Morbid Obesity is the abnormal fat accumulation in humans body. All of those over fat is stocked fat. When body mass index ( BMI ) is over 24 for woman and 25 for man, means that health treaten fat is being stocked in our body.
When BMI is over 30, it’s called as obesity and nfortunately, the probability of the people whose BMI’s are 30 and over is about only 2 % with diet and exercise which ar as known non operationalmethodes.
Although this research is foreign - based, we can say that these results are
similar for Bursa and Turkey. Besides that, obesity is not only simply over weight situation and Metabolic Diseases improve within years, causes a disease called as “ Metabolic Syndrome ( Obesity + Hypertension + Hyperlipidemia ) and the main treatmentfor t his disease is “ Metabolic Surgery ”
For the surgical treatment of “ Morbid Obesity ” weight loss can be achieved in
2 ways :
1 st Way : It aims to decrease the amount of food. The volume of stomach is being reduced in that kind of operations.
1 ) “ Sleeve Gastrectomy ” is the most effective and first choice of those methodes. Stomach volüme is decreased by taking out 80 % and over of the stomach .
2nd Way : It aims to decrease the absorbtion of intaken food. ( Aims to block the absorbtion of glucose, carbonhydrates and fatted food )
2 ) “ Gastric Bypass” operation is a procuder which blocks the absorbtion of food from intestines and the most successful and safe method which is being applied more than 25 years.The same standart surgical treatment is applied in all over the world, even in Turkey and Bursa.By this methode, different sizes of intestines is being closed to food passage and absorbtion.
Sleeve Gastrectomy
It’s an operation only applied for reducing the volume of the stomach.
In this operation is, stomach is being cutted longitudinally. Volume of the
stomach is reduced and seems like a slim tube or banana, that’s why It’s named
as “ Tube stomach ”.
stomach volume when stretched. Remaining part of stomach doesn’t
stretch, hence it blocks eating.
the stomach against food, doesn’t allows the food passage which have big volumes, and food bites have to be smaller.
quickly.
passage of the food into intestines speeds up and this fast passage and stimulates the movements of intestines.
For which Types of Patients can “ Sleeve Gastrectomy ( Tube Stomach ) can
be Applied?
Sleeve gastrectomy can be applied all obese patients who needs to be treated
because of obesity. It’s also the most applied obesity surgery methode in Bursa
and Turkey.
for only “ Over Weight Super Obese Patients ” , today can successfully
applied for the patients widely and successfully for the patients who
have much more less weights.
applied as “ First Step Treatment ” for the “ Super Obese ” patients,
whose BMI’s are > 50 kg / m2 .
bewares the possible long term problems of Gastric Bypass operation
gastrectomy ” can be applied alternatively.
problems with the band, it’s also possible to take off the band and apply “ Sleeve Gastrectomy ”
or who doesn’t want to come back to doctor for regular controls &
adjustments of the “ Gastric Band ”, “ Sleeve Gastrectomy ” should be
applied
operation. ( Revision )
How does “ Sleeve Gastrectomy ” ( Tube Stomach ) Effects ?
Volume of the stomach has been shrinked into a tube or banana shape by
“ Sleeve Gastrectomy ” and so it’s volume decreases significantly ( Your
portions of meals reduces about 70-80 % ).
As an example, being able to feel full of fillness by eating 5 – 6 meat balls, rice / Pasta and salad before the operation; by eating 4 spoons of soup and 1 meat ball you feel as full as a tick after the operation.
We observe the similar results after our operations in Bursa.
Because, “ Hormone of hunger ” released from the extracted part of the
stomach, reduces 70 – 80 % after the tube operation. The name is this
hormone is “ Ghrelin ”. Due to the reduction of Ghrelin, you feel less hunger
between meals and your feel of fullness lasts longer. Pressure of the Antrum increases after the operation. This increase also helps to reduce feeling of hunger.
After the Metabolic Surgery; Morbid Obese patients with accompanying
Metabolic Syndrome, can achieve a weight loss of 10 % at the first months.
Related to this loss, Rapid improvements can be observed in Blood Glucose,
Cholesterole, Triglyceride parameters and HbA1C levels which shows “ Blood
Glucose regulation ”
Most of the patients states that, they don’t have any wish or feel of necessity against the different kinds of food which they liked to eat very much before the operation. And also, they don’t want to eat some food which have a bad effect of taste.
Most of those foods are ; Coffee, Coke, some kinds of cakes and cookies.
What are the Advantages of Sleeve Gastrectomy ( Tube Stomach ):
are being discharged from the hospital in 3 days while the ones from the
other cities after 5 th day.
Gastrectomy ” and so that no problems can be seen related to this.
Because of all those kinds of advantages, it’s the most frequently recommended “ Morbid Obesity ” operation even in all over the World or Turkey.
