Obesity (Sleew ) Surgery
Obesity, or popularly known as obesity, is a disease that occurs as a result of the accumulation of excess fat in the body and must necessarily be treated. Obesity occurs when the amount of energy taken with nutrients exceeds the amount of energy consumed by metabolism and physical activity.
Obesity is a disease that affects systems such as the cardiovascular system, respiratory system, hormonal system, and digestive system in the human body and lays the foundation for many important diseases. Heart diseases, high blood pressure, diabetes, high cholesterol, respiratory problems, joint disorders, menstrual irregularities, infertility, impotence, gall bladder disease, stone disease, some cancers, obesity diseases that are directly attributable to name a few.
As a result, obesity can be defined as a disease that shortens human life and negatively affects the quality of life.
How Is Obesity Measured?
The most commonly used measurement for obesity is the body mass Index (body mass Index) measurement of waist circumference.
* BMI is calculated by dividing body weight (kg) by neck square (m2). This value is independent of age and gender, but does not give correct results in children, pregnant women, and very fair people.
* They divided BMI values into groups of normal weight, overweight and obese.
* Waist circumference measurement and meaning
Although the total amount of fat in the body is important, it is more important to know where the fat accumulates. Fat accumulation around the abdomen causes more health risks than fat accumulation in the buttocks and other parts of the body. A simple but accurate method for this risk is waist circumference measurement
How Is Obesity Treated?
Methods used to treat obesity include:
- Diet treatment
- Surgical methods
- Robotic Surgery
• It was a calorie-calculated program in which the patient ate small portions at frequent intervals without starving, following a specialist
• Even a 45-minute akvite that will be performed at least 3 days a week is extremely effective for the patient to lose weight. In case of excess weight, a simple and continuous exercise program should be applied so as not to strain the body and joints too much.
• If the patient has a metabolic problem with any disease that causes weight gain, the use of medications should be planned for this problem.
Treatment By Surgical Methods
There is a principle underlying obesity surgery. First, reducing the volume of the stomach, and second, preventing the absorption of food can be summarized as.
Obesity body mass index of 35 and above, in the control expert diet, exercise, and medical treatment methods, such as definitive cure, patients and body mass index over 30, which is high blood pressure, diabetes, heart patients that affect the duration and quality of life of the patient such as valid.
Surgical methods used in obesity surgery are divided into :
- Stomach balloon
- Gastric clamp ( gastric band)
- Tube stomach
- Gastric Bypass
- Robotic Surgery
- Stomach Balloon
The most important advantage of this method is that it is performed endoscopically without requiring general anesthesia.
The internal volume of the stomach balloon is resistant to inflating with liquid or air between 400-700 cc. Because of this volume, restrictions on the volume of the stomach are provided, and thus, excess food intake is prevented, as the volume of the stomach decreases.
The estimated duration of the application is 10-15 min. The patient does not need to stay in the hospital, the patient can be discharged after 3-4 hours of supervision and intravenous serum administration after the procedure.
Nausea, vomiting and cramp-style pain can be observed especially in the first 48 hours after application. For the elimination of such ailments, medical treatment is applied. These complaints are temporary .
Gastric balloon application is a non-surgical treatment. It is a suitable alternative, especially for patients who do not consider surgical treatment but cannot lose enough weight through diet and exercise. But this application is limited in terms of time, the duration of the stomach balloon’s stay in the stomach is a maximum of 6 months. After this time, the balloon must be removed. Removal also occurs endoscopically, and the patient can return to normal activation after 2 hours.
During this time, patients may lose 30-90% of their excess weight.
A stomach balloon is a repeatable application if it is deemed necessary.
A stomach balloon is an easy method to apply for obese patients who do not think about surgical treatment or are afraid of such surgical procedures. But with this method, patients should definitely make an effort to change their eating habits in order to achieve permanent weight loss in the long term.
Gastric Clamp (Gastric Band)
The essence of the application is that a silicone clamp is attached to the upper part of the stomach just below the esophagus, forming about 15-20 cc of volume.
This surgery is a surgery that restricts the volume of the stomach. The basis of weight loss is based on the fact that excess food cannot be taken with the reduction of the volume of the stomach.
