How Do We Weaken?

Obesity surgeries provide weight loss by restricting the stomach capacity, disrupting the absorption of food from the intestine (in cases where a part of the small intestine is bypassed) or a combination of both. In addition, these surgeries cause hormonal changes. Today, almost all of these surgeries can be performed laparoscopically .

Gastric reduction (sleeve gastrectomy) is one of the most frequently performed obesity surgeries worldwide . Second and third place is gastric bypass and mini gastric bypass surgery. Gastric band (clamp) surgery is an almost abandoned method, which is used very little now, although it was used a lot in the past. In addition, duodenal switch surgery, in which most of the intestines are bypassed, is also applied to selected patients. So how do we lose weight?

Tube Stomach (Sleeve Gastrectomy, Stomach Reduction) Surgery

Laparoscopic sleeve gastrectomy is a surgical method in which 80% of the stomach is cut and removed with a special device called a stapler.

It was first applied as the first stage of 2-stage duodenal switch (the type of surgery in which the intestines are shortened) surgery in extremely obese and high-risk patients, but since then it has been found to be effective and sufficient as a stand-alone bariatric surgery. Today it has become the most frequently performed surgery in America and Europe; It constitutes approximately 60% of all bariatric surgeries .

Gastric sleeve surgery works in many ways. First of all, because the new stomach is very small in volume compared to the normal stomach; By eating very little, satiety is achieved. In fact, the biggest effect of this surgery is the change in intestinal hormones. A hormone called ghrelin is secreted from the upper part of the stomach called the fundus. This hormone is a hormone that triggers hunger that allows us to eat constantly. Since the fundus area where this hormone is secreted is removed with surgery, the feeling of hunger is suppressed for a long time and it is possible to lose weight comfortably.

In addition, with the effect of various hormones, complete or almost complete improvement is achieved in diabetes mellitus. Studies have shown that sleeve gastrectomy surgery is as effective as gastric bypass in terms of weight loss and corrective effect on diabetes in the short term . The complication rate associated with this surgery is also much lower than gastric bypass.

Our success rate is very high in our tube stomach series over 1000 , which has been followed up for close to ten years . Even after 2 years of follow-up, the rate of getting rid of excess weight in our patients is 84% , which is much higher than the average in the world (60-70%) .

Tube Stomach Surgery Advantages

1. Its restrictive effect on eating lasts for a long time (it provides satiety by eating very little).
2. In comparative studies, it has been shown to provide as effective and rapid weight loss as gastric bypass. According to many studies, at 5-year follow-up, the rate of getting rid of excess weight is over 50% and most of the patients were able to maintain their weight after losing weight. It is an operation with hormonal effects. Its curative effect on early stage type 2 diabetes is as effective as gastric bypass; Recent scientific studies have shown that there is not much difference between gastric bypass and gastric bypass in patients with severe diabetes lasting more than 10 years.
3. The functional anatomy does not change, only the volume of the stomach is reduced. All organs are in place. As in gastric bypass, the intestines are not replaced. When the patient gains weight back, it gives the patient the chance to have another surgery (for example, bypass).
4. Post-operative pain is minimal. Hospital stay and recovery time are very short. (The surgery is done through small holes opened in the abdomen)

Disadvantages of Gastric Sleeve Surgery

1. It is an irreversible process as 80% of the stomach is removed.
2. May cause long-term vitamin deficiency.
3. Long-term (after 5 years) risk of regaining weight is 20-30%

Gastric Bypass

Gastric bypass was the gold standard method before sleeve gastrectomy. Gastric bypass surgery consists of two stages. First about 30-40 ml in the stomachA part of the stomach is cut to create a volume of . The remaining part of the intestine is rejoined with the small intestine at a lower point. Thus, both the volume of the stomach is reduced, saturation is achieved with less food, and the absorption of nutrients is reduced by skipping a certain part of the small intestine. Stomach acid and digestive enzymes required for the digestion of food come together in the lower part of the small intestine. Thus, less calorie intake is provided by being satiated with small portions. By triggering digestive hormones, it has a healing effect on sugar.

Gastric Bypass Advantages

1. In the long term, the rate of getting rid of excess weight is between 60-80% .
2. Since the stomach capacity is reduced, satiety is achieved by eating very little.
3. Triggering various digestive hormones; It provides many benefits such as suppression of hunger and improvement of diabetes.
4. In the long term, the rate of getting rid of excess weight and maintaining it is over 50% .

