What is obesity surgery?
Obesity surgery, also known as bariatric surgery, is a comprehensive set of methods applied to patients who cannot lose weight through non-surgical methods, aiming to completely eliminate obesity. Each person's reasons for weight gain, the way they gain weight, and their metabolism function differently. Naturally, there are multiple surgical methods used to combat obesity. While a single method isn't developed for every individual, there are surgical techniques specifically designed for certain patient groups.
There are several reasons why people consistently gain weight and are unable to lose it. Examples include excessive food consumption, a sedentary lifestyle, and certain genetic factors. Consuming more calories than the daily requirement, often trending upwards, results in mild weight gain, then localized fat accumulation, and finally obesity. While non-surgical methods can help reduce obesity, they are ineffective once a certain point is reached. When excess weight severely impairs a person's quality of life and becomes life-threatening, bariatric surgery becomes necessary. For bariatric surgery, a person's body mass index (BMI) must be 35 or higher. BMIs between 35 and 40 indicate an underlying medical condition. If a BMI of 45 or higher, various non-surgical techniques are used to reduce weight and bring the patient to a weight suitable for surgery.
Obesity surgery is based on the idea of intervening in the digestive system. This intervention is achieved by reducing the volume of the stomach and shortening the intestinal tract. Firstly, the main reason for excessive food consumption is that the stomach volume is too large. Due to this large stomach volume, the person does not feel full. For this reason, the volume of the stomach is reduced by ten to twenty times. A large part of the space removed from the stomach is also responsible for secreting the hunger hormone. Thus, a double benefit is achieved. Secondly, intervention is performed on the small intestines, where calories are extracted from the ingested food. Sometimes a long section of the intestines is completely removed, and sometimes a secondary tract is created. Which method is chosen depends entirely on the patient's specific situation. In obesity surgery:
- Gastric banding,
- Gastric sleeve surgery,
- Gastric bypass surgery can be performed.
In addition to these surgeries, gastric balloon placement may also be used during the preparation phase to help the patient lose weight.
What is Metabolic Surgery?
Human metabolism is a highly complex system where many different factors are constantly interacting, and all factors influence each other. Metabolism, which has both physical and psychological effects, can be disrupted due to thousands of factors. These include cholesterol, sleep disorders, blood pressure imbalances, excess weight, and more. diabetes These are the main metabolic problems. These metabolic problems are sometimes temporary and sometimes permanent. When permanent, they need to be kept under control. Controlling these metabolic problems involves diet, exercise, a stress-free life, and medication. However, even with these methods, metabolic problems such as excess weight and diabetes can become uncontrollable at a certain point. Surgical techniques aimed at completely eliminating diabetes and other diabetes-related metabolic problems are called metabolic surgery.
A condition where metabolic problems occur together is called metabolic syndrome. Metabolic syndrome is quite dangerous, and diabetes is often the main cause of these problems. Diabetes, which manifests itself primarily through tissue damage and organ failure, can even lead to death if left untreated. For this reason, surgical intervention that alters the course of the system is necessary at a critical point.
Surgical intervention is performed on patients who have a high capacity to produce insulin but are somehow unable to produce it or cannot use the insulin they produce in their bodies; these patients have non-functional receptors that would allow them to use insulin. This surgical intervention... ileal interposition surgery or transit bipartition surgery This can be done in two ways. Both types of surgery alter the flow or functions of the digestive system. This alteration does not produce physical effects. The results of the surgical intervention are seen in the metabolism. Because the area of effect is metabolism, these surgical interventions are called metabolic surgeries.
In metabolic surgery, the volume of the stomach is altered to reduce the amount of food consumed, the cells in the stomach that secrete hunger hormones to delay the feeling of hunger are manipulated, and the functioning of the small intestine is altered. In ileal interposition surgeries, the upper and lower parts of the intestines are swapped, while in transit bipartition surgery, a second intestinal tract is created. The common effect of both surgeries is increased insulin secretion and decreased food intake. Furthermore, insulin receptors function more effectively after both operations.
In conclusion, metabolic surgery is performed to eliminate permanent damage to metabolism, thereby extending and improving the person's life. Although it has only been practiced for fifteen to twenty years, it is a highly effective method in the fight against diabetes.
What are the differences between obesity and metabolic surgery?
