Obezite cerrahisine dair derneklerden ortak bildiri: 'Tek başına ameliyat yanlış!'

medikritik Çar, 04/03/2020 - 13:28

Son yılladara ülkemizde de sayısında artış gösteren ve kilo verme konusunda tercih edilen bir tedavi haline gerek bariatrik cerrahiye (obezite cerrahisi) dair 2 dernekten ortak bildiri geldi. 4 Mart 'Dünya Obezite Günü' dolayısıyla Türkiye Endokrinoloji ve Metabolizma Derneği (TEMD) ve Türk Cerrahi Derneği (TCD) tarafından ortak yayınlanan bildiride ameliyatların tek başına bir tedavi olmadığı, bir tedavi sürecinin parçası olduğu vurgulandı.

Bariatrik cerrahiye dair derneklerden yapılan açıklamada tedavi sürecinde yalnızca ameliyatların yapılmasının yanlışlığı açıklandı. 4 Mart "Dünya Obezite Günü" dolayısıyla yapılan dernekler tarafından yapılan ve sürecin bir çok alandaki uzmanın işbirliği ile yürütülmesi gerektiği söylenen bildirinin tamamı ise şöyle:

"Obezite gelişimindeki en önemli faktörler sağlıksız beslenme alışkanlığı ve yetersiz fiziksel aktivitedir. Ancak, bazı endokrin hastalıkların, psikiyatrik bozuklukların, ilaçların veya nadir görülen genetik hastalıkların da obeziteye neden olabileceği unutulmamalıdır. Bu yüzden her obeziteli birey öncelikle kapsamlı olarak değerlendirilmeli, obeziteye neden olduğu tespit edilen faktörlerin ortadan kaldırılmasına çalışılmalıdır.

Obezite tedavisi için öncelikle yaşam biçimi ve alışkanlıklar düzenlenmelidir. Sağlıklı beslenemeyen ve yeterli fiziksel aktivite yapamayan bireylerde her türlü tedavinin başarısı kısıtlı olacaktır. Yaşam biçimini düzelttiği halde yeterli kilo veremeyen olgulara tıbbi tedavi denenmeli, tıbbi tedaviden de yarar görmeyenler ise obezite cerrahisine yönlendirilmelidir. Cerrahi tedavi bugün için obezite ile mücadelede en etkin tedavi yöntemidir. Obezite cerrahisi ile hastaların hem kilo fazlalığı hem de eşlik eden metabolik hastalıklardan kurtulması mümkün olabilir. Ancak cerrahi yaklaşım obezite ile mücadelenin son basamağı olmalıdır.

Obezite Cerrahisi deneyimli cerrahlar tarafından, donanımlı merkezlerde ve aşağıdaki koşullarda yapılmalıdır:

  • Beden Kitle İndeksi (BKI)> 40kg/m2 olması veya
  • Beden Kitle İndeksi> 35kg/m2 ve kontrol altında olmayan Tip 2 Diyabet, Hipertansiyon, Dislipidemi, Uyku-Apne Sendromu gibi obezite ile ilişkili hastalıkların olması.
  • Bu koşullar hastaların diyet, egzersiz ve tıbbi tedaviden oluşan konservatif yaklaşımları en az 6 ay süreyle denediği ve yeterli kilo veremediği tespit edildikten sonra geçerlidir.

Obezite Cerrahisi öncesinde ve sonrasında hastalar deneyimli bir sağlık ekibi tarafından yönetilmelidir. Bu ekipte bir Endokrinolog (veya Obezite konusunda deneyimli bir İç Hastalıkları Uzmanı), Bariatrik Cerrah (bu konuya odaklanmış genel cerrahi uzmanı), Diyetisyen olmalı, ihtiyaç halinde, Psikiyatrist/Psikolog ve ilgili diğer branşlar da ekibe dahil edilebilmelidir. Hastalar sadece ameliyata hazırlık ve ameliyat aşamasında değil, ameliyat sonrasındaki yeni yaşamları boyunca da bu ekip tarafınca düzenli olarak izlenmelidir.

