WHAT IS OBESITY?
Obesity is the accumulation of abnormal amounts of fat in the body. Obesity occurs as a result of a combination of excessive food intake, lack of physical activity, sedentary life and genetic factors. Apart from these, some hormonal diseases also cause obesity. Obesity is graded by the body mass index. If the body mass index is over 30, we are talking about obesity and it constitutes the patients who are candidates for bariatric surgery.
CAUSES OF OBESITY?
Although there are many causes of obesity, the most common cause is overeating. When people take in more calories than they burn, they gain weight. Other causes of obesity include genetics, certain medical conditions, and certain medications. People who are obese often have a hard time losing weight because they have a slower metabolism. This means they burn calories more slowly than people who are not obese. Genetics may also play a role in obesity. If your parents or grandparents are overweight, you may be more likely to be obese.
Certain medical conditions can also cause obesity. These include hypothyroidism, Cushing’s syndrome, and polycystic ovary syndrome. Medications that can cause weight gain include steroids, birth control pills, and some antidepressants. And of course, if you’re obese, you’re at risk of developing other health problems. These include heart disease, stroke, type 2 diabetes and certain types of cancer. Obesity can also lead to joint problems, sleep apnea, and social and emotional problems.
If you are obese, you should talk to your doctor about ways to lose weight. Even losing a small amount of weight can help reduce your risk of other health problems. Or maybe you can consider bariatric surgery for a radical solution to this problem.
WHAT IS OBESITY SURGERY?
Bariatric surgery, also known as bariatric surgery, is an operation performed on the digestive system of people who are obese and have obesity-related diseases (cardiovascular diseases, severe diabetes, arthritis, joint problems, respiratory problems). Body mass index should be 35 or more. Which surgical method to use varies from patient to patient. Surgery is considered in patients who have tried all other treatment methods (diet program, exercise program, behavior change, drug therapy) but were unsuccessful.
TYPES OF OBESITY SURGERY
There are many types of bariatric surgery, each of which has its own advantages and disadvantages. The most common types are;
Gastric sleeve surgery
Mini gastric bypass
WHO SHOULD HAVE OBESITY SURGERY
SUITABLE?
There are many factors that contribute to a person’s suitability for bariatric surgery. The most important factor is the person’s body mass index (BMI). A BMI of 35 or more is considered morbidly obese. Other factors that contribute to a person’s eligibility for bariatric surgery include the person’s age, health history, and motivation to lose weight. Bariatric surgery is not for everyone. However, it is a serious operation that should be considered after all other weight loss options have been exhausted.
SURGICAL TREATMENT OF MORBID OBESITY
The development of laparoscopic surgical instruments and techniques, on the other hand, strengthened the idea of treating morbidly obese patients with laparoscopic (closed) surgical techniques, and finally, in 1983, obesity surgery was performed closed for the first time. In 1993, the first gastric band was put on the market and in 1995 the first series of patients who were cuffed in France was published. Gastric bypass operations became a routinely used surgery in the United States in 1998.
Due to obesity, the probability of the occurrence of many diseases increases drastically. The most well-known of these diseases are high blood pressure and cardiovascular diseases.
Many scientific studies have proven that there is a direct relationship between weight gain and increased blood pressure. In addition to this, the increase in blood fats due to obesity
When there is atherosclerosis, the frequency of arteriosclerosis, vascular occlusions in various body parts and heart diseases increase significantly.
TUBE STOMACH SURGERY
Gastric sleeve surgery is performed by removing most of the stomach with a surgical operation. It is performed laparoscopically, that is, without cutting the abdominal wall, by entering through small holes with special tools. In this way, our body is not exposed to much stress, and recovery after sleeve gastrectomy surgery and returning to daily life is very fast.
STOMACH BYPASS SURGERY
It was the most frequently preferred method in America until 5 years ago. With the widespread use of sleeve gastrectomy surgery, it has become the second preferred method. In this method, the stomach is divided into two just under the esophagus entrance and a small stomach pouch is created. In this surgery, unlike gastric reduction surgery, no part of the stomach is removed.
The newly formed small stomach is combined with the small intestine; It is ensured that foods bypass the first part of the large stomach and small intestine. In this way, it is aimed to be satiated with less food and to absorb less of the food taken.
WHO CAN HAVE TUBE STOMACH SURGERY
Gastric sleeve surgery is a method applied to people who have severe obesity problems and cannot achieve permanent weight loss with diet and sports methods. To determine the degree of obesity, a figure called the “body mass index”, which is obtained by dividing our weight by our height, is used. For example, 2 meters tall
BMI of a person weighing 160Kg:
Neck square 2×2=4,
Weight/height squared 160/4= 40
is determined as.
