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Bariatric Surgery

Bariatric Surgery

What is obesity?

Obesity can be defined as an excessive accumulation of fat tissues that negatively affects general health. According to global data, the incidence of obesity has tripled in the past 50 years. This is not just a cosmetic issue but a medical problem, as excessive weight increases the risk of developing serious diseases. Once adipose tissue has accumulated in the body, it excretes hormones and chemicals that increase appetite, elevate the limits of feeling full, and cause obesity to progress further. Therefore, after a certain point, it can be difficult to solve the problem without help. The good news is that obesity is preventable, and is treatable when the patient is motivated and has a qualified medical team.

How is obesity measured?

Body mass index (BMI) is a simple and commonly used tool to evaluate obesity. BMI considers weight and height. BMI is calculated by dividing weight in kilograms by height in meters, then dividing the result by height again. The result is matched to a BMI classification chart as follows:


Value Interval

BMI lower than 18.5 kg/m²

BMI between 18.5 – 24.9 kg/m²

BMI between 25 – 29.9 kg/m²

BMI between 30 – 34.9 kg/m²

BMI between 35 – 39.9 kg/m²

BMI over 40 kg/m²

Result

Underweight

Normal (healthy weight)

Overweight

Class I Obesity

Class II Obesity

Class III Obesity (Morbid obesity)


Obesity treatment

Obesity is a challenging and complex disease that needs comprehensive treatment by an experienced medical team. The treatment process is determined individually for each patient, and may involve:

Customized diet and exercise programs. When a person’s own efforts for weight control are insufficient, a specialist or, ideally, a team of specialists can do a lot to help them achieve steady weight loss.

Medications. If diet and exercise are not enough, a doctor may recommend weight-loss drugs that decrease appetite or increase the feeling of fullness. Medications for weight loss are not harmless, and they must be prescribed by a specialist considering the patient’s overall condition.

Nonsurgical obesity treatments. Some non-invasive, endoscopic outpatient procedures can be effective in overweight patients when diet and exercise have failed.

Bariatric surgery. There are various surgical methods to reduce the volume of the stomach, decrease absorption of food, or both.

Candidates for bariatric surgery

Bariatric surgery may be an option for patients with a BMI over 40 when diet and exercise alone have not been sufficient. It may be also used for patients with a BMI over 35 who have one or more weight-related health problems, such as hypertension, type 2 diabetes, sleep apnea, non-alcoholic fatty liver disease, or osteoarthritis. Metabolic surgery may also be considered to treat type 2 diabetes in patients with class I obesity (BMI 30.0–34.9 kg/m2) and inadequately controlled hyperglycemia despite optimal medical treatment by either oral or injectable medications (including insulin).
Candidates for bariatric surgery

Bariatric surgery is contraindicated for conditions such as serious heart disorder, current drug or alcohol dependence, cancer treatment, mental disorders, and pregnancy. Candidates for obesity surgery must be aware that they will have to make permanent lifestyle changes to achieve and sustain good results.

Types of Surgery for Obesity Treatment

With the developing technology, there are various surgical techniques used in obesity. The choice of surgery is decided by the physician and the patient together according to the patient's condition.

Gastric Sleeve Surgery

This method is usually the first choice and the most commonly used procedure for bariatric surgery. A sleeve gastrectomy helps patients lose weight in two ways: by reducing stomach volume and by preventing the production of ghrelin, a hormone associated with hunger. The surgeon removes approximately 80% of the stomach, leaving a long and narrow pouch. Because of its shape, the operation is called gastric sleeve or gastric reduction surgery. At Our’s Obesity Center, it is performed laparoscopically through four or five small incisions. The operation usually lasts 50–60 minutes. The patient can drink clear liquids four hours after surgery and must follow strict diet recommendations in the following weeks. The hospital stay is three days, and control examinations are required at one week, one month, three months, six months, and one year post surgery.

Small incisions are made in the abdominal wall for the insertion of small trocars.
The stomach is inspected and the blood vessels to the lateral side of stomach are divided.
A Bougie tube is inserted into the stomach and serves as a sizer for the new stomach.
The stapler is used to divide the stomach into two parts.
Continuous firing of stapler is used to divide the stomach.
The stomach is completely divided into two parts.
The new banana shaped stomach has about 20-25 % of original stomach volume.
Sleeve Gastrectomy Illustration

Gastric Bypass Surgery

Also called Roux-en-Y gastric bypass, this method involves creating a small pouch in the upper section of the stomach and attaching part of the small intestine to it. The food changes its stream, bypassing most of the stomach and part of the small intestine. This procedure reduces both the amount of consumed food and the absorption of calories. At Our Obesity Clinic, a gastric bypass surgery is typically performed with laparoscopic techniques, through small incisions in the abdomen.
The stapler is used to divide the stomach into two parts.
Continuous firing of stapler is used to divide the stomach.
The stomach is completely divided into two parts.

