Obesity is the accumulation of fat in the body which prevents them from being healthy and affects quality of life. Surgical applications are most effective in obesity, which is accompanied by fatal diseases. Surgery gives positive results when applied to the right patient with the right method and the steps are clearly explained to the patient. Importance of the body mass index in the diagnosis of obesity
The Body Mass Index (BMI) provides information on the rate of obesity. Nutrition and diet experts point out that BMI is not always enough, one in two people of the same height and weight may have high abdominal fat and the other may have high muscle mass.
Experts point out that another important factor in the emergence of obesity is insulin resistance. Insulin secreted by the pancreas inserts blood glucose into the cell. To do this, it unlocks the cell. When insulin resistance occurs, the key-to-key relationship between the cell and insulin is broken off and insulin begins to build up in the blood. This insulin, which builds up in the blood, causes high blood pressure, damages the internal veins of the vein, and lubricates the liver.
How is body mass index (body mass index) measured?
Benefits of obesity surgery
In obese patients with hypertension problems, postoperative blood pressure measurements are seriously improved. 60 to 70% of patients stop taking hypertension medication.
Severe improvements in blood sugar occur in 80% of patients with type 2 diabetes. Some patients may discontinue the diabetes medication they are using, or their doses of medication may decrease.
A significant decrease in the risk of heart disease is observed after the operation.
Sleep apnea problems that develop due to excess weight are resolved.
Problems with the respiratory system decrease.
The quality of life of patients is increasing.
After surgery, special attention is paid to the diet and if daily walking for one hour or sports are practiced, excess weight is lost on average 8 months. The ideal healthy weight is reached in 1 year. People who do not pay attention to their diet lose more than their ideal weight if they do not eat regular and healthy food. Gaining and losing weight after this operation depends on people's lifestyle.
Who can undergo obesity surgery?
Those aged 18 to 65
Body mass index greater than 40
The body mass index is between 35 and 40 and other weight-related diseases (hypertension, diabetes, sleep apnea, heart failure, etc.) Those who try and fail other treatment methods to lose weight. Those who can handle surgery and anesthesia Who cannot operate?
Those with psychiatric problems who are not being treated seriously
Addicts or alcoholics
Patients who will not be able to make the necessary lifestyle changes in the post-operative diet
People with an illness who prevent receiving anesthesia
The stomach balloon is not actually a surgical method. The stomach balloon is a logic-based method of placing a balloon placed endoscopically in the stomach with a liquid or air inflator. With this method, a feeling of satiety in the stomach is created and aims to reduce the amount of food. The stomach balloon is a short-term application that does not require hospitalization and can be applied without the need for general anesthesia. Application 15-30 min. This happens there and the patient can go home after several hours of monitoring. In some cases it may be necessary to stay in the hospital for a day or more. At first, there may be complaints such as nausea, vomiting, nausea or abdominal cramps. Most of them are temporary disorders that can be resolved with medication. Depending on the type, the balloon should be removed from the stomach after an average of 6 months. The balloon, which is placed endoscopically in the stomach, is removed by endoscopy. After exiting the stomach balloon, the individual can resume his normal life. It is ideal for patients who are not considering surgical treatment, but it is a temporary method. In addition, the success of this method depends on patient compliance. It is possible to lose 10 to 30% of excess body weight in patients with a stomach balloon. However, the real problem begins after the ball is released. If no further action is taken after removing the balloon, be aware that the lost weight will come back. It is also used to help overweight patients sufficient to interfere with surgical procedures to reduce the weight required for the operation. There are no known major side effects. In addition to intolerance to the balloon (source of nausea and vomiting) occurring during the first days, perforation of the balloon and even intestinal obstruction due to gastric perforation and extinction of the balloon are among the reported side effects. Long-term success is weak.
If, after 6 months, a new gastric balloon can be placed in the patients. This process can be applied in the same session as well as later. Stomach by tube method it is the process of cutting the left outer part of the stomach with staple type surgical devices called a "stapler". With this method, a stomach volume of 150-200 ml is created and the entry of food into the stomach is reduced. Stomach surgery is laparoscopic surgery. In gastric tube operations, the main objective is to make the patient lose weight by decreasing the level of "ghrelin" secreted by the upper left part of the stomach and by decreasing the level of substance "ghrelin", which is released by the reduction of the stomach.