Normal ratios of BMI vary according to age. Between 19 and 25 is considered a healthy range. BMI values: Over 25 overweight, over 30 1st degree obesity, 35 above 2nd degree obesity, 40 and above are considered 3rd degree obesity. Those who are 35 and over are considered suitable for surgical treatment, even if they have co-morbidities, and those over 40 are considered suitable for surgical treatment. BMI alone can be misleading in those with a lot of muscle mass. The situation in patients between 30 and 35 who have obesity-related co-morbidities is controversial.
“American Metabolic and Bariatric Surgery Association”, one of the authoritative associations on this subject, recommends that the surgical approach in first degree obesity should be evaluated by experienced surgeons for each patient.
In terms of age range, the answer to the question of whom gastric reduction surgeries are performed; The age range for gastric reduction surgery is given as 18 – 65. In case of psychiatric illness, gastric reduction surgery can be performed in people whose disease is under control, provided that the approval of the psychiatrist is obtained.
RISKS OF TUBE STOMACH SURGERY
Those who want to have surgery are most worried about the risks of stomach reduction surgery. 10 years ago, complication rates after sleeve gastrectomy surgeries were reported to be approximately 2-5%, and mortality rates were reported as 2 per thousand. Today, these rates have fallen below 1 per thousand in developed centers. Thanks to obesity surgery, developing technology and the increasing experience of surgeons over time, the risks of gastric reduction surgery have decreased and become safer.
At the beginning of the complications is leakage or in other words leakage. If appropriate treatment techniques are applied, leakage can be treated in a shorter time and without the need for reoperation.
can be done. Again, having the operation performed in a suitable hospital and by choosing an experienced team both minimizes the risk of leakage and allows treatment and treatment in case of occurrence.
It significantly increases your chances of recovery. Embolism is the most talked about and not only related to bariatric surgery, but all other
It is among the risks of stomach reduction surgery, which can be seen after surgeries and can be life-threatening when it is large. Here again, the most important issue is embolism formation.
to take measures to minimize the risk. These include using blood thinners, wrapping around the legs during surgery and intermittent air compression.
The use of a device that supports blood circulation will minimize the risk of embolism. Early management of the patient coming out of the surgery is also one of the measures to reduce the risk of embolism.
will be one. Bleeding, which is among the risks of sleeve gastrectomy surgery, is one of the situations that can be encountered, although it is not very common. Most of the time it stops on its own, sometimes it may be necessary to give blood. Rare
The patient may need to be re-operated. It is not life-threatening most of the time.
AFTER TUBE STOMACH SURGERY
Gastric reduction surgery, which should be performed by a specialist surgeon, requires the patient to stay in the hospital for a few days depending on the situation. After leaving the hospital, after a few days of rest without heavy work at home, work and social life can be continued. After the operation, the patient’s appetite will decrease incomparably. After gastric reduction surgery, patients who start with liquid first and then continue to feed with pureed foods can switch to solid food in the 6th week. Patients lose weight effectively in the first six months with the nutrition plan after gastric sleeve surgery. In the future, nutrition after stomach reduction surgery should be programmed with a dietitian. In patients who return to their pre-operative diet, it is possible to gain weight without re-expansion of the stomach. If this situation cannot be controlled with diet, stomach reduction operation
Repeatable or “bypass” type second revision surgery can be performed, which also reduces the absorption of the food taken.
NUTRITION AFTER TUBE STOMACH SURGERY
The early period in nutrition after bariatric surgery starts with clear and viscous liquids. After gastric reduction surgery, food intake begins in the fluid period.
From the first day, a transition from light liquid to dark liquid is ensured. This period covers the first 2 weeks. The 3rd and 4th weeks continue as puree and soft solids period. The nutrition plan after stomach reduction surgery was arranged as a transition to normal nutrition for the first month.
