Obesity/Metabolic Surgery

Anyone with a body mass index of 30 or above is considered obese. The World Health Organization defines obesity as “the accumulation of fat in the body that may adversely affect health.”

People often reject the diagnosis of “obese” or are unaware that they meet the criteria for being obese. Statistics show that this ailment is actually a global problem and that awareness must be raised.

For clarity, we have divided these procedures into two categories: endoscopic and surgical.

ENDOSCOPIC INTERVENTIONS FOR OBESITY

What is Stomach Botox?

The application of Botulinum toxin (Botox) to the stomach is a relatively new weight loss method based on the endoscopic method of injecting Botulinum toxin into certain parts of the stomach. In this method, the contraction of the stomach muscles is limited, the gastric emptying time is delayed, and the patient loses appetite.

Stomach botox can actually be applied to anyone who wants to lose weight. This procedure is not an operation. However, patient selection is important. It should be said that stomach botox will not be very useful for patients with a body mass index of above 40 who can achieve success with surgery. Patients who are overweight but not obese enough to be operated on and who want to lose weight constitute the ideal patient group. Botox for the stomach can be used on people who have had the right treatment for stomach ulcers or gastritis.

Botox is widely used mainly to reduce wrinkles on the skin and no dangerous side effects are known. Since gastric botox application is a standard endoscopic procedure, there are no significant side effects reported in the literature. The procedure is not suitable for people who have muscle disease or who are allergic to botox.

Unlike gastric balloon, gastric botox provides an effective loss of appetite for 3-6 months with a single application. The presence of a foreign body in the stomach in the gastric balloon rarely causes nausea. In addition, many patients complain that their appetite is suddenly regained after the gastric balloon is removed. Since the effect of stomach botox passes slowly, there is no sudden increase in appetite in this way. The appetite gradually returns to normal.

What is a Stomach Balloon?

A gastric balloon is one of the obesity treatments made of silicone or polyurethane material and placed in the stomach before being inflated with sterile liquid. The use of a gastric balloon does not require surgery, but, depending on the type of balloon, some gastric balloons are put in place and taken out by endoscopy while the patient is only slightly sedated.

The mechanism of action of the gastric balloon is to create a constant feeling of satiety by occupying space in the stomach, thus enabling the patient to lose weight with less food consumption at each meal. Studies on this subject started in the 1980s. Up to now, swallowable gastric balloons have also been used, which do not require endoscopy or anesthesia.

A gastric balloon is especially preferred by individuals who find it inconvenient to receive anesthesia or who do not want a surgical procedure.

Gastric balloons stay in the stomach for 4–12 months, depending on their types. With the feeling of satiety and satiety it gives during this period, it makes it easier for the person to comply with his diet by limiting food intake. Nutritional style and eating habits change, and after the balloon comes out of the stomach, the person maintains these habits and maintains his ideal weight.

There are different types of gastric balloons; they all have the same basic mechanism of action. However, the method of application can be varied according to features such as the duration of stay in the stomach and whether it is adjustable or not. Your doctor will recommend the most appropriate method after evaluating and listening to you.

WHAT IS OBESITY SURGERY?

It is a surgical operation for permanent weight loss in cases where successful results cannot be obtained in obese patients after exercise and drug therapy.

In bariatric surgery, the same intervention is not applied to every patient and the approach of “this is the only and best method” is not adopted. However, all obesity surgeries, that is, bariatric interventions, are performed with the laparoscopic, that is, closed surgery method. Your doctor will figure out which option is best for you by looking at your condition and doing preliminary tests. 

Please contact our case representatives for other methods not specified in this section that are applied laparoscopically and/or robotically by our partner physicians.

Stomach Tube Surgery (Stomach Reduction Surgery)

What is Sleeve Gastrectomy?

It is a restrictive obesity and metabolic surgery method. The purpose of this method is to reduce the capacity of the stomach in terms of volume. 80% of the stomach is removed by stapling with laparoscopic surgery, leaving a section equal to the width of the esophagus. Because of the shape of the stomach left behind, it is also called sleeve gastrectomy, sleeve gastrectomy, or stomach reduction surgery.

Tube stomach surgery (Stomach Reduction Surgery) is performed under general anesthesia by the laparoscopic method. Gastric sleeve surgery (Stomach Reduction Surgery) can be performed through 5 holes or a single hole. After the vessels of the stomach are separated, a tube is inserted through the mouth into the stomach and the stomach is cut from the neighborhood of the tube with the help of a tool called a stapler. The stomach is taken out through the hole in the abdominal wall. After checking the bleeding and leakage, the tube is pulled and the cut part of the stomach is sutured again. A drain is not left in the abdomen or nose after sleeve gastrectomy (Stomach Reduction Surgery).

What are the advantages of tube stomach surgery (Stomach Reduction Surgery)?

• It does not disturb the anatomical structure and natural nutrient flow direction.

• Compared to other methods, the technique is simpler and the complication rates are lower.

• Anatomy, intestinal structure, and physiological flow direction of nutrients are not disturbed.

• Dumping syndrome and ulcers do not occur.

• The secretion of an appetite hormone called ghrelin decreases. Appetite decreases from the first day.

• There is no need for lifelong vitamin-mineral supplementation.

• In any case, the entire stomach can be visualized with the help of endoscopy.

• Since the pyloric muscle of the stomach is protected, a feeling of occlusion and satiety occurs.

What are the disadvantages of tube stomach surgery (Stomach Reduction Surgery)?

It is less than other obesity and metabolic surgery operations.

