This Master's Degree offers you access to the most innovative protocols in the organization of an increasingly advanced service”

A Master's Degree created to take professionals through the essential knowledge in each and every one of the areas that make up a high-level Bariatric Unit”

This Master's Degree in Update on Bariatric Surgery not only covers all the controversial topics in the field of obesity surgery but rather extends the contents of other similar Update on Bariatric Surgery. Therefore, it is undoubtedly the most complete and updated Master's Degree on the market.  
 
Among the the aspects which differentiate this course from others, there is a module dedicated to endoscopic and percutaneous treatments, the management and treatment of bariatric emergencies, the follow-up and nutritional requirements of the patient in the postoperative period, and a module related to metabolic surgery. 
 
In the past few years, we have seen the emergence of multiple new endoscopic and percutaneous treatments aimed at treating obesity and the associated complications, but its actual usefulness is relatively unknown.  The Master’s Degree aims to provide up-to-date information on the different alternatives to endoscopic obesity treatment that currently exist. The main focus is on technical aspects and on the existing evidence in the literature on its clinical utility, both in the primary treatment of obesity and in its therapeutic role in weight regain, or in the management of post-surgical complications.
 
The peculiarities of morbidly obese patient in postoperative care, which differentiate them from standard postoperative patients, have led to the creation of a module exclusively dedicated to the management of postoperative emergencies in this type of patient. This module is of extreme importance due to the legal implications involved. Although postoperative complications are infrequent these days, ignoring these peculiarities can lead to a fatal outcome for the patient. Therefore, it is essential that every surgeon who wants to enter into a multidisciplinary bariatric surgery unit has knowledge of these.  
 
What differentiates this course from other master’s degrees on the market, is the focus on the follow-up treatment and nutritional needs of a bariatric patient during the postoperative period. The bariatric surgeon must know how to appropriately monitor their patients, know how to identify and correlate the patient’s symptoms with possible nutritional deficits and to adopt the appropriate therapeutic measures in each case. 
 
Metabolic Surgery is no less important. Metabolic surgery consists of the application of the classic surgical techniques of bariatric surgery to patients with a mild obesity index (BMI < 35) or significant obesity (BMI 35-40) who suffer from type II diabetes mellitus and who are unable to achieve the desired blood glucose levels despite adequate medical treatment. The module not only describes the current scientific evidence of metabolic surgery but also describes the pathophysiological basis of metabolic syndrome, the pathophysiology of diabetes and its therapeutic alternatives, but also controversial aspects such as the role of microbiota, loop lengths, bile acids, NASH, bone metabolism, and the role of bariatric surgery on hypogonadism and polycystic ovary syndrome.
 
Finally, it is important to highlight the chapter on the Creation of Behavioral Therapy Programs for the maintenance of weight loss after surgery. The aspects related to aesthetic and body contouring surgery are of great interest to our patients, as well as the importance of the impact of physical training programs in the maintenance of weight loss before and after bariatric surgery. Together with behavioral therapy, these seem to be the two most important aspects for achieving and maintaining body weight after bariatric surgery.
 
In order to achieve the teaching objectives, this program has different didactic resources: self-assessment activities, video lectures explaining the most complex points of the subject, clinical cases, videos on the techniques used showing practical procedures and recommended readings.

A unique training that stands out for the quality of its contents and its excellent teaching staff, with which you will achieve professional success.

A unique training program with which you can achieve professional success”

This Master's Degree in Update on Bariatric Surgery offers you the advantages of a high-level scientific, teaching, and technological course.  These are some of its most notable features:

• Latest technology in online teaching software
• Highly visual teaching system, supported by graphic and schematic contents that are easy to assimilate and understand
• Practical cases presented by practising experts
• State-of-the-art interactive video systems
• Teaching supported by telepractice
• Continuous updating and recycling systems
• Self-regulating learning: full compatibility with other occupations
• Practical exercises for self-evaluation and learning verification
• Support groups and educational synergies: questions to the expert, debate and knowledge
• Communication with the teacher and individual reflection work
• Content that is accessible from any fixed or portable device with an Internet connection
• Supplementary documentation databases are permanently available, even after the course

The teachers of this Master's Degree have been selected based on two criteria: the excellence of their medical practice in the field of the creation, promotion and maintenance of the bariatric units, and their proven didactic capacity: To offer you the high quality training program that you need”

Our teaching staff is composed of medical professionals, practising specialists. In this way, we ensure that we provide you with the training update we are aiming for. A multidisciplinary team of professors with training and experience in different environments, who will develop the theoretical knowledge in an efficient way, but, above all, will bring their practical knowledge derived from their own experience to the course: one of the differential qualities of this Update on Bariatric Surgery

The efficiency of the methodological design of this master's degree, enhances the student's understanding of the subject. Developed by a multidisciplinary team of e-learning experts, it integrates the latest advances in educational technology. In this way, you will be able to study with a range of easy-to-use and versatile multimedia tools that will give you the necessary skills you need for your specialization. 

The design of this program is based on Problem-Based Learning: an approach that conceives learning as a highly practical process. To achieve this remotely, we will use telepractice learning:  with the help of an innovative interactive video system, and learning from an expert, you will be able to acquire the knowledge as if you were actually dealing with the scenario you are learning about. A concept that will allow you to integrate and fix learning in a more realistic and permanent way.

With a methodological design based on proven teaching techniques, this Master's Degree will take you through different teaching approaches to allow you to learn in a dynamic and effective way”

Our innovative telepractice concept will give you the opportunity to learn through an immersive experience, which will provide you with a faster integration and a much more realistic view of the contents: “learning from an expert”

The contents of this Master's Degree have been developed by the different experts on this course, with a clear purpose: to ensure that our students acquire each and every one of the necessary skills to become true experts in this field. A complete and well-structured program that will take you to the highest standards of quality and success.

