Bariatric Surgery Center
Understanding Obesity
According to the World Health Organization (WHO), an individual is considered obese if their Body Mass Index (BMI) is over 30. BMI is a measure calculated from a person’s weight and height. While BMI is a widely used tool, it may not always provide an accurate assessment for everyone, especially for individuals with high muscle mass, such as athletes.
Other methods, like bioelectrical impedance analysis, are sometimes used to measure body fat percentage. However, BMI remains the most common screening tool for obesity.
Health Risks Associated with Obesity
Obesity is linked to a multitude of chronic health conditions, including:
- Type 2 diabetes
- High blood pressure
- High cholesterol
- Heart disease
- Stroke
- Certain types of cancer
- Sleep apnea
- Nonalcoholic fatty liver disease
- Osteoarthritis
Causes of Obesity
The rising rates of obesity can be attributed to several factors:
- Dietary changes: Increased consumption of processed foods, sugary drinks, and high-calorie foods.
- Physical inactivity: Sedentary lifestyles, reduced physical activity, and increased screen time.
- Genetics: Family history can play a role in an individual’s susceptibility to obesity.
- Medications: Certain medications can contribute to weight gain.
- Medical conditions: Some medical conditions can cause weight gain.
Calculating BMI
BMI is calculated using the following formula:
BMI = weight (kg) / height² (m²)
BMI Categories:
- Underweight: less than 18.5
- Normal weight: 18.5 – 24.9
- Overweight: 25 – 29.9
- Obesity: 30 or greater
Prevention and Treatment
Preventing and managing obesity typically involves a combination of lifestyle changes, including:
- Healthy eating: Adopting a balanced diet rich in fruits, vegetables, and whole grains.
- Regular physical activity: Engaging in regular exercise.
- Behavior modification: Changing eating habits and lifestyle behaviors.
- Medications: In some cases, medications may be prescribed to aid in weight loss.
- Surgery: For severe obesity, weight-loss surgery may be an option.
What is the Treatment for Obesity?
- Adopting a Permanent Diet Plan:
It is essential to follow a diet prescribed by a nutritionist, ensuring it aligns with the principles of adequate and balanced nutrition. The goal is to develop and maintain healthy eating habits.
Short-term diets with low calories may not significantly harm metabolism but primarily affect body weight. Therefore, short-term diet plans are not recommended. Instead, a permanent dietary routine is necessary, with regular follow-ups with a nutrition specialist to monitor your condition.
- Exercise Therapy:
While the weight-loss effect of exercise is debated, physical activity undeniably helps reduce abdominal fat mass. It also prevents muscle mass loss during a diet, promoting overall health.
Everyone, whether obese or not, should engage in at least 30 minutes of exercise daily. Patients must perform exercises within their movement capacity to minimize injury risks.
- Behavioral Therapy:
This involves identifying and avoiding events that trigger overeating or inactivity in daily life. It includes self-monitoring, recognizing harmful triggers, restructuring habits, controlling eating behavior, increasing physical activity, and receiving social support.
Psychiatrists and psychologists typically conduct group therapy sessions lasting 12–20 weeks, with groups of 10–12 participants.
- Medication for Obesity:
The biggest risk under this category is using weight-loss medications purchased online or from pharmacies without medical supervision. Many herbal products sold in pharmacies often lack a verified source, posing significant health risks.
Important Note: No medication should be used for obesity treatment without a prescription from a specialist.
- Obesity Surgery:
Bariatric surgery is one of the most advanced and effective modern medical technologies for treating patients who cannot be treated through conventional methods. It offers excellent results compared to other treatment options.
Diseases Associated with Obesity:
- Diabetes
- Sleep apnea
- High blood pressure
- Gout
- Metabolic syndrome
- Cardiovascular diseases
- Liver diseases and more
Who is a Suitable Candidate for Weight Loss Surgery?
Patients who fall into the following categories are generally considered good candidates for weight loss surgery:
- BMI over 35: Individuals with a Body Mass Index (BMI) greater than 35 are often recommended for surgery.
- BMI over 30 with comorbidities: Patients with a BMI of 30 or more who also have weight-related health conditions such as type 2 diabetes, high blood pressure, or sleep apnea are typically eligible.
