Obesity Surgery
What is Obesity?

According to World Health Organisation data, obesity and related diseases are in the second place in “PREVENTABLE” deaths. The main goal of treatment is to reduce vital risks, especially metabolic syndrome, and to achieve a healthy life in the continuation of our lives.

It would not be wrong to call excessive fat accumulation that impairs our health obesity. Eating habits (eating too many calories), sedentary life (spending few calories) are the main factors in the disruption of the basic balance in my body and the development of obesity.

Who is more common?

A life away from sports is at the forefront of environmental factors. Sport; It both protects us from obesity and is extremely important for the prevention of cardiovascular diseases, lung problems and musculoskeletal disorders. Desk work, a computer-orientated life, modern technology, cars…. everything causes us to spend less calories.

Genetic transmission is also of great importance for obesity. As you have noticed, obesity is seen up to 80% in individuals with obese parents in your environment. In the presence of obesity in a single parent, the rate decreases to 40%. It should not be forgotten that the basis of obesity is not sufficient consumption of these calories rather than excess calorie intake. Again, it is seen that physical activity rates are low in these individuals.

Hormonal diseases are an important cause of obesity especially in childhood. Among these, hypothyroidism is the most common cause of preventable mental retardation and is tested in newborn heel prick blood screening. Adrenal gland diseases, thyroid gland diseases and diabetes should be investigated in paediatric obese patients and it should be kept in mind that obesity will be largely improved after treatment.

What are the Symptoms?

If we look at the effect on our health, some diseases in obese individuals threaten our health. The term “Morbit Obese” is used for individuals with this group of diseases. Especially morbid obese individuals live a life of low quality and short life span due to additional diseases. These diseases reduce comfort in all areas of life and cause an unhappy life.

Obesity-related diseases in the data of the Ministry of Health;

Insulin resistance – Hyperinsulinaemia

  • Type 2 Diabetes Mellitus (Diabetes)
  • Hypertension( high blood pressure)
  • Coronary artery disease
  • Hyperlipidaemia – Hypertriglyceridemia (Elevated Blood Fats)
  • Metabolic syndrome
  • Gall bladder diseases
  • Some types of cancer (gallbladder, endometrial, ovarian and breast cancer in women, colon and prostate cancer in men)
  • Osteoarthritis
  • Paralysis
  • Sleep apnoea
  • Fatty liver disease
  • Asthma
  • Breathing difficulties
  • Pregnancy complications
  • Menstrual irregularities
  • Excessive hair growth
  • Increased risk of surgery
  • Mental problems (such as Anorexia neurosa (not eating) or Blumia neurosa (not benefiting from the food eaten by vomiting), Binge eating, night eating syndrome, or trying to achieve psychological satisfaction by eating more of something)
  • Social disharmony
  • Skin infections, fungal infections in the groin and feet due to excess subcutaneous fat tissue, particularly as a result of frequent weight loss and gain
  • Musculoskeletal system problems

Our main goal is the treatment of patients during the development of morbid obesity and even during the transition to obesity, and unfortunately, patients reach us for treatment after the formation of their comorbidities. Increasing awareness and starting treatment before individuals become morbidly obese has been set as the main goal by the World Health Organisation.

How is the diagnosis made?

Body Mass Index “BMI” is used to provide a standardised method for the definition of obesity. We reach this ratio by dividing our weight by the square of our height in metres. The result is used to determine the degree of obesity.

The degree of obesity guides us on how to choose a treatment method for the patient, the existing risks and the expected life expectancy.

How should the treatment be planned?

Treatment planning should be done in a stepwise manner and by a team of specialists. Personalised treatment planning is made according to the degree of obesity and comorbidities of the patient. The patient is evaluated by expert teams. As a result, endoscopic or surgical treatment options are offered to the patient and the treatment process is determined in the council including the patient and the process is started.

  • Weak
  • Normal 18.5-24.9
  • Bulk (Overweight) 25-29.9 (Slightly increased risk of diabetes and heart disease)
  • Obese 1 (Obesity) 30-34.9 (Increased risk of diabetes and other diseases
  • Obese 2 (Morbid Obesity) 35-39.9
  • Obese 3 (Super Morbid Obesity) > 40 (Risk for fatal diseases)
What are the Treatment Options?

We can divide the treatments into two main groups as endoscopic and surgical methods. Patients are evaluated for both treatment groups in the council and the appropriate method is determined.

What are Endoscopic Treatment Methods?

Gastric botox, gastric balloon and dual treatment options are available.

For gastric botox, the oesophagus, stomach and duodenum are checked accompanied by endoscopy. If there is no obstacle to the procedure in these areas, botox is injected into the stomach with a sclerotherapy needle. Pregnant women, people who have been diagnosed with cancer or whose cancer treatment is ongoing, people who have recently undergone surgery and people with diseases in the digestive system are not suitable for the procedure.

For gastric balloon, the patient is also examined by endoscopy. A balloon is inserted into the stomach in the appropriate patient. The level is checked with an X-ray film, the balloon is filled with liquid and a control X-ray film is taken. After confirming that it is in the right place, we check it from the inside with endoscopy and finalise the procedure.

It is possible to lose 10-15 kg weight with gastric botox, 15-20kg with gastric balloon and 20-30 kg weight loss in individuals with both procedures at the same time.

What are Surgical Treatment Methods?

Surgical treatment methods are divided into 2 groups as restrictive surgeries as a result of volume reduction and surgeries in which both volume and malabosorbtive absorption are reduced, that is, mixed surgeries.

Sleeve Gastrectomy, which is the most commonly applied method worldwide, is a restrictive method that reduces the volume. With the improving stapler technology, the rate of leakage in the surgical area, which was experienced at the beginning of the application, has decreased considerably, and postoperative care and management of complications that may develop are carried out with a more professional approach.

The second most common type of Roux-en-Y gastric bypass is the mixed type, in which a part of the stomach is removed and a part of the small intestine is bypassed. In these patients, more vitamin and mineral deficiency is observed compared to individuals who have Sleeve Gastrectomy, i.e. tube stomach surgery, and it is especially preferred for Diabetes surgery.

Another option among metabolic surgery options is Mini Gastric Bypass. Here, most of the stomach is removed by laparoscopic closed surgery, leaving a ~60-80 ml stomach. A new route is created between 180-200 cm of the small intestine and the stomach and this section is bypassed. When compared with R&Y Gastric bypass, Mini Gastric Bypass surgery is particularly preferred because it is simpler, safer, with fewer complications and less operation time.

We recommend Loop Duodenal Switch surgery, particularly in patients with a BMI>50, which we call super obese, or in patients who have previously undergone obesity surgery and are undergoing surgery again. After performing a closed, laparoscopic Sleeve Gastrectomy, we connect ~200 cm of the intestine to the stomach, thus performing a bypass that both reduces the volume and reduces absorption.

Which Treatment for Which Patient?

The answer to this question is determined by the communication between the patient and the physician. The patient’s comorbidities, previous diet and exercise status, sociocultural status and access to medical treatment are important for the surgery to be chosen. For example, in a treatment where absorption is reduced, the patient’s vitamin/mineral levels should be monitored regularly. If the individual requesting surgery is unable to perform this follow-up, a different method should be preferred.

Will we lose weight directly after surgery?

If only…

But a physician-orientated treatment process awaits you. We need to accustom our patient to the eating habits of normal individuals. In addition, it is necessary to increase the calorie burning of our patient. Of course, psychological management and harmony with the patient are extremely important. For these reasons, the higher the patient-physician harmony, the higher the chance of success. If this harmony is achieved, we have a very high chance of losing weight and continuing our new life at that weight.

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