Patients with a body mass index over 40 kg/m2 should be treated with surgery without looking for another reason. Patients with a body mass index over 35 kg/m2 and a disease that can be treated with obesity surgery, such as diabetes, hypertension, coronary artery disease or sleep apnea, are also suitable candidates for obesity surgery.
Body mass index 30. Patients in the -35 kg/m2 range are also candidates for metabolic surgery. If these patients have a disease such as diabetes, hypertension, heart disease, or sleep apnea, surgeries should be performed to treat this accompanying disease. The International Federation of Obesity Surgery (IFSO) and the American Society for Bariatric Metabolic Surgery (ASMBS) recommend surgery for these patients in their treatment guide, so these patients are treated with surgery abroad. In Turkey, SSI has not yet accepted this situation as a requirement for surgery. For this reason, although surgery has not become widespread in these patients, it has clearly proven to be beneficial.
In this method, a hollow balloon is placed into the stomach with an endoscopy tool. The balloon is then inflated and creates a fullness in the patient's stomach, providing a feeling of fullness. This method is not a surgery. It does not require general anesthesia, does not require operating room conditions, does not require any incision, and does not cause any anatomical or hormonal changes. However, it is recommended that existing balloons remain safe for a maximum of 1 year. Complications such as stomach or duodenal ulcers and intestinal obstructions as a result of the balloon bursting may occur due to balloons remaining for longer periods of time. The effect of the balloon is not permanent. Most of the time, when the balloon is removed, patients regain the weight they lost. It is known to be effective in some patients who are not very obese (Body mass index 30-35 kg/m2). However, it should not be forgotten that it is a temporary solution.
There are many surgical methods that can be roughly divided into 3 groups.
Stomach volume reduction surgeries: Sleeve Gastric Surgery Gastrectomy): The most well-known and most commonly performed surgery among volume-limiting surgeries is sleeve gastrectomy. In this surgery, the stomach is turned into a thin tube and a smaller amount of food is allowed. saturation is achieved. In addition, Ghrelin hormone, called the hunger hormone, is secreted from a part of the stomach. Since this part is largely removed with sleeve gastrectomy, the appetite decreases, so patients with sleeve gastrectomy become less hungry and become full more quickly. Gastric band: (Adjustable Gastric band): In this method, the volume around the stomach is reduced. A silicone clamp that can increase or decrease is placed and the aim is to reduce the stomach volume available to the patient. Since it does not cause any hormonal changes, its success rate has been found to be lower than other surgeries. Due to the high complication rates, it is no longer used except in very special cases. Gastric plication: It is based on the principle of reducing the volume of the stomach by folding on itself. It remained an experimental treatment method and has not become widespread. Surgeries that impair the absorption of food: These are surgeries that prevent food from reaching a part of the small intestines. The aim of these surgeries is to excrete the food taken without mixing with the blood after it enters the body. Surgeries created by combining the first two methods Gastric Bypass (Roux-en Y Gastric Bypass): In this method, the stomach is reduced to a volume of a tea glass and The small intestines are then connected to the stomach. Both the stomach volume decreases and food passes through some of the small intestines without being digested. This surgery has been performed for obesity for over 40 years and its long-term results are well known. It is the surgical method that is considered the gold standard in the treatment of obesity. Mini Gastric Bypass: It is achieved by making a gastric tube and connecting the small intestines to this small stomach. It has been shown to be very effective in the treatment of obesity and especially diabetes. It may be dangerous to administer bile to patients who are likely to leak bile into the stomach and esophagus. Transit Bipartition: Gastric sleeve surgery is performed, and the small intestines are connected to this tube, aiming for some of the food to pass through the normal route and the other part to pass through the alternative route. In this method, foods passing through the normal route are expected to protect the patient from vitamin and mineral deficiencies that will develop in the future. Foods that will pass through the alternative route also increase blood sugar levels. It is aimed to help the patient control various hormones. Although it is a relatively newer surgical method compared to other methods, its early results are promising. Unfortunately, we do not have enough information about the late-term results. Although many types of surgery have been described, such as duodenoileal bypass, Jejuno-ileal bypass, ileal interposition, these surgeries are performed very selectively on a very small number of patients, so their effects and undesirable effects are limited. We do not have as much information about its long-term effects as other surgeries. Such surgeries can be described as promising experimental surgeries rather than as a miraculous method of salvation.
Joint diseases such as diabetes, hypertension, sleep apnea, asthma, cholesterol disorders, fatty liver, gout, herniated disc, and even Even migraine can improve at varying rates. The likelihood of developing breast and uterine cancer in female patients decreases significantly. Additionally, the possibility of developing esophageal cancer, kidney cancer, pancreatic cancer and colon cancer decreases. Additionally, the risk of heart attack decreases. Read: 0
