What is bariatric surgery?

Obesity is the excessive accumulation of fat in the body to the extent that it impairs health. Excessive and wrong eating habits, hormonal factors, sedentary lifestyle, the genetic transition can cause obesity. Obesity is a disease that needs to be treated. Because untreated obesity; causes many health problems such as diabetes, heart diseases, cancer, infertility, infertility, and joint disorders.

Bariatric surgery, also known as obesity surgery, is recommended for patients with a body mass index of 40 and above (morbidly obese) or a body mass index of over 55 and who cannot lose weight with methods such as medical nutrition, exercise, and medical treatment under the supervision of a specialist.

Bariatric surgery is the only effective method for maintaining weight loss in patients with a body mass index of 35 and above or morbidly obese patients over 40. However, those with a body mass index over 35 have concomitant diseases, namely; Obesity surgery can be applied for cardiovascular disease patients and diabetes treatment if they cannot get rid of fatty tissue.

Surgical methods that provide permanent weight control in the treatment of obesity increase the patient’s quality of life and eliminate the risk of many life-threatening diseases that obesity can cause. There are various types and applications of bariatric surgery that are different from each other.

Which treatment method will be applied to the patient is planned according to the patient’s weight, existing diseases accompanying obesity, and eating habits. The rate of weight loss of patients after bariatric surgery is very high; however, one should not forget that to maintain the weight lost after bariatric surgery, the person must change their lifestyle permanently.

What is bariatric surgery?

Although the Body Mass Index is between 35 and 40, in people with obesity-related diseases (cardiovascular diseases, intense diabetes, frailty, joint disorders, respiratory problems) and individuals with a body mass index of 40 or more, surgical intervention on the digestive systems to treat obesity is called bariatric surgery. . Which will prefer method in bariatric surgery varies from patient to patient.

Bariatric surgery is used for patients who have been treated with all other treatment methods (diet program, exercise programs, behavior modification, and drugs) before the surgical procedure but for whom no success has been achieved. The success of bariatric surgery largely depends on the behavior and lifestyle changes adopted by the patient after the surgery.

Patients should meticulously follow the dietician’s diet plan after the surgical procedure and participate in behavioral therapy to change their attitudes towards nutrition and exercise.

Who can undergo bariatric surgery? Who is obesity surgery suitable for?

Bariatric surgery may be a good option in the following cases:

• People with a body mass index between 35-40 and those with obesity-related diseases such as cardiovascular diseases, Type 2 diabetes, infertility, NAFLD, steatohepatitis (NASH), hypertension, sleep apnea
• Patients with a body mass index over 40
• Patients who cannot lose weight with methods such as medical nutrition, exercise, and medical treatment under the supervision of a one-year expert
• People who are not heavily addicted to alcohol or drugs
• People who do not have a health condition that prevents surgery
• Persons with complete understanding and adaptability and who can coordinate with the medical team after the surgical procedure.

What are the risks of bariatric surgery?

As with every surgical procedure, some health risks may occur in both short and long-term bariatric surgery. Bariatric surgeries do not carry more risks than any surgical procedure.

Risks associated with the surgical procedure may include:

• Infection
• Adverse reactions to anesthesia
• Blood clots
• Lung or breathing problems
• Leaks in the gastrointestinal tract
• Life risk (Same as any gene surgery)
• The longer-term risks and complications of bariatric surgery vary with the type of surgery. Long-term complications and risks may include:
• Intestinal obstruction
• Dumping syndrome causes diarrhea, rash, dizziness, nausea, or vomiting
• Gall or kidney stones
  Hernias
• Low blood sugar (Hypoglycemia)
• Ulcer-Acid reflux
• The need for a second surgery
• Life risk (Same as any gene surgery)

What are the types of bariatric surgery?

Methods in bariatric surgery vary according to gender, weight, disease, age, and whether there is a desire for pregnancy in the future in women. All types of bariatric surgery are to achieve sustainable weight loss, increase the quality of life, and eliminate the complications caused by obesity. Various kinds of bariatric surgery methods differ in terms of surgical procedure techniques and long-term results.

Obesity surgery methods can be listed as follows:

A gastric band (Stomach clamp)

The doctor surgically places a biocompatible adjustable band on the upper part of the stomach just below the esophagus so that the stomach is divided into two parts. The tape is attached via the tube to a subcutaneous access port in the abdominal wall, where it can be inflated or deflated through the skin with a needle. The place where the band is placed on the stomach looks like an hourglass. Meals eaten with this surgical method are collected in the upper part and not passed to the lower leg. This method is less popular today. Because, while hormones send signals to the brain to eat, the stomach, which is clamped, allows this situation. The feeling of hunger continues; the person continues to eat because he is hungry. This situation also causes vomiting.