"Obezite Cerrahisi”, “Bariatrik Cerrahi” ve “Metabolik Cerrahi” benzer anlamda kullanılan terimlerdir. Hepsinde kullanılan temel cerrahi yöntemler aynıdır. Uluslararası Obezite rehberleri bu amaçla dört temel yöntemi önermektedir. Sleeve gastrektomi, gastrik bypasslar, gastrik bant, klasik BPD (Biliyo Pankreatik Diversiyon) ya da duodenal switch sık kullanılan obezite ve metabolik cerrahi ameliyatlarıdır ve her birinin kendi risk-yarar oranları vardır. Bunlar dışındaki diğer tüm cerrahi girişimler bu aşamada ancak araştırma amaçlı olarak nitelenir.

Güncel rehberler tarafınca önerilmeyen cerrahi uygulamalar ancak klinik araştırma kapsamında, Etik kurul onayı ve hastalar bilgilendirilip onamları alınarak yapılabilir. Ne yazık ki, ülkemizde bazı merkezler bu yöntemleri kontrolsüz olarak uygulamakta, yaygın kabul edilmiş rutin teknikler gibi sunmaktadır. Son dönemde “Diyabet Cerrahisi” adıyla sıkça reklamı yapılan yöntem de bunlardan birisidir. Tip 2 Diyabeti ve obezitesi olan ve tüm çabalara karşın yeterli metabolik kontrolü sağlanamayan bireylerde, bariatrik cerrahi faydalı olabilir. Ancak bu kişilerde de yine yukarıda söz edilen cerrahi teknikler kullanılmalıdır.

Bilinen yöntemler dışında kalan ve henüz hiçbir rehberde önerilmeyen uygulamaları “Diyabet Cerrahisi” adıyla insanımız üzerinde deneyen kişi, merkez ve kuruluşların mutlaka engellenmesi gereklidir. Henüz deneysel boyutta olan tüm yeni uygulamaların, tanımlanan özelliklere sahip merkezlerde, klinik araştırma kapsamında ve denetim altında yapılması sağlanmalıdır.

Sonuç olarak Obezite cerrahisinin obezite ile mücadelenin son halkası olduğu ve ülkemizdeki tüm Obezite hastaları için çözüm olamayacağı bilinmelidir. Obezite ile mücadelede asıl önemli unsur hastalığın gelişmesinin önlenmesidir. Bu nedenle, ülkemizde sağlıklı beslenme alışkanlığını yerleştirecek ve fiziksel aktiviteyi arttıracak önlemlerin alınması esastır. Obezite ile mücadelede merkezi ve yerel yönetimlerin, Sivil toplum kuruluşlarının ve ulusal basınımızın da sorumluluğu olduğu unutulmamalıdır.

Türkiye Endokrinoloji ve Metabolizma Derneği (TEMD) ve Türk Cerrahi Derneği (TCD) tarafınca Kamuoyuna saygıyla duyurulur."

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https://hub.docker.com/u/newersevena6
https://www.band.us/band/99411799/
https://www.rwaq.org/users/yuimikawad-20250726233653
https://git.project-hobbit.eu/zyfaiydudufe
https://community.wongcw.com/blogs/1118848/%D0%92%D0%B8%D1%81%D0%B1%D0%…
https://vocal.media/authors/bangkok-kupit-kokain-ekstazi-boshki-lsd
https://hub.docker.com/u/VeronicaOwensVer

Roxannegafem (doğrulanmamış) Ct, 02/08/2025 - 04:05

https://rant.li/syfocuaod/niurnberg-kupit-kokain-mefedron-marikhuanu
https://kemono.im/jogyhoudyuce/ishgl-kupit-ekstazi-mdma-lsd-kokain
https://www.brownbook.net/business/54118827/льорет-де-мар-купить-мефедрон-кокаин-марихуану/
https://imageevent.com/baktiadiwang/enqui
https://allmynursejobs.com/author/detectortandyleo36/
https://pxlmo.com/weesestaticx881
https://www.rwaq.org/users/skillseevilmaalol-20250730004102
https://potofu.me/cfryej5p
https://www.band.us/band/99411756/
https://www.rwaq.org/users/estanechampions2-20250728083549
https://jenequnoxajag.bandcamp.com/album/my
https://ucgp.jujuy.edu.ar/profile/waacybczybif/
https://www.band.us/page/99476670/
https://allmynursejobs.com/author/dspsplaza/
https://imageevent.com/viennneonga/zbfqx
https://hub.docker.com/u/ney9juqn35kl
https://community.wongcw.com/blogs/1117963/%D0%9C%D0%B0%D0%B9%D0%BE%D1%…
https://ucgp.jujuy.edu.ar/profile/ufahahwuczad/
https://ucgp.jujuy.edu.ar/profile/yioboddt/
https://community.wongcw.com/blogs/1118547/%D0%98%D1%81%D0%BF%D0%B0%D0%…

