Obesity is a chronic disease characterized by increased fat stores in the body. Body fat mass is calculated in clinical practice by a formula called body mass index. BMI is calculated by dividing body weight (kg) by the square of height in meters (BMI = kg/m²).
Intra-abdominal fat accumulation significantly increases the risk of metabolic and cardiovascular diseases. The amount of intra-abdominal fat is evaluated by measuring the Belly Circumference (UM). The measurement of the belly circumference is found by measuring the middle of the distance between the end of the last rib and the front protrusion of the pelvis. According to the current definition of the International Diabetes Federation, central obesity is defined as IO ≥ 94 cm in men and IO ≥ 80 cm in women.
WHO IS OBESITY SURGERY SUITABLE FOR?
BMI between 18 and 60 years of age is 40 and Overweight patients benefit greatly from surgery. Surgery is recommended for obesity patients with a BMI between 35 and 40 and if they have accompanying diseases. For example, those who have conditions such as diabetes, cardiovascular diseases, respiratory system diseases, metabolic disorders, serious joint disorders, and physiological and psychological problems related to obesity will experience serious improvements in these diseases by losing weight. It has been proven that obesity surgery in type 2 diabetic patients makes significant improvements in the functions of Beta cells that regulate blood sugar in the pancreas. In diabetic patients who undergo bariatric surgery, the need for insulin decreases by 25% from the first day, and the need to use diabetes medications is halved. These medications can be discontinued as weight loss continues and normal weight is achieved. Obesity surgery can be applied to Type 2 Diabetic patients with a BMI between 30 and 35 to improve their diabetes.
PRE-SURGERY EVALUATION
When patients decide on surgery, they undergo a detailed physical examination and laboratory tests. . First, a detailed medical history and anamnesis are taken from the patient.
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Eating Habits
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Family history
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Frequency of physical activity
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Presence of an eating disorder (habit of eating sugar, eating at night, etc.)
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Depression or other psychological disorders
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Patient's expectations and motivation from surgery
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Whether he/she has received obesity treatment before
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It is questioned whether he/she has been on a regular diet before.
Then, the physical examination part takes place.
Height and weight are measured. Umbilical circumference is measured, blood pressure is measured. The presence of obesity-related diseases is evaluated. Diabetes, hypertension, dyslipidemia, hyperlipidemia, cardiovascular and respiratory system problems, joint problems, fatty liver, and sleep disorders are evaluated.
Acanthosis Nigricans, a sign of insulin resistance, is examined.
In laboratory examinations
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Complete blood count
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Blood glucose tests
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Serum Lipid Profile
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Kidney Functions
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Liver Functions
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Thyroid functions
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Endocrine hormones
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Iron and other vitamin and mineral tests are performed.
Liver and gallbladder are evaluated by ultrasonography. Gastroscopy is performed to evaluate the esophagus and stomach.
All patients are evaluated before surgery by branches including Endocrinology, Cardiology, Chest Diseases, Psychiatry, Dietician and Anesthesiology.
OBESITY SURGERY
OBESITY SURGERY
p>The purpose of obesity surgery is to enable weight loss by reducing the total volume consumed by the patient and preventing the absorption of the food consumed. These types of surgery can be examined under two main headings.
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Surgeries in which only food intake is restricted: Sleeve Gastrectomy (Stomach Tube)
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Food intake is restricted. Surgeries in which absorption is prevented due to restriction: R&Y Gastric Bypass
SLEEVE GASTRECTOMY (TUBE STOMACH)
This type of surgery is performed completely by laparoscopic (closed) method. Approximately 75% of the stomach is removed and the stomach is turned into a tube. Since the valve (pylorus) at the stomach outlet is protected, the function of the stomach does not change and there is no problem in the absorption of vitamins and minerals such as iron. Obesity occurs in approximately 80% of patients Surgery is sufficient for treatment. The patient regains normal weight within an average of one year. It is the most commonly performed type of surgery in obesity surgery today. Patients stay in the hospital for an average of 4 days and start consuming liquid foods from the first day after the surgery. Patients continue to eat only liquid foods for the first week after surgery. Starting from the second week, the transition to puree-style foods is made.
ROUX & Y GASTRIC BYPASS
In this type of surgery, a combined surgery is performed. Both the volume of the stomach is reduced and the absorption of food is prevented. A stomach approximately the size of a matchbox is created, and approximately 150 cm of the small intestines are removed from use. A jejunal loop is connected to the stomach, which is shaped like a matchbox, and the passage of food is ensured. Since bile and pancreatic enzymes, which are necessary for the digestion of food, encounter food in the middle part of the small intestine and food cannot pass through the 150 cm small intestine, the absorption of nutrients is restricted. The remaining part of the stomach is left inside the abdomen, but there is no food passage from this area.
FOLLOW-UP AFTER OPERATION
Patients are given vitamin and mineral supplements to use in the post-operative period. It is aimed for patients to reach their normal weight within 2 years after surgery. Follow-up of the patients is done every 3 months in the first year, every 6 months in the second year and annually thereafter, with the first check-up being done in the first month after surgery. Patients' blood counts, laboratory tests, vitamin and mineral levels are evaluated at every check-up. In addition, patients are regularly taken under the control of a dietician for nutritional follow-up.
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