What are the Risks of “ Sleeve Gastrectomy ” ( Tube Stomach Operation )
In “ Sleeve Gastrectomy ” operation, a part of the stomach ( 80-90 % ) is being extracted and remaining stomach part is being tried to standartized.
A little suture line ( Stapler Line ) has remained in the rest part of the stomach with lowered volume. In some cases, there might be a little amonut of leak from that suture line. The risk of those leak is less than 2 %.
( Jama has declared average leak rate 1,8 % in a meta analysis consisting of 160.000 operations, published in 2013 )
Most of the leaks from the suture line recovers by themselves without giving
any symptoms. In some cases, small abscesses may occure due to those leaks.
In that cases draining the abscess from outside and using an appropriate
antibiotics may easily solve the problem. Repeating the operation for treatment is very rare.
The reasons of those leaks sourcing from the stomach, might be related both
surgical technique and the patient.
Risk factors related to the patients mostly occurs due to the load caused by
“ Morbid Obesity ”.“ Morbid Obesity ” itself may weaken the immune system. And this may cause a delay for the recovery of surgical trauma later and harder.
Today, many different kinds of methodes have been improved and being
applied for the safety of suture line. Those methodes are being differently
implemented separately by different surgeons. Both pre and post op caring conditions are very important to overcome those kind of problems and carries the safety of the operation to the highest levels.
Death risk after Sleeve Gastrectomy is less than 1% for Morbid Obesity.
( In a paper published by Jama in 2013, death risk after obesity surgery is found between 0,3 % - 0,8 % )
What are the Disadvantages of “ Sleeve Gastrectomy ” ( Tube Stomach )
Obesity surgery operations may be turned into another operation ( Revision ) after 5-10 years because of gaining weight or some other reasons but “Sleeve Gastrectomy ” is irreversible.
choclate is being consumed, inadequate weight loss might be seen.
What are the Complications of “ Sleeve Gastrectomy ”
Rare Complications :
Ersun TOPAL, MD, Op.
General Surgery Specialist
Metabolic & Diabetes Surgery
www.ersuntopal.com
+90 545 6292948
Gastric Bypass
Gastric bypass is a surgical procedure, which is being used for the treatment of
Morbid Obesity for more than 20 years.
It’s especially applied to reduce the absorption of carbonhydrated and fatted food from intestines.
Operation methode, has been standardized in “ Obesity and Metabolic Surgery
Consensus Meeting ” in 2001.
What Kind of Operation is Being Implemented ?
With this operation, 90 % part of the stomach of Morbid Obese patient is being
deactivated. The rest of 10 % is about a size of cup and this is connected to 80 –
150 cm distal part of intestine. 60-80 % of glucose and fats are being absorbed from this part. ( Our intestine’s average length is about 600 cm ) As a result when the food intaken by the patient passes through this little portion of the stomach;
1 ) “ Early feeling of fullness ” occurs
2 ) When the food has been transferred to the mid part of intestine, especially
starches ( Carbonhydrate – Sugar ) and fats can be removed from the body
without absorbening from intestines and so not mixing with blood
How does it Effects ?
The first reaction of the body is; when Morbid obese patient gets the food even
in little amounts; due to the small volume of the stomach, its wall streches
easily and quickly and “ Signals of fullness ”is being transmitted into brain.
Thus, “ Less eating and less absorbtion results with weight loss in Morbid
Obese patient.
As an addition, the success of this operation is related to eating habits of the
patient such as “ eating only main meals ” and avoid from eating something
between meals.
What’s the Success Rate of the Operation in Morbid Obese Patients ?
All the operations applied for Morbid Obesity is named as “ Bariatric Surgery ”
Bariatric Surgery, is the most effective methode for the treatment of Morbid
Obesity. ( OBESITY and MATABOLIC SURGERY CONGRESS IFSO 2013 İstanbul
Turkey)
For the treatment of Morbid Obesity, there are 4 methodes of operations in
the World, which have been applied, proven their efficacy and accepted by
authorities. Gastric Bypass is one of those methodes.
Marmara Region including the cities Istanbul and Bursa, is the region in which
prevalance of Obesity is the Highest.
( Obesity Surgery, is the second mostly applied Obesity & Metabolic Surgery methode after Sleeve Gastrectomy in Istanbul and Bursa.
Gastric Bypass is the “ Golden Standart ” surgical treatment choice of Morbid
Obesity.
Success rate of Gastric Bypass operation for the treatment of Morbid Obesity is about 75 – 95 % according to the analyses of many publications. ( Obesity
Surgery IFSO 2013 Istanbul Turkey )
Patients who have been operated because of Morbid Obesity by Gastric Bypass methode, loose 85 % of their over weights at the end of first year and can reach their ideal weights at the end of 2 nd year.
It has to be underlined that; this operation is “ Irreversible ”. For that reasons,
it has to be recommended to the patients as a last methode.