- High-risk patients: Even if a patient’s BMI is between 30 and 35, they may be considered for surgery if their weight poses a significant risk of heart attack or stroke.
However, individuals with a BMI between 30 and 35 who do not have any serious health conditions related to their weight may be advised to try non-surgical weight loss methods first.
Intragastric Balloon System
An intragastric balloon is a non-surgical weight loss aid. It’s a silicone balloon that is placed inside the stomach via endoscopy. The balloon is then filled with saline solution, taking up space in the stomach and promoting feelings of fullness.
Advantages of the intragastric balloon:
- Non-surgical procedure
- No general anesthesia required
- Temporary solution
Disadvantages of the intragastric balloon:
- Can cause side effects such as nausea, vomiting, and pain
- Not a permanent solution
- Weight regain is common after balloon removal
Weight Loss Surgery Procedures
The most common types of weight loss surgery involve reducing the size of the stomach. One such procedure is sleeve gastrectomy.
Sleeve Gastrectomy
During a sleeve gastrectomy, a large portion of the stomach is removed, leaving a smaller, tube-shaped stomach. This reduces the amount of food the stomach can hold and promotes feelings of fullness. Additionally, the procedure decreases the production of ghrelin, a hormone that stimulates appetite.
Benefits of Sleeve Gastrectomy:
- Significant weight loss
- Improvement in weight-related health conditions
- Less invasive than some other weight loss surgeries
Note: Weight loss surgery is a serious medical procedure and should only be considered after careful evaluation by a healthcare professional. The decision to undergo surgery should be made in consultation with a surgeon and a team of healthcare providers.
Is Sleeve Gastrectomy a Same-Day Procedure?
While it’s common for patients to be discharged on the same day following a sleeve gastrectomy, this can vary based on individual medical needs and hospital policies. In some cases, an overnight stay may be necessary.
Success Rate of Sleeve Gastrectomy
The success rate of sleeve gastrectomy is generally between 80% and 90%. This means that a significant majority of patients who undergo this procedure experience significant and sustained weight loss.
Weight loss timeline: Patients can expect to lose around 60-70% of their excess weight within the first year post-surgery.
Recovery Time and Hospital Stay
- Recovery time: It typically takes 2-3 weeks to recover from sleeve gastrectomy before returning to work, although some individuals may require a longer recovery period.
- Hospital stay: Patients usually spend 1-2 days in the hospital after the procedure.
Weight Loss After Sleeve Gastrectomy
Initial weight loss: Patients can expect to lose around 30 pounds in the first month.
Long-term weight loss: Over six months, patients can expect to lose up to 50% of their excess weight.
Benefits of Sleeve Gastrectomy
Beyond weight loss, sleeve gastrectomy can also improve or resolve many weight-related health conditions such as:
- Type 2 diabetes
- High blood pressure
- High cholesterol
- Sleep apnea
- Heart disease
Gastric Banding
Gastric banding involves placing a band around the upper part of the stomach to create a smaller pouch. While it was once a popular option, it has become less common due to a higher rate of complications and less effective weight loss compared to other procedures.
Key differences between sleeve gastrectomy and gastric banding:
- Procedure: Sleeve gastrectomy involves removing a portion of the stomach, while gastric banding involves placing a band around the stomach.
- Effectiveness: Sleeve gastrectomy is generally considered more effective for long-term weight loss.
- Complications: Gastric banding has been associated with a higher rate of complications.
Factors to consider when choosing between sleeve gastrectomy and gastric banding:
- Individual health and medical history
- Surgeon’s expertise
- Long-term goals
In conclusion, both sleeve gastrectomy and gastric banding are surgical procedures designed to treat obesity. However, sleeve gastrectomy has become the preferred option due to its higher success rate and lower complication rate.
Gastric Plication
Gastric plication is a relatively newer technique in bariatric surgery where the stomach is folded and sutured to reduce its size. Unlike procedures that involve cutting or removing parts of the stomach, plication involves creating a smaller, tubular stomach by folding and stitching the existing stomach.
Key points of gastric plication:
- Minimally invasive: Performed laparoscopically with small incisions.
- Reversible: The sutures can be removed if necessary, restoring the stomach to its original size.
- Faster recovery: Shorter hospital stay and quicker recovery time compared to other procedures.