After the operation, patients are discharged after being kept under surveillance for approximately 2 to 5 days. This period varies from patient to patient. Patients receive liquid food after the operation. This feeding process, which lasts about 1 month, is followed by dieticians. Then gradually switch to mashed and solid foods. After choosing solid foods, patients can now continue to eat normally. But now they have to be fed less and less due to the decrease in the volume of the stomach. Although early weight control rates after tube stomach surgery account for approximately 50-60% of excess body weight, it has been shown that the volume of the stomach can increase in subsequent years. Success rates are less than 50% after the fifth year.
The operation of the gastric tube is an irreversible method. It is a very reliable operation as long as it is performed by experienced surgeons. The side effects that can be seen immediately after the operation are pain, bleeding, leaking and infections. The probability of these effects is extremely low in an operation performed by an experienced team. Side effects that may be seen later are side effects such as difficulty eating (rare), nausea and vomiting (especially early in the period), temporary weakening or loss of hair, feeling of laziness or fatigue.
Since these surgeries require acid secreted by the parietal cells of the stomach, vitamin supplements will be needed externally, especially at the start.
Ileal interposition (transposition)
There are two different versions of ileal interposition surgery or ileal transposition surgery (IT). In both cases, the stomach tube procedure is performed as standard. In the version which forms the basis of Metabolic Surgery (Divertee Ileal Divertee) applications, the connection between the stomach and the 12-finger intestine is closed and the last part of the small intestine is positioned between the stomach and the head of the small intestine.
In this way, food that comes out of the stomach first enters the last part of the small intestine and then the head of the small intestine. In this way, the "good hormones" of the last part of the small intestine are activated. In the other version, which is mainly used in obese patients, the connection between the stomach and the 12 bowels of the fingers is not closed and the last part of the small intestine is placed in the initial part of the small intestine. Although this surgery provides very effective weight control, especially in diabetic patients without severe weight problems, sugar control has not achieved the desired levels.
It is disconnected. The third is to prepare a 170 cm segment from the last part of the small intestine and place it between the stomach and the initial part of the small intestine. In this surgery, the upper left part of the stomach is removed. This means that about 1/3 of the volume is withdrawn, although it varies depending on the weight of the patient.
As to the reasons for this request;
To decrease the cell mass in which the appetizing substance called Ghrelin is secreted,
Provide for a volume restriction,
If only ileal interposition is performed and no operation is performed on the stomach, the passage becomes very slow due to hormones from the small intestine. To avoid gastric dilation (gastric dilation) progressing in this case with persistent nausea and vomiting,
In order to make the connections healthy in the lower abdomen, the stomach must pass from the middle part of the large intestine to the lower abdomen. Provide the stomach to pass under the large intestine more comfortably and without tension. For these four reasons, the reduction of the stomach is systematically carried out in ileal transposition surgery.
Transit Bipartition is a technique brought to the medical literature by the Brazilian surgeon Sergio Santoro. The bipartition technique in transit is similar to other techniques, in addition to a stomach tube procedure, unlike other procedures, the ten parts of the small intestine are provided by providing a second outlet to the lower part of the 'stomach. In this way, the food consumed passes into all segments of the small intestine.
In Transit Biparition, first of all, the point where the small intestine meets the large intestine is counted as 100 cm and this part is marked. Counting another 150 cm, the small intestine is cut 250 cm from the junction of the small intestine with the large intestine. The lower end of the cut is connected to the stomach. The upper end is connected to the previously marked 100th cm. In this way, a direct entry of food is provided to the last 250 cm of the small intestine. The only important point is that about 1/3 of the food goes through the duodenum, which is a natural route, and 2/3 through the last part of the small intestine, thanks to the new connection. The biggest advantage of this surgery is that less than 5% of patients only need iron in the long term. Over 95% of patients can continue their lives without the need for supplements. Steps after a surgical decision in the treatment of obesity
After the first examination of the person who asked the doctor because of his excess weight, blood tests are carried out, the causes and the diseases that accompany it are examined. Endocrinological and psychological assessments of the patient are performed. Help is obtained from the nutrition and food specialist to establish a diet. The patient's risk factors are assessed. In this multidisciplinary study, the patient also has a lot of work. When the surgical decision is made, the patient should know that the surgery does not touch a magic wand and that no surgery is easier than feeding.