- 1. What are the Types of Obesity Surgery?
- 2. What is Obesity Surgery?
- 3. Am I Eligible for Bariatric Surgery?
- 4. How is Obesity Surgery Performed?
- 5. Preparation for Obesity Surgery
- 6. Obesity Surgery Process
- 7. Post-Obstetrics Surgery Process
- 8. Possible Complications After Bariatric Surgery
- 9. Success Rates of Obesity Surgery
- 10. Criteria for Successful Obesity Surgery
- 11. Obesity Surgery Prices
- 12. Choosing an Institution/Doctor in Obesity Surgery
The goal of bariatric surgery is to limit calorie intake and promote weight loss by reducing stomach volume or changing the way food is digested and absorbed.
Prof. Dr. Mehmet ÖZDOĞAN
Types of Surgery for Obesity Treatment
1. Sleeve Gastrectomy
Sleeve gastrectomy is one of the most commonly performed bariatric surgery methods. In this operation, a large portion of the stomach is removed, leaving only a narrow, tube-shaped stomach. Since the stomach volume is reduced, the person eats less and feels full more quickly. In addition, appetite decreases due to the decrease in appetite-controlling hormones.
2. Gastric Bypass Surgery
Gastric bypass is a procedure that both reduces the stomach volume and bypasses part of the intestines. By bypassing most of the stomach, food is directed to the lower part of the small intestine. This allows for less food to be consumed and less absorption of food. It is also an effective method for controlling type 2 diabetes.
3. Duodenal Switch with Biliopancreatic Diversion (BPD-DS)
This is a more complex surgery that involves reducing the volume of the stomach and bypassing a large portion of the small intestine. This surgery severely limits the absorption of nutrients and is used in individuals with very high BMIs.
4. Transit Bipartition
Transit bipartition is an innovative surgical method developed in the field of obesity and metabolic surgery in recent years. This operation is performed to both provide weight loss and control metabolic diseases such as type 2 diabetes. Transit bipartition surgery is a combination of sleeve gastrectomy and bypassing a portion of the intestines. In this way, both the stomach volume is reduced and some of the food follows the normal digestive tract while the other portion is directed directly to the lower parts of the small intestine.
Mini Gastric Bypass
Mini gastric bypass (MGB) is an effective bariatric surgery method that aims to lose weight and solve obesity-related health problems. It is similar to traditional gastric bypass surgery, but it is performed with a simpler technique and the operation time is shorter. Mini gastric bypass reduces the volume of the stomach and eliminates part of the digestive system, resulting in weight loss. This surgery works by reducing both the amount of food taken in and the absorption of food.
What is Obesity Surgery?
Suitability for Bariatric Surgery
Suitability for obesity surgery is evaluated according to the person's health status, body mass index (BMI) and obesity-related complications. Obesity surgery is usually applied to people who cannot lose weight with methods such as diet, exercise and drug treatments and who have serious health problems. Before the surgical intervention, factors such as the person's general health status, psychological suitability and lifestyle are also taken into consideration.
Suitability Criteria for Obesity Surgery
1. Body Mass Index (BMI)
BMI is a measure that evaluates a person's weight according to their height and plays an important role in suitability for obesity surgery. According to BMI values, eligibility is as follows:
- BMI 40 and above: These people are classified as "morbidly obese" and may be suitable for surgical treatment.
- BMI between 35-40 and those with serious health problems: If you have serious health problems related to obesity such as type 2 diabetes, high blood pressure, sleep apnea, surgical intervention may also be suitable in this case.
2. Health Problems Related to Obesity
Obesity surgery is performed not only for the purpose of losing weight, but also to treat serious health problems caused by obesity. These health problems may include:
- Type 2 Diabetes: Blood sugar levels may improve rapidly after surgery, and some patients may stop taking medications.
- High Blood Pressure (Hypertension): Blood pressure levels may return to normal after surgery.
- Sleep Apnea: Sleep apnea symptoms may decrease with weight loss after surgery.
- High Cholesterol: Cholesterol levels may improve with weight loss after surgery.
3. Failure of Other Weight Loss Methods
Bariatric surgery is generally considered an option for individuals who have not achieved permanent weight loss with traditional methods such as diet, exercise and medication. If you have not achieved permanent success despite your long-term weight loss efforts, surgical methods may be considered.
