Surgery is advisable for patients who do not have any hormonal hormone and who are unable to lose weight with diet, exercise and medication, or who have returned their weight. These patients should have been at least 3 years of obesity problem and have failed at least 6 months of dietary exercise and psychological support. Although the chances of these patients to lose weight with diet and exercise are only 2-4%, they should be tried before surgery. Patient age range for surgical intervention is 18-65 years. This age limit may include exceptions depending on the performance of the patient and additional diseases.
The World Health Organization reports and suggests that the most effective treatment of obesity and associated comorbidities is surgery in patients with VKI> 40 kg / m2 in patients with VKI> 35 kg / m2 in the presence of more than one disease from accompanying diseases, even if there is no coincidental finding.
The patient who will have obesity surgery should not be addicted to alcohol or drugs.
It is surgery that restricts food intake by reducing gastric volume. Tube stomach surgery is this group of operations.
Operations that reduce or both restrict food absorption and reduce absorption;
These operations are generally called bypass operations. During these operations, the varying lengths of the small bowel are separated from the food passage. Thus, the intake of important parts of the calories taken is blocked by the body. Mini Gastric Bypass, R-Y Gastric Bypass, Biliopancreatic Diversion / Duodenal Switch, these types of operations.
The most commonly used mobit obesity surgery is tube stomach surgery because it is easier, it can be applied in a shorter time, and the risk is partly less.
Sleeve Gastrektomi (Tube Stomach)
In the restrictive surgery group, scientific studies have shown that insulin sensitivity hormones such as small intestine-derived GLP-1 are activated. Tube surgery is the process of removing 75-80% of the longitudinal length of the stomach, and is only an obesity practice. Despite the fact that most centers are offered ‘candy surgery’, long-term diabetes control rates range from 50 to 55% even in obese Type 2 diabetes patients. You can examine the surgical methods for diabetes under the title Metabolic surgery.
It is a process of sewing on its own in 3 rows in 2 rows after liberation of the left outer wall of the scalp and is known as stomach folding. Stomach volume is a restrictive procedure. It does not produce any hormonal and physiological changes. Long-term weight loss and diabetes control rates are not very effective.
Combined operations (both restrictive and disruptive)
Roux-Y Gastric bypass and Minigastric bypass are two surgical procedures in this group. While these surgeons play an early role in volume restriction in weight control and blood sugar control, these effects are the consequences of small bowel bypass in the long term. This method, which is accepted as the gold standart surgery in the sense of obesity surgeon in many centers around the world, has negative effects on the procedure of long-term diabetes development in 40% of patients, necessity of revision surgery in 25% of patients and lifelong vitamins, minerals and iron dependent position of some of the patients .
Absorbent Surgery Operations
Duodenal Switch and Biliopancreatic Diversion surgeries are the most effective obesity surgeries known. Long-term success rates in obese Type 2 diabetes patients are over 90%, both in terms of weight control and in terms of diabetes control. However, besides this positive effect, the patients have iron, mineral and vitamin dependency for life, and the change in toilet habits due to impaired absorption is the most important social problem.
Who Surgery Which?
Patients who are candidates for surgery with a morbid obesity cause should be well informed that a single operation can not be solved and a second attempt may be needed in the future, and Tube gastrectomy should be the primary option in this context.
“By-pass” methods are often used as the first surgical procedure in the presence of very old type 2 diabetes with a body mass index above 60 (super super-obese) or long-acting insulin.
In the stomach by-pass, the problem of not being able to “endoscopically” leaving behind a large stomach epidemic without leaving it “blind”, and the difficulties of translating another intestine when it fails, has changed the meaning and significance of this initiative.
However, the “tube stomach” initiative, which has similar effects on weight and sugar control; even if it fails many years later, it can be easily converted to any other amelia. For the second time, a tube can even be re-sleeved and by-pass methods can be stored as a last chance for further use.
As a result, the decision on which patient to perform the surgery is largely linked to the characteristics of the patient. Presence of type 2 diabetes and control, age of the patient and cer