The Process of Obesity Surgery

Obesity is a major problem affecting many people today. If left untreated, obesity can lead to various diseases. It is extremely important for an obese person to seek treatment as soon as possible to avoid future health problems. In this article, we have addressed the most frequently asked questions by obese patients. We have also included information for patients considering obesity surgery. The process of obesity surgery We provided information about it.

What is obesity?

Obesity is defined as excessive fat accumulation, or weight gain, which occurs when the energy we take in from food exceeds the energy we expend. Essentially, it's not about being overweight, but about having an excess of body fat. In recent years, obese patients have increasingly chosen surgical methods as a treatment option. The process of obesity surgery This is one of the topics that patients are most curious about. In the rest of our article... obesity surgery process You can find all the details related to it.

How do I know if I'm obese?

Accurately calculating body fat percentage requires advanced equipment. Since access to this equipment isn't always possible, various calculation methods are used. The most commonly used methods are waist circumference measurement (WC) and body mass index (BMI).

Central obesity is defined as a waist circumference of ≥ 94 cm for men and ≥ 80 cm for non-pregnant women. A more commonly used method than waist circumference measurement is the body mass index (BMI). A more detailed assessment can be made with BMI, which is calculated using the formula: BMI = Weight (kg) / Height (m²).

Calculations based on this formula show that obesity has become an epidemic worldwide and in our country, with its prevalence increasing every day. Unfortunately, research has shown that one-third of the population in our country is overweight and one-third is obese. This means that 60% of our society is struggling with excess weight. Studies predict that by 2030, half of the population will be obese.

Why is obesity important?

Some overweight or obese individuals may not be unhappy with their current condition, but unlike many other diseases, obesity is not a simple illness affecting only one system. Over time, it impacts all systems, leading to diseases such as heart disease, high blood pressure, diabetes, high cholesterol, respiratory diseases, joint diseases, menstrual irregularities, infertility, impotence, gallbladder diseases, gallstones, and certain types of cancer, thereby shortening life expectancy and impairing quality of life.

Should I seek treatment for obesity?

Chronic diseases like obesity show their effects gradually day by day, so individuals become accustomed to and adapt to the situation. This often results in the person constantly postponing and delaying treatment. When discussing the treatment of an obese individual, it is also necessary to talk about the measures that should be taken to prevent obesity from occurring. However, preventive measures are not something that we, as physicians and healthcare professionals, can handle alone. Preventing the development and widespread prevalence of obesity in society requires the collaborative efforts and measures of the World Health Organization, national health ministries, education systems, and relevant authorities such as the Ministry of Food and Agriculture.

Son yıllarda yapılan birçok çalışmada obez olan bir bireyin diyet egzersiz ve yaşam tarzı değişikliği gibi ameliyatsız yöntemlerle fazla kilolarını verme şanslarının neredeyse hiç olmadığını ortaya koymaktadır. Bu çalışmaları genel olarak değerlendirdiğimizde obezitesi olan her 100 kişiden sadece 2 kişi fazla kilolarını verebiliyor ve fazla kilolarını vermiş bu kişilerin %98 de vermiş oldukları kiloluları en fazla 2 yıl koruyabiliyorlar. Dolayısıyla fazla kilolardan kurtulmanın kalıcı ve en etkin yolunun cerrahi tedavi olduğu kanıtlanmıştır.

What methods are used in the treatment of obesity?

In obesity treatment, many methods are tried besides surgery. These include diet, exercise programs, drug therapies, and psychological treatments. However, the success of these treatments is extremely limited. In recent years, non-surgical methods such as gastric balloon and gastric Botox have also come to the fore. Gastric balloon and Botox applications can be used in overweight individuals with a BMI between 25-30 and those with first-degree obesity. For individuals with a BMI of 35 and above, the treatment that should be performed is surgical treatment. Methods used in obesity surgery...

1-Sleeve gastrectomy (gastric sleeve surgery)

2. Gastric bypass surgeries.

3-SADI-S operation

4-Transit Bipartition

5- Duodenal switch surgery

Who is eligible for obesity surgery?

Among patients aged 18-65 who have no contraindications to receiving general anesthesia for obesity surgery:

1- Everyone with a BMI of 40 or higher.

2. Individuals with a BMI between 35 and 40 who also have additional conditions such as hypertension, type 2 diabetes, high blood lipid levels, and sleep apnea can undergo surgery.

However, these criteria are not absolute requirements. These limits can be extended due to certain specific social and medical circumstances. For example, a 16-year-old patient with morbid obesity and deteriorating medical condition may undergo surgery with family consent. Similarly, patients with a BMI between 30-35 and uncontrolled diabetes may be eligible for surgery.

For me, the most important criterion is that the person has done everything in their power but has been unable to lose their excess weight.

I'm considering the operation. How does the process work?