4. General Health Status
Before the surgical procedure, the patient's general health status is evaluated in detail. Conditions such as heart disease, kidney failure or serious respiratory problems may make surgery risky. Therefore, your suitability for obesity surgery is determined by a comprehensive medical evaluation.
5. Psychological Suitability
Bariatric surgery is a process that requires lifestyle changes. Therefore, it is important for the patient to be able to adapt to these changes psychologically. Being disciplined about diet and exercise after surgery is critical to the success of the surgery. It is important to receive psychological support before and after surgery for people who have psychological problems such as eating disorders, depression or anxiety.
6. 18-65 Age Range
Bariatric surgery is generally suitable for people between the ages of 18-65. Surgery is not recommended for individuals under the age of 18 except in very special cases. In patients over the age of 65, surgical suitability is assessed by taking into account their general health status.
7. Preparation for Post-Operative Lifestyle Changes
Adopting a healthy lifestyle after bariatric surgery is important for the success of the surgery. Patients need to pay attention to their diet and exercise habits after surgery. Surgical methods help with weight loss, but long-term success depends on the patient's lifestyle changes.
Who is Not Suitable for Obesity Surgery?
- Those with serious psychiatric illness: Surgery may not be appropriate for people with psychiatric illnesses that are too serious to manage the post-operative process healthily.
- Those with alcohol and substance addiction: Since it is difficult to adapt to lifestyle changes after surgery, surgical treatment is not recommended for these people.
- Those with very high surgical risks: Heart disease, serious respiratory problems or other medical conditions that increase the risk of surgery may not make surgery appropriate.
Obesity Surgery Process
1. Preoperative Process
a. Initial Examination and Evaluation
Before starting the bariatric surgery process, the patient must undergo a comprehensive evaluation. This evaluation includes:
- Body Mass Index (BMI): Used to determine whether you are suitable for surgery. If your BMI is generally over 40 or between 35-40 and you have serious health problems related to obesity, you may be a candidate for surgery.
- General Health Status: The status of organs such as heart, lung, and kidney functions are checked. It is examined whether there are obesity-related problems such as diabetes and hypertension.
- Psychological Assessment: Psychological support may be required to understand whether you are able to adapt to post-operative lifestyle changes.
- Nutrition Counseling: It is important to work with a nutritionist before surgery and get information about the diet to be followed after surgery.
b. Preparation for Surgery
Patients may need to make some changes in their nutrition and lifestyle habits before surgery:
- Diet: Weight loss is usually achieved with a low-calorie diet before surgery. This helps shrink the liver and make the surgery safer.
- Smoking and Alcohol Consumption: It is important to quit smoking and drinking alcohol before surgery, as these substances can negatively affect the healing process.
- Exercise: Increasing physical activity helps the body adapt better to the post-operative process.
c. Pre-Operative Tests
Some tests are performed before the surgery. These tests usually include blood tests, ECG (heart electrocardiogram), chest X-ray and other tests to evaluate your general health status. Evaluations are also performed to determine whether you are suitable for anesthesia.
2. Surgery Process
a. Choosing the Type of Surgery
Obesity surgery involves various methods and the most appropriate method for each patient may be different. Commonly applied bariatric surgery types are:
- Sleeve Gastrectomy: It is the creation of a tube-shaped stomach by removing a large portion of the stomach. It both reduces the amount of food taken and affects the hormones that control appetite.
- Gastric Bypass: It is the method of connecting a small portion of the stomach to the intestines and bypassing a large portion of the food. This method limits both food intake and absorption.
- Mini Gastric Bypass: This is a simpler version of the classic gastric bypass surgery, but it works in a similar way.
- Other Methods: More complex methods such as biliopancreatic diversion and duodenal switch can also be used.
b. Surgery Process
The surgery is usually laparoscopic (closed surgery), meaning it is done by making several small incisions instead of one large incision. The procedure time may vary depending on the type of surgery, but it usually takes between 1-3 hours. Laparoscopic surgery is less invasive, so the recovery process is faster.
c. Post-Operative Hospital Stay
Post-operative hospital stay is usually between 2-3 days. During this period, the patient's general condition is monitored, pain control is provided, and fluid intake is started. Doctor checks are performed to monitor possible complications.
