It is a method that aims to treat a metabolic disease with surgery. It is especially important in the treatment of type diabetes. For many years, surgeries have been performed for obesity, and the number of surgeries has increased as patients' type 2 diabetes has improved.
Metabolic surgery can be a solution for metabolic problems such as diabetes, high cholesterol problems, high blood pressure, sleep apnea.
What is the difference between metabolic surgery and bariatric surgery?
Metabolic surgery is specifically aimed at solving diabetes; the person does not necessarily have to be overweight; Obesity surgery is more aimed at solving weight problems and accompanying / related diseases such as diabetes, high blood pressure, fatty liver, high cholesterol, sleep apnea.
As can be understood, obesity surgeries are also included in metabolic surgery.
What is Obesity Surgery?
These are surgical methods that help to solve the weight problem with surgeries. In recent years, it has been applied more frequently due to the increase in obesity problem.
In which cases is obesity surgery applied / what are the criteria?
In order for the surgery to be performed, the patient's health condition must be favorable and the risks must be acceptable. The following are the general criteria for surgery:
- Body mass index (BMI) above 40 or above 35 and obesity-related comorbidities such as diabetes, high blood pressure, fatty liver disease, sleep apnea...
- Being between 18 and 65 years old. However, if a younger or older patient is suitable for surgery after multiple evaluations, the procedure can be performed.
- No weight loss by diet and other methods for a long time, or if there is weight loss, it should be reversed.
- The surgery candidate should not have alcohol or substance addiction.
- She/he should not have cancer or pregnancy. If pregnancy is planned, it should be 18 months after the procedure.
- The candidate should have a full understanding and awareness of the surgery and its results.
Is there an age limit for bariatric surgery?
Between the ages of 18 and 65, surgery can be performed if it is suitable for health. However, if you have been obese for a very long time and weight loss methods are ineffective, surgery can be performed under the age of 18 after multidisciplinary evaluation. If over 65 years of age is suitable for surgery after health-related examinations are performed, surgery can be performed. We even have 72-73 year old patients in our surgeries
Which obesity surgery is performed most frequently?
Sleeve gastrectomy, i.e. sleeve gastrectomy, is performed most frequently; followed by gastric bypass. Other methods are much less common. In addition, the stomach clamp is almost no longer performed because it causes too many problems.
Why is sleeve gastrectomy performed more in recent years?
All obesity surgeries have started to be performed more and more because obesity is increasing day by day as a global health problem in the world and surgeries are more solvent.
In the past, sleeve gastrectomy surgery was the first stage of a 2-stage surgery, but certain groups were taken and research was done on how the result would be if the 2nd surgery was not performed, and since the results were close in the long term, Sleeve Gastrectomy / tube stomach / stomach reduction surgery became the primary surgery in the early 2000s. Of course, there are pros of sleeve gastrectomy:
- It involves less surgical risk and can be performed more easily,
- Shorter operation time.
- The normal food passageway is not altered. No passage between the intestine and stomach,
- Faster adaptation to life and mineral/vitamin deficiencies are less common.
- Less side effects of surgery compared to other methods (Dumping etc.)
- For these reasons, it started to be performed more frequently.
Are There Risks of Obesity Surgery?
As with any surgery, obesity surgery has certain risks; however, these risks are much less than the risks that may arise if obesity and accompanying diseases are not treated. While the risks in untreated obesity are 20%, the risk of surgery is around 0.1% -02%. In order to minimize the risks, the patient should be well analyzed and the method should be chosen correctly. Surgeries should be performed by a qualified team.
- There may be risks related to anesthesia.
- Risks related to surgery. Bleeding, inflammation, tissue injury, leakage, blood clot, respiratory system problems, pain. Life-threatening as it can happen in every surgery, even if it is minimal.
- Stomach strain and environmental risks.
- Medium / Long-term risks Sagging skin, hair loss, weight regain in 10-15% of patients due to the patient's failure to follow the diet and postoperative program and disruption of follow-up.
- The risks of obesity surgery are lower than many surgeries.
Are There Side Effects of Obesity Surgery?
There are certain side effects depending on the surgical method.
Side effects can be divided into positive and negative effects due to their effects on our lives.
Positive side effects
- Opening the doors of a new life and increasing self-confidence.
- Improved relations with the environment and psychological relief.
- A healthy and organized life.
- Reduction or resolution of obesity-related health problems in our lives.
- Joint problems, high blood pressure, diabetes, sleep apnea, fatty liver, infertility, polycystic ovary, reduction of certain cancer risks, asthma, etc.
Side effects that may be negative
- Diarrhea and indigestion
- In the following years, gallbladder and kidney stones may form.
- Ulcers may occur in the remaining stomach or on the gastrointestinal suture line.
- Incision site hernia, acid reflux may occur.
- Vitamin and mineral deficiencies, anemia may occur.