• It is irreversible.

• The effect of losing weight and saving from co-morbidities is weaker than after gastric bypass and duodenal switch, which cause malabsorption.

What is Gastric Bypass Surgery (Gastric Bypass)?

It is one of the oldest obesity and metabolic surgery operations. It has long been accepted as the gold standard in bariatric surgery. Unlike sleeve gastrectomy surgery, the stomach is not removed and some of the intestines are disabled. It is an obesity surgery that is both restrictive and malabsorptive.

Method: The operation can be performed under general anesthesia by a laparoscopic or robotic method. First, the stomach is divided into 2 parts, and a 15–30 mL gastric pouch is left connected to the esophagus. The remaining part of the stomach remains dysfunctional. The small intestine is separated 75 cm ahead, and the lower end is sutured to the stomach, and the upper end is sutured 100–150 cm away from the lower end. Thus, the food taken passes to the small stomach formed first and then to the small intestine that is cut from there. Digestive enzymes meet food 100-150 cm ahead. This situation creates malabsorption.

What Are the Advantages of Gastric Bypass Surgery?

If we count the advantages of gastric bypass surgery, which is one of the surgeries that cause malabsorption in obesity and metabolic surgery.

• The weight loss effect is more than a tube stomach.

• The recovery rate from co-morbidities is higher than tube stomach.

• It is reversible, albeit difficult and risky.

• It causes both eating restrictions and malabsorption.

What are the disadvantages of gastric bypass surgery?

• The hospital stay is longer.

• At least two vitamin and mineral supplements are required throughout life since gastric bypass from obesity and metabolic surgery causes malabsorption. Severe vitamin deficiency syndrome may occur if vitamins are not used.

• Gastric bypass is a more complicated and longer-lasting operation, so the complication rates are higher.

• Closer follow-up is required.

• Dumping syndrome may be seen.*

• The stomach remains in the abdomen, which cannot be visualized by endoscopy.

• Problems such as intestinal obstruction and ulcers may occur after gastric bypass surgery.

*Dumping syndrome: It is a problem caused by the rapid emptying of the stomach, characterized by nausea, diarrhea, and fatigue felt after eating.

What is Mini Gastric Bypass?

Mini gastric bypass surgery has emerged as an alternative to gastric bypass surgery and has gained popularity recently. Compared to gastric bypass surgery, it is technically simpler and the operation time is shorter. Complications of obesity and metabolic surgery are fewer than with traditional gastric bypass. It is both an eating-restrictive and malabsorption surgery.

Method: The operation is performed under general anesthesia and laparoscopically. Trocars are placed, and after carbon dioxide insufflation, an orogastric tube is placed from the mouth to the stomach. A long and thin stomach is prepared starting from 3-4 cm proximal to the pylorus. An anastomosis is made to the stomach, which is formed by measuring 200 cm of small intestine from Treitz.

What are the advantages of mini gastric bypass surgery? 

If we count the advantages of mini gastric bypass surgery, which is one of the surgeries that cause malabsorption in obesity and metabolic surgery,

• The weight loss effect is more than a tube stomach.

• The recovery rate from co-morbidities is higher than tube stomach.

• It is partially reversible, albeit difficult and risky.

• It causes both eating restrictions and malabsorption.

• It is simpler than gastric bypass. 

What are the disadvantages of mini gastric bypass surgery?

• The hospital stay is longer.

• At least two vitamin and mineral supplements are required throughout life, as mini gastric bypass from obesity and metabolic surgery causes malabsorption. Severe vitamin deficiency syndrome may occur if vitamins are not used.

• Complication rates are higher because mini gastric bypass is a more complicated and longer-lasting operation.

• Closer follow-up is required.

• Dumping syndrome may be seen.

• The stomach remains in the abdomen, which cannot be visualized by endoscopy.

• Problems such as intestinal obstruction and ulcers may occur after mini gastric bypass surgery. 

METABOLIC SURGERY (TYPE 2 DIABETES SURGERY)

The treatment of type 2 diabetes patients using bariatric surgery methods is called “Metabolic Surgery.” The classical treatment algorithm for type 2 diabetes is education, diet, exercise, and drug use. However, despite all these treatments, the disease sometimes shows a progressive course. In this case, metabolic surgery should come to the fore as an effective treatment alternative. Metabolic surgery, popularly known as sugar and diabetes surgery, is also a method used in the treatment of diseases such as hypertension, obesity, type 2 diabetes, and high cholesterol.

How is metabolic surgery done?

All methods applied during metabolic surgery are performed with the laparoscopic method, also known as closed surgery. The incision is not made on the patient; instead, the operation is completed by entering through four or five holes. The duration of the operation varies according to the method used. Depending on the type of method, the operation may take up to 1 or 3 hours. Depending on the operation, the patient may stay in the hospital for 4 or 5 days. Sleeve Gastrectomy, Minigastric Bypass, Duodenal Switch Derivatives, Gastric Bypass, Transit Bipartition, and Ileal Transposition Derivatives are the methods used during these operations. Some of the surgeries are restrictive to eating, and some are those that disrupt intestinal absorption.

Are there risks to metabolic surgery?

Generally speaking, all surgical operations have risks. When the risks of the operation and the risks of treatable diseases are compared, it is concluded that the risk of surgical intervention is much less. The most important issues at the point of surgery are the correct evaluation of the patient and the execution of the operation by an experienced surgeon. It is important to complete the whole process correctly, from the patient’s evaluation process to the operation and to the controls after the operation, in order to ensure maximum benefit.