3. Post-Operative Process
a. Initial Period (First Few Weeks After Surgery)
- Liquid Diet: A liquid diet is applied for the first few days after surgery. Liquid intake is started gradually and the stomach starts to adapt to the new situation.
- Puree and Soft Foods: After the first 2-3 weeks of liquid diet, puree and soft foods are switched to. It is important not to put too much pressure on the stomach during this period.
- Vitamin and Mineral Supplements: Since nutrient absorption decreases after surgery, vitamin and mineral supplements should be taken, especially after surgeries such as gastric bypass. Supplements such as B12, iron, calcium and vitamin D are often recommended.
b. Long-Term Nutrition and Lifestyle Changes
- Small Portions: Portions become smaller after surgery due to the reduced stomach size. A person feels full with a small amount of food.
- Protein-Based Nutrition: A protein-rich diet is important during the post-operative recovery process and weight loss process.
- Water Consumption: It is important to ensure adequate water consumption, but fluids and meals should be taken at separate times.
- Exercise: Regular physical activity accelerates the weight loss process and improves overall health. Starting with light exercises such as walking and progressing to more intense exercises is important for long-term success.
c. Follow-up and Check-ups
Regular doctor check-ups are important during the post-operative period. These checks are necessary to monitor weight loss, vitamin and mineral deficiencies, and possible complications. In addition, post-operative psychological support and dietitian follow-up are also important steps for a successful outcome.
Possible Complications After Bariatric Surgery
1. Infection
There is a risk of infection developing in the wound or in the body after surgery. Infection can usually occur due to failure to keep the surgical area sterile, negligence in wound care, or a weakened immune system. Signs of infection include redness, swelling, increased temperature, fever, and pain in the wound area. If left untreated, it can reach serious levels. Treatment is usually with antibiotics, but more severe cases may require additional interventions.
2. Anastomosis Leaks
During surgeries such as gastric bypass and sleeve gastrectomy, leaks can occur at the connections between the stomach and intestines (anastomoses). These leaks can cause the contents of the stomach or intestines to leak into the abdominal cavity, which can lead to serious infections such as peritonitis. Symptoms of leaks include fever, abdominal pain, nausea, and vomiting. Anastomotic leaks usually occur within the first few days after surgery and may require emergency care.
3. Bleeding
Internal or external bleeding may occur during or after surgery. This is usually due to damage to the blood vessels in the surgical area. Bleeding may be noticed by symptoms such as blood in the stool after surgery or extreme weakness due to blood loss. In severe cases, additional surgery may be required.
4. Dumping Syndrome
Dumping syndrome is a common complication, especially in patients who have had gastric bypass surgery. This condition occurs when food passes quickly from the stomach into the small intestine. Dumping syndrome symptoms include nausea, dizziness, sweating, palpitations, and diarrhea. These symptoms usually occur after eating. Eating habits such as avoiding sugary and fatty foods, eating small portions, and eating slowly can help control this syndrome.
5. Nutritional Deficiencies
Vitamin and mineral deficiencies are common after bariatric surgery, especially after surgeries that affect the absorption mechanism, such as gastric bypass. Since the body's ability to absorb nutrients decreases after surgery, patients may need to take vitamin and mineral supplements for life. The most common deficiencies are:
Vitamin B12 deficiency: Can have negative effects on the nervous system and cause anemia.
Iron deficiency: Can cause anemia, causing symptoms such as fatigue, weakness and pale skin.
Calcium and vitamin D deficiency: Can cause osteoporosis and a tendency to fractures.
Regular monitoring of these deficiencies and treatment with appropriate supplements are important.
6. Intestinal Obstruction
After surgery, intestinal obstruction may develop. This may occur as a result of incisions made during surgery, adhesions in the intestines, or incorrectly routing the intestines. Intestinal obstruction presents with symptoms of severe abdominal pain, nausea, vomiting, and difficulty defecating. This is a serious condition and may require emergency surgery.
7. Gallbladder Stones
Rapid weight loss after bariatric surgery can lead to gallstone formation. Gallstones can block the bile ducts, causing pain, infection, or inflammation of the gallbladder (cholecystitis). Some patients may be given medication after surgery to prevent gallstone formation. If gallstones cause severe pain, gallbladder surgery may be necessary.