- Lower complication rate: Generally considered safer than procedures involving cutting or stapling the stomach.
- Suitable for: Patients with moderate obesity who have not been successful with other weight loss methods.
- Limitations: Not suitable for severely obese patients or those with diabetes or other significant health conditions.
Gastric Bypass Surgery (Roux-en-Y Gastric Bypass)
Gastric bypass is considered one of the most effective and globally recognized treatments for obesity. It delivers long-term results in weight loss and is the first internationally approved surgical procedure for obesity management.
The procedure involves creating a small pouch from the stomach and connecting it directly to the small intestine, bypassing a significant portion of the stomach and the upper part of the small intestine. This limits food intake and nutrient absorption, significantly reducing weight.
Key points of Gastric Bypass:
It allows patients to eat a variety of foods while still experiencing early satiety. Unlike sleeve gastrectomy, there is no need to avoid sweets, carbonated beverages, or juices.
Long-term weight stability, with no weight regain after years of surgery.
A permanent solution for Type 2 diabetes.
Procedure Overview
Division of the Stomach:
The stomach is divided into two parts, leaving a small pouch at the top with a capacity of about 30 ml. The small intestine is then divided, and the lower part is connected to the newly created stomach pouch.
Bypassing the Small Intestine:
A section of the small intestine (150–200 cm) is bypassed, redirecting bile and pancreatic enzymes to aid digestion later in the intestinal tract.
Mechanisms of Action:
- Reduced Stomach Size: Patients eat smaller portions and feel full more quickly.
- Hormonal Changes: Suppresses hunger hormones, reducing appetite.
- Lower Nutrient Absorption: Food digestion is delayed due to the bypassed intestinal section.
Benefits:
- Improves obesity-related Type 2 diabetes in 85% of patients, eliminating the need for insulin or medications.
- Reduces dependency on treatment for hypertension by 70%.
- Improves blood lipid levels in over 70% of patients.
- Alleviates joint and spinal conditions associated with obesity.
- Resolves sleep apnea shortly after surgery.
- Improves GERD in 20% of patients.
- Eliminates risks of thrombotic events associated with obesity.
- Enhances fertility, allowing safe conception two years post-surgery.
This procedure remains the most effective technique for achieving ideal weight, especially for patients with severe obesity.
Laparoscopic Mini-Gastric Bypass
Laparoscopic Mini-Gastric Bypass is an effective and well-established procedure that combines elements of both gastric bypass and sleeve gastrectomy. The upper part of the stomach is divided into a tube, similar to the first three quarters of a sleeve, and then joined to a loop of the small intestine.
Mini gastric bypass can be used as:
A revision surgery for patients who have had previous weight loss surgeries like gastric banding or sleeve gastrectomy but have regained weight.
How does it work?
The upper part of the stomach is stapled to form a narrow tube (30-50 ml in size). This smaller pouch becomes the new stomach and is completely separated from the rest of the stomach. This new stomach is then attached to a loop of the small intestine, bypassing the first part of the small intestine (duodenum) by about 150-200 cm. The remaining stomach and the upper part of the small intestine remain in the body but are no longer used in the digestion process.
Benefits:
- Significant and long-term weight loss (60-80% of excess weight)
- Restricts food intake and absorption
- May lead to increased energy expenditure
- Causes positive changes in gut hormones, leading to reduced appetite and increased satiety
- More sustained weight loss with lower rates of weight regain
Drawbacks and Risks:
- Technically more complex than sleeve gastrectomy, which may lead to more complications
- Requires a highly skilled surgeon
- Potential for long-term vitamin and mineral deficiencies, especially vitamin B12, iron, calcium, and folate
- Requires lifelong vitamin/mineral supplementation
How does mini gastric bypass help with weight loss?
- By reducing hunger through the modified gut that sends signals to the brain
- By reducing the amount of calories absorbed from food as food bypasses a significant portion of the small intestine
- By causing changes in gut hormones that help regulate appetite and metabolism
Long-term results:
Studies have shown that mini gastric bypass leads to significant and sustained weight loss over the long term. Many weight-related health conditions such as sleep apnea, type 2 diabetes, and joint pain improve or resolve after surgery.