Roxannegafem (doğrulanmamış) Ct, 02/08/2025 - 04:06

https://www.brownbook.net/business/54120598/далянь-купить-мефедрон-кокаин-марихуану/
https://community.wongcw.com/blogs/1117654/%D0%A4%D1%83%D0%BD%D1%88%D0%…
https://www.band.us/band/99425064/
https://www.rwaq.org/users/putriandreyanisaputri-20250730181154
https://kemono.im/ubogmyyheicu/bergen-kupit-gashish-boshki-marikhuanu
https://potofu.me/uk17miq0
https://ucgp.jujuy.edu.ar/profile/ufucofkahi/
https://potofu.me/fmcuodye
https://allmynursejobs.com/author/yu6bl64pq6/
https://vocal.media/authors/dublin-kupit-mefedron-kokain-marihuanu
https://www.rwaq.org/users/prabhkeehlxl-20250730004143
https://kemono.im/hihubufqu/tampere-kupit-gashish-boshki-marikhuanu
https://hub.docker.com/u/mhlabashbnam
https://www.brownbook.net/business/54113765/куба-купить-марихуану-гашиш-бошки/
https://paper.wf/uahygroc/bolgariia-kupit-kokain-mefedron-marikhuanu
https://git.project-hobbit.eu/iuhwebaugxa
https://www.passes.com/fitizutawel
https://git.project-hobbit.eu/ahegiheicc
https://hub.docker.com/u/hau4cou2lco69
https://imageevent.com/sxjw8051lwy/mvsen

Roxannegafem (doğrulanmamış) Ct, 02/08/2025 - 04:14

https://www.brownbook.net/business/54114948/бельгия-купить-кокаин-экстази-бошки-лсд/
https://www.rwaq.org/users/sakaengamepro37-20250726114859
https://git.project-hobbit.eu/kjafrklo
https://vocal.media/authors/sozopol-kupit-mefedron-kokain-marihuanu
https://community.wongcw.com/blogs/1118229/%D0%A0%D0%B8%D0%B5%D0%BA%D0%…
https://jennifercool1990.bandcamp.com/album/musician
https://www.band.us/band/99417945/
https://git.project-hobbit.eu/xoaduhofu
https://www.band.us/page/99476975/
https://git.project-hobbit.eu/egocyhafube
https://www.brownbook.net/business/54112156/бат-ям-купить-кокаин-экстази-бошки-лсд/
https://allmynursejobs.com/author/arhumahidek/
https://hub.docker.com/u/KevinUnderwoodKev
https://community.wongcw.com/blogs/1121541/%D0%A1%D0%B0%D0%BD%D1%8C%D1%…
https://community.wongcw.com/blogs/1118324/%D0%A2%D1%83%D0%BB%D1%83%D0%…
https://www.band.us/band/99467818/
https://minodaminwoo.bandcamp.com/album/cheek
https://www.band.us/page/99418218/
https://www.passes.com/oksaynink
https://www.rwaq.org/users/lsizinovyevaada-20250730091511

Roxannegafem (doğrulanmamış) Ct, 02/08/2025 - 04:15

https://www.rwaq.org/users/cirbopruit0w-20250726231259
https://www.band.us/page/99436396/
https://imageevent.com/dalemartinez/padnj
https://rabotboyasof.bandcamp.com/album/teacher
https://www.band.us/page/99411133/
https://www.rwaq.org/users/rmccarthy-20250727134859
https://git.project-hobbit.eu/kegybsegbaeg
https://www.brownbook.net/business/54118974/бар-купить-кокаин-экстази-бошки-лсд/
https://imageevent.com/kwenzisawali/zvius
https://potofu.me/22knkbt0
https://hub.docker.com/u/tolfosaian
https://www.brownbook.net/business/54118832/тромсё-купить-марихуану-гашиш-бошки/
https://allmynursejobs.com/author/prostobest874/
https://www.rwaq.org/users/lavutebugo-20250726120702
https://imageevent.com/astrocreat30/idabg
https://allmynursejobs.com/author/kiberkingstone/
https://ucgp.jujuy.edu.ar/profile/needeedzeck/
https://imageevent.com/novowyrygyxo/mjoeu
https://hub.docker.com/u/newnewLh0mmefoourxi
https://hub.docker.com/u/rubyRobinson1903

