Obesity Surgery

What is obesity?

According to the World Health Organization, Obesity; It is a chronic disease which is defined as “excessive fat accumulation in the body to harm health”. Although it is more common among women all over the world, it is increasing as an “epidemic” disease.


Causes of Obesity

Normally, body weight is maintained by the balance between daily energy intake and consumption. However, in this balance, if the calorie intake is more than the calories expended, obesity occurs over time.

Nowadays, because of the advancement of technology and the changing standards of living, people are living still more. The quality of the food taken decreases and high-calorie foods with high carbohydrate and lipid content become part of the diet. Therefore, the problem of obesity in the society is increasing day by day.

Unbalanced nutrition, insufficient physical activity, various endocrinological diseases (Diabetes, Hypothyroidism, Metabolic syndrome, Polycysticover syndrome, Cushing syndrome, Growth hormone insufficiency) and various genetic syndromes can cause obesity.


Problems and Diseases Caused by Obesity

In case obesity is not treated; The patient may develop insulin resistance, type 2 diabetes, hypertension, heart failure, peripheral vascular diseases, gastroesophageal dysfunction, gallstones, fatty liver and cirrhosis, various joint pathologies, various psychological problems, wounds that do not close after the operations and incisional hernia may develop. These risks increase for every year that obesity is not treated.


How to Calculate Obesity

In obesity measurements, length length and body weight measurement and BMI (Body Mass Index) calculation are used. The BMI is calculated by dividing body weight (kg) by the square (m2) of the height (kg / m2).

Classification of obesity according to BMI (kg / m2)


Obesity Treatment Options

In the treatment of obesity; diet, exercise and surgical treatment options are available. Apart from surgical methods, weight loss can be achieved. However, weight loss cannot be maintained for a long time and most patients gain weight again. Therefore, surgical methods are more prominent in the treatment of obesity.


Surgical Options in Obesity

Although there are a few obesity surgeries that can be selected according to the clinical features of the patient, the most frequently applied ones are;

-SleeveGastrectomy  (Tube Stomach Surgery)

-Roux-en-Y Gastric Bypass (LRYGB) or Mini Gastric Bypass

-Biliopancreatic Diversion and Duodenal Switch (BPD-DS) surgeries

SleeveGastrectomy (Tube Stomach Surgery) is one of the restrictive obesity surgeries. The other three surgeries are both restrictive and absorption-disruptive (malabsortive) obesity surgeries.


Weakening Mechanisms of Surgeries And Their Benefits


SleeveGastrectomy  (Tube Stomach Surgery): This method is based on the removal of approximately 80% of the stomach between the antrum of the stomach and the angle of feeling and creating a tubular stomach. The method provides both a restriction for food intake, a decrease in ghrelin hormone, which is the hormone that controls appetite and released from the stomach fundus, and a decrease in the release of PYY and GLP-1 hormones as a result of the food passing through the intestines faster.


Roux-en-Y Gastric Bypass (LRYGB) or Mini Gastric Bypass: In this method, a small stomach pouch with a volume of 20-50 ml is created proximal to the stomach. Bypassing the duodenum, anastomosis is made between the lower jejunum and this stomach pouch. Thus, due to a small stomach pouch, the amount of food taken is restricted and absorption is reduced as the foods switch from duodenum to jejunum.


Biliopancreatic Diversion and Duodenal Switch (BPD-DS) surgeries: In this method, the tube stomach is created, pylorus is preserved, duodeno-ileal anastomosis is proximal, ileo-ileal anastomosis is performed distally. Thus, both food intake is limited and absorption is reduced.


Risks of Surgery

When talking about the risks of obesity surgeries, if untreated, it is also necessary to take into account the risks that the patient will face throughout his life and the standard of living he will be exposed to. Other postoperative risks such as bleeding, hernia development, wound infection, clot development in the lower extremities, atelectasis, sepsis and death are present after obesity operations; There are also surgery-specific risks such as leakage in the anastomosis line, dumping syndrome, vitamin deficiencies and gallstones. However, the incidence of these risks is very low and it should be taken into consideration that if obesity is not treated, the patient is exposed to hypertension, diabetes, hyperlipidemia, metabolic syndrome, joint pathologies and socio-psychological risks.


Post-operative Period and Nutrition

In order to prevent clot development in the postoperative period, an appropriate dose of blood-thinning medication should be used during the first day and the following postoperative period. It is necessary to roughly divide the nutritional periods after obesity surgery to five. Nutrition programs should be prepared and followed together by the patient, dietician and surgeon.

  1. After the operation (first 4 days): During this period, the patient is in the hospital, fluid is given through the vein, and if there is no leakage, water intake is also initiated. A small amount of pain, nausea, gagging may be seen. Patients walk on the first day after surgery.
  2. Clear fluid period (4-30days): During this period, the patient is now at home. At least 1.5 liters of water and 1 - 1.5 liters of other fluids should be taken daily. Protein and vitamin support must be started.
  3. Puree period (1-2 months): During this period, well-blended protein-based foods are added with water and fluid intake. Patients return to their normal lives during this period. Walking bicycles, light-weight exercises and swimming can also be added for walking as exercise.
  4. The period of weakening (first 1.5 years): In this period, completely normal food is taken, laboratory values ​​of vitamins and protein are checked at 1,3,6 and 12 months and deficiencies are replaced. During this period, heavier exercises can be done.

