For patients with over 40 BMI that fail to lose weight with other methods, surgical procedures are applied. Patient is evaluated multidisciplinary in preoperative period by a team composed of endocrinologist, surgeon, internal medicine, psychiatrist and dietician. Appropriate surgical method is tailored according to age and medical condition of the patient. Surgical procedures are performed laparoscopically and consist of restrictive (sleeve gastrectomy) and malabsorbtive (gastrojejunal bypass) techniques.
Laparoscopic Obesity Surgery (Bariatric Surgery)
What is Obesity?
Obesity and overweight have become a global concern in the last 10 years. According to the World Health Organization (WHO) in 2005, approximately 1.6 billion adults 15 years of age and over were overweight, 20 million of these being children under 5 years old. Experts believe that these numbers will rapidly increase. The scale of the obesity problem has serious consequences if not dealt with.
Patients who have a BMI of 40 or above with comorbidies are eligable for surgery. In Turkey, the Social Security Institution (SGK) will cover the some costs of surgery for patients who are applicable.
The goal of these procedures is to place a restriciton on the amount of food intake and reduce absorption as a result leading to weightloss.
Here are the three most successul methods;
- Adjustable Gastric Banding: The process of placing a silicone band around the stomach through laparoscopic surgery. The apparatus is inflated by injecting fluid through a chamber disposed right below the skin compresses the hourglass shaped stomach and limits food intake. It can be adjusted according to the patient.
- Sleeve Gastrectomy: The operation is performed by removing approximately 75-80 percent of stomach. Sleeve gastrectomy has gained popularity because of its low complication and great weight loss results. The Sleeve Gastrectomy aids in weight loss for a few reasons such as;
-The new stomach pouch holds considerably less than the normal stomach and helps to reduce the amount of food you can eat during a single meal.
- The food also moves faster in the new stomach pouch. There is a significant effect on gut hormones that help you feel less hungry and fuller longer.
- Gastric Bypass Method:
Gastric bypass is surgery that helps you lose weight by changing how your stomach and small intestine handle the food you eat. After the surgery, your stomach will be smaller. You will feel full with less food. The food you eat will no longer go into some parts of your stomach and small intestine that absorb food. Because of this, your body will not get all of the calories from the food you eat.
There are two steps during gastric bypass surgery:
• The first step makes your stomach smaller. Your surgeon uses staples that divide your stomach into a small upper section and a larger bottom section. The top section of your stomach which is called the pouch. It is new place where the food you eat will go. The pouch is about the size of a walnut. It holds only about 1 ounce (oz) of food. Because of this you will eat less and lose weight.
• The second step is the bypass. Your surgeon connects a small part of your small intestine (the jejunum) to a small hole in your pouch. The food you eat will now travel from the pouch into this new opening and into your small intestine. As a result, your body will absorb fewer calories.
Gastric bypass can be done in two ways. With open surgery, your surgeon makes a large surgical cut to open your belly. The bypass is done by working on your stomach, small intestine, and other organs.
Another way to do this surgery is to use a tiny camera, called a laparoscope. This camera is placed in your belly. The surgery is called laparoscopy. The scope allows the surgeon to see inside your belly. In this procedure the surgeon will make small incisions on the belly and insert the instruments and the scope into these openings. The camera is connected to a monitor that allows the surgeons to see the precise area he is working on.