Obesity Surgery

Obesity Surgery

  Obesity is a chronical disease that is defined as abnormal or excessive fat accumulation resulted by imbalance of calorie intake and energy consume. It can be named as obesity when the body fat is over 25% in men and 30% in women. Despite the fact that there are multiple techniques to define obesity, the most common standardized method is the body and fat index (BMI) that is also approved by the World Health Organization (WHO).

  Body Mass Index is a simple calculation with a person's height and weight.

 

 The formula is BMI = kg/m2 where kg is a person's weight in kilograms and m2 is their height in metres squared.

 

 A BMI of 25.0 or more is overweight, while the healthy range is 18.5 to 24.9.

 

BMI <18.5 Undernourished

BMI> = 18,5 - 24,9 Ideal Weight

BMI> = 25 - 29,9 Overweight

BMI> 30 Obesity

 

30- 34.9 Class 1(Low-Risk)  Obesity

 

35-39,9 Class 2 (Moderate-Risk) Obesity

 

40 and over Class 3 (High-Risk) Morbid Obesity

 

              BMI> 50 Super Obesity

 

As in all the living beings’ life, nourishment comes as one of the first steps for survival in human life. Eating habits have constantly transformed during time by changing climate, geopraphical and historical reasons until today.

   Since obesity is a complex and multifactorial disease, it is mentioned that there are multiple factors that lead to obesity. The first reason is the imbalance between calorie intake and energy consume. Medication usage is also well known for a reason to obesity.

The factors that lead to obesity can be listed as;

  • Age
  • Gender
  • Physical inactivity
  • Economical situation
  • Education level
  • Socio-cultural factors
  • Overeating
  • Genetics
  • A diet high in simple carbohydrates
  • Frequency of eating
  • Medications
  • Hormonal reasons
  • Psychological factors
  • Numbers of births

  Most of the corruption in obesity are caused by the metabolic consequences of an increased production of fatty acids and peptides due to the enlargement of fat cells. Others are the result of the increased mass of fat. The major consequences of obesity are the high rates of mortality and morbidity. With obesity, the size of the abdomen tends to enlarge. At times, there are whitish marks on the abdomen areas due to the excess accumulation of fatty tissues. Another preliminary symptom is that the person tends to have shortness of breath. People with obesity cannot breathe properly because of the accumulation of excess fat in the chest area and below the diaphragm.

 

   Obesity also lead to decreased mobility and it becomes difficult for obese people to move around. They often feel tired and breathless as they have much accumulation of fat in the chest, neck and associated areas of the body. There is a constant feeling of breathlessness and fatigue, which leads lack of activity and movement.

  According to the World Health Organisation (2016), there are around 2 billion adults overweight, of those 650 million are considered to be affected by obesity (BMI ≥30 kg/m²). That equates to 39%of adults aged 18 or over who were overweight, with 13% obese. The worldwide prevalence of obesity nearly tripled between 1975 and 2016. It is estimated now that most of the world's population live in countries where overweight and obesity kills more people than underweight.

 

WHAT ARE THE TREATMENT OPTIONS FOR OVERWEIGHT OBESITY?

  Fortunately, a range of obesity treatment procedures are available, which have helped countless people lose weight and live healthier, longer lives. The least invasive of these treatment options involve working with therapists for intensive behavioral therapy or medical nutrition therapy to overcome eating and weight loss challenges through goal setting, education and monitored dietary changes.

  The best options to treat overweight and obesity is to have a healthy  eating plan and regular physical activity, new way of eating habits, weight-management programs, special diets or surgical interventions such as gastric balloon operation,  gastric sleeve surgery or bariatric surgery.


WHAT IS THE TREATMENT OPTIONS?

Professional weight loss programs often include low-calorie diets, increased physical activity, and behavior modification techniques. However, lifestyle changes alone are not effective and sufficient.

The drug used for weight loss does not play an important role as a medical treatment for obesity in the long run. The appetite-reducing medication may help lose weight initially, but most patients who have applied for weight loss programs without surgical intervention have been observed to regain lost weight within 5 years.


SURGICAL TREATMENT

Weight loss surgery, also called bariatric or metabolic surgery, has been practiced as a treatment for people who have been overweight for nearly 50 years. when treatments and diets are not working. The results of our laparoscopic (closed) weight loss surgeries are quite satisfactory.


WHO CAN NOT TAKE WEIGHT SURGERY?

    Those who are psychologically unstable and severe eating disorders
    Alcohol addicts
    Those with serious systemic diseases such as liver cirrhosis, serious respiratory diseases, diseases that increase the risk of bleeding and infection, and serious heart diseases
    Patients over 65 years old
    BMI ineligible

WEIGHT RESOURCES SURGERY
Two of the most common surgeries are laparoscopic gastric bypass and sleeve gastrectomy.

Sleeve gastrectomy
Sleeve gastrectomy can be described as a restrictive method and basically involves reducing the stomach. This procedure is performed laparoscopically while the patient is under anesthesia, by making small holes in the abdomen without making large incisions.

The stomach decreases by removing most of it, including the part that releases hunger hormones. The result is a tube-like structure with a volume of 100-150 ml. This is the closest method to human physiology.

Stomach bypass
Gastric bypass is based on reducing the size of the stomach to reduce food intake and shortening the way the food goes in the small intestine, the way to absorption. This surgery limits both the amount of food taken and absorption.

This procedure lowers the stomach to about 20-40 ml. to reduce food intake. As a result of the operation, food bypasses most of the stomach, duodenum and jejunum, so the absorption of food, especially foods high in calories and sugar, is prevented.

After ingestion, food comes from the esophagus to the small stomach and goes directly into the small intestine. In other words, the food bypasses the parts of the digestive system responsible for absorption, the large stomach, duodenum, and jejunum and passes directly into the small intestine.


Gastric Application
This surgery involves sewing one or more layers in the stomach to reduce the size of the stomach without removing any part of the stomach or intestines. Therefore, unlike arm gastrectomy or gastric bypass, the operation is reversible. However, sleeve weight is not as effective as a gastrectomy or gastric bypass for weight loss. People who do not have extremely BMI and do not want an incision in their stomach should prefer this surgery.


METABOLIC SURGERY (For Diabetes)

Loop Bipartition Surgery (Loop Bipartition Sleeve Gastrectomy)
This is a type of surgery performed as a treatment for uncontrolled type 2 diabetes associated with obesity. This surgery involves first creating a large gastric "cuff" or "tube" and then anastomosing part of the small intestine close to the exit of the newly formed stomach. Thus, food and drink pass both normal and short cut. Thus, blood sugar is taken under control and the patient loses weight.


Roux en Y Transit Bipartition (Sleeve Gastrectomy with Roux en Y Bipartition)
This surgery involves creating a large gastric "sheath" or "tube" and removing part of the small intestine. Then the tip close to the large intestine is anastomosed to the exit of the newly formed stomach. The upper end is anastomosed to a point close to the large intestine. Thus, blood sugar is taken under control and the patient loses weight.


Duodenal Key
Duodenal key or biliopancreatic diversion is a weight loss surgery that reduces the volume of the stomach to greatly restrict stomach intake and absorption. This procedure may be a surgical option for super obese patients with BMI above 50 and those who have already had arm gastrectomy but have lost the lost weight. It can also be recommended for patients with uncontrolled diabetes.