        5.The period when weight loss is preserved (after 1.5 years): During this period, the patient's appetite will also return, so diet and exercise should be adjusted to                 maintain weight.

Frequently Asked Questions About Obesity Surgery

Is there an age and weight limit for obesity surgeries?

Obesity surgeries can be done safely in the 18-70 age group. However, since the postoperative period is better adapted to exercise and the organ effects due to obesity are less, the results obtained from the surgeries performed at a young age are better. In the diagnosis of patients, BMI calculation is used instead of weight calculation. Surgery is recommended for patients with BMI above 40. Surgery is also recommended in patients with BMI over 35 who have concomitant chronic diseases.


At what stage is it best to decide on obesity surgery?

It is necessary to decide on surgery as early as possible in patients who cannot get rid of their excess weight or regain their lost weight despite trying exercise, diet, and medical treatment. Because instead of continuing to life with other chronic diseases caused by obesity and obesity and increasing organ pathologies, it is necessary to prevent these diseases as early as possible and spend life healthier.


Is there any advantage of losing weight with surgical method compared to other methods of losing weight?

In other methods, the weight loss process is quite challenging and wearing. Moreover, even if weight loss is achieved with these methods, success in maintaining the weight lost for a long time is quite low. In obesity surgeries, as the fundus part of the stomach (where the ghrelin hormone that releases the appetite is released) is removed, patients do not feel hunger despite eating very little, which is a serious advantage that provides the patient with a more comfortable weight loss process in about 1-1.5 years.


Is the same surgery performed for every obesity patient?

There are different surgical methods used in the surgical treatment of obesity.


Is it enough to have obesity surgery to lose weight?

To lose weight, obesity surgeries alone are not enough and must be supported by diet, exercise and lifestyle change after surgery. However, it is the biggest step in providing weight loss both by restricting food intake and eliminating the feeling of hunger. It is easier for patients to follow the diet because the feeling of hunger is lost.


Is there a high risk of obesity surgeries?

Firstly, the risk of all other surgeries in obesity patients is higher than those of normal weight. Wound healing problems, the development of a hernia from the wound, the risk of clot removal after surgery are present in obesity patients.


Does sagging occur in the body after obesity surgery?

Depending on the patient's age, tissue characteristics, BMI, and exercise, skin sagging may develop in various areas such as the arm, breast, and abdominal wall. While the amount of this varies from patient to patient, some patients do not need intervention, while others may need to be corrected by plastic surgery. However, it is necessary to wait at least 1.5-2 years after surgery to decide on the surgical intervention.


Is it necessary to use vitamins for the lifetime after surgery?

Multivitamin supplements are needed initially as food intake is restricted after surgery. However, when the need disappears by looking at the laboratory values ​​after the 3-6 months period, vitamin support is stopped. The duration of vitamin supplements is generally longer in absorption-disrupting surgeries than in surgery restricting food intake.


Why shouldn't I use alcohol after obesity surgery?

After obesity surgeries, patients need to change their lifestyle in addition to other surgeries. In addition to exercise, diet types that are less than carbohydrates and fat and rich in protein should be preferred. Alcohol has no place in healthy nutrition with its harmful effects on the body. It can also cause weight gain due to the high calories it contains. Therefore, alcohol is not recommended after obesity surgeries.


Is it possible to return to old weight after surgery?

If sufficient weight loss has been achieved in the postoperative period, some of the patients may gain some weight. However, there is no weight gain in patients who continue to lose weight for about 1.5 - 2 years after surgery, who change their eating habits, and realize the healthy nutrition they have learned.


Is there a lot of pain after the surgery, do I encounter wound problems?

One of the most advantageous aspects of obesity surgeries for the patient is that they are generally performed laparoscopically. These surgeries are performed through a few 0.5 - 1.5 cm long incisions, so compared to open surgeries, pain is less, wound problems are less encountered in the postoperative period, and patients can be mobilized on the same day.


How are the processes of getting up, doing sports, driving, working after the surgery?

Patients can stand up on the same day after surgery. After a day, he can start drinking water, travel, and discharge on the 4th day if the complication does not develop. He can drive after a week or two, start working after three or four weeks, swim after 1 month and start sports after 2 months.


When can I get pregnant after surgery?

Since the weight loss continues, considering the health of the baby, it is not recommended to get pregnant for the first 1 - 1.5 years.


Will I still take the medications I used to use after the surgery?

After losing weight after obesity surgery, many patients either get rid of diseases such as hypertension, cholesterol level, type 2 diabetes, joint disorders, or the degree of these diseases decreases. Therefore, the amount of drugs used for these diseases either decreases or the patient can completely get rid of these drugs.


When are obesity surgery operations considered successful?

Since it is not healthy, it is not aimed to lose all of the excess weight after obesity surgeries. Success is mentioned when 50-80% of excess weight is lost and this condition is maintained.