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Obesity

Obesity can be defined as the collection of fat in the human body at a level that will negatively affect health. The excess weight that a person has interacts with a lot of variables, especially genetic factors, eating habits, environmental and psychosocial effects. Recently, it has been thought that the unobstructed rise in obesity levels is influenced by the current environmental conditions rather than by their genetic effects.

It is determined that there is increase in incidence of  various chronic diseases such as osteoartthritis, cancer, diabetes mellitus, hypertension, dyslipidemia, sleep apnea in people with morbid obesity; therefore, decreased life expectancy and quality of life of individuals.

Types of Obesity

Recently, researches has been carried out on which areas of the body fat is collected, spread or localized, rather than the total amount of fat in the individual. Because the area and distribution of fat in the body is associated with the occurrence of chronic diseases and morbidity and mortality rates of diseases. Obesity is grouped in 2 ways according to the localization of fat in the body.

  • Gynoid Type Obesity

Gynoid type obesity is defined as obesity, which is observed by intense fat localization in the hip area of the person, also called pear-type, which is more common in women.

  • Android Type Obesity

The patient has an increase in adipose tissue, especially in the abdomen and waist area. Android obesity (abdominal, central obesity) carries with it many additional diseases. For example; diabetes mellitus, hypertension, hypercholesterolemia etc. Obesity is considered to have waist-hip ratio greater than 0.85 in adult females and 1.0 in males. This type of obesity is generally seen in male individuals.

What are the types of Bariatric Surgery?

Bariatric surgery, or stomach reduction surgery, can be summarized as a series of ‘closed’ interventions. In bariatric surgery, the same intervention methods are not applied to every patient, However, all obesity surgeries, are performed by laparoscopic, that is, closed surgery method.
Bariatric surgeries are performed by reaching into the abdomen through millimetric holes without a large abdominal incision. Patients can stand up on the same day and be leave the hospital within a few days; They can return to their jobs within 1 week. Since there is no incision, the pain is felt to its minimum, and aesthetically pleasing results are obtained. The bariatric surgeries are classified as below:
• Volume Reduction Surgeries
• Laparoscopic Gastric Balloon
• Gastric Sleeve
1. Absorption Disruptive Surgeries
• Gastric Bypass
• Mini gastric bypass
Who cannot have bariatric surgeries?
• Those with psychiatric problems that will prevent from logical thinking
• Those with substance addiction
• Those who cannot make the necessary lifestyle changes in their eating habits after surgery
• Those who have a disease that will complicate the surgery as these require anesthesia

What is Gastric Sleeve Surgery?

In this surgery, also known as sleeve gastrectomy, the stomach volume is reduced and turned into a narrow tube. The new stomach has a much smaller volume, and during this surgery, the hunger hormone (ghrelin) is removed, so that the feeling of satiety is satisfied with less food.
Gastric sleeve is a simpler surgery than gastric bypass surgery because there is no intervention to the intestines and the risk of nutrient absorption disorder is lower. On the other hand, it can suppress the feeling of hunger for a longer time.
The success rate of sleeve gastrectomy is on a preferred level and it has been observed that those who have undergone surgery lost 60-65% of their excess weight within 2 years. For example, a patient who is over 50 kilograms, will lose approximately 30-33 kilos with sleeve gastric surgery if the diet is strictly followed and exercises are done regularly. As in gastric bypass, an appropriate diet should be followed after sleeve gastrectomy.

Can Gastric Sleeve Surgery Be Applied To Everyone With Weight Problem?

Those who have sleeve gastrectomy have to meet the following conditions:
• Any patient who has a BMI over 40 kg / m
• Those who have a BMI between 35 – 40 and have diabetic illnesses
Also, surgery can be performed in patients with “new” type 2 diabetes and metabolism disorders due to obesity and BMI between 30 and 35, at the decision of the obesity doctor.
Keep in mind that bariatric surgeries are not performed for aesthetic purposes.
At what age should Gastric Sleeve Surgery be performed?
Gastric Sleeve Surgery is a stomach reduction surgery performed on people between the ages of 18-65. For the person to be a suitable candidate for gastric surgery, the Body Mass Index (BMI) values determined by the World Health Organization must be 35 and above.
For people under the age of 18, the degree of obesity and the presence of the above diseases are important and parental consent is also required along with the physician’s decision.
For people over the age of 65, the health status and the necessity of the surgery (problems due to the weight of the person and the problems experienced) are evaluated.
What are Revision Surgeries after Obesity Surgery? Who is recommended for them?
Revision surgeries are operations performed for different complications such as not being able to lose weight and gaining weight on top of excessive weight. Stenosis or leakage are other reasons for revision after obesity surgery.
The main reasons for patients to gain the weight back are not being followed up adequately, informing patients insufficiently, or not following the process even if they are conscious. For these reasons, 20-30% weight gain can be seen in patients.
These operations are technically more difficult and must be performed by highly experienced surgeons.
There are types of surgery recommended for patients who have a recurrence of comorbid diseases such as diabetes, high blood pressure, or who gain weight. The most appropriate type of surgery should be decided by talking to the patient and making an assessment.

