What is Obesity Surgery? A Basic Definition
Obesity surgery, also known as bariatric surgery, is a set of surgical procedures used to help individuals with excessive weight lose weight. These surgeries are not just cosmetic procedures; they are highly effective methods for treating serious health issues related to obesity, such as type 2 diabetes, hypertension, and sleep apnea. The operations limit the body’s calorie intake and absorption by reducing the size of the stomach, altering the structure of the intestines, or doing both.
Who is an Ideal Candidate for Obesity Surgery?
Obesity surgery is not a suitable solution for everyone. There are generally accepted international standards for these operations. The main criteria are as follows:
- Individuals with a Body Mass Index (BMI) of 40 or higher.
- Individuals with a BMI between 35-39.9 who have at least one obesity-related co-morbidity (e.g., diabetes, high blood pressure, joint problems, etc.).
- Individuals who have failed to achieve sustainable weight loss through traditional methods like diet and exercise.
- Individuals who are ready and committed to adapting to a new lifestyle after the surgery (diet, exercise).
Pre-operative Evaluation: Why is It So Important?
Before making the decision for surgery, a comprehensive evaluation is carried out by a multidisciplinary team (surgeon, dietitian, psychologist, cardiologist, endocrinologist). During this process, the person’s general health status, eating habits, psychological condition, and compliance with the post-operative process are examined in detail. This evaluation is vital for both determining the most suitable type of surgery and minimizing potential risks.
Classification of Surgery Types: Restrictive, Malabsorptive, and Combined
Obesity surgery methods are divided into three main groups based on their mechanism of action:
- Restrictive: These procedures reduce the volume of the stomach to create a feeling of fullness with less food intake. Sleeve gastrectomy falls into this category.
- Malabsorptive: These procedures reduce the absorption of food in the small intestines. These methods are now rarely used alone.
- Combined: These procedures both reduce stomach volume and decrease absorption in the intestines. Gastric bypass and mini gastric bypass are examples of this category.
What is Sleeve Gastrectomy Surgery?
Sleeve gastrectomy is a procedure in which approximately 80% of the stomach is irreversibly removed. The remaining part of the stomach is shaped like a banana-shaped tube. This surgery physically restricts food intake and also suppresses the patient’s appetite by reducing the production of the hunger hormone ghrelin.
Advantages of Sleeve Gastrectomy
- A shorter and relatively easier surgical procedure.
- A lower risk of vitamin and mineral deficiencies since the natural function of the stomach and intestines is not altered.
- A lower probability of “dumping syndrome,” a sudden feeling of discomfort that occurs especially after consuming sugary foods.
- The recovery process is generally faster.
Disadvantages and Risks of Sleeve Gastrectomy
- The surgery is irreversible. Once the stomach is removed, it cannot be replaced.
- There is a risk of developing or worsening issues like reflux and heartburn.
- Weight loss may be slightly slower compared to gastric bypass.
What is Gastric Bypass (Roux-en-Y Gastric Bypass) Surgery?
Gastric bypass is considered one of the gold standards of obesity surgery. In this operation, a small pouch is created from the upper part of the stomach, and the small intestine is connected to this pouch. Food bypasses the majority of the stomach and the first part of the small intestine, following the new path.
Advantages of Gastric Bypass
- It is a very effective procedure and provides one of the best long-term weight loss rates.
- It is highly successful in treating obesity-related diseases such as type 2 diabetes and high blood pressure.
- Hormonal changes in the stomach and intestines lead to an increased feeling of fullness and a reduced appetite.
Disadvantages and Risks of Gastric Bypass
- It is a more complex surgery compared to sleeve gastrectomy.
- The risk of vitamin and mineral deficiency is higher. Regular supplement use is mandatory after the operation.
- There is a risk of “dumping syndrome.” This syndrome manifests with symptoms like nausea, diarrhea, and palpitations when consuming sugary and fatty foods.
What is Mini Gastric Bypass Surgery?
Mini gastric bypass is a simpler bypass type with a single connection. The stomach is reduced to a tube shape, and a part of the small intestine is connected to this tube at a single point. It has both restrictive and malabsorptive effects.
Advantages and Disadvantages of Mini Gastric Bypass
- Advantages: The surgery is shorter and technically simpler. It provides effective weight loss similar to gastric bypass.
