Obesity Surgery

Obesity surgery is recommended in patients with Body Mass Index (BMI) >40 kg/m2 and 35 - 39.9 kg/m2 with comorbidities (hypertension, diabetes, insulin resistance, sleep apnoea syndrome, etc.) and unsuccessful weight loss experience.

What are the Patient Preparations Before Obesity Surgery?

• Blood tests
• Hormone tests (thyroid hormone and medicated cortisol test)
• Abdominal ultrasonography
• ECG, chest radiography
• Upper Endoscopy
• Pulmonary Function Test
• Echocardiography

In addition to the tests listed above, the patient is evaluated by specialists in Internal Medicine, Chest Diseases, Cardiology, Psychiatry and Anaesthesia. If deemed necessary, additional examinations are performed and the necessary preoperative treatments and the possible medical risk of the operation are determined by the specialists.

GASTRIC SLEEVE SURGERY

What is Gastric Sleeve Gastrectomy?

Sleeve Gastrectomy (Sleeve Gastrectomy, Stomach Reduction)

Tüp mide (mide küçültme) , midenin uzunlamasına %75-80’ inin çıkarılması ile mide hacminin 80-150 ml arasındaki bir hacme ulaştırılmasını sağlayan ameliyat şeklidir.

It was first performed as a part of another operation in the 1980s, and then it was applied for weight loss before by-pass in overweight patients. In the follow-ups, it was found that the effectiveness of weight loss in obese patients was high and localised and its popularity increased.

Günümüzde ilk tercih olarak laparoskopik (kapalı ameliyat) olarak yapılmaktadır. Etki mekanizmasında 2 ana unsur vardır. İlki mide hacminin azaltılarak gıda alımının kısıtlanması, diğeri de midenin çıkarılan parçasından salgılanan, kişinin iştahını ilgilendiren Ghrelin isimli hormonun azaltılmasıdır. Bu sayede az gıda ile doyan ve iştahı azalmış olan hasta, uygun beslenme ve egzersiz programı ile fazla kilosunun en az %80’ ini verebilmektedir. Aynı zamanda bilimsel çalışmalarda barsak kaynaklı GLP-1 gibi insülin duyarlılık hormonlarının artışı da metabolik olarak kilo verdirmede rol oynamaktadır

To whom is sleeve gastrectomy applied?

Sleeve gastrectomy is recommended for individuals aged 18-65 years, with at least two previous experiences in weight control and BMI >40 kg/m2.

Another patient group includes patients with a BMI between 35 and 39.9 kg/m2 , with obesity-related comorbidities (hypertension, diabetes, insulin resistance, sleep apnoea, etc.) and unsuccessful weight loss experience.

While non-operative treatment methods are prioritised in patients with a BMI between 30-35 kg/m2, the current surgical decision should be evaluated in detail according to the patient and should not be decided only according to the BMI value.

How is Gastric Sleeve Gastrectomy Surgery Performed?

Nowadays, the first option is laparoscopic surgery. The operation is performed under general anaesthesia. The abdominal wall is entered through openings of 0.5-1 cm in size and the abdominal cavity is evaluated with a camera and micro instruments. The stomach volume is adjusted with a calibration tube and a new stomach volume is created using specially developed disposable staples. After bleeding and leakage control, a second row of sutures is applied to reduce the possibility of complications.

How Long Does Tube Stomach Surgery Take?

Although the duration of the operation varies according to the anatomical structure of the patient, the operation time varies between 45 minutes and 1.5 hours. However, the duration of preoperative preparations, recovery after anaesthesia and return to the ward bed is 2.5 to 3 hours. Patients usually do not need intensive care after the standard procedure. However, it may be appropriate to closely monitor patients with accompanying health problems in the intensive care unit overnight if necessary. The patient can get out of bed 4-6 hours after returning to the ward bed and can meet their basic needs. Complaints such as pain, nausea and spasm on the day of surgery can be controlled with intravenous medication.

How Does Gastric Sleeve Gastrectomy Surgery Make You Weak?

