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Bariatric Surgery

Gastric bypass and other weight-loss surgeries — known collectively as bariatric surgery — involve making changes to your digestive system to help you lose weight. Bariatric surgery is done when diet and exercise haven’t worked or when you have serious health problems because of your weight. Some procedures limit how much you can eat. Other procedures work by reducing the body’s ability to absorb nutrients. Some procedures do both. While bariatric surgery can offer many benefits, all forms of weight-loss surgery are major procedures that can have serious risks and side effects. Also, you must make permanent health changes to your diet and do exercise to help ensure the long-term success of bariatric surgery.

Bariatric surgery is done to help you lose excess weight and reduce your risk of potentially life-threatening weight related to health problems, including:

  • Heart disease and stroke;
  • High blood pressure;
  • Nonalcoholic fatty liver disease (NAFLD) or nonalcoholic steatohepatitis (NASH);
  • Sleep apnea;
  • Type 2 diabetes.
    Bariatric surgery is typically done only after you’ve tried to lose weight by improving your diet and exercise habits.

In general, bariatric surgery could be an option for you if:

  • Your body mass index (BMI) is 40 or higher (extreme obesity);
  • Your BMI is 35 to 39.9 (obesity), and you have a serious weight-related health problem, such as type 2 diabetes, high blood pressure or severe sleep apnea. In some cases, you may qualify for certain types of weight-loss surgery if yourBMIis 30 to 34 and you have serious weight-related health problems.

Bariatric surgery isn’t for everyone who is severely overweight. You may need to meet certain medical guidelines to qualify for weight-loss surgery. You likely will have an extensive screening process to see if you qualify. You must also be willing to make permanent changes to lead a healthier lifestyle.

You may be required to participate in long-term follow-up plans that include monitoring your nutrition, your lifestyle, your behavior and your medical conditions.

As with any major procedure, bariatric surgery has potential health risks, both in the short term and long term.

Risks associated with the surgical procedure can include:

  • Excessive bleeding;
  • Infection;
  • Adverse reactions to anesthesia;
  • Blood clots;
  • Lung or breathing problems;
  • Leaks in the gastrointestinal system;
  • Death (rare).

Longer term risks and complications of weight-loss surgery vary depending on the type of surgery. They can include:

  • Bowel obstruction;
  • Dumping syndrome which leads to diarrhea, flushing, lightheadedness, nausea or vomiting;
  • Gallstones;
  • Hernias;
  • Low blood sugar (hypoglycemia);
  • Malnutrition;
  • Ulcers;
  • Vomiting;
  • Acid reflux;
  • The need for a second, or revision, surgery or procedure.
 

If you qualify for bariatric surgery, your health care team gives you instructions on how to prepare for your specific type of surgery. You may need to have various lab tests and exams before surgery. You may have restrictions on eating and drinking and which medications you can take. You may be required to start a physical activity program and to stop any tobacco use.

You may also need to prepare by planning ahead for your recovery after surgery. For instance, arrange help at home if you think you’ll need it.

 

Bariatric surgery is done in the hospital using general anesthesia. This means you’re unconscious during the procedure.

The specifics of your surgery depend on your individual situation, the type of weight-loss surgery you have, and the hospital’s or doctor’s practices. Some weight-loss surgeries are done with traditional large or open incisions in your abdomen.

Today, most types of bariatric surgery are performed with laparoscope. A laparoscope is a small, tubular instrument with a camera attached. The laparoscope is inserted through small incisions in the abdomen. The tiny camera on the tip allows the surgeon to see and operate inside your abdomen without making the traditional large incisions. Laparoscopic surgery can make your recovery faster, but it’s not suitable for everyone.

Surgery usually takes several hours. After surgery, you awaken in a recovery room, where medical staff monitors you for any complications. Depending on your procedure, you may need to stay a few days in the hospital.

Types of bariatric surgery

Obesity Treatment: Gastric Balloon

Gastric balloon is increasingly used for obesity treatment. With this procedure, an empty balloon is placed into the stomach with an endoscopy device. Afterwards, the balloon is blown. Due to the space occupied with the balloon, patients feel early satiety and fullness. However, it differs from other methods in one way that the balloon is removed after a while (6 months – 1 year). In this process, the patient loses 10-20% of their excess weights depending on their structure.

Gastric balloon is performed as a primary procedure for patients whose Body Mass Index is 30-40 kg/m2, who fail to lose weight despite weight-lose diet and exercise, and who are between 18-65 years old. On the other hand, it’s applied as a preparatory procedure in obese patients to diminish operation and anesthesia risks. Especially, in patients whose surgical risk is very high, this method is mostly preferred.

Gastric balloon should not be applied for the patients who have:

  • Gastritis, gastric ulcer;
  • Previous gastric operations;
  • Large hiatal hernia;
  • Pregnancy and breastfeeding;
  • Alcohol addiction;
  • Bleeding disorder.