A comprehensive teaching program, structured in well-developed teaching units, oriented towards learning that is compatible with your personal and professional life”

Module 1. General Aspects of Obesity

1.1. Obesity and Overweight

1.1.1. Introduction
1.1.2. Definition of Obesity 
1.1.3. Epidemiology
1.1.4. Pathophysiology
1.1.5. Energy Intake
1.1.6. Metabolism and Energy Expenditure
1.1.7. Mechanisms of Action in the Update on Bariatric Surgery
1.1.8. Etiology: Genetics and Epigenetics of Obesity  Syndromes with Dysmorphic Obesity
1.1.9. Initial Evaluation of Obesity

1.1.9.1. Body Mass Index
1.1.9.2. Waist Circumference
1.1.9.3. Body Fat Percentage
1.1.9.4. Other Parameters

1.1.10. Evaluation of Patient Risk

1.2. Major Comorbidities

1.2.1. Definition of Major and Minor Comorbidity
1.2.2. Diabetes Mellitus Type 2

1.2.2.1. Prediabetes and Diabetes: Definition
1.2.2.2. Dietary Treatment
1.2.2.3. Oral Anti-diabetic Treatment
1.2.2.4. Insulin Treatment
1.2.2.5. Target Organ Involvement: Signs and Symptoms

1.2.3.    Hyperlipidemia

1.2.3.1. Total Cholesterol
1.2.3.2. HDL and LDL
1.2.3.3. Triglycerides

1.2.4. Cardiovascular

1.2.4.1. Cardiac: Ischemic Heart Disease
1.2.4.2. Vascular

1.2.4.2.1. Venous Stasis with Increased Risk of DVT/PTE
1.2.4.2.2. Arterial Hypertension

1.2.5. Metabolic Syndrome
1.2.6. Respiratory: hypoventilation syndrome and apnea-hypopnea syndrome
1.2.7. Load-bearing Arthropathy: Definition and Common Injuries
1.2.8. Infertility

1.3. Minor Comorbidities

1.3.1. Digestive

1.3.1.1. Hepatic Steatosis, Steatohepatitis and Cirrhosis
1.3.1.2. Colelitiasis, Colecistitis
1.3.1.3. Gastroesophageal Reflux Disease

1.3.2. Obesity and Cancer: Incidence
1.3.3. Asthma
1.3.4. Hypothyroidism
1.3.5. Incontinence
1.3.6. Psychologucal Alterations (Major or Minor?)
1.3.7. Other Minor Comorbidities

1. 4. Dietary and Pharmalogical Treatment

1.4.1. Dietary Treatment

1.4.1.1. Introduction
1.4.1.2. Food plan Dietary Treatment
1.4.1.3. Distribution of Macronutrients in the Diet
1.4.1.4. Modification of Diet Structure
1.4.1.5. General Recommendations for Hypocalorie Diet

1.4.2. Pharmacological Treatment

1.4.2.1. Types of Drugs
1.4.2.2. Drugs Which Affect Appetite and Fullness
1.4.2.3. Drugs Which Work on a Gastrointestinal Level
1.4.2.4. Thermogenic Drugs
1.4.2.5. Other Drugs
1.4.2.6. Medication being Researched
1.4.2.7. Therapeutic Algorithms

1.5. Physical Activity

1.5.1. Program Objectives
1.5.2. Types of Exercise 
1.5.3. Frequency, Duration and Intensity 
1.5.4. Behaviour Modification

1.6. Indications of Endoscopic and Surgical Treatments

1.6.1. According to BMI 
1.6.2. According to Previous Surgery
1.6.3. According to Associated Comorbidities
1.6.4. Listening to the Patient
1.6.5. Therapeutic Algorithms

1.7. Preoperative Study

1.7.1. Basic Preoperative Process
1.7.2. Study of the Upper Digestive Tract: Endoscopy vs Rx
1.7.3. Study and eradication of Helicobacter pylori: When and How
1.7.4. ASMBS Micronutrient Survey and Grades of Recommendations
1.7.5. Indications from Other Studies

1.7.5.1. Respiratory: Functional Respiratory Tests and Polysomnography
1.7.5.2. Digestive: Ultrasound and CAT
1.7.5.3. Cardiac: ECG and Stress Test
1.7.5.4. Movement: Antigravity Treadmill Test
1.7.5.5. Type 2 Diabetes: Hb Glycated A1, Pancreatic Reserve, and Pancreatic Antibodies
1.7.5.6. Studies of Venous Circulation in Lower Limbs

1.7.6. Pre-anaesthesia Assessment in the Update on Bariatric Surgery

1.8. Pre-surgery Preparation

1.8.1. Pre-surgery Preparation
1.8.2. Duration, Objectives and Scientific Evidence Related to Preparation
1.8.3. Liquid Diet
1.8.4. Physical Activity
1.8.5. Respiratory Physiotherapy and Tobacco Consumption
1.8.6. Study and Control of Arterial Hypertension
1.8.7. Blood Glucose Control in the Update on Bariatric Surgery

1.9. Surgical Technique Selection

1.9.1. According to BMI
1.9.2. According to Psychological and Nutritional Profile
1.9.3. According to Associated Comorbidities
1.9.4. Listening to the Patient
1.9.5. Recommended Algorithm

1.10. Indications and Technique Selection in Special Groups

1.10.1. Adolescents and Children

1.10.1.1. Children vs Adolescents: how to identify them
1.10.1.2. Bridging vs. Definitive Techniques: for Whom and Which Ones?

1.10.2. Over 60s

1.10.2.1. How to Differentiate Between Biological Age and Theoretical Age
1.10.2.2. Specific Techniques for >60s

1.10.3.    BMI 30-35

1.10.3.1. Surgery Indications
1.10.3.2. Surgical Techniques

1.10.4. Other Borderline Patients

1.10.4.1. BMI <30 and DMT2
1.10.4.2. BMI 30-35 and C-peptide=0
1.10.4.3. BMI 30 and 35 and DMT1
1.10.4.4. Over 70s
1.10.4.5. HIV Patients
1.10.4.6. Liver Cirrhosis Patients

