Obesity Surgery

In the laparoscopic procedure, surgeons make small incisions (5 mm - 10 mm) to reach the abdominal cavity via trocar (small surgical instruments like tubing). The laparoscope, which is connected to a small video camera, is inserted into a small trocar. The resulting image is projected onto a TV screen, giving the surgeon an enlarged view of the stomach and other internal organs. 5 to 6 small incisions are made and trocars are placed to use special surgical instruments to perform the surgery. All surgery is performed in the abdomen after the intra-abdominal cavity is inflated with carbon dioxide gas. When the operation is over, the gas is taken out.

It is aimed to reduce the stomach volume (about 60-100cc) and thus make the patient feel satiety with very little food. For this purpose, a certain portion of the stomach is surgically removed and a tubular (about the size of a banana) stomach is left behind. In addition, the appetite-controlling ghrelin hormone is under-produced and therefore the patient's appetite for food is reduced. However, sleeve gastrectomy surgery does not affect the digestion of calories and nutrients in the intestines.

It is performed by laparoscopic method like other obesity surgeries. Surgery is performed by entering small incisions in the abdomen. The stomach is reduced and anastomosed to the small intestine. Thus, the stomach is reduced, as well as the absorption of nutrients is reduced.

Like the sleeve gasrectomy, this process starts with removing most of the stomach. The surgeon then closes the middle part of the intestine and connects the last part to the duodenum. This is called the duodenum switch.

The success rate in weight loss is reported to be slightly higher in gastric bypass surgery than tube gastric administration; however, all techniques have shown good or excellent results. Many reports report a 40-50% weight loss for sleeve gastrectomy and 65-70% weight loss for gastric bypass after 1 year.

Obesity surgery is recommended for patients with a body mass index of 40 or more and who cannot be undermined by methods such as medical nutrition, exercise and medical treatment under expert supervision.

In the reported case series, the sudden death rate after laparoscopic obesity procedures is very low (below 1%). On the other hand, complications such as wound infections, wound opening, abscesses, stapler opening and leakage, intestinal rupture, intestinal obstruction, large ulcers, pulmonary problems and formation of blood clots in the legs (5-10%) are also less common in tube gastric surgery.

Other problems that may require additional surgical procedures may occur in the postoperative period. These problems include enlargement of the sac, persistent vomiting, stomach pain or inability to lose weight.

After gastric bypass, deficiencies of nutrients such as vitamin B12-folate and iron may be seen. Taking the necessary vitamins and nutritional supplements often prevents them.

Another potential consequence of gastric bypass is dumping syndrome. Dumping syndrome; It is characterized by abdominal pain, cramping, sweating and diarrhea after consumption of foods with high sugar content.

Avoiding foods with a high sugar content prevents these symptoms. After malabsorption surgery, nutrient deficiencies and protein deficiency are observed similar to those seen after gastric bypass. Diarrhea or loose “feces sık are frequently observed after malabsorption surgery, depending on the amount of fat intake.