8. Thrombosis and Pulmonary Embolism
Serious complications such as deep vein thrombosis (blood clots in the legs) and pulmonary embolism (blood clots traveling to the lungs) can develop after bariatric surgery, although rare. Thrombosis occurs due to immobility and slow blood flow during surgery. Pulmonary embolism is a life-threatening condition. To prevent these complications, patients are usually given blood thinners after surgery and early movement is encouraged.
9. Stomach Ulcer
After bariatric surgery, ulcers may develop in the stomach or small intestine. Especially in patients who have had gastric bypass surgery, ulcers may occur as a result of stomach acid damaging the small intestine. Ulcers present with symptoms such as stomach pain, heartburn, and vomiting. Treatment is usually with stomach-protective medications, but in severe cases, surgery may be necessary.
10. Weight Gain Back
Some patients may regain weight in the long term after successful weight loss after surgery. Bariatric surgery is a tool for permanent weight loss, but patients must maintain healthy eating habits and exercise regularly after surgery. Otherwise, weight regain is possible. To prevent weight regain, it is important for patients to be disciplined about their diet and lifestyle after surgery.
11. Psychological Problems
Some patients may experience psychological difficulties after bariatric surgery. Rapid weight loss after surgery can change a person's body image and cause emotional turmoil. In addition, it can be difficult to change past eating habits during the weight loss process. It may be beneficial for patients to receive psychological support during this process. Psychological counseling can help cope with problems such as eating disorders, depression or anxiety.
Success Rates of Obesity Surgery
Success Rates and Criteria
1. Weight Loss Success
After bariatric surgery, most patients can lose 50-80% of their initial weight. The amount of weight loss may vary depending on the surgical method used:
Sleeve Gastrectomy: Patients usually lose 50-70% of their excess weight in the first 12-18 months after surgery. This method reduces the stomach volume, allowing less food intake.
Gastric Bypass: With this surgery, patients usually lose 60-80% of their excess weight. The stomach volume is reduced and nutrient absorption is limited.
Mini Gastric Bypass: Up to 60-70% of excess weight can be lost. The success rates of this method are similar to gastric bypass.
Biliopancreatic Diversion and Duodenal Switch: This method is one of the methods that provides the highest weight loss and can provide weight loss of up to 70-80% of excess weight.
2. Improvement of Obesity-Related Health Problems
The success of bariatric surgery is not only measured by weight loss, but also the control and recovery of obesity-related diseases is an important criterion. Bariatric surgery alleviates or completely cures many health problems:
Type 2 Diabetes: Gastric bypass and sleeve gastrectomy surgeries are quite successful in controlling type 2 diabetes. Blood sugar levels return to normal in most patients, and some patients can stop using insulin or medication.
High Blood Pressure (Hypertension): Blood pressure levels decrease with weight loss after surgery, and many patients can reduce or completely stop taking blood pressure medications.
Sleep Apnea: Sleep apnea symptoms are greatly reduced with weight loss after bariatric surgery. Many patients do not need to use a sleep apnea device.
High Cholesterol: Cholesterol levels usually improve after surgery, and the risk of cardiovascular disease decreases.
3. Increased Quality of Life After Surgery
Obesity surgery is also successful in improving the quality of life of patients. With weight loss and improved health, the capacity to perform daily living activities increases. Movement becomes easier, joint pain decreases, and patients begin to live a more active life. In addition, increased self-confidence and psychological well-being are frequently observed success criteria after surgery.
Obesity Surgery Prices
1. Type of Surgery
Different types of bariatric surgery have a direct impact on cost. Since the complexity, duration of surgery, and materials used are different for each surgical method, these costs are reflected in these. For example:
Sleeve Gastrectomy: It is one of the most common bariatric surgeries. The cost is usually lower than gastric bypass and more complex surgeries.
Gastric Bypass: It is a more complex surgery because in addition to the stomach reduction, a portion of the intestines are also bypassed, and its cost is usually higher than the sleeve gastrectomy.
Mini Gastric Bypass: It can offer a similar cost to standard gastric bypass, but it may be more appropriate in some cases because it requires a single anastomosis.
Biliopancreatic Diversion and Duodenal Switch: It is one of the most complex and costly surgeries, because both the stomach is reduced and a large portion of the intestines are bypassed.