Module 2. Endoscopic and Percutaneous Treatments in Obesity

2.1. Intragastric balloon (Oballon, ELIPSE)

2.1.1. Definition
2.1.2. Technique
2.1.3. Results
2.1.4. Complications

2.2. Endobarrier

2.2.1. Definition
2.2.2. Technique
2.2.3. Results
2.2.4. Complications

2.3. Vertical Endoluminal Gastroplasty (EndoCinch)

2.3.1. Definition
2.3.2. Technique
2.3.3. Results
2.3.4. Complications

2.4. Transoral Gastroplasty (TOGA)

2.4.1. Definition
2.4.2. Technique
2.4.3. Results
2.4.4. Complications

2.5. POSE

2.5.1. Definition
2.5.2. Technique
2.5.3. Results
2.5.4. Complications

2.6. Endoscopic Plication (Apollo)

2.6.1. Definition
2.6.2. Technique
2.6.3. Results
2.6.4. Complications

2.7. Gastric Electrical Stimulation (Gastric Pacemaker)

2.7.1. Definition
2.7.2. Technique
2.7.3. Results
2.7.4. Complications

2.8. Neurostimulation of the Dermatomes of the Abdomen

2.8.1. Definition
2.8.2. Technique
2.8.3. Results
2.8.4. Complications

2.9. ASPIRE Method

2.9.1. Definition
2.9.2. Technique
2.9.3. Results
2.9.4. Complications

2.10. Uncommon Methods (Lingual Mesh, Surgiclip)

2.10.1. Definition
2.10.2. Techniques
2.10.3. Results
2.10.4. Complications

Module 3. Surgical Treatment of Morbid Obesity

3.1. History of Surgical Treatment of Morbid Obesity 

3.1.1. Historical Background in Ancient Times
3.1.2. Beginning of Obesity Surgery in the Modern Era
3.1.3. Current Use of Bariatric and Metabolic Surgery

3.2. Adjustable Gastric Band 

3.2.1. Introduction
3.2.2. Surgical Technique
3.2.3. Results
3.2.4. Postoperative Complications

3.3. Vertical Gastrectomy 

3.3.1. Introduction
3.3.2. Surgical Technique
3.3.3. Results
3.3.4. Postoperative Complications

3.4. Gastric Bypass Roux-en-Y 

3.4.1. Introduction
3.4.2. Surgical Technique
3.4.3. Results
3.4.4. Postoperative Complications

3.5. Gastric Bypass of One Anastomosis 

3.5.1. Introduction
3.5.2. Surgical Technique
3.5.3. Results
3.5.4. Postoperative Complications

3.6. Biliopancreatic Diversion 

3.6.1. Introduction
3.6.2. Surgical Technique
3.6.3. Results
3.6.4. Postoperative Complications

3.7. Duodenal Crossover 

3.7.1. Introduction
3.7.2. Surgical Technique
3.7.3. Results
3.7.4. Postoperative Complications

3.8. SADIS 

3.8.1. Introduction
3.8.2. Surgical Technique
3.8.3. Results
3.8.4. Postoperative Complications

3.9. Nissen Sleeve 

3.9.1. Introduction
3.9.2. Surgical Technique
3.9.3. Results
3.9.4. Postoperative Complications

3.10. Other techniques: SAGIS/SASI, Intestinal Bipartition, Gastric Plication, Banding Techniques...

3.10.1. Introduction
3.10.2. Surgical Technique
3.10.3. Results
3.10.4. Postoperative Complications

Module 4. Perioperative Management

4.1. ERAS Program in Bariatric Surgery 

4.1.1. Introduction
4.1.2. ERAS Protocols in Bariatric Surgery
4.1.3. Results of Implementation
4.1.4. GERM Multidisciplinary Working Group Protocol Update

4.2. Multidisciplinary Management of the Bariatric Patient 

4.2.1. Preoperative

4.2.1.1. Endocrinology and Nutrition
4.2.1.2. Dietitian
4.2.1.3. Psychiatry 
4.2.1.4. Psychology
4.2.1.5. Pneumology
4.2.1.6. Cardiology
4.2.1.7. Digestive 
4.2.1.8. Radiology
4.2.1.9. Surgery
4.2.1.10. Anaesthesiology
4.2.1.11. Rehabilitation and Physiotherapy

4.2.2. Hospital Admission

4.2.2.1. Pre Surgery
4.2.2.2. Intraoperative
4.2.2.3. Post Surgery

4.2.3. Monitoring

4.2.3.1. Surgery
4.2.3.2. Endocrinology and Nutrition
4.2.3.3. Dietitian
4.2.3.4. Psychiatry and Psychology
4.2.3.5. Pneumology
4.2.3.6. Primary Care

4.3. Patient Information, Objectives and Establishing Realistic Expectations 

4.3.1. What is Obesity?
4.3.2. Affectations Arising from Obesity
4.3.3. Obesity in the Current Day
4.3.4. Can it be Modified?
4.3.5. Benefits of Fighting It
4.3.6. Post Surgery Results

4.3.6.1. Complications
4.3.6.2. Weight Regain
4.3.6.3. Therapy Options

4.3.7. Monitoring

4.4. Psychological Assessment

4.4.1. Psychological Focus on an Obese Patient in Bariatric Surgery
4.4.2. Emotional State and Quality of Life in Candidates of Bariatric Surgery
4.4.3. Considerations in the Pre Surgery Psychological Assessment
4.4.4. Aspects to be Addressed in the Initial Interviews

4.4.4.1. History of the Start and Evolution of Their Obesity
4.4.4.2. Explore Expectations, Motivation and Goals of the Patient
4.4.4.3. Patient’s Lifestyle
4.4.4.4. Family Circle
4.4.4.5. Patient Coping Strategies

4.4.5 Recommended Assessment Instruments

4.4.5.1. Depression/ Anxiety Scale
4.4.5.2. Decision-Making and Self Control
4.4.5.3. Quality of Life
4.4.5.4. Body Image
4.4.5.5. Eating Disorders
 4.4.5.6. Personality

4.4.6. Considerations for Interpreting the Information Collected

4.5. Perioperative Nutritional Management for Patients Put Forward for Bariatric Surgery 

4.5.1. Introduction
4.5.2. Benefits of Pre-Surgery Weight Loss in Bariatric Surgery
4.5.3. Preoperative Treatment Guidelines:

4.5.3.1. Hypocalorie Diet and Very Low-Calorie Diet
4.5.3.2. Pharmacological Treatment
4.5.3.3. Other Treatments

4.5.4. Postoperative Nutritional Treatment

4.5.4.1. Dietary Progression in the First Weeks 
4.5.4.2. Micronutrient Supplementation Guidelines
4.5.4.3. Special Situations

4.6. Thromboembolic Prophylaxis in Bariatric Surgery Prevention Measures for Surgical Site Infections 

4.6.1. Thromboembolic Prophylaxis

4.6.1.1. Introduction
4.6.1.2. Early Mobilization
4.6.1.3. Mechanical Prophylaxis
4.6.1.4. Pharmacological Prophylaxis

4.6.2. Prevention of Surgical Site Infections

4.6.2.1. Introduction
4.6.2.2. Preoperative Phase

4.6.2.2.1. Smoking Control
4.6.2.2.2. Shower and Shaving
4.6.2.2.3. Skin Asepsis and Antisepsis
4.6.2.2.4. Antibiotic Prophylaxis

