsy, if required, are very important tools in determining the nature of the nodule.

What is the advantage of being treated by an Endocrine Surgeon?

The benefits of seeking the care of an endocrine surgeon are extensive and well established:

1. An integral vision
The endocrine surgeon knows in depth the pathophysiological processes of glandular diseases. This allows you to perform a comprehensive and complete approach through the different phases of the disease, diagnosis and treatment.

2. Surgical indication
Endocrine conditions are mostly complex and intricate. The endocrine surgeon adequately understands the processes that lead to the disease and its biological behavior, which is why he is able to correctly discern between cases that require surgical treatment and those that can be treated more conservatively, frequently avoiding unnecessary interventions and vice versa.

3. Adequate criteria
Once the surgical indication is defined, it is extremely important to decide the type of operation and the route by which it will be carried out. The highly specialized training that the endocrine surgeon receives allows him to recommend an appropriate intervention to each one of his patients. Factors such as the type of approach, the extent of the resection of the affected organ (partial or complete), the need to remove or not remove lymph nodes and other adjacent tissues, among other factors, have a direct impact on the well-being and prognosis of the patient.

4. The operation
Endocrine diseases that require surgical treatment are not highly frequent. That is why it is important to receive the care and recommendations of a person who dedicates his professional life to these conditions. Repetition generates experience and this, in turn, excellent results. Endocrine surgeons perform a high number of thyroid, parathyroid, adrenal, and other gland surgeries each year. This allows them to know and master the anatomical, physiological and surgical aspects necessary for an operation to meet the objectives of curing the disease, preserving function and optimizing recovery. It is proven that a surgeon with specific training who dedicates most of his practice to treating these types of diseases, has much better results and fewer complications than a surgeon who only faces them sometimes.

5. Postoperative care and follow-up
Post-surgery care and ongoing follow-up after surgery are almost as important as the intervention itself. For this reason, it is of great importance that these are conducted by a surgeon who has a broad vision of the biological behavior of gland diseases. The endocrine surgeon knows the details and minutiae of these processes and takes care of every detail of the post-treatment evolution that is offered to his patients

What is the difference between Clinical Endocrinology and Endocrine Surgery?

In simple terms, endocrinology is the branch of medicine that is dedicated to the study of the glands. The glands are organs that produce hormones, which in turn fulfill different functions, many of them of great importance in the rest of our body.
Clinical endocrinologists and endocrine surgeons often work as a team to ensure the best possible care for patients with endocrine conditions. Endocrinologists deal with the clinical aspect of glandular diseases and endocrine surgeons with the surgical aspect, in a similar way as cardiologists / cardiovascular surgeons or neurologists / neurosurgeons.
Alivio Capital is a company that is dedicated on helping patients that undergo surgery and / or treatment (including plastic surgery), granting personal credits this with the possibility of scheduling or starting a treatment, providing a payment option with facilities. Credits of 3 or 6 months are also granted without interest, with payment of an opening commission of 8% plus VAT.