Medical Park Obesity Center and Bariatric Surgery
OBESITY AND DIABETES SURGERY
Morbid obesity, or in other words, body weight fatally above normal limits implies the fat component of body above 30% in women and 25% in men. The more scientific definition is the body mass index (BMI), which is expressed by the ratio of the weight in kilograms to the square of the height in meters. If BMI is above 30 kg/m2, this person is deemed obese, while a BMI score above 35 kg/m2 and above 40 kg/m2 points to severe obesity that should be managed and morbid (fatal) obesity, respectively.
CONDITIONS CAUSED BY OBESITY
Obesity stands out as a factor that triggers or progresses many conditions. Type II diabetes, hypertension, cholesterol disorders, cardiovascular occlusions, heart attack, gastric reflux, asthma, fatty liver and the resultant liver failure, gout, degenerative joint diseases (arthritis), migraine, phlebitis (venous inflammation), polycystic ovary syndrome and menstrual irregularities are more common in obese individuals. Moreover, it is known that the risk for cancers of the breast, uterus, colon, esophagus, pancreas, kidney and prostate increases with obesity. The majority of obesity-related conditions recover when obesity is treated, or in other words, when healthy body weight is restored.
Although short-term results can be rarely achieved in some patients with diet, exercise, herbal treatments and drug therapies as well as acupuncture and similar alternative treatments, sound results usually fail or the gains cannot be maintained for a long time.
Patients with body mass index above 40 kg/m2 and people with body mass index above 35 kg/m2 and obesity-related diseases, such as diabetes, hypertension, coronary artery disease or sleep apnea, can also undergo obesity surgery.
Metabolic surgery can also be considered for patients with body mass index between 30 and 35 kg/m2 who have type II diabetes that cannot be controlled by drugs and this operation can help selected patients with diabetes mellitus.
1. Surgeries that reduce volume of stomach:
a. Sleeve Gastrectomy: Sleeve gastrectomy is the most commonly known and performed surgery among all volume-reducing operations. In this surgery, the stomach is shaped into a small tube and thus, the patient feels full with less food. In addition, the appetite hormone, Ghrelin, is secreted from a certain part of the stomach. Since this segment is largely removed in sleeve gastrectomy, the appetite is suppressed; the patients who undergo this surgery will feel hungry infrequently and be full more quickly.
b. Gastric plication: It is based on reducing the volume of the stomach by making folds. It has remained as an experimental method and is not widely recognized.
2. Operations that impair absorption of foods: These surgeries bypass foods from a certain part of the small intestine. These surgeries aim excretion of foods before they are digested and nutrients are absorbed into the bloodstream.
3. Combination of first two methods
a. Gastric Bypass (Roux-en-Y Gastric Bypass): In this method, the stomach is reduced to a volume as small as a tea cup and then, the small intestines are re-connected to the stomach. Both volume of the stomach is reduced and foods are not digested in a part of the small intestine. This surgery has been performed for more than 40 years to manage obesity and long-term outcomes are well-known. This surgery method is regarded as golden standard in the treatment of obesity.
b. Mini Gastric Bypass: Stomach is shaped into a tube form and small intestine is re-connected to this small stomach. It is shown that this technique is very effective for obesity and especially diabetes mellitus. It may be contraindicated for patients with risk of bile drainage into stomach and esophagus. It is known that good outcomes can be obtained in selected patients.
c. Transit Bipartition: Sleeve gastrectomy is performed, small intestines are connected to this tube and it is aimed that a part of the food follows the anatomic route, while other foods are bypassed to the alternative route. In this method, it is expected to prevent potential future vitamin and mineral deficiencies, as a part of foods follows the normal route. Foods that follow the alternative route are expected to help the patient regulate blood glucose over various hormones. Although it is a relatively new surgical technique compared to other methods, early outcomes are promising.
d. Although many surgical techniques have been introduced to date, including but not limited to duodenoileal bypass, jejuno-ileal bypass and ileal interposition, we do not have as much information about the effects, adverse effects and long-term effects as the other surgeries, since these surgeries are performed in very scarce selected patients. Such surgeries can be described as promising experimental operations rather than miraculous salvation methods.
Use of gastric balloon for slimming
Gastric balloon was first implanted in 1982 and it is still successfully used; endoscopic technique is used to implant a balloon that are inflated with water or air. Overweight patients can lose 20% to 30%, in average, of their body weight within 6 to 12 months depending on type and content of the balloon, but they usually maintain the final body weight by 90% within the first one to three years.
Balloon insertion: This technique does not require anesthesia administration and a silicone balloon is inflated with air or water. The air-filled balloons are left in lumen of the stomach for 12 months in average, while the water-filled balloons can stay inside the stomach for 6 to 8 months in average. Thus, significantly reduced volume of the stomach and continuous feeling of fullness help patients follow a personalized diet program. Although patients need to visit the clinic at certain intervals in this period time, they can resume ordinary life and the balloon is deflated and removed, again with endoscopic technique, at the end of this period.
It is necessary to consult with dietitian before obesity surgery and obtain detailed information about postoperative nutrition plan. You will be prescribed a diet that is easy to follow. Anatomy and hormone secretions that are modified with the surgery will help you follow this diet. In addition, you are recommended to avoid strenuous exercises for the first 3 months. Gentle exercises like walking and swimming are better that do not tire the body too much. You can do any exercise you want 3 or even 6 months after the surgery. Non-sedentary lifestyle is essential to achieve ideal body weight. Also, it is very important to attend follow-up visit at regular intervals in postoperative period. If nothing goes wrong, you should attend follow-up visits quarterly for the first year, semiannually for the second year and annually thereafter.
The medications you take for diabetes, hypertension, high cholesterol or sleep apnea will probably be changed; their doses will be reduced or medications will be stopped. Regardless of type of obesity surgery, some deficiencies may develop secondary to both insufficient eating and malabsorption. The iron, Vitamin B, calcium or other vitamin and mineral deficiencies detected in the follow-up examinations are usually managed very easily. However, long term deficiencies lead to serious problems if you ignore follow-up visits. This condition is so important that many healthcare facilities do not operate on patients who specify that they will not be able to attend follow-up visit. You do not need to worry about any deficiency as long as you attend follow-up visits.
Weight loss surgeries have been performed approximately for 45 years. Previously, open surgery technique was used. Thanks to modern surgical methods, closed (laparoscopic) surgery techniques can be used. All obesity surgeries specified above can successfully be performed with closed method. Thus, convalescence is shorter, pain is very minimal and there is almost no scar in postoperative period.