4.6.2.3. Intra and Perioperative Phase

4.6.2.3.1. Door Opening Control
4.6.2.3.2. Body Temperature and Blood Sugar Level Control
4.6.2.3.3. Tissue Oxygenation
4.6.2.3.4. Wound/Operation Site Irrigation
4.6.2.3.5. Sutures with Antiseptics

4.6.2.4. Post Operative Phase

4.6.2.4.1. Skin Dressings
4.6.2.4.2. Measurement Packages

4.7. Antiemetic Prophylaxis and Goal-Directed Fluid Therap 

4.7.1. Antiemetic Prophylaxi

4.7.1.1. Identification of Patients from Risk of Suffering Post Operative Nausea and Vomiting (PONV) in Bariatric Surgery.
4.7.1.2. Detection and Intervention of Factors with Reduce the Basal Risk of PONV
4.7.1.3. Antiemetic Drug Management
4.7.1.4. Establishing a Prophylactic Algorithm to Establish Preventive Strategies in High-Risk Patients.
4.7.1.5. Description of Treatment for PONV in Bariatric Surgery

4.7.2. Goal-Guided Fluid Therapy

4.7.2.1. Different Approaches to Fluid Administration in Obesity Surgery: Liberal vs. Restrictive Approach

4.7.2.1.1. Liberal vs Restrictive Fluid Therapy 
4.7.2.1.2. Preoperative, Intraoperative and Postoperative Periods
4.7.2.1.3. Surgical Factors which Affect the Administration of Fluids

4.7.2.2. Concepts Goal-Guided Fluid Therapy
4.7.2.3. Description of the Parameters that Guide the Administration of Fluids in Bariatric Surgery

4.7.2.3.1. Volume Monitoring
4.7.2.3.2. Functional Hemodynamic Variables

4.7.2.4. Review of Current Monitoring Recommendations in Bariatric Surgery

4.8. Early Mobilization and Reintroduction or Oral Feeding 

4.8.1. Early Mobilization

4.8.1.1. Inconveniences Period of Inactivity
4.8.1.2. Benefits of Early Mobilization
4.8.1.3. Early Mobilization Guidelines

4.8.2. Reintroduction of Oral Feeding

4.8.2.1. Benefits of Early Oral Feeding
4.8.2.2. Importance of Protein Supplements
4.8.2.3. Guidelines for Reintroduction of Oral Feeding

4.9. Impact of Physical Training Programs on the Maintenance of Weight Loss Before and After Bariatric Surgery 

4.9.1. Impact of Physical Training Programs on the Physical Aptitude of Obese People
4.9.2. Physical Activity in the Preoperative and Postoperative Periods of Bariatric Surgery

4.9.2.1. Preoperative Physical Activity
4.9.2.2. Postoperative Physical Activity

4.9.3. Advice Before Starting a Physical Activity Program After Bariatric Surgery
4.9.4. Planning on Physical Activity after Bariatric Surgery

4.9.4.1. Physical Activity During the 1st Month
4.9.4.2. Physical Activity Between the 2nd and 6th Month
4.9.4.3. Physical Activity After the 6th Month

4.9.5. Types of Routines and Exercises

4.10. Optimization of Comorbidities Prior to Bariatric Surgery 

4.10.1. Concept of Multimodal Reahbilitation in Bariatric Surgery
4.10.2. Preanaesthetic Consultation in Bariatric Surgery
4.10.3. Study and Detection of the Risk Factors of Corony Heart Disease
4.10.4. Screening for Sleep Apnea-Hypopnea Syndrome
4.10.5. Indications for Preoperative Spirometry in Obese Patients
4.10.6. Description of the Recommended Laboratory Studies on Proposed Patients for Bariatric Surgery
4.10.7. Nutritional Optimization in the Preoperative Period
4.10.8. Respiratory Physiotherapy
4.10.9. Physical Rehabilitation of the Bariatric Patient

Module 5. Emergencies of the Bariatric Surgery Patient

5.1. Semiology of Abdominal Pathology and Complementary Explorations in the Emergency Department in Patients with a History of Bariatric Surgery

5.1.1. Introduction
5.1.2. Medical History and Anamnesis
5.1.3. Physical Examination
5.1.4. Complementary Examination Orientation
5.1.5. Blood Analysis
5.1.6. Abdomen Rx
5.1.7. Abdominal Ultrasound
5.1.8. Axial and Computerized Tomography
5.1.9. Esophagogram and Upper Intestinal Transit
5.1.10. Upper Digective Endoscopy
5.1.11. Endoscopic Retrograde Cholangiopancreatography
5.1.12. Cholangio Nuclear Magnetic Resonance
5.1.13. Echoendoscopy
5.1.14. Exploratory Laparoscopy 

5.2. Complications of Endoscopis Procedures (intragastric balloon, POSE, Apollo)

5.2.1. Definition of Techniques
5.2.2. Indication of Techniques
5.2.3. Development of Complications
5.2.4. Solution of Complications

5.3. Fistula Management After Bariatric Surgery

5.3.1. Introduction
5.3.2. Leakage and Postoperative Sepsis
5.3.3. Fistula after Laparoscopic Vertical Gastrectomy 

5.3.3.1. Causes
5.3.3.2. How to Avoid Them
5.3.3.3. How to Diagnose Them
5.3.3.4. Management

5.3.4. Fistula after Gastric Bypass

5.3.4.1. Causes
5.3.4.2. How to Avoid Them
5.3.4.3. How to Diagnose Them
5.3.4.4. Management

5.3.5. Fistulas after Malabsorptive  Techniques

5.4. Intestinal Obstruction of the Upper and Lower Digestive Tract (bridles, internal hernias, trocars...) after Bariatric Surgery 

5.4.1. Introduction
5.4.2. Obstruction of Upper Digestive Tract
5.4.3. Causes of Intestinal Obstruction

5.4.3.1. After Open Surgery

5.4.3.1.1. Early Onset
5.4.3.1.2. Late Onset

5.4.3.2. After Laparoscopic Surgery

5.4.3.2.1. Early Onset
5.4.3.2.2. Late Onset

5.4.4. Diagnosis of Intestinal Obstruction
5.4.5. Treatment of Intestinal Obstruction
5.4.6. Additional Material

5.5. Acute Digestive Complications: marginal ulcer of anastomotic, stenosis, diarrhea, proctalgia...  

5.5.1. Introduction
5.5.2. Anastomotic Fistula
5.5.3. Marginal Ulcer
5.5.4. Anastomic Stenosis
5.5.5. Acute Diarrhea after Bariatric Surgery
5.5.6. Proctalgia after Bariatric Surgery

