In which cases should obesity surgery be preferred?
Obesity is the excessive accumulation of fat in the body to the extent that it impairs health. Excessive and wrong eating habits, hormonal factors, sedentary lifestyle, genetic transition can cause obesity. Obesity is a disease that needs to be treated. Because untreated obesity; It causes many health problems such as diabetes, heart diseases, cancer, infertility and joint disorders.
Bariatric surgery is recommended for patients with a body mass index of 40 and above (morbidly obese) or a body mass index of over 55 and who cannot lose weight with methods such as medical nutrition, exercise, and medical treatment under the supervision of a specialist.
Obesity negatively affects the whole body
“Obesity can cause many co-morbidities such as sleep apnea, shortness of breath, stones in the gallbladder, heart diseases, along with metabolic disorders such as high blood pressure, diabetes, waist circumference, and fatty liver. If the waist circumference is 88 cm or more in women and 102 cm in men, it indicates that fat is stored around the waist due to unbalanced nutrition. The ideal waist circumference should be below 80 cm for women and 94 cm for men.”
Bariatric surgery is indicated as the only effective method for maintaining weight loss in patients with a body mass index of 35 and above or morbidly obese patients over 40. However, those who have a body mass index over 35 and have concomitant diseases, namely; Obesity surgery can be applied for patients receiving cardiovascular diseases and diabetes treatment, if they cannot get rid of adipose tissue.
If excess weight is not lost with diet and exercise, attention!
“It is very difficult to lose weight with diet and exercise in morbid obesity. The main goal of the treatment is to ensure that the person receives as much energy as he needs and to ensure that the accumulated fat is used by the body. For this, first of all, the person’s intake of excess calories is controlled by diet. In the diet program, it is necessary to take all kinds of nutrients, vitamins and elements in a balanced way in small amounts and to consume plenty of water.
Support should be obtained from a specialist dietitian for diet. Exercise is an activity that everyone should do regularly throughout their entire life. In obesity, brisk walking is the most appropriate form of exercise that can be recommended. Cycling and swimming are in second place. Surgical treatment is recommended for patients who cannot lose weight despite diet and exercise.
What is Bariatric Surgery?
Although the Body Mass Index is between 35 and 40, in people with obesity-related diseases (cardiovascular diseases, intense diabetes, frailty, joint disorders, respiratory problems) and in individuals with a body mass index of 40 or above, surgical interventions on the digestive systems to treat obesity; It is called obesity surgery.
Which method will be preferred in bariatric surgery varies from patient to patient. Bariatric surgery is used for patients who have been treated with all other treatment methods (diet program, exercise programs, behavior modification and drugs) before the surgical procedure, but for whom no success has been achieved.
The success of bariatric surgery largely depends on the behavior and lifestyle changes adopted by the patient after the surgery. Patients should meticulously follow the diet plan determined by the dietitian after the surgical procedure and also participate in behavioral therapy to change their attitudes towards nutrition and exercise.
Who can have bariatric surgery? Who is suitable for obesity surgery?
Bariatric surgery may be a good option in the following cases:
People with a body mass index between 35-40 and those with obesity-related diseases such as cardiovascular diseases, Type 2 diabetes, infertility, NAFLD, steatohepatitis (NASH), hypertension, sleep apnea
Patients with a body mass index over 40
Patients who cannot lose weight with methods such as medical nutrition, exercise and medical treatment under the supervision of a one-year expert
People who are not heavily addicted to alcohol or drugs
People who do not have a health condition that prevents surgery
Persons with full understanding and adaptability who can coordinate with the medical team after surgical procedures.
What are the risks of bariatric surgery?
As with every surgical procedure, some health risks may occur in bariatric surgery, both in the short and long term. As a matter of fact, bariatric surgeries do not carry more risks than any surgical procedure.
Risks associated with the surgical procedure may include:
- Adverse reactions to anesthesia
- blood clots
- Lung or breathing problems
- Leaks in the gastrointestinal tract
- Life risk (Same as any gene surgery)
What are the types of obesity surgery?
Methods in bariatric surgery vary according to gender, weight, disease, age, and whether there is a desire for pregnancy in the future in women. The goals of all types of bariatric surgery are sustainable weight loss, improvement in quality of life and elimination of complications caused by obesity. There are various types of bariatric surgery methods that differ from each other in terms of surgical procedure technique and long-term results.
Obesity surgery methods can be listed as follows:
Gastric band (Stomach clamp)
The doctor surgically places a biocompatible adjustable band on the upper part of the stomach just below the esophagus so that the stomach is divided into two parts. The tape is attached via tube to a subcutaneous access port in the abdominal wall where it can be inflated or deflated through the skin with a needle. The place where the band is placed on the stomach looks like an hourglass. Meals eaten with this surgical method are collected in the upper part and do not pass to the lower part. This method is less popular today. Because while hormones send signals to the brain to eat, the stomach, which is clamped, allows this situation. The feeling of hunger continues, the person continues to eat because he is hungry. As a matter of fact, this situation also causes vomiting.
Note: The gastric band has lost its effectiveness in recent years, and it is a method that we do not use anymore.