What needs to be considered before the procedure?

A diet should be made and some weight should be lost before the procedure. This act both decreases the risks involved with surgery along with any type of complications. All routine tests are conducted for surgery preparation. Respiratory functions are evaluated. Also, the status of the pre-op stomach is evaluated with endoscopy for possible gastric pathologies. This way, possible complications are prevented. Consultations will be carried out from cardiology, endocrinology, chest, psychiatry, and anesthesiologist to map the operation with received data about a patient’s medical history with a series of tests. The patient is requested to be fasting the night before the operation. The patient is informed about what to do for the formation of vascular clots and blood thinners are started.

What needs to be considered after the procedure?

The first day after the procedure, the liquid diet is kick started as per the condition of the patient. Operations are performed by closed methods, such as laparoscopy. It is made by entering the abdomen through between 5 – 6 tiny incisions with the help of a telescope. Patients can start to walk on the fourth hour after the operation. Patients may leave the hospital between 3 to 5 days after the operation, depending on the type of surgery chosen and the condition of the patient. It is recommended to drink at least 1 to 1.5 liters (8 glasses) of water every day after leaving hospital and to feed with food that is in liquid form as determined for the first 2 weeks. It is highly recommended to take protein supplements every day. After 2 weeks, soft food is started and the most important part about this is the sizes of bites chewing thoroughly. Heavy physical exercises and heavy lifting are banned for a month from patients. People who have work can return to work after 10 – 15 days. The only condition of not performing heavy work. It is important for women who want to have a child after the operation should wait for at least a year and to bear a child after the evaluation for blood assays by health professionals.

What is Gastric Bypass Surgery?

Gastric bypass surgery is a common method in obesity surgery. It is a combined method that decreases the level of absorption and causes malabsorption.
Gastric Bypass surgery is performed by shrinking the stomach into a small pouch and by taking the small intestine from a certain segment to the shrunk stomach and making an upward connection. Unlike in gastric sleeve surgery, the rest of the stomach is not removed. However, there is no entrance to the remaining stomach for food consumption. Stomach acids and enzymes continue to be produced for digestion and absorption of nutrients from the rest of the stomach.
Thus, patients who have had Gastric Bypass both have less food consumption and thus take fewer calories due to the reduction of the stomach into a small pouch. Besides, a decrease in the absorption of high-calorie foods taken due to the transition from the remaining small stomach to the small intestine is created, and thus also provides weight loss. Therefore, weight loss is provided in an issue of obesity with two different mechanisms.
After gastric bypass operations were performed with the laparoscopic method. Thus there is no deep incision in the skin and pain associated with the operation. General anesthesia is used for the operation and takes approximately 1 hour. Although extensive pre-op tests are performed before the surgery, consultations are made with chest diseases, anesthesia, psychiatry, and endocrinology units. After the surgery patient’s leakage test. Patients may leave the hospital on the second day after the operation.

How Long Does Gastric Bypass Surgery Take?

The duration of gastritis bypass surgery is approximately one and a half hours. Before this surgery, the patient can be treated for a long time. After the necessary tests and examinations are completed, the patient is operated on. Small incisions are made during the operation. While some doctors may need stitches, some of them may not. After the operation, the patient can be kept in the hospital to see if there is a leak, as in sleeve gastrectomy. Afterward, the patient is fed with liquid or pureed food for a while.

What are the types of Gastric Bypass Surgery?