Roxannegafem (doğrulanmamış) Ct, 02/08/2025 - 04:21

https://community.wongcw.com/blogs/1121556/%D0%9F%D0%B0%D1%80%D0%BC%D0%…
https://www.band.us/band/99409965/
https://www.brownbook.net/business/54129439/кемер-купить-кокаин-экстази-бошки-лсд/
https://community.wongcw.com/blogs/1119751/%D0%9F%D0%BE%D1%80%D1%82%D0%…
https://community.wongcw.com/blogs/1119723/%D0%A8%D0%B0%D1%80%D0%BC-%D1…
https://www.rwaq.org/users/sejdiatiarra-20250728015739
https://pxlmo.com/buehneralfaboy26
https://kemono.im/xefuboohugo/rostok-kupit-ekstazi-mdma-lsd-kokain
https://laceyhendersonlac.bandcamp.com/album/worry
https://pimpimmernes.bandcamp.com/album/photographer
https://vocal.media/authors/tulum-kupit-mefedron-kokain-marihuanu
https://www.brownbook.net/business/54133303/рим-купить-кокаин-экстази-бошки-лсд/
https://hoo.be/mmigohegug
https://ucgp.jujuy.edu.ar/profile/hofyehlqicy/
https://allmynursejobs.com/author/theendstory90/
https://hub.docker.com/u/sixPeixototwok
https://www.brownbook.net/business/54126231/гуанчжоу-купить-марихуану-гашиш-бошки/
https://allmynursejobs.com/author/leonardscottleo/
https://kemono.im/yhafyfqk/konstantsa-kupit-ekstazi-mdma-lsd-kokain
https://kemono.im/qjkuhdbt/tiraspol-kupit-kokain-mefedron-marikhuanu

Roxannegafem (doğrulanmamış) Ct, 02/08/2025 - 04:29

https://imageevent.com/riyasakramar/rtlap
https://www.rwaq.org/users/visionhendra4-20250730141706
https://allmynursejobs.com/author/karaukreunds/
https://hub.docker.com/u/oktavlabar
https://www.band.us/page/99478772/
https://ucgp.jujuy.edu.ar/profile/adifaabeog/
https://rant.li/cmogubycuho/ol-borg-kupit-ekstazi-mdma-lsd-kokain
https://paper.wf/ryicebacyoh/essen-kupit-gashish-boshki-marikhuanu
https://kemono.im/adeaoihradai/kuta-bali-kupit-gashish-boshki-marikhuanu
https://allmynursejobs.com/author/alijanarapan/
https://vocal.media/authors/granada-kupit-marihuanu-gashish-boshki
https://www.band.us/page/99411824/
https://hub.docker.com/u/intallemio
https://git.project-hobbit.eu/acafacauiobt
https://community.wongcw.com/blogs/1119425/%D0%A1%D0%B0%D0%BD-%D0%9C%D0…
https://www.rwaq.org/users/riosaputrak737-20250731002617
https://www.band.us/page/99417361/
https://kemono.im/ziubigage/sumgait-kupit-ekstazi-mdma-lsd-kokain
https://hub.docker.com/u/risbeksabree
https://imageevent.com/jwylovehamdi/mffdb

Roxannegafem (doğrulanmamış) Ct, 02/08/2025 - 04:30

https://www.band.us/band/99429552/
https://www.passes.com/kakiolede
https://git.project-hobbit.eu/ediiohagihe
https://www.band.us/band/99476972/
https://www.band.us/page/99452090/
https://www.band.us/band/99400444/
https://vocal.media/authors/kiczbyuel-kupit-kokain-ekstazi-boshki-lsd
https://www.band.us/page/99410178/
https://hub.docker.com/u/ngambekejia
https://paper.wf/oedaefufc/giumri-kupit-kokain-mefedron-marikhuanu
https://rant.li/xagogufogobe/ispaniia-kupit-ekstazi-mdma-lsd-kokain
https://hub.docker.com/u/tswakmirtic
https://atywiviqyqyzo.bandcamp.com/album/plane
https://www.band.us/page/99422790/
https://allmynursejobs.com/author/biowarriorsold0/
https://www.band.us/page/99412930/
https://rant.li/udnyyduh/goa-kupit-gashish-boshki-marikhuanu
https://www.band.us/page/99421986/
https://www.band.us/page/99422513/
https://www.band.us/band/99430025/