Obesity surgery and metabolic surgery are two distinct types of surgery that involve very similar procedures but are not entirely identical. Metabolic surgery originated from medical discoveries made in obesity surgery regarding the digestive system. From this perspective, we can consider obesity surgery as the ancestor of metabolic surgery. However, with the addition of new discoveries, the two are now completely distinct. The differences between metabolic surgery and obesity surgery are as follows:
- The primary goal of obesity surgery is to eliminate excess weight, while the secondary goal is to treat diabetes or other metabolic diseases. In metabolic surgery, the primary goal is to eliminate metabolic diseases, and subsequently, to control excess weight.
- The mechanisms by which the two types of surgery affect the body are quite different. In obesity surgery, the small intestine is secondary. The aim is to perform restrictive interventions and impair absorption. In metabolic surgery, the primary goal is to restore hormonal balance. Restrictive interventions are secondary or even tertiary, while absorption is not interfered with.
- The long-term outcomes of the two types of surgery are quite different. After metabolic surgery, the patient no longer needs supplements one year later. In obesity surgery, however, lifelong supplement use is necessary.
These are the general differences between the two types of surgery. There are also various differences in patient selection. For metabolic surgery, patients are required to have a body mass index of thirty-five or below. In obesity surgery, thirty-five or above is necessary. In other words, even at the most basic level, they encompass two different patient groups.
What are the procedures used in obesity and metabolic surgery?
Obesity surgery and metabolic surgery are often confused with each other. While the procedures are generally similar, there are significant differences in their mechanisms of action. Just as diabetes exacerbates excess weight, and excess weight exacerbates diabetes, a similar process exists between metabolic surgery and obesity surgery. Metabolic surgery, performed to completely cure diabetes, also eliminates excess weight in patients, if any. Similarly, obesity surgery, performed to eliminate excess weight, also completely eliminates diabetes, if any. Therefore, these are two different types of surgery that support each other but differ in their mechanisms of action. Another point to note is that the foundations of metabolic surgery were laid within obesity surgery. In other words, obesity surgery is a much older surgical procedure.
Both metabolic surgery and obesity surgery can be performed using different methods. The procedure of the chosen method also varies. Which method is chosen depends on the patient's specific situation. In metabolic surgery:
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- Ileal Interposition
- Transit Bipartition
These surgeries are performed. There are also various other methods that have emerged as variations. In obesity surgery:
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- Gastric Sleeve Surgery
- Gastric Bypass Surgery
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It is being done. There are variations here as well.
Procedure for Ileal Interposition Surgery
The primary goal of ileal interposition surgery is to alter the structure of the intestines and change the hormonal balance. To achieve this, the large portion of the stomach that secretes the hunger hormone is removed. Then, a small section from the lower part of the small intestine is placed in the upper part, and a small section from the upper part is placed in the lower part. This causes undigested food to first pass through the lower section of the intestines. Because the lower section increases insulin secretion, diabetes is controlled within six to twelve months.
Transit Bipartition Surgery Procedure
In transit bipartition surgery, as in ileal interposition surgery, the primary goal is to interfere with hormone balance. To achieve this goal, the portion of the stomach that secretes the hunger hormone is first removed. Then, the small intestine is divided into two near the middle. The upper part of the lower section is connected to the stomach as a second pathway. The freed lower end of the natural pathway is then attached to the lower part of the small intestine at a suitable point. This shortens the digestion time and ensures that most of the food first comes into contact with the lower part of the small intestine.
Gastric Sleeve Surgery Procedure
The primary goal of sleeve gastrectomy is to limit the amount of food that can be consumed. It can be performed with or without diabetes. It is generally applied to patients with eating disorders. During the surgery, the stomach is reshaped into a tube. A large portion of the stomach, which secretes the hunger hormone, is removed. The stomach volume is reduced by approximately ten times. The person cannot consume food even if they want to.
Gastric Bypass Surgery Procedure
Like sleeve gastrectomy, gastric bypass surgery also involves intervening in the area of the stomach that secretes the hunger hormone. Additionally, the upper part of the small intestine is rendered dysfunctional. This allows for controlled absorption of calories from both sides. However, due to the resulting absorption problems and vitamin and mineral deficiencies, this method is increasingly being abandoned today.