The most important feature of the clamp is that it can be inflated by injecting liquid into the chamber in its internal structure. In this way, the width that connects the small stomach at the top and the stomach at the bottom can be easily adjusted. The advantage of this is that if a person eats too much, food intake can be reduced by making this adjustment, thus increasing the rate of weight loss can be achieved.
This adjustment is due to a reservoir at the end of the connecting tube of the tape. This reservoir is placed above the novelization layer under the skin. In this way, after surgery, the passage from the upper stomach to the lower stomach can be narrowed by inflating the inner volume of the tape, provided that it is inserted into it with the help of a needle-injector and gives liquid.
The most important point to note in patients considering applying gastric clamp is to examine the eating habits of these people. Weight loss rates are low in people who have a habit of eating foods high in calories.
The most important aspect of this operation is that the application is performed laparoscopically and the duration of the hospital stay is minimal. But after surgery, patients need a certain amount of time to switch to solid foods. It is no longer possible to maintain a eating habit as before.
In this operation, the large edge of the stomach is cut and removed, creating a stomach tube with a volume between 100-150 ml. In this application, weight loss occurs with 2 mechanisms.
* Restrictive effect: a mechanical restriction by reducing stomach volume and weight loss due to reducing stomach movements
* Endocrine effect: a decrease in the level of the hormone GHRELIN, secreted from the removed part of the stomach and defined as the hunger hormone, leads to the formation of a feeling of satiety. Ghrelin is a peptide protein secreted by cells in the upper part of the stomach called the fundus. It’s a powerful stimulus of the appetite-boosting region in the brain. Since the fundus area of the stomach produced by ghrelin is removed in tube stomach surgery, appetite is also reduced and contributes to weight loss.
This procedure is the most commonly used surgical method in the world for the treatment of obesity. First, the volume of the stomach is reduced, and therefore the amount of food the patient can take decreases. Second, the absorption of nutrients decreases as The meant pathway in the small intestine is shortened.
This surgery should be more preferred, especially in patients with a habit of eating a high-calorie diet. Because this group of patients are fed small amounts but high-calorie foods. Achieving sufficient weight loss can be a problem only with surgical interventions that restrict food intake. Gastric Bypass surgery, in addition to reducing the volume of the stomach, also affects the absorption of food eaten, allowing it to be discarded without being beneficial to the body.
After this operation, patients lose 70-80% of their excess weight within 1-2 years on average. This result is close to perfect. On the other hand, after surgery, a period of easier adaptation to the new eating habit is passed.
The most important problem of this operation is that a number of vitamin deficiencies may occur in the following days due to impaired absorption in the food taken. But for this condition, there is no problem with vitamin supplements that will be taken from outside. Surgeons who have experience in this regard inform their patients about this and take the necessary precautions.
Operations performed with The Da Vinci Robot are described as ‘robot-assisted laparoscopy surgery’. With the Da Vinci robot, the expert has the opportunity to intervene in the patient as desired with small incisions. Surgeries performed by robotic surgery method are performed with very small incisions, which gives better results aesthetically. Side effects that may occur after surgery, such as bleeding and leakage, can be reduced, which prolongs the patient’s hospital stay. In patients undergoing obesity surgery, the most important problem after surgery is leakage. Robotic surgery has been shown to significantly reduce the leakage rate compared to laparoscopic surgery. The use of robots in obesity surgery provides technical facilities to doctors. In robotic surgery, tools are more ergonomic, better visibility with a three-dimensional image, and more precise operations are listed among these amenities. Using the robot’s very small tools, the surgeon can move gracefully around the patient’s abdomen, protecting the tissues and intestines that surround the organs. Anatomical connections or anastomoses (connecting the intestines) can be made safer.
Robotic Surgery Obesity Surgery Methods
* Sleeve gastrectomy (tube stomach)
* Roux-en-Y gastric bypass
* Adjustable gastric band (stomach clamp)
Robotic surgery has made it possible to perform operations (gastric bypass) in which part of the intestines, which is one of the most difficult operations of bariatric surgery, can be bypassed easily and with better results.
Benefits Of Obesity Surgery With A Robot