Rivera et al. published a review summarizing 142 articles on this topic in the journal “Front Neuroscience”. Obesity in pregnancy and the metabolic syndrome it causes affect the postnatal behavior and psychological state of the baby. Epidemiological studies have shown that there is an increase in the frequency of attention disorder and hyperactivity syndrome, autism, anxiety, depression, schizophrenia, eating disorders (food rejection, anorexia, bulimia) in older ages in children of overweight mothers. High fatty acids, blood sugar, insulin, leptin and inflammatory factors in overweight mothers negatively affect the baby’s brain and neuro-endocrine development. The increase in obesity in the last 30 years and the increase in these diseases in parallel prove the accuracy of this connection.

Asthma is one of the most common chronic diseases worldwide. Asthma and obesity are epidemiologically interconnected diseases. This is also seen with asthma and other components of the metabolic syndrome, insulin resistance and hypertension. As shown in many studies, obesity plays a role in the etiology of asthma in children and adults. Asthma is very difficult to treat and control in obese patients. With weight loss, clinical status improves, lung capacity increases, and asthma is controlled. Obesity triggers asthma by white blood cells attacking the airway and causing resistance to steroids. In addition, some hormones secreted from adipose tissue increase the frequency of asthma attacks. In addition, in a study conducted in boys, it was shown that increased leptin level is directly related to asthma. Overweight individuals with asthma must reach their normal weight, otherwise it is obvious that their life expectancy will be shortened.

Based on the article titled “Biliopancreatic Diversion: The efficacy of Duodenal Switch and the limits of the operation” published by Anderson et al. in the journal “Gastroenterology Research and Practice” in 2013; When the by-pass types performed in super-morbid obese (BMI≥50) patients were compared in the summary of 48 studies including 1565 patients, “Biliopancreatic Diversion+Duodenal Switch” operation was found to be superior to other by-pass types. In 2010, 810 patients with a BMI of 40-50 underwent duodenal switch operation, and it was observed that 69% of the excess weight was lost in the 1st year, 73% in the 3rd year, and 66% in the 5th year. In other words, the patients gained weight in the 5th year. In the analysis of 85048 patients including various bariatric surgeries, the highest rate of early complications was seen in the “Biliopancreatic Diversion+Duodenal Switch” operation with a rate of 1.23%. Again in this review, 5% of 701 patients were reoperated for anastomotic leakage. In all patients; iron deficiency anemia, protein deficiency, low calcium, fat-soluble vitamin deficiency, vitamin B1 deficiency, vitamin B12 deficiency and folic acid deficiency are observed. As a result; It can be performed with acceptable complication rates in experienced centers in patients with BMI ≥50. In addition, “Biliopancreatic Diversion+Duodenal Switch” may be the second choice in selected patients who gain weight after Tube-Stomach surgery.

Medical evaluation begins by looking at whether the patient meets the criteria for bariatric surgery. The most common condition encountered in obesity patients is Type-2 Diabetes. “Metformin” is the first choice in the treatment of obese and overweight patients. Vitamin B12 deficiency may be seen in patients using metformin due to impaired absorption. Care should be taken as B12 deficiency will also be seen in the postoperative period. Gastric protective drugs reduce the absorption of vitamin B12 by reducing stomach acid. It has been observed that drugs to be used in psychiatric and neurological diseases cause weight gain in the long-term in patients who have undergone surgery. The drugs that are likely to be used after the surgery should be decided. Heavy painkillers and rheumatism drugs can cause ulcers in the intestinal and stomach incisions. The psychosocial status of the person should be evaluated in detail for possible complications and changes in eating habits after surgery. Although it is known that smoking delays the healing of surgical wounds, it has been shown that quitting smoking in the long term causes weight gain. It should not be forgotten that alcohol habits will cause vitamin deficiencies in the postoperative period.

Blood Pressure; Hypertension is not always associated with obesity and food intake. Obesity-related high blood pressure is controlled with weight loss, lifestyle changes, and a bariatric surgery. Patients should be monitored regularly in the first weeks and drug doses should be changed gradually.
Diabetes; Diabetic patients undergoing bariatric surgery should be followed closely in the early postoperative period and insulin should be administered according to the values. In most patients, insulin doses and the amount of diabetes pills are reduced. If the doses are not adjusted, “sugar drop attacks” are seen. “Metformin” is the safest drug in the postoperative period as it does not fluctuate in sugar levels. By-pass surgery results in a permanent improvement in type-2 diabetes in most, if not all, patients.
Reflux; While reflux disease is controlled in patients who underwent Roux-n-y bypass surgery, reflux can be seen more frequently in patients who underwent tube stomach surgery. In cases where reflux persists despite medical treatment, revision to a different surgical procedure may be considered.
Nausea-vomiting; Even if it is controlled with drugs after the operation, this situation may be persistent in some patients and these patients should be carefully evaluated in terms of psychosocial factors. In chronic cases, tomography and endoscopy should be performed, if there is no pathology, low-dose antidepressant drugs should be tried.
Marginal Ulcer; Most pain relievers increase the risk of ulcer formation and should therefore be discontinued after the operation. Paracetamol should be preferred as a pain reliever after surgery. Smoking, alcohol, fried foods, surgical connection-fistulas and Helicobacter plori infection are other risk factors for ulcer formation. It is usually controlled with medical treatment and does not cause surgical intervention.

(1) As the prevalence of obesity increases, obesity-related diseases will also increase. Weight loss, improvement in obesity-related diseases, prevents current and future obesity-related economic expenditures.
(2) Individuals with a body mass index of 25-30 are defined as “overweight”, over 30 “overweight (obese)”, over 35 “severely obese” and individuals with obesity-related complications are defined as “morbidly obese”. In addition, patients in the “severely obese” and “morbidly obese” groups who fail in medical treatment and diet are candidates for bariatric surgery.
(3) children’s body mass index is evaluated according to percentile curves calculated according to age and gender; “Obesity” above the 95th percentile is defined as overweight between 85 and 95.
(4) Patients who will undergo bariatric surgery should be evaluated for deficiencies of macro and micro nutrients, and this does not prevent operations.
(5) 80% of patients undergoing bariatric surgery are women and 40% of all patients are of reproductive age. Women of reproductive age who cannot have children are more likely to get pregnant after bariatric surgery. In addition, by-pass patients should be careful as the absorption of birth control drugs will decrease. In general, pregnancy should be delayed for 6-12 months. After bariatric surgery, the risk of gestational diabetes, pre-eclampsia (pregnancy blood pressure crisis), overweight birth is seriously reduced; The risk of growth and development retardation increases in the womb.
(6) All bariatric surgery procedures are uptake and/or absorption reduction procedures.
(7) The most frequently performed bariatric surgery operation in the world is “tube stomach” surgery. The stomach is cut in its vertical axis, tubed and intake is reduced. Roun-en-Y gastric bypass; By reducing the stomach volume, a small space is created and in addition, this place is connected to the end of the small intestine, reducing both intake and absorption. The stomach is formed into an hourglass shape with an adjustable gastric band (stomach clamp), and this less harmful technique provides a temporary weakening. By-pass and additional medical treatment is a more effective method for the treatment of type 2 diabetes.

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(8) Complications vary according to the surgical procedure. Gallstones, kidney stones and incisional hernia are late complications; bleeding, leakage, infection and pulmonary embolism (clot in the lung) are early complications. The overall complication rate is below 1% worldwide.

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