Roxannegafem (doğrulanmamış) Ct, 02/08/2025 - 04:31

https://allmynursejobs.com/author/keyesmajakii/
https://git.project-hobbit.eu/zeciugue
https://www.brownbook.net/business/54120777/майнц-купить-мефедрон-кокаин-марихуану/
https://www.rwaq.org/users/harkovliiaa-20250729144224
https://www.brownbook.net/business/54111180/гранада-купить-мефедрон-кокаин-марихуану/
https://potofu.me/pito1cf1
https://www.brownbook.net/business/54133347/манчестер-купить-мефедрон-кокаин-марихуану/
https://www.passes.com/lovefutttes1x
https://vocal.media/authors/birmingem-kupit-kokain-ekstazi-boshki-lsd
https://www.brownbook.net/business/54114959/кемер-купить-марихуану-гашиш-бошки/
https://git.project-hobbit.eu/afydudayg
https://vocal.media/authors/loret-de-mar-kupit-kokain-ekstazi-boshki-lsd
https://www.rwaq.org/users/ikunokawt-20250727132408
https://www.brownbook.net/business/54129820/мамая-купить-мефедрон-кокаин-марихуану/
https://legendavipbow565.bandcamp.com/album/ticket
https://kozaaigi.bandcamp.com/album/fireman
https://www.band.us/page/99411787/
https://vocal.media/authors/gshtaad-kupit-mefedron-kokain-marihuanu
https://www.brownbook.net/business/54127310/петровац-купить-марихуану-гашиш-бошки/
https://mariumlil00nesx.bandcamp.com/album/short

Roxannegafem (doğrulanmamış) Ct, 02/08/2025 - 04:37

https://kemono.im/qpxyaubvofyf/tegu-kupit-kokain-mefedron-marikhuanu
https://kemono.im/fqofoycidy/zagreb-kupit-ekstazi-mdma-lsd-kokain
https://git.project-hobbit.eu/ahyhyoagahgy
https://www.band.us/band/99476719/
https://ucgp.jujuy.edu.ar/profile/yegwygeodauu/
https://www.passes.com/dyjeqixuriq
https://allmynursejobs.com/author/mitsumit3nlol/
https://rant.li/ydibucehog/triest-kupit-gashish-boshki-marikhuanu
https://kemono.im/zxugydcehduc/paros-kupit-gashish-boshki-marikhuanu
https://paper.wf/liygifyheuhy/borakai-kupit-kokain-mefedron-marikhuanu
https://kemono.im/igaheoudecec/vantaa-kupit-gashish-boshki-marikhuanu
https://www.brownbook.net/business/54114950/макао-купить-кокаин-экстази-бошки-лсд/
https://kemono.im/jogyhoudyuce/ishgl-kupit-ekstazi-mdma-lsd-kokain
https://fivesofiealexaandratenpf.bandcamp.com/album/smell
https://www.passes.com/margjeboily
https://www.rwaq.org/users/ksmrhgorbunovaelizaveta-20250801004313
https://kemono.im/icafocgoyoff/gdynia-kupit-gashish-boshki-marikhuanu
https://www.band.us/page/99454229/
https://community.wongcw.com/blogs/1122439/%D0%9A%D0%BE%D1%88%D0%B0%D0%…
https://git.project-hobbit.eu/aaibuauflh

Roxannegafem (doğrulanmamış) Ct, 02/08/2025 - 04:40

https://www.brownbook.net/business/54128443/лихтенштейн-купить-мефедрон-кокаин-марихуану/
https://git.project-hobbit.eu/sygecodkk
https://rant.li/lhifiohi/islandiia-kupit-kokain-mefedron-marikhuanu
https://www.brownbook.net/business/54114462/сантандер-купить-марихуану-гашиш-бошки/
https://vocal.media/authors/rumyniya-kupit-marihuanu-gashish-boshki
https://community.wongcw.com/blogs/1119782/%D0%9C%D0%B0%D0%BB%D1%8C%D0%…
https://allmynursejobs.com/author/rindbroker/
https://imageevent.com/qj5rc2nfw8hi/gzruh
https://allmynursejobs.com/author/eulinkeshek/
https://hub.docker.com/u/hWennseelove
https://v82y1jmgcg4c.bandcamp.com/album/sister
https://potofu.me/upbvk20d
https://potofu.me/cfet2cmt
https://www.passes.com/skoffallan21
https://www.band.us/page/99449904/
https://hub.docker.com/u/knkynakeeb
https://hub.docker.com/u/airtmujdin
https://allmynursejobs.com/author/abattistalilysix/
https://www.brownbook.net/business/54113751/ксамиль-купить-мефедрон-кокаин-марихуану/
https://allmynursejobs.com/author/ruppsweet35/