2. Hospital Selection
The quality of the hospital where the surgery will be performed is also an important factor affecting the cost. Bariatric surgeries performed in private hospitals may be more costly than in public hospitals. Additionally, surgery costs may be higher in internationally recognized and accredited surgical centers. Luxury hospitals or private health centers in large cities may have higher surgery costs.
3. Experience of the Surgeon and His Team
Experienced and successful surgeons can often charge higher fees. Factors such as the surgeon's level of expertise, the number of previous bariatric surgeries, and their success rate affect the cost. The experience and expertise of the team performing the surgery (anesthesiologists, nurses, and other support staff) can also increase the cost.
4. Pre- and Post-Operative Care
The cost of surgery usually includes preoperative testing, dietitian and psychological evaluations, postoperative checkups and follow-up services. Long-term care such as postoperative nutrition plans, vitamin and mineral supplements and lifestyle changes may also add up.
5. Insurance Coverage
Insurance companies often offer policies that cover bariatric surgery, but each insurance plan is different. Some insurance policies may cover bariatric surgery in part or in full, while others may only cover it under certain conditions (for example, if there is morbid obesity and serious health problems). If insurance does not cover the cost, patients must pay for it themselves.
Hospital / Doctor Selection for Obesity Surgery
1. Accreditation and Certificates
The hospital or clinic you choose should have national or international accreditations. Accredited institutions guarantee that healthcare services are provided at high standards. In addition to being a hospital/doctor approved by the Ministry of Health, international accreditations such as Joint Commission International (JCI) can be an important reference for the hospital's reliability. Accreditations show that the health center meets certain standards in safety, hygiene, patient care and surgical practices.
2. Experienced and Expert Surgeons
Surgical intervention is directly related to the surgeon's experience and expertise. Choosing an institution that has surgeons who are experts in obesity surgery and have many years of experience in this field increases the chance of success of the surgery. The surgeon who will perform the surgery should have received sufficient training, especially in the field of bariatric surgery, and should be performing such surgeries regularly. The surgeon's success rates and past patient experiences should also be taken into consideration.
3. The Surgeon and Team Must Specialize in Bariatric Surgery
Bariatric surgery requires a multidisciplinary approach. In addition to the surgeon who will perform the surgery, the anesthesiologist, dietician, psychologist, nurses and other healthcare personnel must be experienced in bariatric surgery. The entire team's understanding of the bariatric surgery process and the importance of postoperative care positively affects the patient's recovery process.
4. Hospital Equipment and Technology
It is important for the safety of the surgery that the hospital you choose is equipped with modern surgical equipment. Surgeries performed with modern techniques such as laparoscopic surgery are less invasive and speed up the recovery process. The high technology of operating rooms and intensive care units allows for rapid management of possible complications. In addition, the hospital's advanced intensive care service is an important factor for post-operative care.
5. Post-Operative Follow-up and Support Programs
Successful bariatric surgery requires regular follow-up and support in the post-operative period. A reliable institution does not leave the patient alone after the surgery and offers a long-term follow-up process. This process includes dietician control, vitamin and mineral supplements, psychological support and regular doctor visits. It is important that the selected hospital offers a comprehensive program that will provide patient follow-up in the post-operative period. This increases post-operative success and prevents weight regain.
6. Patient Reviews and Success Rates
Researching patient reviews about the hospital or surgeon you are considering can provide an important clue about reliability. Reading the experiences of patients who have had bariatric surgery before can provide information about the success of the doctor and hospital. Online patient reviews and patient testimonials from the surgeon can help you make a more informed choice before surgery. It is also important to learn about the success rates and complication rates of the hospital and surgeon after bariatric surgery.
7. Hospital Comfort and Patient Satisfaction
The bariatric surgery process can often require a few days of hospitalization. Therefore, the services and comfort offered by the hospital are also important. The comfort of patients during the postoperative recovery process, receiving quality care and being in a hygienic environment contribute positively to the surgical process. The comfort of patient rooms, the quality of patient care services and the hospital's hygiene standards directly affect patient satisfaction.
8. Pre-Operative Preparation Process
A reliable hospital offers a detailed preparation process before the surgery. Processes such as tests, dietician and psychological evaluations to be performed before the surgery are important for the safety of the surgery. The patient's general health status is evaluated and it is checked whether they are suitable for surgery. A good preparation process increases the chance of success of the surgery and reduces the risk of possible complications.