Gastric sleeve surgery (Sleeve Gastretomy)
Sleeve gastrectomy is a surgical procedure in which most of the stomach is removed by leaving a 100-150 ml gastric tube. During the procedure, a certain part of the stomach is surgically removed and a tube-shaped stomach (looks like a banana) is left behind. In addition, since the part of the stomach that secretes hunger hormone is removed, the feeling of hunger in the patient decreases. In other words, the feeling that the stomach is full prevents overeating.
Gastric sleeve surgery is restrictive, and the absorption of nutrients is not impaired by this method. Since the absorption of food continues in the same way, the patient does not need to take supplementary vitamin or mineral supplements.
The application of the sleeve gastrectomy method is relatively easier than other types of bariatric surgery. The success of sleeve gastrectomy surgery is permanent; however, it is of great importance that this method is applied to the right people.
Patients should be seen by a dietitian before and after the surgical procedure. The duty of the dietitian here is to prescribe the food to the patients.
What are the advantages of sleeve gastrectomy surgery:
- There is a regression in diseases caused by obesity such as type II diabetes, hypertension and sleep apnea.
- Reduced stomach volume provides a feeling of fullness
- There is no problem in consuming most foods
- Dumping syndrome is not seen after sleeve gastrectomy procedure
- The hunger stimulating hormone produced in a part of the stomach is reduced.
- It is a method that can be applied more easily than gastric bypass surgery.
- There is no foreign body effect like gastric band.
- The success of sleeve gastrectomy surgery is permanent.
- Weight loss is easy after this procedure
What are the disadvantages-risks of sleeve gastrectomy surgery?
- Risk of staple line leakage
- Less weight loss compared to gastric bypass
- Risk of regaining lost weight in a small proportion of patients
- Complaints of nausea/vomiting if too much food is eaten
- Reflux risk
- Intolerance in some foods
Gastric Bypass – Also called Roux-en-Y gastric bypass. Gastric Bypass procedure is one of the most common types of obesity surgery, such as sleeve gastrectomy surgeries. Bypass means using the shortcut.
Gastric bypass generally means establishing a passageway from the stomach to the intestines. There are also modifications of this method such as mini gastric bypass and biliopancreatic diversion. The success of these surgical procedures in weight loss for obesity patients is slightly higher than the sleeve gastrectomy operation. The common purpose of gastric bypass surgeries is to shrink the stomach and ensure that the consumed foods reach the intestines faster.
Two conditions are targeted with gastric bypass surgery. First, the person’s calorie intake is restricted, and secondly, the absorption of the edible nutrients is reduced. While patients can be discharged in 2-4 days in sleeve gastrectomy, this period increases to 4-6 days in gastric bypass surgery.
What is a mini gastric bypass?
Compared to volume-restricting techniques, mini gastric bypass stands out in terms of better weight loss and more effective healing of comorbidities. In the Mini-Gastric Bypass, the stomach is formed as a tube using special stapler tools.
What are the advantages of Gastric Bypass?
- Rapid realization of targeted weight loss for 18-24 months
- Clear regression in diseases such as Type 2 diabetes, hypertension, sleep apnea, GERD associated with obesity
- Noticeable increase in quality of life
What are the disadvantages-risks of Gastric Bypass surgery?
- Staple leakage
- Increased risk of gallstones due to rapid weight loss
- Internal hernia
Duodenal Switch surgery
Duodenal Switch surgery, like gastric bypass, is one of the surgical procedures that have both restrictive and absorption-reducing effects. This method is mostly used for people with a body mass index of more than 50 Kg/m2 or in the treatment of Type 2 diabetes. Duodenal Switch is an effective method in the treatment of diseases such as obesity-related diabetes and hypertension.
However, it has some side effects such as diarrhea. In addition, patients with Duodenal Switch surgery stay in the hospital longer than patients who undergo other obesity surgery. Vitamin, iron and protein deficiencies are also frequently seen after Duodenal Switch surgery, which has absorption-reducing effects.
What is robotic bariatric surgery?
The use of Da Vinci Robotic Surgery technology in laparoscopic bariatric surgeries all over the world offers special privileges to doctors and patients. Due to the anatomical structures of obesity patients, the extra precision required in such surgeries can be achieved with the robot’s non-vibrating arms and the ability to move with great grace in the patient’s abdomen.
Robot technology, which provides a three-dimensional and high-resolution image to the surgeon, also allows the protection of organs, tissues and nerves adjacent to the area where the operation is performed. In some groups of patients, the procedures that can be performed through several or a single hole without creating an incision, eliminates the aesthetic concerns of the patients.
In bariatric surgery, sleeve gastrectomy and gastric bypass surgeries are successfully performed using robot technology.
The privileges of robot technology for patients and doctors can be listed as follows:
- Since the surgery is performed with a closed technique and only a few holes, the risk of infection that can be seen due to the contact of the organs with air in open surgeries is eliminated.
- Thanks to robot technology, the surgeon performs the surgery with a 3-dimensional and digital view, with an opportunity where the patient’s nerves, veins, muscles and tissues are more protected from the risk of injury.
- Thanks to the robot technology, a large surgical incision is not formed on the patient’s body. After the procedure, which is completed through several holes instead of a large incision, the risk of infection of the patient is reduced to almost non-existent and he has a comfortable recovery period with less pain.
- Since the patient’s discharge, return to daily life and recovery time are shortened, and pain control is provided, the patient is fed orally in a shorter time and the body regains its resistance.
- After achieving the quality of daily life, the patient can return to work and social life more quickly.
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