If diet, exercise and drug therapy fail in the treatment of obesity,
the remaining option is surgery. A patient's BMI over 40 kg/m2 for 5
months or longer is an important indication for bariatric surgery.
Surgery is also indicated in patients with a BMI of 35-39.9 and a
serious obesity-related medical condition such as type 2 diabetes,
hypertension or sleep apnea. In some cases, patients with a BMI of 30-35
and who have serious obesity-related health problems may also be
candidates for bariatric surgery. The increasing number of obese people
all over the world and the failure of other treatment methods have
increased the importance of surgical treatment methods. The number of
surgical procedures is increasing exponentially every year.
Surgical Treatment Options
Gastric band (Stomach staple) The
basis of the application is to attach a silicone band (staple) to the
upper part of the stomach just below the esophagus to create a volume of
approximately 15-20 cc. In simpler terms, it is the shaping of the
stomach into an hourglass.
It is a restrictive (limiting food
intake) surgery. The basis of weight loss is based on the principle of
not getting more food by shrinking the stomach volume. When the small
stomach formed as a result of stapling is full, it is not possible to
take more food.
Sleeve gastrectomy (Tube stomach, Stomach reduction) In
this method, 2/3 of the stomach is removed laparoscopically. Normally,
the volume of the stomach is 800-1000 ml. After sleeve gastrectomy, the
stomach volume is reduced by 250-300 ml. This means that the patient can
only eat 1/4 of what he or she could eat before the surgery. Another
effect of sleeve gastrectomy is the decrease in the feeling of hunger
after the operation. The hormone (Ghrelin), which gives the feeling of
hunger, is largely secreted from the removed part of the stomach.
Therefore, the level of Ghrelin hormone decreases after the surgery and
thus the appetite.
Stomach folding (Gastric plication) It is
the reduction of the stomach volume by 70% by placing one or two layers
of stitches on the stomach. Therefore, patients feel full when they eat
1/3 of what they eat. In the plication process, the stomach is not
stapled and removed as in sleeve gastrectomy, it is simply folded into
itself. Therefore, it is a reversible process. Complications and risks
are less than other methods.
Gastric Bypass The stomach is
divided into 2 separate parts by stapling so that approximately 50-60 ml
of volume is left just below the junction of the stomach with the
esophagus. Then, a new sac is created between the small intestine and
this newly formed stomach sac so that approximately 100 cm of the small
intestine is out of digestion. Thus, both the food that the stomach can
take will be very limited and the absorption surface of the small
intestine will be reduced by about 30%. When the food taken fills the
small sac, a feeling of fullness occurs.