Roxannegafem (doğrulanmamış) Ct, 02/08/2025 - 04:46

https://www.rwaq.org/users/pointanstewiediana-20250725225145
https://www.band.us/band/99399981/
https://www.rwaq.org/users/s43s7gks2p-20250730004214
https://potofu.me/5drnkwz5
https://lovepaula09.bandcamp.com/album/short
https://allmynursejobs.com/author/tommesgalin/
https://community.wongcw.com/blogs/1119706/%D0%9B%D0%B8%D0%B1%D0%B5%D1%…
https://www.rwaq.org/users/mairnicetenve-20250727130205
https://imageevent.com/moinathssein/otuou
https://www.band.us/band/99463659/
https://allmynursejobs.com/author/multikfunmaker296/
https://danmorrisdan.bandcamp.com/album/doctor
https://imageevent.com/aoulokozlova/rwfzv
https://www.brownbook.net/business/54129810/флоренция-купить-мефедрон-кокаин-марихуану/
https://git.project-hobbit.eu/ufuhoidehub
https://ucgp.jujuy.edu.ar/profile/ugyhwogoc/
https://allmynursejobs.com/author/fang00ne/
https://www.brownbook.net/business/54119011/мерибель-купить-кокаин-экстази-бошки-лсд/
https://kemono.im/cagecnif/frantsiia-kupit-gashish-boshki-marikhuanu
https://vocal.media/authors/bangkok-kupit-kokain-ekstazi-boshki-lsd

Roxannegafem (doğrulanmamış) Ct, 02/08/2025 - 04:47

https://imageevent.com/satagyugos/hqlej
https://www.band.us/page/99401561/
https://hub.docker.com/u/newnewLh0mmefoourxi
https://ucgp.jujuy.edu.ar/profile/rybohibfiehu/
https://kemono.im/echtehacegxi/degu-kupit-gashish-boshki-marikhuanu
https://imageevent.com/frihamde/odkdp
https://kemono.im/ubeyybyci/lozanna-kupit-ekstazi-mdma-lsd-kokain
https://imageevent.com/ysakytesorak/eesjm
https://ucgp.jujuy.edu.ar/profile/ahuodacafebf/
https://hoo.be/yehebjlpo
https://pxlmo.com/tolinavais
https://www.passes.com/magorkwadu
https://www.band.us/page/99434358/
https://www.band.us/page/99399602/
https://hub.docker.com/u/tezfh2j4i
https://allmynursejobs.com/author/sevesgurav/
https://vocal.media/authors/paduya-kupit-kokain-ekstazi-boshki-lsd
https://imageevent.com/maskajmomar/zysjy
https://imageevent.com/ayegboarblit/aovna
https://community.wongcw.com/blogs/1118857/%D0%A8%D0%B8%D0%B1%D0%B5%D0%…

Roxannegafem (doğrulanmamış) Ct, 02/08/2025 - 04:48

https://paper.wf/ocjugdec/slovakiia-kupit-gashish-boshki-marikhuanu
https://ucgp.jujuy.edu.ar/profile/mihadafifo/
https://potofu.me/2md1pk33
https://vocal.media/authors/dublin-kupit-marihuanu-gashish-boshki
https://git.project-hobbit.eu/wyguboydiuo
https://paper.wf/abififihs/verb-e-kupit-kokain-mefedron-marikhuanu
https://www.brownbook.net/business/54120906/падуя-купить-мефедрон-кокаин-марихуану/
https://www.band.us/page/99467904/
https://www.band.us/band/99428420/
https://ucgp.jujuy.edu.ar/profile/byebiecbegwi/
https://www.band.us/page/99428645/
https://rant.li/ubeciiybqa/portu-kupit-kokain-mefedron-marikhuanu
https://vocal.media/authors/lezh-kupit-mefedron-kokain-marihuanu
https://www.band.us/page/99472557/
https://www.brownbook.net/business/54114920/сиде-купить-кокаин-экстази-бошки-лсд/
https://community.wongcw.com/blogs/1123105/%D0%9A%D0%B5%D0%B9%D0%BF%D1%…
https://www.brownbook.net/business/54116605/сицилия-купить-кокаин-экстази-бошки-лсд/
https://fnstopiboja.bandcamp.com/album/milk
https://git.project-hobbit.eu/oguedaecog
https://lyahvilter.bandcamp.com/album/client

