Obesity and metabolic surgery
Obesity is the accumulation of excess fat in the body. It is considered as one of the most important health problems of modern societies. Obesity causes many different diseases, is fatal and leads to psychosocial problems in patients. Many people try to lose weight by doing extreme diets, popular diets, or weight loss exercises. Unfortunately, without expert support, these efforts can lead to a yo-yo effect. After the end of the diet, weight gain often occurs. Bariatric surgery is being used more and more often, because it is difficult to lose weight due to diet, exercise, behavior changes and pharmacological methods, and the long-term success rate is low.
Who cannot have surgery
Those who will not benefit from the operation and those who have a fatal disease at an advanced stage cannot be operated on.
Although there are no absolute contraindications in bariatric surgery, there are relative contraindications. These include
- Severe heart failure
- Unstable coronary artery disease
- End-stage lung disease
- Active cancer treatment
- Portal hypertension drug / alcohol addiction Impaired mental capacity is a contraindication.
Crohn s disease is a relative contraindication.
Since bariatric surgery is performed under general anesthesia, any contraindication to general anesthesia is a contraindication to this operation.
Opinions Before Surgery
Living with obesity is a much greater risk than surgery
Obesity surgeries are not cosmetic surgery. In public opinion, however, obesity is viewed as a physical defect rather than a disease. Therefore, obesity treatments are not treated like other diseases such as blood pressure, diabetes, cancer, etc. Complications observed in the past for example Gastric banding has sparked prejudices about obesity surgery in society. Complications seen after the operations created prejudices against obesity operations in the community. Obesity does not have a sudden impact like acute illnesses, but it does have an insidious and serious impact on a person s entire life. Obesity is associated with long-term serious illnesses like diabetes and blood pressure. People who have obesity problems may show different tendencies, because they don t want to be disturbed by society s approach to viewing obesity as a mistake. They may have due to unsuccessful attempts at weight loss serious problems with self-confidence. As it would be illegal not to be able to get the results of their efforts to be uncomfortable while eating, which is one of the most basic needs and an act that usually is fun. When these and many other reasons are mentioned, different thoughts may arise, such as;
- Patients do not see the surgery as a treatment.
- They see the operation as an arbitrary choice
- The thought of taking risks from nowhere.
- To be willing to believe, that they are going with aesthetic concerns under the knife.
- Actually, I can lose weight and this operation is not necessary for me.
- I would lose weight anyway, if I did what I had to do after the operation.
- I have never managed to lose weight on a diet, so I’m going to fail again.
- Self-comparison with other patients who underwent surgery.
- At obesity-related diseases, the surgery could be seen as a miracle.
What should be considered after surgery?
Attention should be paid to fluid consumption
After surgery attention should be paid to fluid consumption.
- Nutrition rules and recommendations should be followed
- Attention should be paid to fluid consumption
- No smoking in the first month
- Abdominal exercise should not be done for 12 weeks
- Heavy exercise should be avoided in the first month
- Heavy duty should not be done during the first 2 weeks
- Pregnancy for the first 12 months
- Surgery should not be seen as a miracle
Attitude of Families and Relatives
Before the operation, they say ‘no’. After the operation they say; ‘I wish you had surgery much earlier.’
Different tendencies can be observed among the relatives of those who decide for an obesity surgery. A large majority are against surgery at the time of decision making. People who decide to have obesity surgery may have different tendencies. Generally, these people are the ones, who put the most pressure on because of your weight. In fact, for them, these attitudes are nothing more, than thinking about the health of their loved ones. There is no need to question the goodwill, but it is important to remember, that not all goodwill will produce good results. You can read this article to people who speak out against your operation, without any specific reason.