Gastric Balloon Procedure

The simplest method to help lose weight is the stomach balloon application. In this method, a balloon filled with liquid or air in the stomach is placed under mild anesthesia with the help of an endoscope.  This operation takes 15-20 minutes. Thus, the food intake capacity of the stomach is reduced and quick saturation is provided. With this method, patients can lose 7-8 kilos in a few months. However, this balloon can remain in the body for 6 months, a maximum of 1 year, and is removed within 5-6 minutes by endoscopic method.  Although it is the advantage of the method that it is simple to apply and there is no permanent change in the body, if the patient does not change his lifestyle and does not continue his diet after the balloon is removed, the lost weight can be regained.

However, within the period of use of 6 months-1 year, people get training on how to eat by trying them out. Today, the stomach balloon method is used as a preparation for basic morbid obesity surgery either in patients who are too risky for surgery or in super obese people. It can also be used by those who are not overweight.

Mini Gastric Bypass Surgery

This procedure is the light version of the traditional gastric bypass, but is still more complex than the gastric sleeve. It works by restricting the stomach and causing malabsorption by reducing the absorption area in the small intestine.

Comparison chart for the different types of weight loss surgeries:

Feature/ProcedureGastric Sleeve SurgeryGastric Bypass SurgeryGastric Balloon ProcedureMini Gastric Bypass
DescriptionRemoves a portion of the stomach, reducing its size.Creates a small pouch in the stomach and reroutes the small intestine to it.A balloon is temporarily placed in the stomach to reduce space for food.Similar to standard bypass but with a simpler and shorter intestine rerouting.
InvasivenessHighly Invasive.Highly invasive.Non-surgical, endoscopic procedure.Highly invasive.
Duration Of Surgery1-2 Hours2-3 hours.About 30 minutes.1-2 hours.
Hospital  Stay2-3 Days2-4 days.Outpatient (no overnight stay).2-3 days.
Recovery Time2-4 weeks.3-5 weeks.Immediate return to normal activities.2-4 weeks.
EffectivenessSignificant long-term weight loss.Significant long-term weight loss, more effective for severe obesity.Temporary weight loss solution, effective for moderate weight loss.Similar to standard bypass, potentially more effective for certain patients.
Nutritional ConsiderationsRequires lifelong vitamin supplementation and dietary changes.More extensive dietary changes and supplementation needed.No major changes in diet post-removal.Similar to standard bypass, requires dietary changes and supplementation.
Risks and ComplicationsRisk of leaks, nutritional deficiencies.Higher risk of complications like malnutrition, dumping syndrome.Risk of balloon deflation, gastrointestinal discomfort.Similar risks to standard bypass, but potentially lower complication rates.
ReversibilityIrreversible.Reversible but complex.Reversible.Reversible but complex.
Ideal CandidateBMI ≥ 40, or ≥ 35 with obesity-related conditions.BMI ≥ 40, or ≥ 35 with obesity-related conditions, especially effective for high BMI patients.Overweight individuals with BMI ≥ 30 who prefer a non-surgical option.BMI ≥ 40, or ≥ 35 with obesity-related conditions, especially those seeking a less complex surgery.

This chart provides a general overview, but individual suitability and results may vary. It’s important for patients to consult with a medical professional to determine the best option based on their specific health needs and weight loss goals.

Benefits of bariatric surgery

Patients undergoing obesity surgery can expect to lose about  60–80% of their excess body weight within two years of the operation. These  results are permanent if the patient follows their recommended program and  maintains healthy lifestyle habits. An average of 80–90% of patients  undergoing bariatric surgery achieve their weight-loss goals.    

Along with weight loss, obesity surgery provides significant  improvement to many medical conditions:    High blood pressure is regulated. 70% of patients stop taking  hypertension drugs.    Blood cholesterol improves. Over 80% of patients report normal  levels 2–3 months after the operation.    


Benefits of bariatric surgery

The risk of developing cardiac diseases is reduced due to the  decreased workload of the heart.    

Diabetes is reversed. About 70–85% of patients with type 2  diabetes are able to maintain normal blood sugar levels without medications.    

Asthma and respiratory problems are improved, with some  patients recovering completely.    

Obesity-related sleep disorders such as sleep apnea are cured.    

Joint and back pain caused by excess weight is relieved.


La chirurgie bariatrique est-elle sûre ?

La chirurgie bariatrique est-elle sûre ?
Obesity surgery can be lifesaving for people with severe obesity. However, it is a major surgery that carries risks and side effects, such as blood clots, infections, and bleeding. These are manageable conditions, and the long-term advantages of bariatric surgery exceed the potential risks. At our Obesity Clinic, we perform an extensive evaluation with a multidisciplinary team of experts to ensure that each patient receives the most suitable medical procedure. Bariatric surgery is generally safe when performed in an experienced center that is capable of managing potential complications.

Post-Operation Weight Loss

Nutrition after obesity surgery is an issue that needs attention. General weight loss continues for up to 1 year. We must establish a new eating habit and lifestyle after the surgery. We should not continue our old habits. We need to eat more protein-rich nutrition. In addition to regular and healthy nutrition, we should not forget exercises for permanent weight loss. Do not lose contact with your dietitian and doctor.

Post-Operation Weight Loss
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