BARIATRIC SURGERY

There are different methods in bariatric surgery. Among the surgical methods, the most frequently performed method in the world is sleeve gastrectomy, that is, gastric reduction surgery. The fact that the operation is technically easier than the others has brought stomach reduction surgery to the fore in obesity surgery. The success of sleeve gastrectomy surgery is limited in individuals with uncontrolled diabetes and severe obesity. In this group of patients, bipartition surgery or bypass surgery should be preferred.

Weight loss methods are recommended for people whose weight is higher than normal sizes. Bariatric Surgery is one of them. In 2022, the American Society for Obesity and Metabolic Surgery clearly determined the selection of patients who are candidates for surgery. Body mass index is used for this distinction. It is based on the weight ratio of paint. For years, obesity surgery has been recommended for people with a BMI of 40 and above, without looking for an extra feature, and this rate has been updated to 35 and above in 2022. In individuals with a BMI between 30-35, permanent weight loss could not be achieved by non-surgical methods and bariatric surgery is recommended in the presence of diseases accompanying obesity. In the presence of diabetes in patients with a BMI of 30 and above, metabolic surgery is recommended.

The absolute upper limit for bariatric surgery is 72 years. Patients who are believed to be able to manage the metabolic state of the patient and the process after bariatric surgery can safely undergo the surgical process.

Choosing different methods in obesity surgery in accordance with the patient requires significant experience. In addition to absolute indications, there are situations that are open to interpretation and to be decided by experience. There are two important points of distinction. The first of these is the anatomical disorders in the stomach of the patient. If there is significant gastric hernia and associated esophageal damage in patients who are candidates for bariatric surgery, then classical type gastric bypass should definitely be chosen. If the main problem of the patient is not metabolic disorders but only weight problem, gastric reduction surgery or bypass (rny gastric bypass, minigastric bypass, sadi-s, duodenal switch, bipartition) may be preferred according to the ratio of the weight to be lost to the target weight. Metabolic surgery methods are preferred according to the status of metabolic diseases (diabetes, hypertension, high cholesterol and triglyceride) in obese individuals where the main problem is not weight. The idea that I only do sleeve gastrectomy surgery and not others is unacceptable and unrealistic, it is just an inadequacy.

One of the most common problems is weight gain after surgical methods. As long as patients and healthcare professionals look at these methods as providing permanent weight loss, the problem will not be solved. All bariatric surgery methods are used only for weight loss. Permanent weight loss cannot be achieved in any method. The main problems in not reaching the target weight after bariatric surgery may be the inability to determine the appropriate method for the person, the inability to lose sufficient weight due to the chosen method not being performed in accordance with the rules, and the patient’s failure to act in accordance with the nutrition program. In this case, it is necessary to get help from centers where all bariatric surgery methods are applied, experienced in revision preference and application, and where the patient is followed. Gastric sleeve surgery is not a revision method in obesity surgery revision.

Two parameters are important for us after bariatric surgery. The first of these is to reach the age-appropriate effective fat ratio by having a BMI below 25. Another important parameter is improvement in co-morbidities related to weight. It is not possible to talk about a constant weight gain.

Liquid diet is preferred for the first 2 weeks after bariatric surgery and protein needs are met with protein supplement milks. In the 3rd week, softer, well-cooked vegetable dishes are preferred. In the 4th week, full solid nutrition is started. It should not be forgotten that a strict diet program is not applied after bariatric surgery. With calorie counting and quantity control, diet change will lead to success. Patients should evaluate the weight loss process as a long-term marathon. In the early period of the surgery, it does not matter how much weight you lost in how many months.

The decision for obesity surgery in children varies according to the patient’s degree of obesity, hormonal disorders and age of perception. Gastric reduction surgery is the preferred method in obesity surgery in children. Impairment of absorption is undesirable. In the period when bone development is important, malabsorption may manifest itself with curved bones and growth and development retardation in the next two years. Obesity surgery is safely performed in eligible patients over the age of 14.

Obesity surgery can be performed safely in specialized centers. The surgery itself is a C-Group risk surgery, which is in the same risk group as gallbladder surgery. Surgeries such as Heart Surgery, Neurosurgery, Cancer surgery are risky surgeries. The risk factors in bariatric surgery are the patient’s co-morbidities and physical condition. You must act quickly to make a decision so that your health does not deteriorate further.

Obesity surgery is performed through closed incisions of 8 mm, defined as laparoscopic. In general, the condition that causes pain in patients during surgery is incisions in the skin, so operations performed with closed methods are quite painless. Carbon dioxide gas used in closed methods may cause a feeling of pain for the first 3-4 hours of the operation, but this pain situation is controlled with different painkillers during this period when you are in the hospital. Patients usually do not use painkillers when they are discharged from the hospital.