Protein sources after gastric reduction surgery are the most desired group to be consumed in nutrition. For this reason, importance is given to its consumption in the liquid period. In the hospital, fluid intake is started with water and 100% apple juice. In the following days, it is continued in the form of unsweetened tea, meat / chicken broth. After discharge, the same clear liquids as in the hospital should be consumed for the first 7 days at home. In addition to the first days, the liquids you will continue at home; Ayran, light milk or lactose-free milk, legumes, flour, filtered soups that do not contain tomato paste, 100% fruit juices and sugar-free compote that you can start from the 5th day. Consistent liquids can be started in the 2nd week of the liquid period after gastric reduction surgery. From the 7th day, dairy products can be consumed without dilution. After gastric reduction surgery, protein powder should be consumed in order to meet the protein need in sufficient amounts. During this period, soft-boiled eggs,
Soft solids such as soft cheese, poached fish and omelette are tried by evaluating the food tolerance status of the people. Soups that do not contain solid meat and chicken pieces (can be seasoned from the 10th day) can be preferred by blending them. The mash period after stomach reduction surgery covers the 3rd and 4th weeks. During this period, low-fat, blenderized foods should be consumed. While continuing with protein powder, vegetable purees enriched with meat and chicken juices should be preferred. In addition, meat and chicken pieces should not be blenderized. From the meat group, only fish meat can be consumed softly from the 21st day. The foods that should not be consumed in the early period after obesity surgery are divided into two as foods that negatively affect the healing process of the stomach and are difficult to digest. For example, acidic-carbonated drinks, Turkish coffee and caffeinated coffees, oil and fatty foods, table sugar and sugary foods, hot sauce or spices, meat, chicken, dried legumes, raw vegetables should not be consumed as solid foods that are difficult to digest. Changes in the sense of taste can be brought under control with recipes after obesity surgery.
can be obtained. At this point, it is very important to cooperate with your dietitian.
HOW DOES THE PATIENT’S LIFE CHANGE AFTER THE STOMACH REDUCTION SURGERY?
The purpose of stomach reduction surgery is to reduce the volume of the stomach. Due to the shrinking stomach volume, a feeling of early satiety occurs and thus the food that can be taken during the day
amount is significantly reduced. After stomach reduction surgery, food consumption decreases by approximately ¾. If the diet is not taken care of after stomach reduction surgery, weight gain may occur even if the stomach does not expand again. In order not to allow this, it is essential to follow the patient regularly by a professional team after the surgery. Success is possible with proper follow-up after gastric sleeve surgery as well as proper surgery.
FREQUENTLY ASKED QUESTIONS ABOUT OBESITY SURGERY
If you’re considering bariatric surgery, you’re probably wondering what to expect. Here are some frequently asked questions about surgery and the healing process.
HOW LONG DOES THE SURGERY TAKE?
The surgery itself is usually only about an hour. However, you will need to stay in the hospital for a few days to recover.
WHAT ARE THE RISKS OF THE SURGERY?
As with any surgery, there are some risks. These include bleeding, infection, and blood clots. However, the risks are usually very low.
HOW MUCH WEIGHT WILL I LOSE?
Most people lose about 50-75% of their excess weight. However, this may vary depending on the type of surgery you have and your personal situation.
WHAT ARE THE SIDE EFFECTS OF THE SURGERY?
The most common side effects are nausea and vomiting. This is usually temporary and passes within a few days. Other side effects may include diarrhea, constipation, and hair loss.
IS THERE AN AGE LIMIT FOR OBESITY SURGERY?
There is no age limit in bariatric surgery. Obesity surgery can be applied to people of all ages, from children to the elderly. However, it is generally applied for patients between the ages of 18-60 unless it is mandatory. The decision to have surgery depends on many factors such as the severity of obesity, the presence of other health problems, and the person’s ability to adapt to post-operative care.
RISKS OF OBESITY SURGERY
As with any surgery, there are many risks in bariatric surgery. These risks include, but are not limited to, infection, bleeding, blood clots, and pulmonary embolism. There is also a risk of perforation of the stomach or intestines during surgery. Bariatric surgery is also associated with the risk of malnutrition, as it can cause changes in the way the body absorbs nutrients.
The risks of bariatric surgery also vary according to the type of surgery performed. For example, gastric bypass surgery carries a higher risk of malnutrition than sleeve gastrectomy surgery. In addition, gastric bypass surgery is associated with a higher risk of complications such as bleeding and infection than sleeve gastrectomy surgery.
It is important to discuss the risks of bariatric surgery with your doctor before having surgery. In addition, you must carefully follow your doctor’s instructions after surgery to minimize the risks.
WILL I GAIN WEIGHT AFTER OBESITY SURGERY?
A common question asked by those considering bariatric surgery is will I regain weight after surgery? The best answer that can be given to this question is depending on the situation.
Relapse after bariatric surgery, including the type of surgery you had, how well you adhered to your post-operative diet and exercise plan, and your overall health.
There are a number of factors that will affect whether you gain weight or not. However, generally speaking, most people who have bariatric surgery usually do not regain the weight they have lost. Many people maintain significant weight loss over the long term. Of course, weight loss is not the only benefit of bariatric surgery. Surgery can also help improve or resolve a number of health problems, such as type 2 diabetes, sleep apnea, and high blood pressure.
If you are considering having bariatric surgery, you should consult your doctor about all the potential risks and benefits.