Tüp mide ameliyatının zayıflatıcı 2 temel mekanizması vardır. Birincisi mide hacminin küçültülerek gıda alımının kısıtlanması, diğeri ise Ghrelin hormonunun azaltılmasıdır. Ghrelin  midenin çıkarılan kısmından salgılanan, kişinin iştahını ilgilendiren bir maddedir. Böylece hasta daha az yemekle doyar, iştahı azalır ve uygun beslenme ve egzersiz programıyla fazla kilolarının en az %70-80’inden kurtulabilir. Aynı zamanda bilimsel çalışmalarda bağırsaktan salgılanan GLP-1 gibi insülin duyarlılık hormonlarının artmasının da metabolik kilo kaybında rol oynadığı bilinmektedir.

Is there a risk of sleeve gastrectomy surgery?

If left untreated, obesity is a disease that predisposes to more than 70 comorbidities, including cancer. When effective weight control is achieved with obesity surgery, the current health quality improves and possible health problems are prevented.

The most common problem after sleeve gastrectomy is bleeding. However, the use of a hose called drain, which drains blood and fluids, helps to monitor possible bleeding. With early intervention, treatment can be provided with serum and blood supplementation.

After bariatric surgery, the risk of embolism, i.e. intravascular coagulation, increases more than all surgeries. For this reason, pre- and postoperative blood thinning injection therapy and stockings and compression devices that prevent clot formation during surgery are used.

Gastric line leaks are potentially risky problems and one of the most frequently asked health questions. In case of leakage, the patient experiences abdominal pain, fever, chills, palpitations and general deterioration of the general condition. If detected, it ensures early intervention and short treatment time. To prevent this, a leakage test is performed during and after the operation, the second row of sutures is placed on the staple line, and it is recommended to strengthen the staple line if there is a concomitant disease or drug use that increases the possibility of leakage and impairs wound healing.

NUTRITION AFTER SLEEVE GASTRECTOMY

The first 24 hours after the operation are very important for monitoring vital signs. No food, including water, is given orally during this period. During 24 hours, intravenous serum and vitamin support is given. After 24 hours, food intake is started with clear liquids such as water and apple juice. During the following 6-8 weeks, a transition programme from liquid food to solid food is followed according to the patient's tolerance to food. This process is closely monitored by dieticians according to the current condition of the patient. Protein supplements specially developed for bariatric nutrition are used for the first four weeks. Water consumption is of vital importance during this period. Portion restriction and solid-liquid separation are important.

Exercise After Gastric Sleeve Gastrectomy

Mobility is very important in the early postoperative period. In the first two weeks after the operation, it is recommended to be mobile at home and to take walks on flat ground inside the house. After the third week, daily outdoor walks on a flat and slope-free area should be started. Gradually increasing resistance exercises between the fourth and sixth week and weight training after the eighth week can be started. It should not be forgotten that regular exercise is essential to achieve healthy and permanent results after surgery.

MINI GASTRIC BYPASS SURGERY

Mini gastric bypass surgery is a bariatric intervention that combines portion restriction (restrictive) and malabsorptive (malabsorptive) effects. It has emerged as an alternative to gastric bypass surgery and its popularity has increased because it can be performed more easily and the number of anastomoses is less.

Who Can Have Mini Gastric Bypass Surgery?

Similar to sleeve gastrectomy, mini gastric bypass surgery is between the ages of 18-65,

It is recommended for people with a BMI >40 kg/m2 and previous experience of weight loss and maintenance problems.

Another group included patients with a BMI between 35 and 39.9 kg/m2 , with obesity-related comorbidities (especially diabetes, insulin resistance, sleep apnoea, etc.) and unsuccessful weight loss experience.

How is Mini Gastric Bypass Surgery Performed?

Like all bariatric interventions, Mini Gastric Bypass surgery is performed laparoscopically. The operation consists of two parts. Firstly, a pouch is prepared by reducing the stomach. However, unlike the sleeve gastrectomy, the rest of the stomach is not removed at this stage. This procedure creates the portion restriction effect of the surgery.