- Disadvantages: The risk of vitamin deficiency is higher than with sleeve gastrectomy. It may carry a risk of long-term reflux and bile reflux.
What is Duodenal Switch (Biliopancreatic Diversion)?
The duodenal switch is the most powerful and effective of the obesity surgery methods. In this operation, a large part of the stomach is removed to create a sleeve-like structure, and a large portion of the small intestine is bypassed. While food intake is restricted, absorption is also significantly reduced.
Advantages and Disadvantages of Duodenal Switch
- Advantages: It provides the highest and most permanent weight loss rates. It has the highest success rate in resolving type 2 diabetes.
- Disadvantages: It is one of the most complex and highest-risk surgeries. It can lead to severe vitamin and mineral deficiencies. Strict lifelong follow-up and vitamin supplementation are mandatory after the surgery.
Which Surgery is Best? Key Questions
There is no single answer to the question, “Which surgery is best?” The best surgery is the one that is most suitable for you. When making this decision, you should ask yourself the following questions:
- How much weight do I aim to lose?
- Which of my co-morbidities do I prioritize treating?
- Can I consistently take vitamin and mineral supplements?
- Am I ready to accept the risks of complications like dumping syndrome after the surgery?
Body Mass Index (BMI) and Surgery Selection
BMI is an important factor in choosing the surgery.
- BMI between 35-40: Sleeve gastrectomy may often be the first choice.
- BMI over 40: More effective methods like gastric bypass may also be considered.
- BMI 50 and above (Super Obese): Combined surgeries like bypass or duodenal switch may be more suitable as more radical weight loss is required.
The Impact of Co-morbidities on the Decision
Some co-morbidities can make certain surgeries more suitable:
- Type 2 Diabetes: Gastric bypass provides a higher rate of diabetes remission than sleeve gastrectomy.
- Severe Reflux: While sleeve gastrectomy can worsen reflux, gastric bypass can be effective in treating it.
The Psychological and Social Effects of Surgery
Obesity surgery is not just a physical transformation; it is also a psychological and social change process. Eating habits, social environments, and self-identity change after surgery. It is crucial to be prepared for this process and to seek psychological support.
Post-Operative New Lifestyle
Surgery is not a magic wand. Success depends on post-operative changes in diet, exercise, and mental outlook. The new lifestyle involves a high-protein, low-sugar, and low-fat diet. Regular exercise is vital for both weight management and overall health.
What are the Possible Risks and Complications?
As with any surgical procedure, obesity surgery has risks. These include infection, bleeding, leakage, blood clots, and nutritional deficiencies. The risk of complications varies depending on the surgeon’s experience and the type of surgery.
The Importance of Long-Term Follow-up: Why is It Necessary?
Lifelong follow-up after surgery is essential for sustained success. Regular check-ups monitor vitamin and mineral levels, update the nutrition plan, and allow for early intervention for any potential problems. This follow-up plays a critical role in preventing weight regain.
Weight Regain: Why and How to Prevent It?
Weight regain can occur after the first few years following surgery. This is often associated with non-compliance with nutritional rules, decreased physical activity, or a return to emotional eating habits. For long-term success, it is important to remember that surgery is a tool and that it’s a lifelong process.
Nutritional Supplements: A Lifelong Necessity
Especially after malabsorptive surgeries like gastric bypass, vitamin and mineral supplements become mandatory. Deficiencies in B12, iron, calcium, and vitamin D are common. Blood tests should be done regularly to adjust supplement dosages.
Obesity Surgery and Having Children
Obesity surgery can positively affect fertility. It is recommended to avoid pregnancy for at least 12-18 months after surgery. This period is necessary for the body to stabilize and recover from the effects of the operation.
Conclusion: The Decision Process is a Team Effort
Choosing the right surgery is not a decision to be made based solely on information you find on the internet. This is a personal journey, and the most accurate decision can only be reached with a team of expert surgeons and a bariatric team. Doing your own research, understanding the different types of surgery, and asking your surgeon all your questions are the most important steps in this process.
I hope this guide helps you better understand the options for obesity surgery and make the right decision.
If you would like to delve deeper into any of these topics or have other questions, you can always ask me. For example, you can continue with questions like, “Can you detail the nutrition plan after a sleeve gastrectomy?” or “I’d like to know more about the risks of a mini gastric bypass.”