The types of gastric bypass surgery are divided into two segments as gastric bypass surgery and mini gastric bypass surgery. The main purpose of gastric bypass surgery is to decrease the volume of the stomach to ensure that the food consumed reaches the intestines faster. There are two goals achieved. The first one is to reduce the size of the stomach to make the patient feel full easily. The second one represents the event that the nutrients are getting fewer calories from nutrition intake as they pass faster through the stomach, which limits weight gain.
In mini gastric bypass surgeries, the patient can recover in a shorter time. In this operation, a shorter route directly to the stomach – small intestine is provided to restrict the amount of the current caloric values of the foods taken. After the mini gastric bypass operation, The patient can leave the hospital after at least two to four days.

What needs to be considered before the procedure?

An eating habit should be had to lose some weight before the medical procedure. This method both diminishes the dangers related to a medical procedure and can facilitate the surgery with the least chance of complications. All standardized tests are led to a medical procedure arrangement for gastric bypass surgery. Respiratory capacities are assessed. Likewise, before the surgery, the status of the stomach is assessed with endoscopy for conceivable gastric pathologies. Along these lines, potential inconveniences are forestalled. Discussions will be done from cardiology, endocrinology, chest, psychiatry, and anesthesiologist units to plan the surgery with received information about the patient’s medical history with a series of tests. The patient is informed to fast the night before the surgery. The patient is informed about vascular clots and blood thinners.
What needs to be considered after the procedure?
After surgery, patients can feel satiated much earlier than before while having a small portion of food.
As a result of having gastric bypass surgery the total amount of food intake is significantly reduced. Due to the smaller size of the newly formed stomach and reduced food absorption, the instructions of the surgeon should be followed.
One of the main items to pay attention to is nutrition intake after the gastric bypass surgery. Below, there is a list of points to be careful about. These are:
• Consuming enough vitamins – minerals to prevent deficiency. These can lead to hair and/or hair loss.
• Consuming a small number of solid foods as much as possible.
• Focusing on a diet plan with high protein ingredients with low carbohydrate ingredients.
• Removing all kinds of carbonated drinks, processed fat, and sugar for life.
• Minimizing the consumption of caffeine and salt to its minimum.
• Having 3 main meals and 3 snacks in 1 day.
• Having a diet plan that focuses only on fruits for snacks.
• Having a habit of chewing food thoroughly.
• Consuming a minimum of 2.5 liters of water daily. These rates do not apply immediately after the surgery. It can progress gradually as 1 liter in the first week, 1.5 liters in the next week, and 2.5 liters in the following periods.

What are the risks involved with Gastric Bypass Surgery?

In any other surgical procedure, gastric bypass surgery has potential involved risks and complications. These are rare and all is done to prevent them from happening. The most common complications are leakage, bleeding, and embolism. These risks can be seen especially in the first 15 days after surgery. When symptoms of complications are seen, contact your doctor immediately. This will help shorten the treatment process of complications and can affect the success of the treatment positively.
The riskiest complication of this surgery is to have leaks in the staple line. Symptoms of leakage can be the following: high fever, severe abdominal pain, high pulse, tremors, and feeling weak. In the treatment of possible leaks timely and successful interventions of your doctor play a crucial. Detection and treatment of leakage are very easy for an experienced obesity surgeon. Only the process is getting longer.
Another risk involved with gastric bypass surgery is the risk of embolism. There is always a risk of embolism in every surgery; However, in bariatric surgeries, the risk of embolism is higher because of patients’ obesity issues. To prevent the risk of embolism, a blood thinner injection is started one day before or on the day of surgery, and patients are dressed in embolism stockings. The patient should use the anti-embolism stocking and blood thinner needle for ten days at home after discharge.
The most common type of complication is bleeding. Observation of bleeding is easy with drain. The patient who has bleeding can experience low blood pressure, dizziness, and weakness. Treatment of bleeding can be quick with the only supplementation of blood, depending on the amount of bleeding.
Apart from these, vitamin-mineral deficiencies may occur due to malnutrition and decreased absorption. Patients should have regular blood assays after surgery and regularly use the medications and supplements for vitamin and mineral deficiencies.
‘Dumping syndrome’, also called rapid gastric emptying, is seen when food, especially sugar, passes from the stomach to the small intestine very quickly. Dumping syndrome occurs 10 to 30 minutes after eating and causes symptoms such as abdominal pain, cramping, and diarrhea in individuals. It helps prevent post-operative nutritional changes syndrome. Dumping syndrome can be prevented by eating smaller meals and limiting high sugar foods.
In conclusion, gastric bypass surgery is an extremely harmless operation. If you are severely obese and have trouble losing weight, your healthcare provider may recommend gastric bypass surgery.