5.6. Management of Bleeding after Bariatric Surgery (Upper GI Hemorrhage, Hemoperitoneum...) 

5.6.1. Upper Gastrointestinal Bleeding

5.6.1.1. Early Onset
5.6.1.2. Late Onset

5.6.2. Lower Gastrointestinal Bleeding
5.6.3. Hemoperitoneum

5.7. Hepato-biliary Complications Secondary to Post-Surgical Intestinal Malabsorption. Bacterial Overgrowth  

5.7.1. Hepato-biliary Complications Colelitiasis
5.7.2. Effect of Bacterial Overgrowth on MO
5.7.3. Bacterial overgrowth and NASH

5.8. Medical Complications Related to Bariatric Surgery (dumping syndrome, reactive hypoglycemia, cardiopulmonary, renal)

5.8.1. Dumping Syndrome
5.8.2. Reactive Hypoglycemia
5.8.3. Cardiopulmonary Complications
5.8.4. Renal Complications

5.9. Nutritional or Toxic Deficiency Emergencies

5.9.1. Introduction
5.9.2. Digestive Emergencies
5.9.3. Neurological Emergencies
5.9.4. Cardiac Emergencies
5.9.5. Nephrourological Emergencies
5.9.6. Psychiatric Emergencies

5.10. Chronic Pain After Bariatric Surgery: a Challenge for the Multidisciplinary Team 

5.10.1. Introduction
5.10.2. Definition
5.10.3. Etiology
5.10.4. Diagnosis
5.10.5. Non-Invasive Treatment
5.10.6. Invasive Treatment

Module 6. Revision Surgery

6.1. Definition and Indications of Revision Surgery 

6.1.1. Definition and Indicators of the Success or Failure of the Bariatric Surgery
6.1.2. Indications of Revision Surgery
6.1.3. General Features of Revision Surgery
6.1.4. Surgical Strategy in Revision Surgery
6.1.5. General Criteria According to the Type of Primary Technique

6.2. Revision Surgery of Techniques No-Longer Used 

6.2.1. Introduction. Historical Review
6.2.2. Description of Techniques No-Longer Used
6.2.3. Indications of Revision Surgery
6.2.4. Preoperative Study and Preparation of the Patient
6.2.5. Therapy Options
6.2.6. Conclusions

6.3. Revision Surgery Following Adjustable Gastric Band 

6.3.1. Introduction, Indications and Basic Principles When Should We Consider Bandage Revision Surgery?
6.3.2. Revision Surgery Following Adjustable Gastric Band. Technique Analysis of Surgery 
6.3.3. Revision Surgery Following Adjustable Gastric Band: Results

6.4. Revision Surgery after a Vertical Gastrectomy

6.4.1. Motives and Candidates for Revision Surgery after a Vertical Gastrectomy
6.4.2. Revision Surgery Due To Insufficient Loss or Weight Regain after Vertical Gastrectomy

6.4.2.1. Duodenal Crossover / SADI-S Revision or 2nd Part
6.4.2.2. Gastric Bypass as an Alternative to Duodenal Crossover
6.4.2.3. Other Possible Alternatives?

6.4.3. Revision surgery for GER after Vertical Gastrectomy

6.4.3.1. Gastric By-Pass as the Best Option
6.4.3.2. Other Possible Alternatives?

6.5. Revision Surgery after a Gastric Bypass

6.5.1. Introduction
6.5.2. Indications

6.5.2.1. Insufficient Weight Loss
6.5.2.2. Weight Regain
6.5.2.3. Persistence of Comorbidities
6.5.2.4. Late Complications

6.5.2.4.1. Reservoir Dilatation
6.5.2.4.2. Alterations of the Gastro-Gastric Anastomosis
6.5.2.4.3. Gastroesophageal Reflux
6.5.2.4.5. Internal Hernias
6.5.2.4.6. Malnutrition
6.5.2.4.7. Hypoglycemia

6.5.3. Technical Aspects

6.5.3.1. Reconfection of the Reservoir
6.5.3.2. Reparation of the Gastro-Gastric Anastomosis
6.5.3.3. Modification of Handle Length
6.5.3.4. Conversion of Normal Anatomy

6.5.4. Conclusions

6.6. Revision Surgery after a One Anastomosis Bypass 

6.6.1. Introduction
6.6.2. Relevance of a Correct Technique
6.6.3. Indications

6.6.3.1. Weight Loss or Weight Regain
6.6.3.2. Persistence of Cormobidities
6.6.3.3. Gastroesophageal Reflux
6.6.3.4. Nutritional Disorders

6.6.4. Technical Aspects
6.6.5. Results
6.6.6. Conclusions

6.7. Revision Surgery after a Duodenal Crossover 

6.7.1. Revision Surgery after a Duodenal Crossover

6.7.1.1. Revision Surgery for Nutritional Complications

6.7.1.1.1. Indications
6.7.1.1.2. Technique Options

6.7.2. Revision Surgery for Insufficient Weight Loss or Weight Regain after Duodenal Crossover

6.7.2.1. Indications
6.7.2.2. Technique Options

6.8. Revision surgery after BPD 

6.8.1. Indications of Revision Surgery for Biliopancreatic Diversion
6.8.2. Revision Surgery Due To Insufficient Loss or Weight Regain after Biliopancreatic Diversion
6.8.3. Medical-Surgical Criteria for Revision Surgery For Protein Malabsorption

6.8.3.1. Technique Options in Revision Surgery for Severe Protein Deficiency 

6.8.4. Revision Surgery in Ulcerative Complications of Gastrojejunal Anastomosis in Biliopancreatic Diversion

6.9. Revision surgery after SADI-S 

6.9.1. Medium and Long-Term Results of SADI-S, Common Problems 
6.9.2. Indications of Revision Surgery after SADI-S
6.9.3. Technique Options in Revision Surgery for Severe Protein Deficiency

6.10. Role of Endoscopic Surgery in the Management of Complications and Weight Regain 

6.10.1. Introduction
6.10.2. Gastrointestinal Bleeding
6.10.3. Anastomotic Ulcers
6.10.4. Stenosis
6.10.5. Leakages and Fistulas
6.10.6. Pancreatobiliary Pathology
6.10.7. Weight Regain