 

Patients should fast for 8 to 12 hours before the operation. Procedure lasts 10-15 min on average. Patients are sedated to prevent any discomfort. First of all, esophagus, stomach and duodenum are evaluated with endoscopy. Afterwards, the balloon, lubricated with gel, is sent to stomach with ease and placed inside the stomach under endoscopic control. The balloon is inflated with serum or air using a special extension line inside the stomach. The procedure is completed. After this, patients are kept under observation for a few hours and later discharged. Patient don’t need to stay at hospital. However, it’s very important to keep in touch with the doctors for following processes.

Gastric bypass

In this surgical technique, in the first phase stomach is incised from incisura angularis, stomach capacity is reduced and tube-shape is given. In the 2nd phase, small intestine is specified between 150-200 cm on average (this length varies depending on body mass index, diabetes mellitus presence, total length of small intestine and metabolic rate of the patient). 

In 3rd phase, single anastomosis (connection) is applied between specified small intestine part and stomach, so that the food entering the stomach passes with bypass through the that part of the small intestine. In this technique applied especially in type 2 diabetes patients, it’s aimed to restrict the stomach and to accelerate food passing to the last part of small intestine, called ileum, to increase secretion of hormones and some substances in that area. 

So that, ß (beta) cells which are not functioning in pancreas will start to function and insulin resistance is reversed. In that way, patients will get rid of Type 2 diabetes mellitus.

After this operation, 85-90% of diabetes mellitus cases are regulated and patients quit the medication.

  • Shorter procedure;
  • Highly effective in weight loss;
  • It’s a reversible operation;
  • It’s an operation that can be preferred for revision after sleeve gastrectomy.

 

  • After the operation, patients need to use vitamins and some minerals throughout their lives;
  • It’s hard to examine bile ducts with E.R.C.P after operation.
 

Sleeve Gastrectomy

Even though Sleeve Gastrectomy Surgery is a kind of restrictive operation, scientific researches have found that it activates insulin sensitivity hormone such as GLP-1 arising from small intestine. So it’s not correct to evaluate Sleeve Gastrectomy just as a restrictive operation. In Sleeve Gastrectomy Operation, 75-80% of the stomach is removed vertically. Patients do not feel the need to fast as there is decrease in Ghrelin hormone released in the removed part of the stomach. Ghrelin is a peptide protein consisting of 28 amino acids and produced by parietal cells in upper part of the stomach, called fundus. It’s a strong orexigenic (appetite stimulant) peptide regulated with the activation of receptors in cranial hypothalamus or pituitary areas. As 80% of ghrelin peptide is released in fundus of the stomach, our patients can easily lose weight by applying recommended diet without feeling the need to fast. After this operation, stomach keeps its sleeve shape. Stomach its about the size of tea glass. After Sleeve Gastrectomy as the stomach capacity decreases, appetite stimulant-ghrelin also decreases and the patient won’t feel hunger, on the other hand, insulin resistance disappears. With these 2 effects, weight-loss will be observed in patients. Sleeve Gastrectomy is still the most common (60-70%) bariatric surgery in the world. It has been the most preferred operation as it’s safe and a short-term, patients are able to return their daily life quickly. In patients who gain weight after this operation, revision operations are carried out safely and easily. After this operation, Type 2 diabetes patients permanent success rate is between 50-55%. Hypertension can be controlled 60-70% permanently and patients quite their medications. Fatty liver decreases in a few months and insulin resistance disappears. We also observed that our patients who had sleep apnea, get rid of it. In scientific researches it’s stated that sleep apnea disappears with 80%.
Stomach botox, which has been used in the world for 10-15 years, is an endoscopic procedure which aims to paralyze fasting and appetite nerves of the stomach temporarily to provide weight loss. With this procedure, “Botulinum Toxin” (botox) is injected to some parts of the stomach. After the operation, muscle strain of the stomach is restricted, the stomach is emptied in a longer time and weight-loss process begins. In this procedure 300 unites of botox are injected into 3 various parts of the stomach. In this procedure, applied to fundus area in particular, fasting feeling is eliminated. As a result, this procedure eliminates fasting and gives an early satiety so that patients lose weight. As the procedure is performed with endoscopy, it lasts less then 20 minutes and the patients are discharged after they get relieved in the health center where procedure performed.
Stomach botox is performed for patients whose body mass index (BMI) is less than 35. This procedure is not a surgery neither an alternative to surgery. Therefore, it should be performed for the patients who have 15-20 kg excess weight, in particular. However, patient selection is very important. It should be noted that stomach botox will not benefit to morbid obese patients whose body mass index is 40 and more. In patients who have gastric ulcer or gastritis, stomach botox is performed after these diseases are treated.
Who can undergo stomach botox?

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