Dr. Alfonso Antequera - Upper G.I & Metabolic Consutlant Surgeon

 
_DSC8556.jpg
 
 
 

BIO

Dr Antequera is Consultant Surgeon at St Bernard's Hospital, located in Gibraltar. 

He is a leading expert in laparoscopic and endoscopic treatment for Obesity. He offers alternative weight loss solutions such as, gastric balloons, gastric bypass, gastric sleeve, gastric band/lap-band, bariatric surgery and gastric band adjustments. 

Dr Antequera was associate professor of surgery at the European University of Madrid and a Honorary professor of surgery at Rey Juan Carlos University and Trinity College of Dublin. He is currently a Fellow of the American College of Surgeons and a Fellow of the Royal College of Surgeons in Ireland. 

Dr Antequera successfully earned his PhD in 2004. His research focused predominantly on Obesity & Weight Loss surgery. He belongs to the faculty programme of Masachussets Institute of Technology in Madrid called M+Vision. 


 

What is bariatric surgery?

Bariatric surgery is an operation that is performed to help overweight and obese individuals lose weight. The basic principle of bariatric surgery is to limit food intake and reduce the absorption of nutrients in the stomach and intestines. Bariatric procedures also often cause hormonal changes which drive the decrease of appetite and the resolution of different comorbidities such hypertension, hypercholesterolemia, hypertriglyceridemia, ovarian polycystic disease, type 2 diabetes, etc. 

In 2009 the American Society for Bariatric Surgery (ASBS) changed its name to the American Society for Metabolic and Bariatric Surgery (ASMBS) to promote information on the beneficial effects of surgeries for weight loss in treating metabolic diseases, especially Type 2 Diabetes Mellitus (T2DM). 

Today, the term Metabolic Surgery is used to describe surgical procedures to treat metabolic diseases, especially, type 2 diabetes. 

Physician experts inspect the causes of obesity, how it can be prevented and intervene to reduce obesity-related conditions. Within bariatric surgery, there are a number of weight-loss procedures that can be performed. As bariatric surgery is a major procedure, it is custom tailored to every individual. The best-known metabolic surgery is the Gastric Bypass with over 20 years of experience with this procedure. Other established procedures are the Gastric Band, Gastric Sleeve and the Biliopancreatic Diversion with or without Duodenal Switch. 

Most weight loss and metabolic surgeries today are performed using minimally invasive techniques (laparoscopic surgery). 

How can a bariatric surgeon help you? 

Successful results have been shown in patients and longitudinal studies have shown that Bariatric procedures cause significant long-term weight loss as well as: 

  • A long-term change in attitude towards healthy eating 
  • Improved health and mobility 
  • Improved mental wellbeing 
  • Boost to self-esteem and self confidence 
  • Stop the longer-term urges to regain weight by modifying the appetite drives and food cravings 
  • Increase life expectancy 

Who does a bariatric surgeon help? 

Dr Antequera will perform an in-depth consultation with you and will advise you on the best suited option. Individuals that are overweight and obese have a tendency to seek external help and advice to achieve sufficient long term weight-loss.  

Candidates for bariatric surgery have often been overweight for a long period of time and have failed conventional weight-loss treatments. Successful patients who are interested in bariatric surgery for achieving weight-loss, should be committed to changing their life-style to incorporate healthy food intake and regular exercise on a regular basis. 

Is bariatric surgery a 'Quick Fix' to Lose Weight? 

Although undergoing bariatric surgery results in rapid weight loss, the procedures are principally used for long-term weight-loss maintenance and the improvement of medical conditions caused by obesity. At the Ocean Medical Clinic we work with our patients by offering them nutritional support and emotional support, to ensure that patients do not revert back to old eating patterns. It is important that all procedures are complemented with physical, emotional and dietary changes to ensure maximum long term results. 


     

    Invasive Procedures

     
    iStock-504643164.jpg

    Gastric Sleeve

    What is the gastric sleeve?

    The Gastric Sleeve also known as a vertical sleeve gastrectomy, is a surgical bariatric procedure whereby the stomach is reduced by 75% of its original size. The Gastric Sleeve weight loss surgery is a permanent and non-reversible procedure.

    What is the procedure?  

