OBESITY SURGERY
(MORBID OBESITY SURGERY METHODS)
Gastric Band (clamp) to restrict food intake
In this surgery, the patient's food intake is restricted with a band placed at the entrance of the stomach. The band cannot be removed even if it reaches its ideal weight, except in special cases. The operation is performed under general anesthesia, and the patient can start eating liquid foods the next day.
Stomach-reducing surgeries and preventing food absorption
These surgeries are performed laparoscopically. No matter how much the patient eats, he loses weight because food absorption is impaired. Laparoscopic gastric bypass is the most commonly performed surgery.
- Gastric Balloon
A balloon is placed into the stomach endoscopically from the mouth and inflated. The aim is for the patient to lose weight by creating a feeling of fullness. The balloon must be removed after 6 months. It is a method that does not require general anesthesia. There is a high risk of the patient gaining weight after the balloon is removed.
- Adjustable Gastric Band
AGB is a 12mm wide elastic balloon that can be inflated by injection as needed. It is a soft silicone band that has the basic principle; It is the limitation of proximal stomach volume by restricting oral intake. Its advantage over VBG is that it is adjustable.
- Sleeve Gastrectomy
Sleeve gastrectomy (sleeve gastrectomy) surgery has begun to be performed at increasing rates in recent years. During sleeve gastrectomy surgery, a large part of the stomach is removed without reversal. The stomach tissue left behind is approximately 150-200 ml. Sleeve gastrectomy surgery has two types of effects on obesity:
1. Restrictive effect:Since the stomach volume is reduced, the stomach becomes full sooner.
2. Hormonal effect:Since most of the appetite hormones are produced in the stomach, there is a decrease in appetite and a decrease in the feeling of hunger between meals.
Advantages of gastric sleeve surgery
Gastric sleeve surgery is performed in a shorter time and reduces the risk of leakage as there is no passage between the stomach and intestines. It is an operation with lower weight loss.
Disadvantages of sleeve gastrectomy surgery
The 5-year results of such surgeries show that they provide weight loss similar to bypass surgery. However, there is no definitive information about patients' weight regain in the long term.
- What is Gastric Bypass
In obesity surgery“stomach bypass”, in addition to reducing the size of the stomach; It is the process of surgically bypassing and disabling the uppermost part of the small intestine (near the stomach), which is at least 1 meter long. In this way, in addition to the restrictive effect of stomach reductionon food intake, there is also a decrease in the absorption of the food taken, and this; It creates an even greater weight loss effect. Moreover; By creating some hormonal effects, the small intestine that is bypassed and deactivated can provide an additional and“plus” benefit to the treatment of type II diabetes.
- Gastric By-Pass Methods. What are they?
Below are the most commonly used By-Pass surgery methods today. These methods; They serve both malabsorption and restrictive functions:
- ROUX-EN-Y GASTRIC bypass basic principles
This is what is done in gastric bypass surgery: First of all, the stomach; It is separated from the uppermost part where it meets the swallowing tube by closing and cutting it, leaving a small stomach part on the side of the swallowing tube (5-10% of the entire stomach). In this surgery, no part of the stomach is removed and is left in place. The second stage is the bypass stage. In this stage, the small intestine is first cut transversely from a certain distance and separated by closing both ends. The lower one of these two ends is pulled up and the small piece of stomach remaining on the side of the swallowing tube is mouthed and combined with some special techniques. In the final stage, the upper end of the cut small intestine is reconnected to the small intestine at a certain distance and the integrity of the digestive system is restored in this way. is done. All these cutting, separating, joining and mouthing operations are carried out with special tools known as "staples", which are completely high-tech, disposable.
In this way, the stomach is almost 95% of it, the duodenum and the first 1 meter of the upper part of the small intestine, are disabled, that is, they are medically bypassed. When a person who has had this surgery eats, the food passes through the esophagus to the tiny part of the stomach, and a feeling of fullness occurs in a very short time, even immediately. Because the most important stimuli regarding the feeling of hunger and the desire to eat is that the stomach is empty and tension-free. When the small stomach suddenly fills with incoming food and there is an immediate increase in tension and pressure; With the influence of some hormones, a person's desire to eat is severely curbed after the first bite. The "restrictive" effect of gastric bypass surgery, that is, restricting food intake, is due to what we have explained.
Moreover, as the name suggests, gastric bypass surgery; It is also "malabsorptive" as it allows the ingested food to immediately pass to the lower parts of the digestive system without ever visiting the upper part of the digestive system (that is, by-passing this part) after reaching the tiny stomach. /strong>, that is, it is a method that reduces the absorption of food. This is a second and independent effect of gastric bypass for weight loss. This is the basic mechanism of all bypass surgeries.