In the second part of the operation, the small intestine is connected to the newly formed stomach pouch. Thus, the food from the new gastric pouch enters the system without using a certain part of the glass. this procedure constitutes the absorption restriction effect of the operation.

How Long Does Mini Gastric Bypass Surgery Take?

Although the operation time varies according to the anatomical structure of the patient, it takes longer than sleeve gastrectomy and shorter than RYGB. However, with the preoperative preparations and recovery period after anaesthesia, the return to the ward bed is approximately 3-4 hours. Patients generally do not need intensive care after the standard procedure. However, it may be appropriate to closely monitor patients with accompanying health problems in the intensive care unit overnight if necessary. The patient can get out of bed and fulfil basic needs four to six hours after returning to the ward bed.

How Does Mini Gastric Bypass Surgery Make You Weak?

As in Gastric Bypass surgery, Mini Gastric Bypass surgery provides portion reduction with the small stomach pouch created. At the same time, the absorption of nutrients is reduced due to the gastrointestinal connection made and the transport of nutrients without using part of the intestines. In this way, the patient effectively gets rid of excess weight by eating a regular and balanced diet.

What are the Advantages of Mini Gastric Bypass Surgery?

The slimming effect of Mini Gastric Bypass surgery is more effective than sleeve gastrectomy surgery. The rate of resolution of health problems accompanying obesity is higher.

It is easier to apply and has fewer complications than RYGB.

In the long term, weight gain rates are less than sleeve gastrectomy surgery.

Although it is difficult, it is possible to return to the anatomy because no part of the body is removed.

What are the Disadvantages of Mini Gastric Bypass Surgery?

Mini Gastric Bypass surgery has more weight loss and health problems than sleeve gastrectomy surgery.

The difficulty and complexity of the operation and the complication rate are between sleeve gastrectomy and RYGB.

It takes more time than sleeve gastrectomy and requires longer hospitalisation and close follow-up.

Since it is an operation that causes malabsorption, there is a need for lifelong use of vitamins and trace elements.

A part of the stomach remains that cannot be visualised by endoscopy.

Nutrition After Mini Gastric Bypass Surgery

Nutrition after Mini Gastric Bypass surgery is similar to RYGB. Intravenous serum support is given during the hospital stay after the operation. If everything is fine in the first 24 hours after the operation, clear liquids such as water, apple juice and food intake is started. Unlike sleeve gastrectomy, there is no liquid feeding period. However, pureed foods are consumed for the first four weeks. Fat-containing and high-calorie foods are avoided. After all obesity interventions, a healthy and balanced diet should be followed. This process is shaped by dieticians according to the current condition of the patient. Protein supplements are used for the first four weeks. Water consumption is vital during this period. It is important to pay attention to portion restriction and solid-liquid separation.

Exercise After Mini Gastric Bypass Surgery

Mobility is very important in the early postoperative period. In the first two weeks after the operation, it is recommended to be mobile at home and to take walks on flat ground inside the house. After the third week, daily outdoor walks on a flat and slope-free area should be started. Gradually increasing resistance exercises between the fourth and sixth week and weight training after the eighth week can be started. It should not be forgotten that regular exercise is essential to achieve healthy and permanent results after surgery.

ROUX-EN-Y GASTRIC BYPASS SURGERY

RYGB is one of the oldest obesity and metabolic surgery operations. Unlike sleeve gastrectomy, it both restricts food intake and prevents absorption. Unlike sleeve gastrectomy, part of the stomach or intestines are not removed, but part of the intestines are deactivated. RYGB has a higher rate of weight loss and improvement in diabetes than sleeve gastrectomy. However, it is a longer and more complex operation than sleeve gastrectomy because it is a method that restricts absorption. Therefore, the hospital stay is longer and requires closer follow-up. Since absorption is restricted after gastric bypass surgery, vitamin and mineral supplements are needed for life.

Who Can Perform RYGB Gastric Bypass Surgery?