Potential complications:
While complications are rare, they can occur. Common early complications include bleeding, infection, and blood clots. Long-term complications may include vitamin deficiencies, hernias, and bowel obstruction.
Note: As with any surgery, there are risks involved. It’s essential to discuss these risks with your surgeon and make an informed decision.
Side Effects After Simple Gastric Bypass
- Internal Hernia: The risk of an internal hernia is much lower after a mini bypass (1 in 500) compared to a standard gastric bypass (1 in 100). Sometimes, intestinal loops in the abdomen can become entangled and obstruct. If this happens, the surgery needs to be repeated to resolve the issue.
- Adhesions: Any abdominal surgery can cause adhesions (scar tissue). This can occur anytime after surgery, leading to problems with the intestines, such as obstruction or twisting. This may require hospitalization and, in some cases, a reoperation.
- Gastroesophageal Reflux Disease (GERD): If reflux occurs after surgery, some patients may need acid-suppressing medication. This procedure should be avoided for those with severe reflux symptoms before surgery.
- Malabsorption of Vitamins and Minerals: Low levels of iron, vitamin B12, and other micronutrients can occur even if supplement recommendations are followed. For this reason, it is strongly recommended to visit a doctor for follow-up and have blood tests once a year to avoid the risk of malnutrition.
Which Surgical Technique Is Best for the Patient’s Health?
The choice of any surgical technique depends on the patient’s characteristics and problem. The ideal surgery type for the patient is determined, and not all surgical techniques are suitable for every patient.
Why is Obesity Surgery More Effective and Successful Than All Other Treatments?
Obesity is a vicious cycle. The more a patient weighs, the harder it becomes to move, leading to immobility, which causes further weight gain. This is where obesity surgery plays a crucial role in breaking the cycle, making the patient more mobile by providing smaller food portions. Additionally, changes in insulin hormones offer benefits that cannot be achieved with other treatments in terms of appetite suppression and blood glucose control.
What is the Goal of Obesity Surgery?
The goal of obesity surgery is to lose 50% of excess weight in the first year. There is an ideal weight determined by an individual’s age and gender. However, most patients can surpass these goals and reach their natural weight. Achieving normal weight is much easier with more physical activity after the initial weight loss. The patient’s effort is crucial for losing excess weight after surgery.
When Can the Patient Leave the Hospital After Surgery and Resume Daily Life?
If everything goes well, the patient will be discharged on the third or fourth day after surgery, and they can resume daily activities at home after a rest period of 10-15 days. Lifting heavy loads is not recommended for up to 3 months. Recovery times may vary if there are any complications during or after surgery, or if the normal recovery process is disrupted for any reason. In such cases, the patient may need to stay in the hospital longer until the issue is resolved, or be readmitted after discharge.
Will There Be Any Scars After Obesity Surgery?
In obesity and diabetes surgery, all procedures are performed laparoscopically using advanced techniques. Therefore, no visible scars remain after the surgery.
Will There Be Skin Sagging After Obesity and Diabetes Surgery?
Anyone who gains weight is at risk for skin sagging. Although this may depend on the patient’s skin structure, a diet rich in protein and regular exercise are measures to reduce skin sagging. Excess skin in areas like the abdomen, chest, arms, or legs can be removed through cosmetic surgery performed by plastic surgeons. The best time for cosmetic surgery is at least one year after obesity surgery, in order to reach the ideal body weight.
Can a Patient Get Pregnant After Surgery?
It is recommended to avoid pregnancy for at least two years after surgery, especially during the early post-operative period. This is because pregnancy may interfere with the goal of obesity surgery and prevent weight loss. Furthermore, it can result in insufficient fluid and nutrition for the baby. It is best for patients to consult with a doctor before surgery.
What Are the Risks of Obesity Surgery?
Obesity surgery involves various risks, such as complications that may occur during the initial surgery (2-5%). In other words, 95-98% of patients are discharged without issues and begin their new lives. Higher success rates have been achieved in surgeries performed by general surgeons specializing in gallbladder and obesity surgeries.
What Are the Possible Risks for Patients After Obesity Surgery?
- Leakage: The most significant risk is the development of leakage due to the anatomical structure of the stomach and intestines. Although it often occurs in the first week after surgery, it is known that patients who experience leakage after a month may face complications. Leakage can occur due to infections inside the abdomen, which may extend the hospital stay and require repeated endoscopies or interventions, potentially leading to death even with intensive care.
