What is Obesity?
Obesity is the increase of our weight above a certain rate. According to WHO data, as of 2017, approximately 2 billion people in the world are struggling with obesity. 400 million people between the ages of 5-19 are obese.
How is obesity classified?
Body Mass Index (BMI; Body Mass Index), BMI ratio is used to classify obesity. This ratio is the ratio to be obtained by dividing the person's weight by the square of their height. BMI 18.5 and below; Weak 18.5-24 ; Normal weight 25-30; Overweight 30-39; Obese 40-49; Morbid Obese 50-59; Super Morbid Obese 60 and above; It is called super super Morbid Obese.
Obesity has significant negative effects on all systems in our body. These:
High blood pressure uncontrolled cholesterol values
Type 2 Diabetes Metabolic Syndrome
coronary artery disease
Brain vascular disease stroke
sleep apnea and sleep disorders anxiety depression
Low quality of life
Body aches, decreased activity
Increase in the incidence of cancer, especially breast and colon
Obese patients have an increased mortality rate due to all the above reasons.
Obese people generally live 10-12 years less than normal-weight people.
Gastric sleeve surgery
In other words, with gastric reduction surgery, the stomach becomes a longitudinal tube. Eighty percent of the stomach is removed with sleeve gastrectomy surgery. Therefore, it is also called banana stomach. Gastric sleeve gastrectomy is the most common operation in the treatment of obesity today. Since the stomach volume is reduced after sleeve gastrectomy surgery, less food can be consumed than before. As the special part of the stomach where the hunger hormone Ghrelin is secreted is removed, the appetite decreases with stomach reduction surgery.
It can be performed laparoscopically (closed), with less pain and a short recovery time.
Since the stomach's capacity is reduced and its functions are not changed, it is appropriate to consume many food groups in small quantities.
Since the fundus area, where the hunger hormone is produced, is removed, the appetite will also decrease.
Dumping syndrome is prevented because the valve mechanism called pylorus, which allows food to move slowly through the stomach and thus facilitates digestion, is preserved. This syndrome can occur especially in gastric bypass surgery. Since the food leaves the stomach later, a feeling of fullness is experienced for a longer time.
By avoiding bowel bypass; intestinal obstruction, large ulcers, anemia (bone loss), protein and vitamin deficiency risk is eliminated
It gives very effective results for first-stage surgery in patients with very high BMI (BMI> 50 kg/m2) suitable for dual surgeries.
Intestinal bypass carries a high risk in diseases such as Crohn's disease. Gastric sleeve surgery can be easily performed in such patients.
Gastric sleeve surgery was an operation that could be partially reversible. 8-10 years after this surgery, there may be a slight weight gain again. In this case, it can be converted to bypass and doudenal switch + Biliopancreataic diversion surgery with a second operation and the person loses weight again.
Although there are slight differences from person to person after this surgery, there is a weight loss of up to 15 Kg in the first month. There is a loss of 10 Kg in the 2nd month following, 5-6 Kg in the 3rd month and 4-5 Kg in the following months. It is undesirable to have rapid weight loss anyway.
Although the length of stay in the hospital after sleeve gastrectomy surgery varies depending on the recovery process of the patient, it usually varies between 3 and 5 days.
There are 360 million Diabetic patients all over the world. 40% of these patients also have weight problems. In people with these diseases, we call co-morbidities; sleep problems, high blood pressure, heart diseases, knee pain, high blood fat, fatty liver, sexual and hormonal problems, infertility, some types of cancer are common. Surgical methods are increasingly providing effective and permanent results in order to save these patients from being condemned to insulin and diabetes medications.
There are basically two types of diabetes. Insulin production in people with type 2 diabetes is close to zero. Insulin injections must be made externally. Type 2 diabetes covers about 90% of all patients. There is usually insulin, but not enough or there is resistance to insulin.
About 70% of people with diabetes can get rid of this disease by surgery. The other 30% of patients are unfortunately not suitable for this surgery. Therefore, it is very important to identify the patient who will benefit. For this, the patient must have the following features for the surgery to be suitable:
Must have type 2 diabetes
Tests showing insulin resistance and insulin secretion from the pancreas are suitable for surgery
Kidney failure due to diabetes, loss of vision, non-healing wounds on the legs should not have developed.
Having a body mass index over 35 Kg/m2,
HbA1c over 7,
C peptide level is normal,
High HOMA-IR index
Sleeve Gastrectomy (Tube Stomach) surgery is 40-60%, Roux-en-Y Gastric By Pass 80% to 90%, Mini Gastric BY Pass 92% of these surgeries, which we call metabolic surgery operations and also applied in the treatment of obesity. It provides enough control to stop using the drug. If other patients who cannot stop the drug also use insulin, they switch to a lower dose or blood sugar control is provided with oral anti-diabetic drugs.
Today, thanks to developing medicine, metabolic surgery is performed in a closed manner. Operations, which are usually performed by opening 4-6 small incisions, are performed with different methods. The common feature of all surgeries is to intervene in the stomach, reduce appetite and restrict food intake, and additionally make shortcuts that will allow food to reach the last part of the small intestine.