Obesity Surgery

Obesity Surgery

Obesity is a disease which should be definitely treated, and it arises from accumulation of excess fat in the body. Obesity takes place in the case where the amount of energy taken in with food exceeds the amount of energy consumed by metabolism and physical activity.

Obesity is a condition which affects systems including cardiovascular system, respiratory system, endocrine system, digestive system, etc. and sets the scene for several major illnesses. Heart diseases , high blood pressure, diabetes , high cholesterol , respiratory disorders , joint disorders , menstrual irregularities, infertility, impotence , gallbladder diseases , calculus formation, certain types of cancer are several  disorders directly related to obesity. 

How is obesity measured?

The most widely used measurement for obesity is a measurement of waist circumference , by Body Mass Index ( Body Mass Index).

  • BMI is calculated by dividing body weight ( kg) by height squared ( m² ). This value is independent of age and gender , but it doesn’t give correct results in children , pregnant women and very muscular people.

BMI values are classified as normal weight, overweight, and obese.

  • Measurement of waist circumference and what it means

Although the total amount of fat in the body is important, it is more important to know where it has accummulated.  Accumulation of fat around the abdomen causes more health risks that the accumulation of fat in buttocks and other parts of the body. A simple but accurate method for this risk is measurement of waist circumference.

How is Obesity Treated?

Nonsurgical Treatment

  • Diet Treatment

It is a program with calculated calories during which it is ensured that the patient eats small portions at frequent intervals without being hungry under supervision of a specialist.

  • Exercise

Even an activity that lasts 45 minutes, minimum 3 days a week is extremely effective for the patient to lose weight. In the case of obese people, a simple and sustained exercise program should be implemented so as not to strain the joints and the body.

  • Drug Therapy

If the patient has any condition or metabolic problem which causes putting on weight, use of drugs for this problem should definitely be planned.

  • Treatment by Surgical Methods

There are underlying principles of bariatric surgery.  The first one is to reduce the size of the stomach and the second one is to prevent absorption of food.

Bariatric surgery is applied to patients whose body mass index is 35 and above and who failed to lose weight by methods including diet, exercise and medical treatment , and to patients whose body mass index is above 30 and who have conditions affecting the patient’s quality and length of life, including hypertension, diabetes, heart disease, etc. 

Surgical Methods in Use

Gastric Balloon

The most important advantage of this method is that it can be performed endoscopically without general anesthesia.

Inner volume of gastric balloon is resistant to being filled with liquid or air of 400 to 700 cc. This volume allows restriction of the stomach volume and thus the volume of the stomach is reduced and excess food intake is prevented.

Gastric Balloon procedure is a non-surgical treatment.  It is an appropriate alternative for patients who don’t consider surgical treatment but cannot lose weight by dieting and exercise. However, this procedure is limited in time; the balloon can be left in the stomach for a maximum of 6 months. After this period, the balloon must be removed. Removal procedure is also performed endoscopically and the patient can go back to normal life after 2 hrs.

Lap Band (Gastric Band)

The procedure is based on placing a silicone device around the top portion of the stomach which is immediately below the esophagus so that it creates a volume of around 15-20 cc. 

This surgery aims at reducing the volume of the stomach. The basics of weight loss are based on the principle of preventing excess food intake by reducing the volume of the stomach. 

The most important feature of the band is that it can be inflated by giving fluid into the reservoir in it. Thus, the width which provides a connection between the small upper stomach and lower stomach can be adjusted easily.  The advantage of this procedure is that the amount of food intake can be reduced if the person eats too much, thus an increase in the ratio of weight loss can be achieved.

This adjustment is made by a reservoir on the tip of the connection tube on the band. This reservoir is placed over the muscle layer beneath the skin.  Thus, after the surgery, a solution is introduced into the band using an injector so as to increase inner volume of the band, narrowing the passage from upper stomach to lower stomach.

The most important advantage of this operation is that it is performed laparoscopically and results in a shorter hospital stay. However, after the surgery, the patient needs a certain amount of time to start eating solid foods. It is no longer possible to continue an eating habit like the one in the past. 

Sleeve gastrectomy

During this operation, greater curvature of the stomach is removed to leave the stomach shaped like a tube with a volume of 100-150 ml. Weight loss is achieved through 2 mechanisms in this procedure.

  • Restrictive effect: Weight loss associated with a mechanical limitation and reduction of gastric motility as a result of gastric volume reduction 
  • Endocrine Effect: Sense of satiety is achieved by ensuring reduction of levels of ghrelin hormone, defined as hunger hormone, produced by the portion of the stomach removed. Ghrelin is a peptide protein secreted by the cells in upper portion of the stomach called fundus. It strongly stimulates the region in the brain that increases appetite. During sleeve gastrectomy operation, fundus region which produces ghrelin of the stomach is removed so appetite is reduced, contributing to weight loss.

Gastric Bypass 

This procedure is the most widely applied surgical method for the treatment of obesity worldwide. First, the stomach is reduced in volume , thus decreasing the amount of food the patient can take. Second, the absorption of nutrients is reduced because the length of the path in small intestine has been shortened.

This operation should be especially preferred in patients who have the habit of consuming high calorie foods because this group of patients consume foods small in amount but high in calories. In the case of surgical interventions aimed to limit food intake only, reaching adequate rate of weight loss can be a problem. Gastric Bypass surgery reduces stomach volume as well as affects absorption of foods ingested, ensuring that they are excreted from the body without having any benefits to the body.

After this surgery, the patients lose 70-80% of their excess weight in about 1 to 2 year(s). This result is close to perfection. On the other hand, the patient undergoes an easier period of adaptation to a new eating habit after the surgery.

The most important problem of this surgery is that vitamin deficiency can take place in the following days because of malabsorption of foods ingested.  However, this situation is overcome by vitamin supplements. Surgeons experienced on this matter inform their patients on this matter and take necessary actions.

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