Similar to sleeve gastrectomy, RYGB is recommended for people aged 18-65 years, with a BMI >40 kg/m2 and with at least two previous weight control experiences.

Another group included patients with a BMI between 35 and 39.9 kg/m2 , with obesity-related comorbidities (especially diabetes, insulin resistance, sleep apnoea, etc.) and unsuccessful weight loss experience.

How is RYGB Realised?

Like all bariatric procedures, RYGB is performed laparoscopically. The operation consists of two parts. Firstly, a small pouch is created in the part of the stomach that connects to the oesophagus. This pouch occupies a volume of approximately 30-50 ml. Unlike sleeve gastrectomy, the rest of the stomach is not removed.

In the second part of the operation, the small intestine is separated and one end is connected to the newly formed stomach pouch. The other end is connected to the new digestive system and ensures the continuity of the bile, pancreatic digestive enzymes pathway.

How Long Does RYGB Surgery Take?

Although the duration of the operation varies according to the anatomical structure of the patient, the duration of the operation varies between one and one and a half hours. However, with the preoperative preparations and recovery period after anaesthesia, the return to the ward bed is approximately 3-4 hours. Patients generally do not need intensive care after the standard procedure. However, it may be appropriate to closely monitor patients with accompanying health problems in the intensive care unit overnight if necessary. The patient can get out of bed and meet basic needs 4-6 hours after returning to the ward bed. On the day of surgery, complaints such as pain, nausea and spasm can be controlled with intravenous drugs.

How Does RYGB Surgery Make You Slimmer?

The small gastric pouch created in the basic RYGB surgery enables portion minimisation. At the same time, the absorption of nutrients is reduced due to the gastrointestinal connection made and the transport of nutrients without using part of the intestines. In this way, the patient effectively gets rid of excess weight by eating a regular and balanced diet.

What are the Advantages of RYGB Surgery?

The weight loss effect of RYGB is more effective than sleeve gastrectomy. The rate of resolution of health problems accompanying obesity is higher. In the long term, weight gain rates are less than sleeve gastrectomy. Although it is difficult, it is possible to return to the anatomy since no part of the body is removed.

What are the Disadvantages of RYGB Surgery?

Although RYGB has a greater effect on weight loss and solving health problems, it is a more complex surgery with a higher complication rate than sleeve gastrectomy.

It takes more time than sleeve gastrectomy and requires longer hospitalisation and close follow-up.

Since it is an operation that causes malabsorption, there is a need for lifelong use of vitamins and trace elements.

A part of the stomach remains that cannot be visualised by endoscopy.

What are the Risks of RYGB Surgery?

As with any obesity intervention, problems such as bleeding, embolism, leakage from staple lines may occur after RYGB. Conditions such as respiratory tract infection, wound infection, surgical hernia may occur after any surgical intervention.

In the long term, the most common problems that can occur in RYGB are gallstone formation, development of ulcers in the stomach, dumping syndrome, ulcers and obstruction of the small intestine.

Nutrition after RYGB Surgery

Intravenous serum and vitamin support is given during the hospital stay after the operation. If everything is fine in the first 24 hours after the operation, clear liquids such as water, apple juice and food intake is started. Unlike sleeve gastrectomy, there is no liquid feeding period. However, pureed foods are consumed for the first four weeks. Fat-containing and high-calorie foods are avoided. After all obesity interventions, a healthy and balanced diet should be followed. This process is shaped by dieticians according to the current condition of the patient. Protein supplements are used for the first four weeks. Water consumption is vital during this period. It is important to pay attention to portion restriction and solid-liquid separation.

Exercise after RYGB Surgery

Mobility is very important in the early postoperative period. In the first two weeks after the operation, it is recommended to be mobile at home and to take walks at home. After the third week, daily outdoor walks on a flat and slope-free area should be started. Gradually increasing resistance exercises between 4-6 weeks and weight training after the eighth week can be started. It should not be forgotten that regular exercise is essential to achieve healthy and permanent results after surgery.