What are the disadvantages-risks of the gastric band?

• Some complications may develop due to the discomfort of the stomach tissue due to the foreign body effect in the stomach.
• Compared to other types of obesity surgery, weight is lost more slowly, and when the clamp is deflated, weight is gained again.
•   may feel persistent hunger
• Doctor follow-up is essential for optimal results.
• The risk of nausea-vomiting and reflux is inherent in the treatment.
• Belt slip-sagging-erosion may occur. The band may pass into the stomach or the esophagus.

Note: The gastric band, that is, the gastric band, is a method that has lost its effectiveness in recent years and is no longer used.

Gastric sleeve surgery (Sleeve Gastrectomy)

Sleeve gastrectomy is a surgical procedure in which most of the stomach is removed by leaving a 100-150 ml gastric tube. A specific part of the stomach is surgically removed during the process, and a tube-shaped stomach (looks like a banana) is left behind. In addition, since the part of the stomach that secretes hunger hormone is released, the feeling of hunger in the patient decreases. In other words, the sense that the stomach is full prevents overeating.

Gastric sleeve surgery is restrictive, and the absorption of nutrients is not impaired by this method. Since the absorption of food continues in the same way, the patient does not need to take supplementary vitamin or mineral supplements. The application of the sleeve gastrectomy method is relatively more accessible than other types of obesity surgery. The success of sleeve gastrectomy surgery is permanent; however, it is of great importance that this method is applied to the right people. A dietitian should see patients before and after the surgical procedure.

The dietitian here has to prescribe the food to the patients.   should apply radiologic control to the patient between 24-48 hours after the operation. This application is a radiological examination that reveals whether there are complications after the surgery. It should not be forgotten that sleeve gastrectomy operation and afterward require close doctor follow-up. Patients who have undergone sleeve gastrectomy should not miss their first, second, fourth week, 3, 6, 9, 12, 18, and 24-month controls.

What are the advantages of sleeve gastrectomy surgery:

• There is a regression in diseases caused by obesity, such as type II diabetes, hypertension, and sleep apnea.
• Reduced stomach volume provides a feeling of satiety
• There is no problem in consuming most foods
• Dumping syndrome is not seen after sleeve gastrectomy procedure
• The hunger-stimulating hormone produced in one part of the stomach is reduced.
• It is a method that can be applied more quickly than gastric bypass surgery.
• No foreign body effect like gastric band
• The success of gastric sleeve surgery is permanent.
• Weight loss is easy after this procedure.

Gastric Bypass -also called Roux-en-Y gastric bypass.

Gastric Bypass procedure is one of the most common types of obesity surgery, such as sleeve gastrectomy surgeries. Bypass means using the shortcut. Gastric bypass generally means establishing a passageway from the stomach to the intestines. There are also modifications of this method, such as mini gastric bypass and biliopancreatic diversion. The success of these surgical procedures in weight loss for obese patients is slightly higher than the sleeve gastrectomy operation. The common purpose of gastric bypass surgeries is to shrink the stomach and ensure that the consumed foods reach the intestines faster.

In this surgery, a small stomach pouch is created by stapling the upper part of the stomach. The first part of the small intestine, called the duodenum, is separated from the second part, called the jejunum. The jejunum is then lifted and attached to the newly formed small stomach sac, and the duodenum is reconnected to the small intestine. Two conditions are targeted with gastric bypass surgery. First, the person’s calorie intake is restricted, and secondly, the absorption of edible nutrients is reduced. While patients can be discharged in 2-4 days in sleeve gastrectomy, this period increases to 4-6 days in gastric bypass surgery.

What is a mini gastric bypass?

Compared to volume-restricting techniques, mini gastric bypass stands out regarding better weight loss and more effective treatment of comorbid diseases. Compared to a similar process, Roux en Y Gastric Bypass (RYGB) is frequently preferred by many centers as an easy-to-apply technique that can be performed with less anastomosis and has low perioperative complications. In Mini-Gastric Bypass, the stomach is formed as a tube using special stapler tools. This newly created stomach pouch is long.

What are the advantages of Gastric Bypass?

• Rapid achievement of targeted weight loss for 18-24 months
• Apparent regression in diseases such as Type 2 diabetes, hypertension, sleep apnea, GERD associated with obesity
• Noticeable increase in quality of life

What are the disadvantages-risks of Gastric Bypass Surgery?