Gastric Bypass Disadvantages

1. It is a technically more difficult operation compared to sleeve gastrectomy and the risk of complications is higher. The biggest handicap in gastric bypass surgery is the lack of a new surgery option when patients regain weight.
2. In the long term, it can lead to a deficiency of vitamins such as vitamin B 12, iron, calcium and folic acid. Therefore, lifelong vitamin and mineral support is required.
3. Difficulty reaching the remaining stomach (the remaining stomach and duodenum cannot be reached by oral endoscopy).
4. Internal herniation of the intestines (internal herniation).
5. Dumping syndrome (after eating, feeling sick, nausea, headache).
6. Marginal ulcer (ulcer (wound) formed at the junction of the stomach and intestine, can cause perforations).

Mini Gastric Bypass

Mini gastric bypass is a type of obesity surgery that is becoming more and more common in the world. In the first stage, the stomach is cut, similar to the tube stomach, and a long, thin banana-shaped stomach is formed. Then, the small intestine is bypassed in the range of 150-200 cm and brought to the stomach with a single anastomosis. It is an easier operation than classical gastric bypass surgery. (Since it is a single anastomosis)

Mini Gastric Bypass Disadvantage

In some patients, it may cause bile reflux as bile passage into the stomach. Apart from that, the negativities seen in gastric bypass can also be seen in mini gastric bypass (stomach ulcer, dumping syndrome, etc.).

Biliopancreatic Diversion with Duedonal Switch (BPD/DS)

Biliopancreatic Diversion Surgery with Duedonal Switch consists of two stages. A large part of the stomach is removed and the tube stomach is brought. In the second stage, it is bypassed (combined) with the small intestine segment. The duodenum (duodenum) is separated just below the pylorus, which is the exit door of the stomach, and the lower small intestine is connected to the exit door of the stomach.

Thus, after the food passes through the newly formed tube stomach, it bypasses a long part of the small intestines and goes directly to the lower part of the small intestines. About three quarters of the small intestines are bypassed. Pancreatic enzymes and bile acids, which are necessary for digestion, meet with food in the last part of the small intestine and digestion takes place.

Since a very long part of the small intestine is bypassed with this surgery, the absorption of nutrients and calorie intake are also significantly reduced. In this surgery, intestinal hormones are affected, as is the case with tube stomach and gastric bypass, suppressing appetite and providing a good blood sugar control. It is one of the most effective surgical methods in the treatment of diabetes.

Advantages of Biliopancreatic Diversion with Duedonal Switch

1. It leads to more effective weight loss than sleeve gastrectomy and gastric bypass. The rate of getting rid of excess weight in the five-year follow-up is 60-70% .
2. It is more effective in sugar control than sleeve gastrectomy and gastric bypass.
3. It reduces oil absorption by 70% .
4. Since a large part of the small intestines is bypassed, weight loss continues as the food absorption will decrease very little even if the patients eat in normal sizes.

Disadvantages of Biliopancreatic Diversion with Duedonal Switch

1. The risk of complications and mortality are higher than sleeve gastrectomy and gastric bypass surgery.
2. It requires a longer hospital stay than other methods.
3. Protein deficiency due to severe malabsorption and deficiency of many vitamins and minerals (iron, calcium, zinc, fat-soluble vitamins such as vitamins A, E, K and D) can be seen in the long term.
4. For this reason, it is very important to follow the diet strictly and to support vitamin and mineral in order to avoid complications in the long term.

Adjustable Gastric Band (Stomach Clamp) Surgery

In clamp surgery , an inflatable band is placed on the upper part of the stomach. The band is inflated with physiological saline by means of a connection apparatus placed under the skin. In this way, the passage of nutrients is controlled. This method, which was used frequently in the past, is almost abandoned today. Clamp surgeries have had two major problems:

• Because a foreign substance is placed in the body, complications such as abrasion of the stomach wall and penetration have occurred in some patients.
• Since the ghrelin hormone, which triggers hunger secreted from the fundus of the stomach, was not suppressed, people's urge to eat could not be suppressed.

In the next period, due to the inability to suppress the urge to eat or problems related to the band, most of the cuffs had to be removed or the liquid inside could not be used fully. Today, the clamp method is almost never used.