Sustainable Weight Loss in Obesity Treatment: “Bariatric Surgery”
The surgical procedures, which are performed to patients who are unable to lose weight regardless of the treatments administered and of diets and who have a Body Mass Index (BMI) over 40 or over 35 and suffering from chronic diseases, and therefore, to patients who have serious medical problems, are known as “Bariatric Surgery” or “Obesity Surgery”. With obesity surgery, not only patients may get back to their normal weight, but also the prevalence of diseases related to obesity are reduced; that’s why bariatric surgery plays a crucial role for treatment of obesity. Laparoscopic surgery for obesity shortens the recovery period. The researches on bariatric surgery patients show that patients who have undergone bariatric surgery are less likely to develop the types of cancer linked to obesity when compared to patients who did not undergo bariatric surgery. The reason for this is that while weight loss with dieting and exercise result in 7-10% of weight loss, bariatric surgery ensures 80% of weight loss, if supported by necessary life style changes.
Who is a candidate for bariatric surgery?
In the pre-operative period, eating and drinking habits of patient, diabetes and life style and the status of other health disorders are taken into consideration. Especially, patients between 18 and 60 years of age may undergo this operation. There are several conditions for patients to undergo operation.
Having body mass index over 40 or having body mass index between 35 and 40 and suffering from diseases linked to obesity.
Suffering from an incurable obesity for at least 5 years.
No change in the course of the disease as a result of drug treatment and dieting.
Not suffering from endocrine diseases.
Not suffering from alcohol or drug addiction.
Complete perception and adaptability and being coordinative with obesity team in the post-operative period.
Not having a condition that prevents the surgical operation.
Which surgery procedures are used for surgical treatment of obesity?
Restrictive and malabsorptive surgeries
Certain restrictive surgeries, such as gastric banding, have lost their efficiency. Although the efficiency of malabsorptive surgeries are high; they have quite many adverse effects. Nowadays, the most efficient bariatric surgery is the laparoscopic sleeve gastrectomy (gastric sleeve surgery). The most important point for these operations is that patients should know that a new life is awaiting for them in the postoperative period. Adopting a low carbohydrate-high protein diet by guidance of a nutritionist; eating little and often; properly chewing food; getting multivitamin, calcium and vitamin D supports and adding physical exercises are very important.
Gastric Sleeve Surgery
Gastric sleeve surgery is a bariatric operation, during which approximately 80% of stomach is removed. The weight loss is achieved with more than one mechanisms. First of all, the significantly reduced stomach volume leads to less food intake, and therefore, less calories. However, the main effect is not restricting the food intake, but the change it creates on hormones regulating the hunger, fullness and blood glucose.
Looking at short-term results, we may say that gastric sleeve surgery, like the older method gastric bypass, is an important surgical operation both for weight loss and for complete treatment of or recovery from the metabolic disorders, such as diabetes. Moreover, likewise in gastric bypass, the metabolic effect of gastric sleeve surgery is independent from weight loss. Short after surgical operation, high blood glucose level is reduced to normal and diabetic drugs or insulin are totally or partially discontinued, even before the weight loss starts. Furthermore, gastric sleeve surgery has less complication, when comparison to gastric bypass surgery. The gastric sleeve surgery is favoured as it is a restrictive surgery, it ensures the loss 50-60% of body weight easily soon after surgical operation, it does not require change in food passage route in gastrointestinal system, it shortens the hospitalisation period, and it has a positive effect on hormones regulating hunger, fullness and blood glucose.
Gastric Bypass Surgery
Gastric bypass surgery is an older operation method in comparison to other bariatric surgery methods. Therefore, it may be deemed as the most used bariatric surgery among others. In the first step of gastric bypass surgery, the stomach is reduced to 30 millilitres. The gastric tissue close to oesophagus and stomach junction is used. The stomach is connected to small intestine. There are two types of gastric bypass surgery. In the first type, the small intestine is formed in a thin circle and is connected to stomach. This is called as “Mini-gastric bypass”. In the second type of gastric bypass surgery, the small intestine is bypassed and one end is connected to stomach, while the other end is connected to small intestine. This method is known as “Roux en Y gastric bypass”. Except of small technical differences, the two methods have similar surgical results. The mechanism in gastric bypass surgery is restrictive as in gastric sleeve surgery, i.e. patient may intake limited amount of food and bile salts and pancreas enzymes found in duodenum meet the nutrients in a distal part of small intestine. Therefore, the breakdown and absorption of nutrients are rendered difficult and the absorption mechanism is changed. In other words, patient eats less and gets less benefits from nutrients. The change in gastrointestinal hormones is more significant than in gastric sleeve surgery. Patient feels less hungry, even though eating less and blood glucose is regulated. Losing 60-80% of body weight is one of its advantages. The gastric bypass surgery is a food intake restrictive method and it has a more significant effect on gastrointestinal hormones. Also it is a reversible procedure in comparison with gastric sleeve surgery.
Other operations –duodenal switch- are very specific surgical operations, when we look at the group who underwent operation or at the rarity of surgical operations; and therefore, patients should be evaluated by the centres.
The most important point for these operations is that patients should know that a new life is awaiting for them in the postoperative period. Adopting a low carbohydrate-high protein diet by guidance of a nutritionist; eating little and often; properly chewing food; getting multivitamin, calcium and vitamin D supports and adding physical exercises are very important. Since patients may feel full with less food, they have no problem to adopt a new life style in the post-operative period.