• Staple leak
• Increased risk of gallstones due to rapid weight loss
• Internal hernia

Duodenal Switch surgery

Duodenal Switch surgery, like gastric bypass, is a surgical procedure that has both restrictive and absorption-reducing effects. This method is mainly used for people with a body mass index of more than 50 Kg/m2 or in the treatment of Type 2 diabetes. Duodenal Switch is an effective method in the treatment of diseases such as obesity-related diabetes and hypertension. However, it has some side effects, such as foul-smelling diarrhea. In addition, patients with Duodenal Switch surgery stay in the hospital longer than patients who undergo other obesity surgery. Vitamin, iron, and protein deficiencies are also frequently seen after Duodenal Switch surgery, with absorption-reducing effects.

Robotic bariatric surgery

The use of da Vinci Robotic Surgery technology in laparoscopic bariatric surgeries worldwide offers special privileges to doctors and patients. Due to the anatomical structures of obese patients, they can achieve the extra precision required in such surgeries with the robot’s non-vibrating arms and the ability to move with incredible grace in the patient’s abdomen. Robot technology, which provides a three-dimensional and high-resolution image to the surgeon, also protects organs, tissues, and nerves adjacent to the area where the operation is performed. Procedures that can act through several holes without creating an incision in certain patients eliminate aesthetic concerns in patients.

In bariatric surgery, sleeve gastrectomy and gastric bypass surgeries are successfully performed using robot technology. Robotic obesity surgeries are performed at Memorial Şişli and Bahçelievler Hospitals.

The privileges of robot technology for patients and doctors can be listed as follows:

• Since the surgery is performed with a closed technique and only a few holes, the risk of infection that can be seen due to the contact of the organs with air in open surgeries is eliminated.

• Thanks to robot technology, the surgeon performs the surgery with a 3-dimensional and digital view, with an opportunity where the patient’s nerves, veins, muscles, and tissues are more protected from the risk of injury.

• Thanks to robot technology, a large surgical incision is not formed on the patient’s body. After the procedure is completed through several holes instead of a large incision, the patient’s risk of infection is reduced to almost non-existent, and he has a comfortable recovery period with less pain.

• Since the patient’s discharge, return to daily life, and recovery time is shortened, and pain control is provided, the patient is fed orally in a shorter time, and the body regains its resistance.

• After achieving the quality of daily life, the patient can return to work and social life more quickly.

What can I expect after bariatric surgery?

To lose weight and not regain the lost weight, you will need to make significant changes in lifestyle after bariatric surgery. For example, you will need to follow a healthy balanced diet and will likely take vitamins or other supplements for a long time. In addition, after bariatric surgery, physical activities will be as important as healthy nutrition. After the operation first, fluid consumption will take place. In a few weeks, you’ll switch to pureed foods and then solid foods in small meals.

Pre bariatric surgery diet?

Following a diet before bariatric surgery; Preparing your body for surgery is extremely important in speeding up your recovery and increasing your weight loss rate. The weight you will lose before the surgery with a suitable diet program helps reduce the excess fat in the abdomen and the liver and reduces the possibility of complications.

Diet plan (Before surgery)

The recommendations listed below may vary from person to person and also depend on the type of surgery:

• Avoid overeating
• Eliminate high-sugar drinks
•   should avoid high carbohydrate foods
• Remove saturated fats from your diet

What should I pay attention to in nutrition after bariatric surgery? What are the foods to be consumed?

Diet Plan (Post Surgery)

Your doctor and dietitian will arrange the postoperative diet plan according to the surgery applied and may continue in several stages.

Stage 1: Liquid Diet

In the days after the surgery, patients should enter a liquid feeding period. During the liquid feeding period, the ‘clear liquid’ diet is completed first, and after a few days, the transition to ‘liquid’ foods is made. After that, there will be gradual changes in what types of liquids can be taken.

• Skimmed milk
• Soup and broth
• Decaffeinated tea or coffee
• Unsweetened fruit juice

Stage 2: Puree diet

This period in which liquid foods are gradually abandoned and transition to more dense foods is made is called the puree diet. It is recommended to take foods slowly during the puree diet period, which requires the foods to be consumed to be brought to a puree consistency with the help of a blender. Spices can irritate the stomach; during this period, it is necessary to avoid spicy foods altogether. Foods such as omelets and canned fish (tuna or salmon) are not compatible with the puree diet. Although protein-rich foods are emphasized at this nutritional stage, they can include fruits and vegetables in the puree.