“Probably you can’t forget the possibility to lose the person you love and care about, out of nothing. You might even think about not talking about the weight problem anymore. Thoughts may arise like; ‘Isn t it too easy to choose surgery and its risks while losing weight with diet and exercise?’ You should know, that most of the relatives of the patients, who were opposing this operation, were saying after two months, “I wished you had the operation much earlier”. Please note that it is not easy for overweight people to opt for obesity surgery. It is not easy to lie under the knife and you should know that they don’t want to be constantly accused and they also don’t want to be seen as the cause of their problems. It is not easy to understand, what it means to be challenged, even if it’s the most basic daily needs (nutrition, physical activity, etc.). It is not enough to witness the situation. Obesity is an illness and unfortunately it is very difficult to lose weight successfully after certain weight levels. Do not be biased because of the news in the press, when you hear about techniques that are almost never used (gastric band, etc.) anymore. If an obesity operation were riskier than an obese life, it would not be preferred by doctors and would not be used increasingly. Hundreds of obesity surgeries are performed worldwide every day, and the complication rate for obesity surgeries is low, compared to other abdominal surgeries (including cesarean section). You may not trust doctors and popular trends, but statistics don t lie. Please consider the health problems associated with obesity and the risks of surgery and carry out analysis from precise, reliable and verifiable sources. Rely on science, not someone else s words, even if it is a doctor’s words. Remember that your support is very important at every stage of the operation. Your friend believes, that surgery is a need to overcome obesity and not because he is not able to lose weight. If you think your friend is not eligible for surgery, please find out who can undergo surgery.
Bariatric Training and Consultation
Informations about diet, exercise, medication, forbidden things, weight measurement, habits and metabolism will be given before discharge. 24/7 expert support can be provided if necessary.
Blood tests should be performed at regular intervals.
- The website login password is generated. Each patient is prepared for her nutrition, exercise, life, weight tracking, surgery information, control tests, advice, habits and so on. matters can only reach the web site module.
- 1.- 3.-6. - Twelve -18. In the 24th and 24th months, weight, nutritional - supplementary food - exercise - habits - aesthetics - psychology, etc. matters are evaluated in detail.
Which instruments are used in bariatric surgery
Specially used advanced laparoscopic instruments
The instruments used in bariatric surgery operations may differ from surgeon to surgeon. In addition to the basic surgical equipment, the materials used in sleeve gastrectomy are as follows;
- Trocar (material for laparoscopic instruments)
- Ligasure (surgical incineration)
- Tissel, (can be used to reduce bleeding according to the surgeon s request)
- Stapler (cutting and gluing tool at the same time)
- Laparoscopic Camera
Stapler brands: Covidien and Ethicon are the most preferred brands in obesity surgery in the world. With the widespread use of obesity surgery in recent times, Chinese production has become more prominent in the market, but it is seen that these brands are mostly used in the places where the surgical fee is low.
What Is Laprascopic Surgery?
Closed operations that do not require a large incision.
Laparoscopic or “minimally invasive” surgery is a special technique for performing the surgery. In the past, this technique has been widely used for gynecological surgery and gall bladder surgery. The use of this technique in the last 20 years has varied in surgical procedures. In traditional “open” surgery, the surgeon uses a single incision to enter the abdomen. Several 0.5-1 cm incisions are used in laparoscopic surgery. Each incision is called a “port.. A tubular instrument known as a trocar is placed in each port. Special instruments and a special camera, known as a laparoscope, are passed through the trochars during the procedure. At the beginning of the procedure, the abdomen is inflated with carbon dioxide gas to provide the surgeon s working and imaging field. Laparoscopy transmits images from the abdominal cavity to high-resolution video monitors in the operating room. During the operation, the surgeon monitors detailed images of the abdomen on the monitor. This system allows the surgeon to perform the same procedures as conventional surgery with smaller incisions.
Length of hospital stay is 4 days.
Generally, it is sufficient to stay in the hospital for 4 nights. One day before the surgery, hospitalization is started and examinations are started. In this process, preparations are completed by evaluating the safety of surgery, anesthesia and whether a combined operation is required. The patient is dressed with emboli socks before the operation. Pain may occur in the first hours after surgery. 6-8 after the operation, the gait is performed with the help of nurses and is removed after urine. The next day, transparent liquids are started to be consumed and a leak test is performed to determine if there is any leakage. Necessary treatments are made during the hospital stay to ensure the safety of the patient. After feeding, exercise and obesity surgery, the patient is discharged with detailed information about life.