The process of obesity surgery The process is easier than patients expect. The process begins with the initial consultation with patients considering surgery. Through social media and phone calls, our clinical assistants gather preliminary information from the patient and schedule appointments at the most convenient time for everyone. After scheduling your surgery appointment, you will be informed about what needs to be done in the period leading up to your appointment date.

Before Obesity Surgery

• You will be asked to provide recent blood test results and reports detailing your medical condition.
• If you use them, you will need to stop smoking and drinking alcohol 15 days before your surgery date.
• A liver-protective diet will be given 15 days prior to the surgery to promote liver shrinkage.
• If you are taking blood thinners, they will be stopped one week beforehand or replaced with another blood thinner.
• Food and beverages will be completely prohibited from midnight the day before your appointment.

Upon arrival at the hospital, after registration, you will be admitted and taken to a private VIP room. Then you will meet Dr. Necat Kaplan and his team. A comprehensive discussion will be held regarding your current condition, medical history, habits, and expectations, and you will be given detailed information about the planned surgery. The entire process will be explained verbally, and all your questions will be answered. After this meeting, if there are no contraindications to the operation, the preparation process for surgery will begin. During this process:

• You will have blood tests and ultrasounds to measure all parameters.
• To check your cardiovascular health, you will have an ECG, echocardiogram, and cardiology examination.
• You will undergo tests to assess your lung function and will be evaluated by a pulmonologist.
• You will be examined and informed by the anesthesiologist who will perform the endoscopy in order to assess the condition of your stomach and to ensure there are no underlying conditions that would prevent surgery.
• Once all procedures are complete, you will meet with Dr. Necat Kaplan again and be informed. After obtaining your necessary consent, your treatment will begin and you will be taken to the operating room.

After Obesity Surgery

• After the surgery, you will be taken to your room on the ward, not to the intensive care unit, and you will be briefed about the surgery by Dr. Necat Kaplan.
• Three hours after the surgery, once the effects of anesthesia have worn off, you will be helped to stand up under the supervision and assistance of a nurse. You will be asked to walk.
• You will be asked to work with the equipment provided for breathing exercises. You will repeat this for about 5 minutes every hour.
• You will be able to start drinking water one day after the surgery, and a leak test will be performed using a blue liquid. Immediately afterward, your drain will be removed. After the drain is removed, your wounds will be covered with waterproof tape, and you will be able to shower.
• You will be discharged 48 hours after the surgery.
• On the day you are discharged, your diet will be explained in detail by a dietitian. You will also be informed about the medications you will be using.
• Dr. Necat Kaplan's personal mobile number will be provided, and you will be able to contact him directly 24/7 with any questions or problems you may encounter.

Things to keep in mind and diet after surgery:

We recommend a diet for the first month after surgery. This diet, recommended for the first month, has two purposes: firstly, to protect your stomach from the surgery and prevent damage to the incision site; and secondly, to allow time for your new stomach to adapt. For these reasons, we recommend consuming liquid foods for the first 15 days, and then soft and pureed foods for the following 15 days. After one month, we no longer provide the usual, boring list of foods. In other words, we don't recommend any diet after the first month. The only thing we ask of our patients is to eat healthy foods. We want them to stay away from high-calorie and unhealthy foods and drinks. The process of obesity surgery After providing you with this information, let's look at which surgery is most suitable for you:

Which surgery is most suitable for me?

Sleeve Gastrectomy (Gastric Sleeve Surgery)

The process of obesity surgery At this stage, the most suitable surgery is selected for the individual. Sleeve gastrectomy, commonly known as stomach reduction surgery, is currently the most frequently used method in the surgical treatment of obesity. Its many advantages over other methods used in obesity surgery, and its very low disadvantages and shortcomings, are increasing the popularity of sleeve gastrectomy every day.

How is Gastric Sleeve Surgery Performed?

Gastric sleeve surgery is performed under general anesthesia. It is performed laparoscopically, meaning using a minimally invasive technique. Four 1 cm incisions are made in the abdominal skin to access the abdominal cavity. The abdominal space is then inflated with gas, making the internal organs visible. The left side of the stomach is separated from the surrounding fatty tissue, and approximately 100% of the stomach is cut and removed using special instruments called sleeves. A tube-shaped or banana-shaped stomach remains. Because the shape of the remaining stomach resembles a tube, the surgery is named after it. gastric sleeve surgery It is said that, contrary to popular belief, a permanent tube is not placed in your stomach. The procedures up to this point take approximately 40 minutes. In fact, the surgery ends with the removal of the cut stomach. However, in my patients, I stitch the stapled line once more. This extra stitching takes another 15 minutes. In total, the surgery is completed in about 55-60 minutes.

How does gastric sleeve surgery cause me to lose weight?