- Biliopancreatic Diversion Bypass Procedure
This surgery is a longer and more complicated type of gastric bypass procedure. The bariatric surgeon removes almost 3/4 of the stomach to reduce food intake and stomach acid secretion. The part of the small intestine that is separated and joined to the stomach is called the "alimentary limb", that is, the food leg. Foods in the stomach go down this segment, which completely bypasses the duodenum and jejunum, that is, the first and second parts of the small intestine. Meanwhile, the duct called biliopancreatic leg, which carries the digestive fluids of the pancreas, merges with the food leg and forms a common r creates a channel. Absorption of some calories and nutrients occurs in this common channel. Bariatric surgeons can change the length of this common channel to adjust the degree of absorption of protein, fat and fat-soluble vitamins.
- Duodenal Switch
In DS, the common channel is 100cm and the entire digestive tract is 250cm long. The major differences between BPD and DS relate to gastrectomy and proximal anatomy. Sleeve gastrectomy is performed at the greater curvature of the stomach instead of distal hemigastrectomy.
Two-stage DS
Sleeve Gastrectomy alone is sufficient for patients with high operative risk and extremely high BMI. provides loss. This method has a low mortality rate even though the patient is operated on twice.
- Postoperative care and Follow-up
Surgery due to Morbid Obesity Patients should be observed in the first postoperative month. Subsequent visits are scheduled at monthly, bimonthly and increasingly less frequent periods. After RYGB, wound healing, transition from aqueous to solid food and all other parameters are checked in the 2nd-3rd postoperative week. Subsequent visits are scheduled annually after 6 weeks, 3 months, 6 months and 1 year.
On average, 100% of the excess weight is lost. At the end of 5-year follow-up, BMI increased from 42-46kg/m2 to 30-30kg on average. It was observed that it decreased to 36kg/m2.
2/3 of the cases with Type II DM improved.
It was determined that hypertension decreased by 50-70%.
It was observed that the triglyceride level decreased and the high-density lipoprotein (HDL) level increased in the patients.
Preoperative obstructive sleep apnea decreased postoperatively, asthma symptom score decreased in the first postoperative year, An improvement was found in all patients.
An important advantage in the laparoscopic method is that incisional hernia and wound site complications are minimal compared to open.
The patient who will undergo a malabsortive procedure such as BPD will lose more weight than other standard bariatric procedures. It should be emphasized that surgery is the only effective method rather than a last resort. The positive contribution of laparoscopic methods to patient outcomes positively affects patients' tendency towards these procedures.
- TRANSIT BIPARTATION
(METABOLIC SURGICAL METHOD)
Type 2 diabetes is a disease that occurs in middle and older ages, and 90% of it is caused by obesity. Metabolic syndrome; high blood pressure, diabetes, high cholesterol and an abdominal circumference of over 88 cm in women and over 102 cm in men. Having two or more of these in a person indicates the presence of metabolic syndrome in that person. Eating high-energy foods starting from childhood and inadequate physical activity lead to obesity. Especially fat around the abdominal area indicates fat around the internal organs, which is a sign of metabolic syndrome. Metabolic syndrome is a set of diseases that predispose to cardiovascular diseases. In order to urgently eliminate this situation, life and nutrition patterns must first be changed. Diet and exercise must be done. When it is not successful, which most of the time results in failure, there is a great benefit in performing obesity and metabolic surgery.
Metabolic surgery is a surgery that has become increasingly common lately and is performed by surgeons specialized in this field. In summary, it is based on the principle of removing a portion of the stomach and relocating the small intestines.
Transit Bipartition
Transit bipartition surgery is one of the metabolic surgery methods. Metabolic surgery is a surgical method performed on people with parameters such as type 2 diabetes, high cholesterol, high blood pressure and increased abdominal circumference.
Transit bipartition surgery is performed laparoscopically (closed surgery). The surgery is performed through five incisions, the smallest of which is 0.5 cm and the largest of which is 2 cm. Through these incisions, the abdominal cavity is entered with special tools. The abdominal cavity is inflated with carbon dioxide gas to allow surgery and create sufficient space. First of all, the omentum (intra-abdominal fat tissue) on the left side of the stomach is separated and released. Starting from a distance of 6 cm from the stomach exit section, the stomach is cut vertically and stitched with special materials used. Approximately 70% of the stomach
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