Module 7. Postoperative Aftercare and Supplementation

7.1. Postoperative Aftercare and Screening for Nutritional Deficiencies

7.1.1. Dietary and Lifestyle Guidelines after Bariatric Surgery
7.1.2. Macronutrient Deficiencies

7.1.2.1. Vitamins
7.1.2.2. Minerals

7.2. Postoperative Supplementation Mineral and Vitamin Supplements 

7.2.1. Supplementation in Restrictive Techniques
7.2.2. Supplementation in Malabsorption Techniques
7.2.3. Supplementation in Mixed Techniques

7.3. Nutritional Recommendations after Restrictive Techniques 

7.3.1. Nutritional Recommendations in Patients Undergoing Restrictive Techniques
7.3.2. Post- Surgery Complications and Nutritional Problems 

7.4. Nutritional Recommendations after Mixed Techniques

7.4.1. Introduction
7.4.2. Nutritional Objectives
7.4.3. Dietary Progression after Surgery 

7.4.3.1. Clear Liquid Diet

7.5. Nutritional Recommendations after Malabsorptive Techniques

7.5.1. Introduction
7.5.2. Preoperative Evaluation and Supplementation
7.5.3. Postoperative Diet and Supplementation

7.5.3.1. Protein
7.5.3.2. Micronutrients

7.5.4. Gastrointestinal Symptoms
7.5.5. Long-Term Monitoring
7.5.6. Conclusions

7.6. Nutritional management of the patient with complications (critically ill patient) 

7.6.1. Nutritional assessment of the critically ill patient
7.6.2. Therapeutic approach in the patient with complications

7.7. Specific Nutritional Requirements in Children and Adolescents  

7.7.1. Introduction
7.7.2. Nutritional Recommendations
7.7.3. Assessment of Nutritional Status
7.7.4. Nutritional Education
7.7.5. Nutritional Needs
7.7.6. Monitoring of Nutritional Status

7.8. Special Nutritional Requirements in the Elderly

7.8.1. Preoperative Age-Focused Assessment 
7.8.2. Age-related Physiological Changes that Alter Supplementation
7.8.3. Special Supplementation and Monitoring 

7.9. Special Nutritional Requirements in Women (Pregnancy, Breastfeeding and Menopause) 

7.9.1. Introduction
7.9.2. Obesity and Reproductive Function in Women
7.9.3. Bariatric Surgery, Pregnancy and Breastfeeding

7.9.3.1. Dietary Recommendations
7.9.3.2. Nutritional Supplements
7.9.3.3. Gestational Diabetes
7.9.3.4. Pregnancy Complications after Bariatric Surgery
7.9.3.5. Neonatal Care
7.9.3.6. Breastfeeding

7.9.4. Bariatric Surgery and Menopause

7.10. Postoperative Management of Specific Complications: Anaemia, Protein Deficiency and Neurological Problems 

7.10.1. Introduction
7.10.2. Anaemia
7.10.3. Protein Deficiency 
7.10.4. Neurological Complications

Module 8. Basics of Metabolic Surgery

8.1. Metabolic Syndrome and Mediators of Inflammation 

8.1.1. Bariatric Surgery vs Metabolic Surgery. Anatomo-Physiological Basis of Metabolic Surgery
8.1.2. Control Mechanisms of the Different Comorbidities Associated with Obesity
8.1.3. Future Perspectives of Metabolic Surgery 

8.2. Pathophysiology of Diabetes Medical and Dietary Treatment of Diabetes 

8.2.1. Insulin and Alteration in its Cellular Response
8.2.2. Hyperglycemia, Hyperlipidemia and Tissue Damage
8.2.3. Energetic Metabolism Alterations
8.2.4. Associated Phenomena; Inflammation, Apoptosis, Steatosis and Cellular Fibrosis

8.3. Role of Gastrointestinal Hormones in the Resolution of Type 2 Diabetes Mellitus after Bariatric Surgery 

8.3.1. Introduction
8.3.2. Gastointestinal Hormones Involved in the Metabolism of Glucose

8.3.2.1. Incretinic Effect

8.3.3. Pathphysiology and Etipathogenesis of Type 2 Diabetes in Obese Patients

8.3.3.1. Role of Gastrintestinal Hormones in Resistance to Insulin 

8.3.4. Contribution of Bariatric Surgery to the Resolution of Type 2 Diabetes

8.3.4.1. Weight Loss
8.3.4.2. Modification of Nutrients and Microbiota
8.3.4.3. Effect of Gastrointestinal Hormones: Proximal and Distal Bowel Theory

8.3.5. Evidence of Bariatric Surgery in Type 2 Diabetes

8.3.5.1. Short and Long term Impact of Bariatric Surgery in Regulating Glucose Metabolism
8.3.5.2. Medical vs Surgical Treatment
8.3.5.3. GBP vs VG

8.4. Concept of Metabolic Surgery, Concept and Scientific Evidence 

8.4.1. Introduction: History of Metabolic Surgery
8.4.2. Concepts of Metabolic Surgery:

8.4.2.1. General Concepts: Obesity Surgery and the Metabolic Complications
8.4.2.2. Specific Concepts: Diabetes Surgery

8.4.3. Indications of Metabolic Surgery:

8.4.3.1. Indications in Diabetic Patients with Morbid Obesity 
8.4.3.2. Indications in Type 2 Diabetic Patients with BMI 35-40
8.4.3.3. Indiciations in Diabetic Patients with BMI< 30

8.4.4. Surgical Techniques

8.4.4.1. Classic Techniques (Gastric Banding, Vertical Gastrectomy, Gastric Bypass and Biliopancreatic Bypass)
8.4.4.2. New Techniques: BAGUA SADI-S, Gastroileal Bypass of One Anastomosis, others)

8.4.5. Current Scientific Evidence on Metabolic Surgery 
8.4.6. Ethical and Deontological Aspects of Metabolic Surgery 

8.5. Importance of Loop Lengths in Bariatric Surgery 

8.5.1. Determing the Cutting Points
8.5.2. Patient Monitoring
8.5.3. Comorbidity Remission

8.6. Influence of the Microbiota in Bariatric Surgery 

8.6.1. Microbiome: basic concepts
8.6.2. Microbiome and Obesity 
8.6.3. Changes in Microbiome after Bariatric Surgery

8.7. Obesity and NASH Role of the Liver as Metabolism Regulator

8.7.1. Role of the Liver as Metabolism Regulator
8.7.2. Obesity and Non-Alcoholic Fatty Liver Disease
8.7.3. Bariatric Surgery and Non-Alcoholic Fatty Liver Disease

