İbrahim Karataş | Bariatric Surgery

OBESITY AND METABOLIC SURGERY

Metabolic surgary operations are effective and successful methods which have been used for more than 65 years in obesity treatments. The techniques used since then have gradually advanced and have been applied to tens of thousands of people until today. In addition to providing weight control with metabolic surgery procedures, obesity-related metabolic problems such as T2DM, HT, dyslipidemia and sleep apnea are also significantly improved. The treatment of the metabolic disturbances in the question is so fast and clear that it is not possible to explain this effect only with weight loss. Today, the term ‘metabolic surgery’ is used more frequently instead of bariatric surgery since individuals with obesity provide significant improvements not only in their weight but also in all their metabolic activities after the procedure.

Advantages provided with metabolic surgery

In the literature, there are long-term follow-up results of approximately 20 years of metabolic surgery cases. According to these results, there is a significant reduction in almost all obesity-related complications. According to Swedish Obesity Study (SOS) data, a 30% reduction in all-cause mortality was achieved in 11 years of follow-up after BC surgery. It is stated that metabolic surgery is the most effective solution for morbidly obese people in terms of treatment of T2DM and other diseases that may occur in patients who have not been treated with metabolic surgery, prevention of hospitalizations, loss of work force and premature death.

Suitability criteria for metabolic surgery

1-) BMI ≥ 40 kg/m2 (Calculate Mass Index)

2-) In case of BMI ≥ 35 kg/m2, there must be at least one comorbid obesity-related disease.

These associated conditions are:

Type 2 diabetes mellitus
Hypertension
Dyslipidemia
Sleep-apnea syndrome
Obesity-hypoventilation syndrome
Pickwick syndrome (combination of sleep-apnea syndrome and obesity-hypoventilation syndrome)
Non-alcoholic fatty liver disease or “non-alcoholic steatohepatitis (NASH)”
Pseudotumor cerebri
Gastro-esophageal reflux disease
Asthma
Venous stasis disease
Severe urinary incontinence
Arthritis affecting daily life

The conditions that constitute an obstacle for metabolic surgery

Being younger than 18 or older than 65 is evaluated by our doctor only in cases where there is a serious comorbidity (such as T2DM, HT).
Presence of an untreated and obesity-causing endocrine disease (such as Cushing’s, hypothyroidism, insulinoma)
Having an untreated eating disorder (such as bulimia nervosa)
Presence of untreated major depression or psychosis
Presence of severe coagulopathy
Presence of cardiac disease severe enough to preclude receiving anesthesia
Alcohol or substance abuse
Inability to comply with dietary recommendations, such as lifelong vitamin replacement or a calorie-restrictive diet
Being currently pregnant or having a pregnancy plan within 12-18 months
Known cancer disease
Severe gastroesophageal reflux disease (GERD) (especially for sleeve gastrectomy)
Portal hypertension
Gastric bypass surgery in patients with Crohn’s disease

Advantages

It is a safe and simple application. In addition to its restrictive effect, it also reduces appetite by reducing orexigenic hormone levels such as ghrelin. Dumping syndrome does not occur since the pylorus is intact. The risk of malnutrition is low. It is preferred in super obese patients with high surgical risk or those with Crohn’s disease. Weight loss: 60-67% in the first year, 53-65% in the 5th year.

Laparoscopic Adjustable gastric band

It has been used as a restrictive method since 2001 in the USA with FDA approval. An inflatable silicone band is wrapped around the stomach, 3 cm below the esophago-gastric junction and a 25-30 cm reservoir is created proximally. At the other end of the tape, there is a port placed under the skin. The caliber of the gastric opening can be changed by filling and emptying with serum. With the feeling of satiety, the patient’s calorie intake decreases by 1000-1200 kcal.

Roux en-Y Gastric Bypass (RYGB)

In RYGB, a section is made in the upper part of the stomach and thus, a small gastric pouch between 10 and 30 ml in size is created. This gastric pouch bypasses the rest of the stomach, duodenum and a small part of the jejunum. In the second National Bariatric Surgery (NBSR) report, excessive weight loss 1 year after gastric bypass was 68.7%, and excessive weight loss within 3 years after surgery was 65.4%.

Mini gastric bypass

Mini gastric bypass (MGB) is a procedure recently increasingly used in some centers. Although mini gastric bypass is the easiest technique since it involves less anastomosis and the anastomosis is performed distal to the long gastric pouch, it is recommended to be performed by trained surgeons in experienced centers. Restricted stomach volume reduces the amount of meals and it is an easy technique to practice and learn.

Biliopancreatic diversion ± duodenal switch

Biliopancreatic diversion (BPD) can be performed with or without a duodenal switch (DS). In biliopancreatic diversion, a long enteric leg gastroileostomy and a short common canal are created together with distal gastric resection. It provides maximum weight loss in the long term with minimal dietary restrictions. It is the most effective technique in the recovery of T2DM, HT and dyslipidemia.

VISUAL You can contact us if you want to learn the most suitable surgical operation for you in the light of examination and tests performed by our doctor.

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