WHAT IS OBESITY:
Obesity is an excessive accumulation of fat in the body, that is, an energy metabolism disorder that can lead to chronic, psychosocial and physiological problems with an increase in the ratio of adipose tissue to other tissues. Fat accumulation in cells and tissues causes deterioration of the functions of cells and organelles within the cell. In this way, the burning of energy in the cell is disrupted. This leads to disruptions in the functioning of the relevant tissues and organs. Gradually increasing adipose tissue causes obesity as well as hypertension, insulin resistance, diabetes (type II diabetes), high blood lipids, cardiovascular diseases, musculoskeletal system disorders, asthma, sleep apnea, fatty liver, skin diseases, rheumatic problems and psychological problems. may cause discomfort. In the advanced stages of obesity, it becomes difficult to return because disorders occur in many tissues and organs. The probability of permanent weight loss with diet and exercise alone is extremely low (<1%). Here, endoscopic and surgical methods used in the treatment of obesity come to the rescue of patients at this point. The treatment method to be applied to the patients depends on the weight of the obesity of the patients and the associated obesity.
It is decided according to the presence of other diseases. Body mass index (BMI) calculation is the most widely used method in the classification of obesity. In this simple method, weight (kg) is divided by height (m) squared. While endoscopic methods such as gastric balloon or gastric botox are preferred between BMI 30-35, laparoscopic surgical procedures such as sleeve gastrectomy or gastric bypass are applied to patients with BMI above 35 and additional disease or BMI above 40.
WHAT IS OBESITY SURGERY:
Obesity surgery is the restriction of the calorie intake of the patients by various interventions to the stomach and small intestines with endoscopic or laparoscopic methods, or the restriction of the amount of energy entering the body from the consumed foods by reducing the absorption. Depending on the severity of the disease, more complex methods such as gastric bypass can be used.
A gastric balloon is a silicone ball that is placed inside the stomach and inflated with air or water. Since the gastric balloon occupies the volume in the stomach, it gives a feeling of satiety, the patient gets full early and increases the patient’s compliance with the diet by causing nausea and bloating when he eats too much. The gastric balloon is placed with the help of an endoscope in the endoscopy unit with a slight sleep. These balloons can stay in the stomach for 6 months. Some gastric balloons, which can stay for 1 year, can be re-endoscopy and the amount of fluid in them can be adjusted according to the patient’s condition. There is also a swallowable gastric balloon that does not require anesthesia and endoscopy and can stay in the stomach for an average of 4 months. According to the patient’s condition and needs, the dietitian and obesity surgeon determine the most accurate method and apply it to the patient.
Stomach botox is the process of injecting botulinum toxin into the stomach wall with the help of an endoscope, with a slight sleep. This drug is a toxin that paralyzes the muscles. After the drug administration, the muscles and nerves of the stomach begin to work less. Since the stomach works more slowly, the patient has a feeling of fullness and early satiety.
ADJUSTABLE GASTRIC BAND
The adjustable gastric band is a device made of silicone that is placed laparoscopically on the upper part of the stomach and connected under the skin with a pump. By means of the subcutaneous pump, the width of the band around the stomach can be adjusted. In this way, the amount of food passing through the stomach, which is shaped like an hourglass, can be adjusted.
SLEEVE GASTRECTOMY (TUBE STOMACH SURGERY-STOMACH REDUCING SURGERY)
Sleeve Gastrectomy, also known as sleeve gastrectomy, is the process of cutting the stomach with the help of special tools that sew and cut the stomach in a vertical plane from bottom to top after the left outer part of the stomach is liberated by laparoscopic method. With this procedure, 80% of the patient’s stomach is removed. The patient is satiated early and excessive food intake is prevented. In addition, the activity of some anti-insulin hormones increases as the foods quickly pass into the small intestine. Since the part of the stomach that produces the hunger signal is also removed with this surgery, the feeling of hunger of the patients decreases. Except for rare problems such as bleeding and suture failure, they do not have serious complications.
ROUX-EN-Y GASTRIC BYPASS
Gastric bypass is an operation performed laparoscopically using instruments that can cut and sew the stomach automatically. The stomach is cut and sutured a few cm below the esophagus, leaving half a tea glass of capacity. Y-shaped small intestine connections are made into this small stomach pocket. Since he has a very small stomach, the patient can eat very little. The patient loses weight because the food passes quickly to the small intestine and some of the intestines are removed from food absorption with the Y-shaped intestinal connection. Many of the patients may develop various vitamin and mineral deficiencies.
MINI GASTRIC BYPASS
Mini gastric bypass is a slightly modified and simplified version of gastric bypass. The stomach part that comes into contact with the food is left a little longer and the small intestine connection is made directly to this stomach part. It is a method similar to gastric bypass, except for bile leakage into the stomach in some patients and related stomach inflammation.
BILIOPANCREATIC DIVERSE (DUODENAL SWITCH)
Duodenal switch surgery is the process of separating the intestine from the duodenum at the level of the duodenum after the stomach is formed into a tube with the laparoscopic method, and then the small intestine is connected to this stomach tube in such a way that some small intestine is disabled from food absorption.