8.8. Influence of Bile Acids

8.8.1. Bile Acid Synthesis and Hepatic Circulation
8.8.2. Regulation of Dietary Fat Availability by Bile Acids
8.8.3. Main Bile Acid Receptors: TGR5 - FXR
8.8.4. Regulation of Metabolism by the Bile Acids
8.8.5. Metabolic Effects of Manipulating Intestinal Bile Acid Availability after Bariatric Surgery

8.9. Influence of Bariatric Surgery on Hypogonadism and Polycystic Ovary Syndrome (POS) 

8.9.1. Prevalance of Male Hypogonadism and POS in Bariatric Surgery Candidates 
8.9.2. Effects of Bariatric Surgery in the Hormonal Concentrations of Patients with Male Hypogonadism and the Semen Quality 
8.9.3. Effects of Bariatric Surgery on the Resolution of POS and Female Fertility

8.10. Timing of Metabloic Surgery and its Effect on the Pancreas 

8.10.1. Time as a Predictor of Diabetes Resolution after Metabolic Surgery
8.10.2. Pancreas Remodeling Capacity of the Pancreas in Man versus Animal Models
8.10.3. Regeneration of the Pancreas and Hyperinsulinism after Bariatric Surgery

Module 9. Transplantation, Abdominal Wall and Special Situations in Bariatric Surgery

9.1. Technical Considerations in the Perioperative Management of the Morbidly Obese Patient with Associated Abdominal Wall Pathology 

9.1.1. Preoperative Optimization
9.1.2. Obesity Surgery Before Wall Surgery 
9.1.3. Dermolipectomies as an Associated Procedure in Abdominal Wall Reconstruction

9.2. Solid Organ Transplant and Bariatric Surgery 

9.2.1. Obesity and Donors
9.2.2. Transplantation and Surgical Technique
9.2.3. Post-Transplant Obesity: Metabolic Syndrome
9.2.4. Bariatric Surgery and Liver or Kidney Transplant

9.3. Obesity and Gastroesophageal Reflux 

9.3.1. Pathophysiology of Reflux Diagnostic Tests
9.3.2. GERD in the Context of Obesity
9.3.3. GERD Therapy Focus in an Obese Patient

9.3.3.1. Medical Treatment
9.3.3.2. Surgical Management

9.3.4. Monitoring of Patient with GERD

9.4. Management of a Morbidly Obese Patient What is the Ideal Strategy?

9.4.1. Definition of a Superobese Patient
9.4.2. Is a Superobese Patient Different to a Simple Obese Patient?
9.4.3. Multidisciplinary Preoperative Management of the Superobese Patient
9.4.4. Role of an Intragastric Balloon in a Superobese Patient
9.4.5. Anesthetic Management and Monitoring of the Superobese Patient
9.4.6. Surgery in Superobese Patients Is There a Technique of Choice?
9.4.7. What Results Can We Expect Following Surgery in Superobese Patients?
9.4.8. Nutritional Monitoring in a Superobese Patient After Surgery

9.5. Surgery in a Patient with BMI <35

9.5.1. Introduction
9.5.2. Impact of Class I Obesity (BMI 30-35kg/ m2) On Health 
9.5.3. Non-Surgical Treatment of Class I Obesity
9.5.4. Evidence in the Literature on Bariatric Surgery in BMI 30-35 Kg/M2
9.5.5. Safety of Bariatric Surgery
9.5.6. Cost-Benefit Ratio
9.5.7. Recommendations from Different Scientific Societies

9.6. Pregnancy and Bariatric Surgery 

9.6.1. Perinatal Risks and Complications in Pregnant Women undergoing Bariatric Surgery
9.6.2. Management of Pregnant Woman Undergoing Bariatric Surgery

9.7. Adolescents and Bariatric Surgery. Technique and Results 

9.7.1. Adolescents and Morbid Obesity
9.7.2. Indications and Current Scene
9.7.3. Therapeutic Perspectives and Results

9.8. Effects of Bariatric Surgery on Bone Metabolism 

9.8.1. Introduction
9.8.2. Pathophysiological Mechanisms

9.8.2.1. Malabsorption  of Nutrients
9.8.2.2. Mechanical Disorders
9.8.2.3. Neurohormonal Mechanisms

9.8.3. Effects of Bariatric Surgery on Bone Metabolism

9.8.3.1. Adjustable Gastric Band
9.8.3.2. Gastric Bypass
9.8.3.3. Vertical Gastrectomy
9.8.3.4. Biliopancreatic Diversion- Duodenal Crossover

9.8.4. Fracture Risk
9.8.5. Recommendations in the Preoperative Evaluation and Treatment of Bone Metabolism Alterations after Bariatric Surgery

9.8.5.1. Properative Evaluation
9.8.5.2. Treatment of Bone Metabolism Alterations after Bariatric Surgery 

9.9. Other Special Situations in Bariatric Surgery  

9.9.1. Inflammatory Bowel Disease
9.9.2. Heart Disease
9.9.3. Kidney Diseases
9.9.5. Neurological Diseases and Mobility Problems
9.9.6. Psychiatric Illness

9.10. Sarcopenia and Loss of Muscle Mass 

9.10.1. Body Tissue
9.10.2. Energy Expenditure
9.10.3. Sarcopenia

9.10.3.1. Definition
9.10.3.2. Evaluation
9.10.3.3. Sarcopenic Obesity

9.10.4. Changes in Body Composition in Bariatric Patients
9.10.5. Inconveniences of Loss of Fat-Free Mass in Bariatric Patients

Module 10. Innovation, Quality of Life, Training and Clinical Management in Bariatric Surgery

10.1. Innovation, Quality of Life, Training and Clinical Management in Bariatric Surgery

10.1.1. Application of Robotics in Bariatric Surgery

10.1.1.1. Bariatric Procedures: General Aspects (Indications, Contraindications, Advantages and Disadvantages) 
10.1.1.2. Restrictive Laparoscopic and Robot-Assisted Procedures   

10.1.1.2.1. Gastric Sleeve: Advantages and Disadvantages of Using a Robot
10.1.1.2.2. Other Restrictive Procedures Gastric Banding, Bariclip, Gastroplication, Intragastric Balloon and Endorobotics
   