How many days should I spend on obesity surgery
5 days is enough to leave.
It is enough to leave the operation for 5 days unless an extra treatment is required.
Why are Pre-operative controls necessary?
It is necessary to minimize the risks of surgery
1. Blood test To determine a possible problem in advance, to check if there is an obstacle to surgery, the patient
2. Cortisol suppression test, Obesity problem may also be caused by hormonal problems. It is very important to test the presence of diseases such as Cushing syndrome by pre-operative cortisol suppression for patient safety.
3. All abdominal ultrasound (usg) - (Radiology control) In terms of the safety of the patient s internal organs, lubrication, bile, stone and so on. ultrasound examination should be done with ultrasound, combined operations (removal of bile in case of stones in the gallbladder), and an open procedure that cannot be performed laparoscopically.
4- Endoscopy: It is important for the evaluation of conditions that may cause obstacles to surgery or cause postoperative problems such as ulcers in the stomach.
5- Psychiatric control; The psychiatrist should check the patient s drug-alcohol dependence, eating disorder, consciousness level and awareness. Thus, conditions such as possible anorexia and conditions that may lead to deterioration in the patient s health should be examined.
6- Internal Medicine - Endocrinology control; Diabetes, thyroid and many other diseases should be examined and conditions that may interfere with surgery, and the conditions to be considered during and after the hospital should be evaluated.
Who can have surgery
Obese people who fail to lose weight for a long time can have surgery
- People with a body mass index above 40 kg / m2
- Body mass index of 35 kg / m2 and more people with co-disease
- Body mass index of 30 kg / m2 and above and non-alcoholic comorbidity associated with concomitant disease (type 2 diabetes (T2DM), insulin resistance (IR) or impaired fasting glucose (IFG), high blood pressure (htn), dyslipidemia and at least one obesity fatty liver disease (NAFLD))
- In addition, long-term diet and other methods to lose weight with people who have failed sleeve gastric surgery
You can continue your daily life after discharge
Daily life can be continued after discharge. To return to the office, one week s rest is enough. Wait for 2 weeks for other light work and 1 month for heavy work. When you feel ready, you can have sexual intercourse. Light walks can be started immediately. After 1 week, you can go cycling and after 20 days you can start swimming.
Health After Bariatric Surgery
There is a 89% reduction in the risk of death and a 95% improvement in quality of life.
After bariatric surgery, patients lives change rapidly. After the surgery;
- 40% to 100% of excess weight is expected to be
- Diabetes (Type 2),
- Sleep apnea ,
- Joint pain,
- Polycystic ovary syndrome,
- High cholesterol levels,
- Thyroid hormones
- in Asthma
- Reflux complaints
- The problem of incontinence
- In gout
- Balls in vascular circulation disorder
- Metabolic syndrome
- Liver problems (fatty, hardening, etc.)
- False brain tumor
- Menstrual irregularity
- Complete recovery and / or improvement occurs.
- Positive changes in self-esteem,
- Motivation of success in losing weight
- Not feeling guilty after dinner,
- enjoy eating,
- Increased sexual perfomance,
- Improvement and / or improvement of pregnancy problems
- Clothing exchange,
- Improvements occur in situations such as being in social settings.
The first 2 weeks after liquid should be continued with puree and soft solids
From the day of discharge
- 0-14. Days of liquid
- 15-28. Days of mash
- 2. months of soft solid foods
- After 2 months, normal foods should be consumed.
- Food should be consumed slowly and chewed enough
- Solid-liquid separation should be made
- Food should not be continued after saturation
What should be considered before surgery?
Smoking, alcohol consumption should be avoided and diet should be done if necessary.
- Accurate information should be given about the weight and height of the patient, the history of his / her weight, the health history (known diseases, medications, surgery, etc.).
- Adequate information should be given about the operation. Obesity surgery is a process that will change your life.
- If necessary, diet and exercise may be required for a certain period of time
- Prior to surgery, the use of blood thinners should be discontinued with the consent of the physician.
- Intensive smoking and alcohol consumption should be avoided.
- Weight should not be taken after deciding on surgery