    With this procedure, the structure of your stomach is changed and shaped like a sleeve, restricting the number of calories your body absorbs without affecting the stomach's function. The gastric sleeve is non-reversible. 

    PROS:

    • The patient notices when he should stop eating 
    • It does not need any regulation nor should it carry any prosthesis 
    • The stomach is smaller but normally digests any type of food 
    • Patients do not suffer from loss of vitamins, just iron 
    • In case of suspected gastric disease of any kind, studies such as gastroscopy can be performed 
    • Very effective as a first stage procedure in high BMI patients (> 50-55 kg / m2) 

     


    Gastric Bypass 

    What is the gastric bypass? 

    Gastric Bypass helps you lose weight by changing how your stomach and small intestine handle the food you eat. This surgery involves the construction of a small stomach pouch to restrict food intake. 

    During meals, food is quickly collected in the bag. As the bag needs only a small amount of food to be filled, the stomach receptors located on the top of the bag send an early signal of fullness to the brain, as if the whole stomach were full. Therefore, feel full sooner and eat less. The stomach and the small intestine are then bypassed which reduces the absorption of calories and nutrients from food.  

    This procedure: 

    • Causes you to reduce the amount of food you can take during a single meal (restriction) 
    • Causes less food to be absorbed (malabsorption) 
    • Will make you intolerant of foods that you should avoid anyway (e.g. concentrated fats and sugars) 
    • Changes intestinal hormones reducing your appetite and changes your food preferences for healthy options 
    • The gastric bypass is non-reversible. 

    Pros: 

    • Greater overall weight loss is achieved in comparison with restrictive procedures 
    • Due to malabsorption, less stringent dietary compliance is required than with purely restrictive procedures 
    • It is the most performed bariatric surgery all over the world
    • It is the best option to treat Type 2 diabetes 
     

    Minimally Invasive Procedures

     
     
    iStock-663845678.jpg

    Gastric Band

    What is the gastric band? 

    Gastric Banding is one of the most popular weight loss surgeries.  It is less invasive than other bariatric surgeries, because it is reversible and thus carries less complications. Restrictive obesity surgery reduces the amount of food consumed at one time, so you will feel full for longer. Therefore, you will eat less and lose weight.  

    What is the procedure? 

    In this procedure the surgeon places an adjustable, low-pressure gastric band around the upper part of the stomach, giving it an hourglass shape and creating a second smaller stomach. A narrow passage between the upper, smaller stomach and the rest of the stomach allows food and liquids to be passed through. During meals, food quickly accumulates in the small upper pouch and slowly passes into the lower part of the stomach. This slows digestion down, resulting in an early feeling of satiety or fullness.  Therefore, you will feel fuller for longer and will eat less. In this procedure, the anatomy is not altered; resulting in the surgery being completely reversible. In addition, digestion and absorption take place completely in the digestive tract. 

    The band is adjusted with in-fills which are injections of saline (salt water) into the band through the port (attached on the abdominal muscle wall) which in turn shrinks the opening of the stomach. This is a quick and relatively painless procedure performed by your surgeon. 

    In restrictive procedures, patient cooperation is very important. After the procedure, you should follow the strict and specific dietary guidelines and behavioural modifications that your multidisciplinary team tells you, adapting to a new way of eating. If you do not follow the guidelines, you can stretch the stomach pouch and/or the narrowed opening between the two portions of it, thereby undoing the goal of the surgery. The gastric band is reversible. 

    Pros

    • As the adjustable gastric band does not alter the anatomy, the absorption of nutrients occur in a normal way. Therefore, there is no vitamin or mineral deficiencies or other side effects associated with malabsorption 
    • The adjustable gastric band can be easily removed, and the normal shape and structure of the stomach is restored 
    • As the procedure is performed by laparoscopic surgery (small incision), patients recover quickly from the operation and only need a brief hospital stay (usually 48 hours) 
    • The volume of the gastric band is adjustable, which means that the rate at which the stomach bag empties can be increased or reduced according to the situation and the needs of the patients. 
     

    Endoscopic Procedures

     
    1429302027627.jpg
     
     

    POSE Procedure

    What is POSE? 

    Primary Obesity Surgery Endoluminal, or POSE procedure, is an endoscopic incision-less weight loss procedure that reduces the size of the stomach and helps to diminish hunger cravings. This procedure is particularly advantages as it is a non-surgical weight loss endoscopic procedure. 

