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Obesity has been defined by the World Health Organization (WHO) as excessive accumulation of fat in the body to the extent that it affects health.
“Morbid obesity”, which means obesity at disease level, is a chronic disease with hereditary and environmental causes, causing physical, psychological and economic problems.
Major health problems caused by obesity include type II diabetes, hypertension, hyperlipidemia, cardiovascular disease, sleep apnea, neck, back, waist, and joint pain, gallstones, and cancers of organs such as the breast and colon.
Body mass index (BMI) is commonly used to determine obesity based on the World Health Organization’s obesity classification. BMI is a value obtained by dividing the person’s body weight (kg) by the square of his height (in m) (BMI = kg / m2).
Classification
BKI 20-25 normal
Obesity treatment
In the treatment of obesity, diet, exercise, and behavior modification are the main requirements. Surgical treatment options are available for patients who are unable to achieve results with these treatments.
Surgical treatment options
The goal of surgical treatment for obesity is to ensure that 80% or more of the patient’s excess weight is lost within a period of 1 to 1.5 years.
Before performing obesity surgery, the patient’s eating habits, psychological and hormonal status should be thoroughly evaluated.
In order to apply a surgical procedure to the patient;
the body mass index (BMI) must be over 40
Obesity-related disease in patients with BMI 35 and above.
When repeated diet, exercise and behavior modification treatments do not work
No alcohol or drug dependence
There should be no mental or physical illness that prevents the surgery.
1. tube stomach surgery (sleeve gastrectomy)
Tubular gastric surgery removes 75-80% of the stomach with an incision in the longitudinal axis of the stomach, which is one of the surgeries that limit stomach capacity. Although its main effect is to reduce the stomach volume, it increases its effect by removing the center where the hormone “ghrelin”, known as the appetite hormone in the stomach, is secreted.
The operation is performed under general anesthesia laparoscopically (closed) with the help of 4 or 5 holes. In the longitudinal axis of the stomach it is cut with the help of a cutting adhesive instrument called stapler and removed from the abdomen.
As with all obesity surgeries, the goal after the surgery is to lose 80% of the patient’s excess weight in a period of 9 to 12 months.
Because the method does not alter the digestive mechanism, the loss of vitamins and minerals after surgery is minimal and does not require long-term vitamin and mineral supplements.
Patients are discharged from the hospital on the 3rd or 4th day of surgery and can return to their daily routine after a rest period of 10-15 days.
2. gastric bypass surgery
Since it is an older technique compared to tube gastric surgery, it is a surgery that both restricts stomach volume and affects absorption and is more commonly used worldwide. In other words, the patient eats less and benefits less when they eat.
It is based on the principle of connecting the certain point of the small intestine with the prepared stomach by preparing a stomach of about 30-35 cc in the part of the stomach near the esophagus. It is called “mini gastric bypass” or “Roux En Y gastric bypass” depending on the prepared stomach and subsequent small intestine point. Both are performed under general anesthesia and laparoscopic method.
Although the hospital stay and recovery time after surgery are identical to those of gastric bypass surgery, patients must receive long-term vitamin and mineral support after gastric bypass surgery.
Follow-up
Surgical checkups of patients are performed at the 1st, 3rd, 6th and 12th month after surgery. During this process, patients are closely monitored by our hospital’s dietitians.
It should be remembered that these interventions provide our patients with a new body between 9 and 12 months. The protection and improvement of this body is in the hands of our patients with healthy diet and appropriate exercise programs.
Gastric balloon as a non-surgical alternative
Gastric balloon application, one of the methods of obesity treatment, is a method that facilitates the adaptation of patients to diet by reducing the volume of the stomach through a 600-700 cc balloon placed in the stomach. It draws attention to itself as a preferred method in the preparatory phase of surgery, especially in patients who do not want surgery, in patients whose body mass index is not suitable for surgery and who want to lose weight, or in patients with super-diseased obesity. Gastric balloon application is a totally non-surgical method, and the balloon is only inserted and removed endoscopically. The procedure is performed by creating a sleep state, which we call sedation, and patients do not feel anything during the procedure.
Due to the nature of the stomach, it either wants to transfer its contents to the small intestine or throw it out by vomiting. Therefore, some discomfort such as nausea, vomiting, and pain in the stomach area may occur during the first week (especially the first three days) after use. During this time, patients should be supported with both oral medications and intravenous serum therapy. After this stressful period, patients should continue the process with a nutritionist.
The balloon remains in the stomach for approximately 8 to 9 months and is removed endoscopically (without surgery) at the end of this period.
The use of gastric balloons is a method with higher failure rates compared to surgical methods. In particular, after the balloon is removed, there is a risk of regaining the lost weight. The reason for this may be that balloon application is a more patient-dependent method compared to surgical methods. The purpose of balloon application is to temporarily reduce stomach volume and ensure that patients develop a new eating habit. Failures occur in patients who do not gain this habit or who later return to their old eating habits.