What are the effects of the operation over accompanying diseases
( Metabolic Syndrome ) which occured depending to Morbid Obesity ?
Although Gastric Bypass is the most efficious methode for the Morbid Obesity
patients to reach their ideal weights; it has also have a dramatical effect on
accompanying diseases occured by depending Morbid Obesity.
recovers 85 %. Dependence on to Insulin or other medicines may be
recovered completely.
decrease on more than 70 % of the patients.
be recovered completely.
Morbid Obesity ) is one the diseases which is recovered earliest.
patients recovers completely
operation, all of those risks disappears.
men and women. Hormonal irregularities disapperars depending on
weight loss after the operation. If the women desire to have a child, they can become pregnant from the end of 2 nd year.
What are the Effects of Bariatric Surgery Operations Over Food ?
Following Gastric Bypass operations, patients “ Early feeling of fullness ” by
taking little amounts of food, That’s to say “ Loss of apetite ” which is an
expected result of the operation.
Due to the dramatically decrease of daily food problems below might be
seen:
A, D, E and K ) deficiencies
So that, close follow – up is crutial after the operation. The food, vitamin and minerals can be replaced by the help of supplemental therapies.
Proteins are important building blocks of human’s body. To avoid the deficiency of proteins is available by the help of some simple precautions
and also it’s possible by taking liquid & powder protein reinforcements.
Daily need of protein is about 60 – 100 gr. After the post op period,
patients can avoid protein deficiency by choosing their food from
proteins.
To remedy the deficiency of the vitamins melting in fat, forms of those
vitamins melting in water can be used. Likewise, the post op deficiency of
vitamin B 12, mouth – dissolvable or depot forms of injection can be
used.
What are the Risks of Gastric Bypass Operation ?
Bleeding:
Bleeding is the most frequent complication after all surgical operations, which
has been seen instantly and always. The reasons of this bleeding might be:
Blood transfusion and / or sometimes repeating the operation might be
necessary.
Infection :
Infection might be seen about 10 % after open abdomen surgeries, due to
many factors ( Age, duration of the operation, Obesity, Diabetes Mellitus,
opening of intestines, some medicines being used ). But when the operation isapplied by closed / laparoscopic methode, infection is seen because of the
same reasons much and much more lower rates. ( Lower than 5 % ) It might occur due to the leaks from stomach / intestine sutures.
Most of the infections can be treated by drainage and antibiotic therapy but if it occurs intra abdominally, surgical operation be needed. ( 1-5 % )
Intravenous Coagulation :
Prevalance of Bleeding & Coagulopathies is about 6-18 % in many publications.
Especially if the blood clot occurs at the veins of leg, it may cause emboly in
some organs such as lungs. Blood diluenting injections started before the
operation continued after the operation and emboly sucks worn in the Morning of the operation and early mobilisation of the patients after the operation can prevents from this complication.
Anastomosis Leakage:
It may occur because of the “ Intra abdominal Leakage of stomach or intestine content ” from:
This may be resulted with intra abdominal infection or abscess.
Prevalance of this complication is about 2 – 4 % and may increase due to
some risks and promoter situations. It might seen in patients of Diabetes
Mellitus patients, Super Obese patients ( BMI is over 50 ), elderly
patients and related to the duration of the operation the prevalance
might be higher. Leakage can be treated by drenage and antibiotics and very rarely needs an other operation to control the infection.
Suture - Staple Line Obstructions:
All the wounds occured in the body recovers by “ Tissue shrinkage and
tightening ” Wounds over the stomach and between stomach & intestine occured during the operation recovers by the same way. It’s a process in the nature of recovery.
Suture - Staple Line between stomach & intestine may result with an
obstruction which doesn’t allow the passage of foods. If something like this has been detected, it might required to enter from the opening of Suture – Staple Line endoscopically by baloons and widen that point.
This operation might required to be repeated a few times.
What is Dumping Syndrome ?
It’s the common name given to the symptoms of; Tummy ache, Cramps,
Nausea, Diarrhea, Sudden Rashes at face and neck, tachycardia and syncope .
Those symptoms might be seen about 70 – 75 % of the patients after Gastric
Bypass operation at the beginning period, after taking food which contains
intensive simple sugar – carbonhydrate.
It occurs in the first year after the operation more frequent. It has been
reported that, severity and frequency of the symptomes decreases.
Dumping Syndrome can be taken under control in nutritional habits and / or
medical treatment.
Intestine Obstruction ( 1-6 %)
What are the Changes Seen after Gastric bypass Operation ?
Even Gastric Bypass operation is the golden standart for the surgical treatment of Morbid Obesity, it brings together, mandatory changes into the life style of the patients:
It’s very important to underline that, all of these problems can be
balanced at the end of adaptation period by learning conscious food
consumption.