Weight is a very simple mathematical equation. It works on the formula: Weight = energy intake - energy expenditure. If we want to lose weight, we need to either reduce our energy intake or increase our energy expenditure. Someone who consumes 2000-2500 calories a day and expends 2500 calories through physical activity will not experience a change in weight. We obtain the energy we need from food. The average person's stomach capacity is approximately 1 liter. This capacity is even larger in obese individuals, and therefore they consume much more food at each meal. This leads to increased calorie intake and weight gain. Furthermore, a hormone called ghrelin is produced and secreted in the fundus, the storage part of our stomach. This is an appetite hormone, and it specifically increases our craving and appetite for carbohydrates. Gastric sleeve surgery During sleeve gastrectomy, approximately 1 TP3T 80 portion of the stomach is removed. It is essential to include the fundus, the area where ghrelin hormone is released. This reduces our interest and desire for food, leading to lower calorie intake and weight loss. Since the stomach volume is also reduced, you will eat less. In short, after sleeve gastrectomy, you will neither crave food nor be able to eat excessively even if you wanted to.

Does sleeve gastrectomy have any advantages over other surgeries?

Looking at the history of obesity surgery, we can see that the earliest procedures have been completely abandoned. The very aggressive surgeries used in the past, which could cause many problems later on, either completely lost their popularity or were abandoned altogether. The sleeve gastrectomy (tube stomach) surgery, which began to be performed in the early 2000s, was very effective in this regard. The ease of performing sleeve stomach surgery, its much lower complication rate compared to other methods, its highly physiological nature, the fact that no segment of the intestine or stomach is bypassed, and the absence of lifelong vitamin and mineral supplementation have made this surgery superior to other procedures and reduced the frequency of their application. One of its most important advantages is that it is a surgical procedure as effective as other obesity surgery methods.

What is the difference between sleeve gastrectomy and gastric bypass surgery?

Today, the two most commonly used surgeries in obesity surgery are sleeve gastrectomy and gastric bypass surgery. These are the most frequently performed surgeries in our country, as well as in America and Europe. obesity surgery This is a sleeve gastrectomy. A less frequently performed surgery is bypass surgery. The differences between these two surgeries can be summarized as follows.

1- Gastric sleeve surgery takes approximately 40 minutes, while bypass surgery takes about 2 hours.

2- tüp mide de midenin yaklaşık %80 ni çıkarılır. Çıkarılan mide karın içerisinde bırakılmaz ve dışarı alınır.  By pas ameliyatında ise midenin %95 i gıda girişine kapatılır ve kapatılmış alan karın içerisinde bırakılır. Dışarı çıkartılmaz.

3- In sleeve gastrectomy, the small intestine is not touched. In gastric bypass surgery, however, the intestines are separated and a new connection (anastomosis) is created with the stomach; in other words, there are segments of the intestine that are bypassed.

4. Since malabsorption does not occur in sleeve gastrectomy, there is no need to take vitamins and minerals for life. However, vitamin and mineral supplementation is mandatory in gastric bypass surgery.

5. Leakage and other surgical complications are more common in bypass surgery compared to sleeve gastrectomy.

6- Both surgeries have similar corrective effects on comorbidities such as obesity, diabetes, and sleep apnea.

In summary, sleeve gastrectomy has many advantages over gastric bypass surgery.

What are the risks of gastric sleeve surgery?

Obesity surgery process One of the most frequently asked questions by patients before surgery is what the risks are. Let's address this issue now:

Gastric sleeve surgery Gastric sleeve surgery is performed under general anesthesia. Although it is not significantly more dangerous than other digestive system surgeries, it is commonly believed to be extremely dangerous and potentially fatal. For example, while the early mortality rate in cardiovascular surgery is around 2 percent, in gastric sleeve surgery it is less than 1 in 1000. Every surgery carries its own risks. The important point in any surgery is to weigh the risks of the surgery against the risks posed by the pre-existing condition. Without exception, in all diseases treated with surgery, the risks posed by the surgery are much lower than the risks posed by the disease itself.

The possible complications that may occur during sleeve gastrectomy surgery can be summarized as follows:

1- Leakage: Leakage, the dreaded nightmare of both patients and surgeons, has a probability of occurring of %1 in the literature. Leakage is the leakage of stomach contents from the opening created in the incision in the stomach lining. The surgeon's experience, the quality of the materials used, and adherence to pre- and post-operative guidelines are very influential in determining whether or not a leak occurs. This is closely related to the surgeon's experience. In my clinic, I manually re-stitch the incision line as a second layer (Over Stitch Technique). In the 2400 sleeve gastrectomy surgeries I have performed so far, I have not encountered a single case of leakage.

2- Bleeding: Unexpected bleeding after surgery is rare. The vast majority of such bleeding resolves with medical treatment. In some cases, however, bleeding that worsens the patient's overall condition and does not respond to medical treatment may require further surgery to stop the bleeding.

3- Embolism: Its incidence is below % 1. However, since it can have serious consequences, all precautions should be taken to prevent it. For this, smoking should be stopped 10 days before the operation, blood-thinning medication should be started 12 hours before and after the operation, and the patient should be able to stand up and walk 3 hours after the operation.