    It is performed entirely endoscopically (through the mouth) and does not require any external cuts into the body. This speeds healing time, minimises surgical pain and discomfort and leaves no visible scars. It is generally an outpatient procedure (about 1 hour), with most patients making a quick return to normal activities (only a few days to a week, depending on the individual). 

    The ideal patient for this procedure is anyone who has not been successful in losing weight with a diet and exercise and who do not qualify or do not want to undergo a more extensive type of bariatric surgery. The POSE procedure is primarily designed for patients who want to lose more the 15 kilograms and no more than 30 kilograms and have a BMI of 30 to 40.

     

    How it Works? 

    The POSE procedure is a type of weight loss surgery that restricts eating and reduces hunger by reducing the size and capacity of the stomach by folding and anchoring the stomach tissue. These gastric plications reduce the stomach’s ability to accommodate & stretch, decreasing the sensation of being hungry and reducing the urge to eat. This will help your body recognise when you have had enough food, even after a small meal. 

    Pros: 

    • No external cuts or incisions, leaves no visible scars 
    • Quick procedure (1 hour), usually performed on an outpatient basis 
    • Quick recovery time, resume normal activities within 2-3 days 
    • Overall risks much lower than with open or laparoscopic surgery 
    • May be reversible if necessary 
     
     

    Gastric Balloon

    What is the gastric balloon? 

    The Gastric Balloon is a type of bariatric treatment that involves a saline-filled silicone balloon to aid weight-loss. This treatment is viewed as a non-surgical weight loss treatment or a “scar free” weight loss treatment. If you have tried various diets and exercise regimes but have been unsuccessful or if you have a BMI of 27 or more, this might be the perfect treatment to help jumpstart your weight loss transformation. 

    Once the Gastric Balloon is inserted into the stomach, it is filled with saline and creates a feeling of satiety, decreasing hunger cravings. The shape and volume the balloon takes up in your stomach will help you adapt to healthier portion sizes. The technology and design of the balloon helps patients lose up to 3x the weight of diet and exercise alone. 

    The gastric balloon procedure

    During the procedure, the soft deflated gastric balloon is inserted through the oesophagus and into the stomach via an endoscope, a long thin tube that is entered through the mouth. The endoscope travels down your throat and as the balloon reaches the stomach, it is filled with saline solution. A syringe is then used to fill the balloon with saline solution. Once the balloon is filled with the saline it resembles the size of a grapefruit. The entire procedure takes about 30 minutes. After roughly two hours of recovery, most patients head home to begin the rest of their new life. 

    Pros: 

    • Non-Surgical and minimally invasive, the gastric balloon is placed into your stomach gently through the throat, rather than through any incisions 
    • Limited recovery time, procedure takes approximately 30 minutes and no need for a hospital stay 
    • Not permanent, the balloon can be removed at any time
    • Encourages portion control and healthy lifestyle changes 
    • The volume and space occupied by the balloon encourages smaller portion sizes and health lifestyle changes 
     

    Non - Endoscopic Procedures

     
    WhatsApp Image 2018-01-16 at 18.18.17.jpeg

    Swallowable balloon

    The procedure

    The ‘Elipse Balloon’ is swallowed inside a capsule that is attached to a tube (a micro-catheter). The capsule is approximately the size of a vitamin pill. Once you have swallowed the pill, an X-ray will be performed. The X-ray will confirm that the capsule is safely in your stomach. As the capsule dissolves, the balloon is inflated with a saline blue liquid and micro-catheter is removed quickly and smoothly. After Mr Antequera is satisfied with the result, you can return back to you daily activities.  

    Pros: 

    • After 16 weeks the valve disintegrates and the device is secreted naturally 
    • Obese patients who used a swallowable gastric balloon lost on average about 15.2kg over a four-month period 
    • The Elipse Balloon is a procedure-less gastric balloon 
    • No need for sedation, general anaesthetic or endoscopy  
    • Procedure takes approximately 30 minutes and no need for a hospital stay 
    • Encourages portion control and healthy lifestyle changes 
    • The volume and space occupied by the balloon, encourages smaller portion sizes and health lifestyle changes