10.1.1.3. Laparoscopic Gastric Bypass Roux-en-Y with Robot Assitance

10.1.1.3.1. Pouch Confirmation and Probe Calibration 
10.1.1.3.2. Distances of Intestinal Loops: Food Loop, Biliopancreatic Loop, Common Loop 
10.1.1.3.3. Types of Anastomosis: Manual, Linear, Circular, Robotic Grappling (Anterior, Posterior, One Plane, Two Plane) 
10.1.1.3.4. Closing Spaces and Gaps 
10.1.1.3.5. Intraoperative Tests: Methylene Blue, Pneumatic Prieba, Endoscopy 
10.1.1.3.6. Use of Open and Closed Drains

10.1.1.4. Other Robot-Assisted Mixed Procedures: 

10.1.1.4.1. Gastric Bypass of One Anastomosis 
10.1.1.4.2. SADI-S 
10.1.1.4.3. Duodenal Crossover and Biliopancreatic Diversion 
10.1.1.4.4. Intestinal Bipartition

10.1.1.5. Revision Surgery and Robotic Surgery 
10.1.1.6. Superobesity and Robotic Surgery 
10.1.1.7. Use of New Platforms in Gastrointestinal Surgery 
10.1.1.8. How to Reduce Costs in Robotic Surgery Without Putting the Patient at Risk  
10.1.1.9. Future of Surgery Robotics in Bariatric Surgery 
10.1.1.10. Pandemic and Robotic Surgery
10.1.1.11. Telemedicine and 5G Technology 
10.1.1.12. Conclusions

10.2. Application of NOTES and Single Port in Bariatric Surgery

10.2.1. Basics of Access Reduction in Bariatric Surgery
10.2.2. Surgical Techniques
10.2.3. Results

10.3. Quality of Life After Bariatric Surgery

10.3.1. Introduction
10.3.2. Concept of Quality of Life
10.3.3. Questionnaires

10.3.3.1. Generic Questionnaires
10.3.3.2. Specific Questionnaires

10.3.4. Results

10.3.4.1. Surgical Techniques Results

10.3.4.1.1. Short-Term Results
   

10.3.4.2. Long-Term Results
10.3.4.3. Future Perspectives
10.3.4.4. Conclusions

10.4. Bariatric Surgery Cost-Benefit Studies

10.4.1. Economic Impact of Obesity and Bariatric Surgery

10.4.1.1. Economic Load of Obesity
10.4.1.2. Costs of Bariatric Surgery
10.4.1.3. Benefits of Bariatric Surgery
10.4.1.4. Cost-effective Aspect of Bariatric Surgery

10.4.2. Systems or Mehtods for the Evaluation of the Impact on Health Costs

10.4.2.1. Comparison of Approaches for Measuring Cost Impact

10.4.2.1.1. Cost Minimization Analysis (CMA)
10.4.2.1.2. Cost-effectiveness Analysis (CEA)
10.4.2.1.3. Cost-utility Analysis (CUA)
10.4.2.1.4. Cost Benefit Analysis (CBA)  

10.4.2.2. Visualization of Cost-effectiveness Using the Cost-effectiveness Plan

10.4.3. Summary of Current Data on the Economic Benefit of Bariatric Surgery

10.5. Management of Waiting List and Selection of Candidates in Bariatric Surgery

10.5.1. Introduction
10.5.2. Selection of Candidates for Bariatric Surgery
10.5.3. Factors Affecting the Waiting List

10.5.3.1. Resources Availability
10.5.3.2. Severity 
10.5.3.3. Waiting Capacity 

10.5.4. Criteria for Prioritizing Patients on the Waiting List  Severity Scales
10.5.5. Conclusions

10.6. Experimental Animal and Cadaver Training Thiel in Bariatric Surgery

10.6.1. Introduction
10.6.2. Learning Curve in Laparoscopic Gastric Bypass
10.6.3. Ex vivo Laparocopic Gastric Bypass Training Strategies

10.6.3.1. Training Models   

10.6.3.1.1. Laboratory Models
10.6.3.1.2. Virtual Reality Simulators
10.6.3.1.3. Animal Experimentation Models
10.6.3.1.4. Thiel Human Cadavers
   

10.6.3.2. Laparoscopic Surgery Workshops

10.7. Bariatric Tourism 
10.8. Quality Standards After Bariatric Surgery. What is the Current Evidence? 

10.8.1. In Relation to Weight Loss 
10.8.2. In relation to the Resolution of Comorbidities in Revision Surgery  
10.8.3. Mortality and Morbidity of Bariatric Procedures Record of Complications 
10.8.4. How to Measure the Quality of Life in Bariatric Patients? Measuring Systems

10.9. Aesthetic and Body Contouring Surgery

10.9.1. Selection Criteria for Intervention of Morbid Obesity Sequelae Following Bariatric Surgery
10.9.2. Plastic Surgery Techniques for the Intervention of Sequelae

10.9.2.1. Upper Limbs Classification and Techniques

10.9.2.1.1. Horizontal, L, T Brachioplasty
10.9.2.1.2. Posterior Brachioplasty

10.9.2.2. Posterior Brachioplasty

10.9.2.2.1. Horizontal Lifting
10.9.2.2.2. Vertical Lifting
10.9.2.2.3. Complementary Techniques

10.9.2.3. Abdomen Classification and Techniques    

10.9.2.3.1. Conventional/ Anchor Abdominoplasty with/ without Rectus Plication, with/ without Umbilical Transposition
10.9.2.3.2. Upper/ Lower Bodylift
10.9.2.3.3. Complementary Techniques: Liposuction    

10.9.2.4. Breast  Classification and Techniques

10.9.2.4.1. Breast Reduction
10.9.2.4.2. Mastopexy with/without Prosthesis

10.9.3. Intra / Postoperative Management
10.9.4. Complications after Obesity Sequelae Surgery

10.10. Creation of Behavioral Therapy Programs for Maintaining Weight Loss after Surgery 

10.10.1. Introduction
10.10.2. Psychological Aspects of the Patient with Morbid Obesity Post-Surgery
10.10.3. Phases in the Post-Surgery Monitoring
10.10.4. Areas to Evaluate in the Postsurgical Monitoring
10.10.5. Individual Psychological Monitoring

A fully comprehensive teaching program, structured in very well developed didactic units, oriented to a learning process compatible with your personal and professional life”