Roxannegafem (doğrulanmamış) Ct, 02/08/2025 - 04:48

https://z5q2rn2h3pbbk.bandcamp.com/album/wait
https://www.passes.com/lucrusmpit
https://potofu.me/di8riqj5
https://allmynursejobs.com/author/gnadedworkv4/
https://cereoablogfe.bandcamp.com/album/beef
https://community.wongcw.com/blogs/1122414/%D0%98%D1%80%D0%BB%D0%B0%D0%…
https://potofu.me/d39x90hy
https://community.wongcw.com/blogs/1117683/%D0%A5%D0%B0%D0%B9%D0%BD%D0%…
https://hobitmarzal.bandcamp.com/album/yellow
https://potofu.me/figbbg8j
https://community.wongcw.com/blogs/1118489/%D0%9E%D0%BC%D0%B0%D0%BD-%D0…
https://www.band.us/band/99441576/
https://community.wongcw.com/blogs/1121387/%D0%A1%D0%B0%D0%BD%D1%82%D0%…
https://www.rwaq.org/users/meyermary-20250730003320
https://www.brownbook.net/business/54111106/сицилия-купить-марихуану-гашиш-бошки/
https://rant.li/iohiuafo/kipr-kupit-ekstazi-mdma-lsd-kokain
https://community.wongcw.com/blogs/1123069/%D0%97%D0%B5%D0%BB%D1%8C%D0%…
https://skerdiscen.bandcamp.com/album/she
https://www.band.us/page/99412135/
https://git.project-hobbit.eu/offahgncegcy

Roxannegafem (doğrulanmamış) Ct, 02/08/2025 - 04:54

https://hub.docker.com/u/lolFredderiketd
https://www.band.us/page/99454574/
https://imageevent.com/acucutajomuz/korcf
https://ucgp.jujuy.edu.ar/profile/uhibadrvofub/
https://rant.li/rahaihedu/kanarskie-ostrova-kupit-ekstazi-mdma-lsd-koka…
https://allmynursejobs.com/author/kiierulffseesomey/
https://ucgp.jujuy.edu.ar/profile/yahocubeaf/
https://imageevent.com/okivipeseput/oznxj
https://www.brownbook.net/business/54114888/риека-купить-марихуану-гашиш-бошки/
https://allmynursejobs.com/author/owerfan44netankist/
https://ucgp.jujuy.edu.ar/profile/giubahogu/
https://allmynursejobs.com/author/ernadavelma/
https://imageevent.com/jaybedeeng/gzjfb
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https://potofu.me/x1ltz6p4
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https://vocal.media/authors/sanya-kupit-marihuanu-gashish-boshki
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https://kemono.im/mohufyfay/avstriia-kupit-ekstazi-mdma-lsd-kokain
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Roxannegafem (doğrulanmamış) Ct, 02/08/2025 - 05:02

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Roxannegafem (doğrulanmamış) Ct, 02/08/2025 - 05:04

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Roxannegafem (doğrulanmamış) Ct, 02/08/2025 - 05:09

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Roxannegafem (doğrulanmamış) Ct, 02/08/2025 - 05:10

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Roxannegafem (doğrulanmamış) Ct, 02/08/2025 - 05:17

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Roxannegafem (doğrulanmamış) Ct, 02/08/2025 - 05:19

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Roxannegafem (doğrulanmamış) Ct, 02/08/2025 - 05:19

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Roxannegafem (doğrulanmamış) Ct, 02/08/2025 - 05:20

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Roxannegafem (doğrulanmamış) Ct, 02/08/2025 - 05:20

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Roxannegafem (doğrulanmamış) Ct, 02/08/2025 - 05:26

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Roxannegafem (doğrulanmamış) Ct, 02/08/2025 - 05:28

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Roxannegafem (doğrulanmamış) Ct, 02/08/2025 - 05:34

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Roxannegafem (doğrulanmamış) Ct, 02/08/2025 - 05:35

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Roxannegafem (doğrulanmamış) Ct, 02/08/2025 - 05:35

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Roxannegafem (doğrulanmamış) Ct, 02/08/2025 - 05:36

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