- Malnutrition / dumping syndrome and blood sugar fluctuations.
- Rarely life-threatening possibility.
- Aesthetic problems. Due to sagging skin.
*** Most of these negative effects are much more common in bypass surgery.
How is weight loss after obesity surgery?
On average, 75-80% of excess weight can be lost after surgery. Weight loss is faster in the first months.
- Approximately 40% of the excess weight can be lost in the first 3 months.
- Approximately 60-65% of excess weight can be lost in the first 6 months
- Approximately 70-75% of the excess weight can be lost in the first year.
- Weight loss may slow down and continue for up to 18 months.
- Real success in weight loss is the Gold standard if more than 85% of the excess weight can be lost.
There may be slowdowns in the rate of weight loss in the interim periods; then the patient's program can be reviewed and some changes can be made.
Things to remember in order to achieve real success: To stick to the diet program and not to have any occasional misses, to follow the sports / exercise program, not to go back to our bad old habits, not to forget psychological support and doctor controls. Only in this way can we fully realize the necessary changes in our lives for our health.
How should nutrition be after obesity / stomach reduction surgery?
As we always say over and over again, weight loss surgeries are procedures that can help solve many of our health problems by causing significant changes in our lives / health. For this reason, we should pay great attention to nutrition after surgery and not return to old bad eating habits. If we follow the rules and are balanced, we will solve the weight problem.
In the postoperative period:
- On the 1st day, nutrition with clear liquids begins.
- Between 2-14 days is the Liquid Nutrition period. Water, clear soups, fruit juices, buttermilk, kefir, protein drinks are consumed.
- Between 15-30 days: This is the feeding period with puree and soft foods.
- After day 30: Normal nutrition starts, but it should be calorie-adjusted nutrition within a certain program. It should be learned to eat certain things, not everything, in certain amounts without exaggeration.
- Food portions should be small and should be eaten 5-6 times a day. Do not forget to drink enough water. Foods that should be avoided should not be touched and should never be eaten once.
- Food should be chewed well (at least 25-30 times).
- Solid foods and liquid foods should not be taken at the same time, there should be at least 25-30 minutes between them.
- Vitamin and mineral support is generally not required in stomach reduction; even if it is required, improvement occurs within 1-2 months. However, in gastric bypass and other types of surgeries, support may need to be taken for a long time or even for life due to deficiency.
Exercise After Obesity Surgery
We do not want too much immobility after surgery. The first 1-2 weeks are the period of adapting to one's new life and new eating habits. Patients who return to their normal life after 1-2 weeks are given a certain movement program.
- After 15 days, a walking program is applied without forcing
- After 1 month, a personalized program of swimming and water exercises, cycling and brisk walking is organized.
- After the 6th week, a fitness and specific body exercise program is organized.
Of course, these exercise programs are not the same for every patient. Since people's weight and accompanying health problems may be different, a road map is drawn by making a personalized analysis.
How should follow-up be after obesity surgery?
Follow-up is very important after obesity surgeries. Only in this way, success is much higher.
Follow-up after surgery:
- Patient control examination after10-15 days. Diet and psychological evaluation
- After 1 month, a doctor's check-up and blood tests are done. Diet program &
- psychological evaluation is done.
- 3rd month doctor check and blood tests are done. Diet program &
- psychological evaluation is done.
- At 6 months, a doctor's check-up and blood tests are performed. Diet program &
- psychological evaluation is done.
- At 12 months, a medical check-up and blood tests are performed. Diet program &
- psychological evaluation is done.
- After 1 year, at least 2-3 doctor checks are recommended every year.
Does Obesity Surgery Have an Impact on Life Extension?
Obesity surgery has two most important effects on our lives. These are to help improve the quality of our lives and prolong life. According to all studies, the quality of life of obese people decreases and life expectancy is shortened by 10-15%. In other words, if we say that the average life expectancy is 75 years old, although it varies according to countries, obese people lose 7 to 10 years of their lives.
Due to diseases such as diabetes, high blood pressure, cardiovascular system diseases, sleep apnea, fatty liver, cholesterol disease, cancer, both poor quality life and death can be earlier.
The risks of obesity on life are many times higher than the risks of surgery and are around 20%.
What are the Diseases Caused by Obesity?
The diseases that obesity can cause are under general headings:
- Diabetes (Diabetes)
- Cardiovascular diseases
- High blood pressure
- Fatty liver, gallstones, pancreatic diseases
- Sleep Apnea
- Infertility and sexual reluctance.
- Lack of self-confidence and psychological problems.
- Polycystic ovary and cysts.
- Hygiene problems and skin problems.
- Some cancer risks. Risk of colon, stomach, pancreas, gall bladder cancer, risk of breast, ovarian, uterine cancer in women, risk of prostate cancer in men.
- Some hormonal disorders.
- Joint pains, disorders, hernias.
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