Patient group for which sleeve gastrectomy will be preferred
The patient's body mass index is the first determinant. Performing bypass surgeries may be unacceptably risky in patients with a body mass index higher than 60kg/m2. Therefore, gastric sleeve surgery is primarily suitable for these patients. In addition, patients with inflammatory bowel disease and patients with adhesions in their intestines due to previous surgeries are not suitable for by pass surgery.
Sleeve gastrectomy surgery is generally recommended for very young and very old patients and patients who have to use drugs that suppress the immune system.
Patient group for which Gastric Sleeve is not preferred
Sleeve gastric surgery may not be effective enough, especially in people who are fond of very sugary foods and drinks (we prefer bypass procedures in such patients).
In patients with reflux (stomach contents leaking into the esophagus), there may be a slight increase in reflux complaints with gastric sleeve. We also take this into consideration when selecting patients. We can also say that gastric sleeve surgery is unsafe in patients with large hiatal hernias.
In the treatment of diabetes, sleeve gastrectomy may not be as effective as bypass. The decision should be made by looking at how long the patient has had diabetes, which medications he/she uses, whether his/her blood sugar is under control, and whether there are complications due to diabetes.
The patient group for whom bypass surgery will be preferred
It is known that the most effective treatment method in suitable patients for many diseases such as obesity, diabetes, high blood pressure, sleep apnea, called metabolic syndrome, is Roux en Y Gastric bypass. Therefore, it is considered the gold standard. We have very long term results. The long-term effects of this surgery, which has been performed for more than 40 years, are well known and reliable. When a new surgical technique is developed, it can only become widespread if it is compared to Roux-en Y bypass and is as effective.
Mini gastric bypass and transit bipartition surgeries are also offered as competitors to Roux-en Y bypass. Although there are surgeries that have proven their effectiveness and reliability in the short term (3-4 years) in the treatment of diabetes, there is not enough information about their long-term results (after 10 years). We do not have any information.
In summary, the type of obesity and metabolic surgery should be determined individually. An ideal bariatric and metabolic surgeon should be able to perform all these surgeries by having full knowledge of the digestive system and decide which surgery to perform according to the characteristics of the patient.
Actually, there is an answer to this question in the history of sleeve gastrectomy surgery. Gastric sleeve surgery was first performed as a part of biliopancreatic diversion surgery. When it was started to be applied with the plan of performing the second surgery after performing sleeve gastrectomy and losing some weight in very obese patients where it is risky to perform the surgery in a single session, the surgeon was amazed that there was no need for a second surgery in 75% of the patients. However, as it was, it was too early to launch it as a single surgery, as a quarter of the patients still required a second surgery. After the studies and a few changes in the technique, sleeve gastrectomy as it is known today began to be performed. Unfortunately, gastric sleeve surgery performed with the current technique may fail to achieve adequate weight loss in 10-15% of patients.
Unfortunately, there is a possibility of gaining weight back after gastric bypass surgery, although it is low. Although gaining weight again is less likely than in sleeve gastrectomy, the possibilities of revision when weight regain is achieved are not as wide as in sleeve gastrectomy.
Metabolic surgery is a surgery used in the treatment of diabetes. In fact, although very similar techniques are used with obesity surgery, the goal here is not to provide the patient with too much weight loss, but to control blood sugar by increasing the strength of the patient's existing insulin. Some weight loss is definitely achieved, but it can also be applied safely in patients who are not extremely obese and its effectiveness has been proven.
Type 2 diabetes is a disease that can be treated with surgery. However, unfortunately, not every patient is a suitable candidate for diabetes surgery. Body mass index (BMI) is an important parameter for selecting patients who will benefit from surgery. International Association of Metabolic Surgery states that patients with a BMI over 30 will benefit more from surgery. It has been accepted by scientists who are members of e. The key point here is that the patient's own insulin reserve must be sufficient. To evaluate this, it is necessary to evaluate fasting blood sugar, insulin and C peptide levels. With the right patient selection, it is possible for 90% of Type 2 diabetes patients to be cured of this disease.
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