- Bleeding: There is a risk of bleeding after any surgery, and bleeding occurs in 1-2% of obesity surgeries. The use of blood thinners (aspirin, clopidogrel, coumadin, heparin, etc.) increases the risk of post-operative bleeding. Bleeding may occur in the abdomen (internal bleeding) or the digestive system (gastric bleeding). The correct surgical technique and the use of tissue adhesives are known to be effective preventive measures. The majority of bleeding cases stop on their own. In some cases, the patient may need blood or blood products, requiring additional surgery to stop the bleeding. Severe bleeding can threaten the patient’s life.
- Blood Clots: Obese individuals who sit for extended periods may develop blood clots in the veins of the legs, which can lead to a stroke or embolism. This risk is higher after surgery, causing congestion in various veins of the body, including the lungs. Using compression stockings and blood thinners after surgery is important to prevent this condition.
- Vomiting: Some medications given during anesthesia may lead to vomiting during the early post-operative period. However, this effect usually occurs within the first day or two. If vomiting persists and adequate nutrition is not possible, a gastrointestinal obstruction should be checked.
- Internal Hernia: This is very rare but can occur after surgery inside the abdomen due to anatomical changes, leading to potential gaps. These gaps can cause bowel obstruction, which can lead to gangrene. Internal hernias can develop years after surgery and require immediate treatment to prevent death.
- Surgical Site Infection: Bacterial infection can occur at surface or deep surgical sites, leading to abscess formation, which may require drainage and antibiotic treatment.
- Exacerbation of Pre-existing Conditions: Conditions like lung diseases, hypertension, and heart failure may worsen in the early post-operative period, sometimes even in the later stages. However, as the patient loses weight, these conditions improve and may even be resolved.
Can We Reduce These Risks?
- Stop smoking (at least 45 days before surgery).
- Maintain controlled blood sugar and blood pressure.
- Lose 5-10% of weight before surgery to reduce surgery risks and increase its success.
Does the Risk of Heart Attack Increase After Obesity Surgery?
Obese patients are already at high risk for heart attack, which can lead to death. Research in Sweden followed over 4,000 patients for 18 years and showed that the risk of heart attack in obese patients who underwent obesity surgery was reduced by half.
What Should We Pay Attention to After Obesity Surgery?
Before surgery, it is essential to consult with a nutritionist and get detailed information on post-surgery nutrition. The patient will receive a diet that can be easily followed. Changes in anatomy and hormones will help maintain this diet.
Avoid heavy exercises in the first three months. Low-impact activities like walking and swimming are more suitable for the first 3 or even 6 months after surgery. An active lifestyle is essential for achieving the ideal weight.
Regular follow-up is crucial after surgery. If no complications occur, the patient should attend control visits every three months during the first year, every six months in the second year, and once a year thereafter. Medication doses for conditions like diabetes, blood pressure, cholesterol, or sleep apnea may change. Nutritional deficiencies can be easily addressed if monitored regularly. However, if long-term deficiencies are not controlled, they can lead to severe issues.
Is It Possible to Gain Weight Again After Obesity Surgery?
After obesity surgery, 85-90% of patients start a new life and maintain their weight loss. However, 10-15% of patients may not lose enough weight or may struggle to keep the weight off. This can happen for several reasons:
If the patient’s initial BMI is very high, they may still have some excess fat even after significant weight loss.
Some patients may still eat after feeling full, which can enlarge the stomach.
Overconsumption of calorie-dense foods like alcohol, ice cream, or chocolate can lead to weight gain.
In some cases, the stomach may narrow after gastric surgeries, leading to weight gain as the stomach expands over time.
It is important to screen patients for any psychological or hormonal issues that could affect their weight loss progress.
For inquiries and medical consultation regarding your treatment, please send all medical information, test results, and analyses regarding the patient’s condition via social media platforms such as WhatsApp and Viber. You can also directly contact the medical consultants through the numbers available on the website.
Once all the required information is received, the patient’s condition will be evaluated within 24 hours, and we will provide you with all the details regarding the treatment plan, treatment costs, length of stay in Turkey, and other services offered by our institution.
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