In the puree diet period, mostly seedless fruits are preferred. Fruits such as banana, peach, apricot, pear, pineapple, melon are usually recommended at this stage. The dietitian can also add pureed vegetables such as tomatoes, spinach, carrots, and green beans to the diet.

Stage 3: soft diet

At this stage, your doctor will recommend that you consume juicy, soft, and easily chewable foods. Food should never be finished quickly and should be chewed as much as possible. Soft diets are applied at the 5th, 6th, 7th, and 8th weeks. The target is 60-80 grams of protein per day. As protein-based foods increase, protein support is reduced. Protein-based foods are consumed first. Then should destroy vegetables, fruits, and then grains.

Some of the nutrients at this stage include:

• Boiled egg
• Lean ground beef
• Meat and chicken broth
• compost juice
• Fat-free cottage cheese
• Low-fat omelet
• Chicken (Ground)

Stage 4: Standard diet

After bariatric surgery, the standard diet is started at the 9th week. The target protein intake in this diet is 60-80 grams. As protein-based food consumption increases, protein supplementation is reduced. Moist, tender meats are better tolerated. The target fluid consumption is approximately 1800 ml per day. It is continued to avoid consuming liquids at meals, and 30 minutes should be waited to continue drinking beverages after meals. Can start the consumption of raw vegetables such as lettuce and carrots. However, foods with hard surfaces and large seeds, such as cucumbers, should be avoided. Three months after the surgery, the diversity of the diet can be increased and can consume foods from all food groups.

The points to be considered in nutrition after bariatric surgery are as follows:

•   should prefer more meals and small portions.
•   Should chew food very well.
•   Should do regular exercise and sports.
•   Should not consume water and other liquid drinks 10-15 minutes before and 20-30 minutes after meals.
•   Should not consume solid and liquid food and beverages together at meals.
• It is essential to pay attention to the amount of water drinking. If necessary, 1 liter of water should be drunk using a pipette in a day, and the amount of water should be increased to 1.5-2 liters over time.
•   Should not skip routine checks.
•   Should apply the protein-rich diet in the postoperative period.
• Vitamin and mineral supplements are recommended by endocrinology, diabetes, and metabolic diseases and should take nutritionists.

How much weight will I lose after bariatric surgery?

Each patient will have a different experience depending on the surgery option they choose. Patients who have a balanced diet and exercise consistently get the best results. Along with these, gastric bypass patients lose 60-80% of their excess weight on average. Patients who have gastric sleeve surgery lose 50-70% of their excess weight on average.

Will I no longer be able to enjoy eating after bariatric surgery?

Obesity surgery will not have an obstructive result in taste and pleasure that people will get from foods.

How long do I need to stay in the hospital for the surgery?

The average hospital stay is 1-2 nights.

When can I return to work?

Most patients can return to work within 2-3 weeks of surgery, but the time required varies depending on the person and the type of work they do.

How will my diet change after surgery?

I will inform you about the progress of the diet after the surgery. Initially, patients are given a clear liquid diet; However, three months after the surgery, the diversity of the diet can be increased, and they can consume foods from all food groups.

How effective is bariatric surgery?

Studies among patients who have had gastric bypass surgery to lose weight have revealed that those who have had gastric bypass surgery have a lower incidence of obesity-related cancers than those who do not. While the targeted weight loss with diet and sports results in a 7-10% weight loss in the body, it provides 30% weight loss with gastric reduction surgery and the nutrition programs applied after it.

Can treat type II diabetes surgically. While drugs provide an improvement of 13% in the treatment of type II diabetes, the success of bariatric surgery reaches 75%.

According to the New England Journal of Medicine, bariatric surgery efficiency statistics are as follows:

• 56% reduction in death rates from coronary heart disease.
• 92% reduction in death rates from diabetes mellitus
• 60% reduction in cancer death rates.
• On average, people after obesity lose 40% to 75% of their diseased body weight.
• If the doctor’s recommendations are followed, ten years after bariatric surgery, the patients’ weight remains 25% less than before.
• In 85% of the patients, the complaint of sleep apnea ends.

Bariatric Surgery Cost

The price of sleeve gastrectomy surgery varies from person to person. Because each patient may have their own unique needs. The price range varies between 3,000-30,000 USD. Here we can explain why there is such a difference. It is possible to get excellent service in Turkey, especially from advanced medicine countries, at very reasonable prices based on dollars. The choice here will depend on where and what kind of service you will receive.

Bariatric Surgery Before and After ( Photos )

Our health contents have been prepared for informational purposes only and with scientific data on the registration date. For all your questions, concerns, diagnosis, or treatment about your health, please consult your doctor or health institution.