What are the surgical methods in the treatment of obesity?
Gastric Reduction Surgery
Gastric reduction surgery is sleeve gastrectomy. Gastric reduction surgery briefly; the large curvature of the stomach (long and outward-facing part) of the so-called side of the stomach by removing the tube into a tube shape. Sleeve gastrectomy is one of the most commonly performed gastric reduction surgery in Turkey and in Europe. The main effect of the gastric reduction surgery, the secretion of the hormone secreted by the stomach fundus appetite hormone Ghrelin hormone with reduced appetite and reduced stomach volume with much less food intake is formed by the feeling of satiety.
Sleeve gastrectomy FAQ
Gastric Sleeve Surgery is a procedure in which approximately 80% of the stomach is removed. Also known as Sleeve Gastrectomy. It is referred to by this name because the outer part of the stomach is removed and the stomach is shaped like a tube.
Gastric Sleeve Surgery is performed laparoscopically, i.e. by closed method. For the procedure, the abdominal wall is not cut, the operation is done with special surgical instruments with a camera at the end of the small incisions opened. This accelerates the recovery process after surgery.
Methods such as diet, exercise, behavioral change and medical treatment which are the first 4 steps of obesity treatment should be tried before Gastric Sleeve Surgery. If they are not successful;
- Patients with body mass index above 40 kg / m2
- Body mass index is between 35-39. 9 kg / m2 and those with additional disease such as hypertension, diabetes, arthritis, sleep apnea syndrome
- The body mass index is between 30-34.9 kg/m2 and patients with uncontrolled diabetes.
With Sleeve Gastrectomy, the size of the stomach is considerably smaller and the smaller stomach means less food and less calorie intake. The part removed from the stomach by Gastric Sleeve Surgery also includes the fundus region that secretes the hormone Ghrelin, which gives the feeling of hunger. The feeling of hunger and the desire to eat decreases and it is easier for the patient to lose weight.
The main goal of obesity surgery is to bring you to your healthy weight and the targeted weight may vary from person to person. On average, you can lose 75% or more of your excess weight. Based on your Body Mass Index value, your target weight and your ideal weight will be determined with your doctor and dietitian and procedures will be started.
After surgery, patients are hospitalized for 48-72 hours. This period may vary depending on the patient’s preoperative weight and additional illnesses.
After the operation, patients can return to work on average within 7-10 days. This period may vary according to the process performed.
First 2 weeks after surgery liquid foods, between 2 to 4. weeks juicy-soft foods and after 5th week solid foods should be consumed. Patients should take at least daily 1.5-2lt fluids. In particular, it should be fed with healthy foods that are high in protein and low in calories.
The European Society for laparoscopic surgery’s control recommendation is as follows:
3 to 8 times in the first year of surgery, at 2. year 1 to 4 control is recommended.
We call pour patients in the months ahead 10 and 30 days after surgery. 3, 6. 9., and 12. Months for routine checkups.
Pregnancy is not recommended for the first 12 months after the surgery. It will be helpful to talk to your doctor before pregnancy.
In the first 24-48 hours after gastric reduction surgery, 1-2% leakage can be seen. Between 5.and 7. Days, leaks due to decreased tissue blood supply can be seen. 80% of the fugitives that occur develop within the first 7 days and 99% within the first 1 month. After the first 7 days, the risk of being seen as a fugitive is seriously reduced with the report of fugitives later in the literature.
The choice of gastric surgery varies according to the patient’s eating habits, body mass index and expectations of weight after surgery. This decision determines the nutritional habits of the patient, the doctor and the patient together and applies individually. Gastric Reduction Surgery will not be suitable for someone who consumes intense calorie-like foods like hot chocolate. Therefore, the decision of surgery must be made with the patient.
What Is Gastric Bypass?
It has been described as the main method of gastric reduction surgery. It is a type of surgery that reduces both size and prevents absorption. However, nowadays operations such as Sleeve gastrectomy, Gastric mini-Pass and Transit Bipartition are performed more frequently.
The most common type of gastric bypass surgery is gastric bypass surgery, which is performed for the first time, the longest duration of surgery, and the most research about it is structured. The return to work time after surgery is longer than other types of surgery.
There are many differences between gastric sleeve surgery and gastric mini-by-pass in comparative studies conducted with other gastric reduction surgeries. Until 2012, it was the most commonly performed gastric reduction surgery, but today it has been replaced by gastric sleeve surgery.
Since the intestine is the initial part of the small intestine after the gastric by-pass surgery and the small intestine of about 1 m is removed from the absorption part of the digestive system, it is necessary to obtain iron and vitamin supplements in the long term. This operation, which accounted for 63% of all obesity surgeries in 2003, declined to 46% in 2013 and to 25% in 2016. However, in the literature, Gastric Reduction remains the basic standard of surgery.
After obesity surgery, some patients may need revision surgery years later. Revision operations can be performed for 3 main reasons:
- Weight gain again.
- Technical and anatomical problems such as reflux, stenosis, torsion
- Incorrect techniques and deficiencies used in surgery
After gastric reduction surgery, an average of 10% of patients can regain weight. Surgery in non-professional clinics may increase this rate. Failure to follow up the patient postoperatively is one of the factors causing weight gain.
The types of revision surgery that can be performed after Gastric Reduction Surgery are as follows:
- Mini-gastric by pass
- Transit Bipartition
- Roux n-y gastric by pass
- Re-sleeve gastrectomy
Revision surgery is often performed in patients undergoing gastric band operation. In patients with gastric band, a surgical procedure called a sleeve gastrectomy or Roux N-y gastric by-pass is performed. The increase in the preference of obesity surgery increases the use of revision surgery. According to all surgical rules and techniques, 10% of patients who underwent surgery may undergo reoperation.
Causes of revision surgery;
* Application of the wrong surgery method
* Stomach growth
* Inadequate stomach reduction due to technical reasons or lack of surgical experience.
* Experiencing technical reasons or stomach torsion