Bariatric Surgery

What is Bariatric Surgery?

What is Obesity?

Obesity, that is, obesity, is the body weight being above normal due to the excessive amount of adipose tissue in the body. Obesity is determined by calculating the body mass index (BMI), and BMI is obtained by dividing the person’s weight by their height twice (weight/height²). A BMI of 30-40 is considered obesity. If the BMI is over 40, it is mentioned as morbid obesity, that is, severe obesity that causes life-threatening health problems.

Obesity grades according to BMI (weight/height²) results;

• 18.5 and below -> Weak
• 18.5 – 25 -> Ideal Weight
• 25 – 30 -> Overweight
• 30 – 35 -> 1st Degree Obesity
• 35 – 40 -> 2nd Degree Obesity
• >40 -> Morbid obesity

What is Obesity Surgery? What is Weight Loss Surgery?

Bariatric surgery, also known as bariatric surgery or weight loss surgery, is all of the surgical methods that are performed due to obesity and provide rapid weight loss in a short time. These surgeries vary according to the mechanism of action and surgical technique.

What are the Types of Obesity Surgery ?

Obesity surgeries are divided into three main classes as stomach reduction surgeries, absorptive surgeries and combined surgeries where these two are applied together.

Volume Reduction Surgeries

Gastric reduction surgeries are interventions that limit the amount of food taken by reducing the stomach volume. By removing 80% of the stomach, it allows the patient to be satiated quickly with a small amount of food and limits calorie intake. The most typical example of stomach reduction surgery is sleeve gastrectomy, that is, sleeve gastrectomy surgery. It is the most frequently performed obesity surgery in the world because it can be performed laparoscopically.

Absorption Preventive Surgeries

In absorptive surgeries, a part of the intestine is bypassed, preventing the absorption of the food taken and reducing the calorie intake in this way, allowing the patient to lose weight. Examples of these surgeries are jejunoileal bypass and biliopancreatic diversion (BPD). These surgeries are not performed very often.

Combined Surgery

These surgeries are both restrictive food intake and prevent absorption. The most typical example is the Roux en Y gastric bypass.

Who Can Have Obesity Surgery (slimming surgery)?

Certain conditions are necessary in order to perform bariatric surgery (slimming surgery).

– Body mass index (BMI) should be over 40 (35 according to some sources).

– In the presence of uncontrolled diabetes, hypertension and hyperlipidemia, this rate can be reduced.

– There should be no serious co-morbidities.

– The person must be in good mental health.

At What Age Ranges Is Obesity Operation Performed?

Obesity surgeries are performed between the ages of 18-65. Bariatric surgeries can be performed in some special cases for those under the age of 15 (pediatric obesity). In some cases, bariatric surgery can be performed over the age of 65.

Can Heart Patients Have Obesity Surgery ?

Except for those with severe or serious heart disease, heart patients can have obesity surgery. The decision for surgery usually depends on whether the heart’s condition is suitable for anaesthesia.

Is Obesity Surgery Risky ?

Although obesity surgery has low risks such as bleeding and leakage, the risk rates vary according to the type of surgery.

What is the Role of a Dietitian in Obesity Surgery?

Bariatric surgery is the most effective method for morbidly obese patients to maintain weight loss. In order to obtain a permanent and successful result from bariatric surgery, the patient should be evaluated by a multidisciplinary team (general surgeon, endokinologist, dietitian, psychologist) before the operation. Again, post-operative follow-ups should be done by this team.

The dietitian plays a major role in pre- and post-bariatric surgery monitoring, determining the nutritional program and evaluating the nutritional status.

It helps the patient to establish a healthy lifestyle after the surgery by examining the previous lifestyle, detecting mistakes and nutritional problems. Post-operative follow-up is the most important step of this process. The importance of post-operative nutrition occupies a great place in increasing the success of bariatric surgery. Studies have shown that patients who work with a dietitian after surgery provide a longer and permanent weight loss.

How should I eat after the operation?

Nutrition after bariatric surgery basically has two purposes:

1. Tissue healing and avoiding various post-operative discomforts (Dumping Syndrome, etc.)
2. Preservation of muscle mass during sudden weight loss

Although nutrition is very important after bariatric surgery, gradual diets should be applied. Nutritional status and duration vary according to the type of surgery performed. These phased diets are as follows in general terms.

Stage 1: The Clear Liquid Diet

It is the first stage applied after the surgery. Dietary supplements are provided. Depending on the type of surgery, this process can be extended or shortened. Water to be consumed daily is shared between meals. Small sips are taken.

Water, lean broth, diluted freshly squeezed fruit juices, diet gelatin, artificial sweeteners, light tea, protein drinks are consumed. Avoid beverages containing carbonate, caffeine and sugar.

Stage 2: Full Liquid Diet

After making sure that the clear liquid diet phase is completed, the full liquid diet phase is started. Compared to the clear liquid diet, more concentrated liquids are involved. The duration of the full liquid diet varies depending on patient compliance and the type of surgery.

Fat-free milk and dairy products, vegetable juices, diluted fruit juices, filtered soups, sugar-free puddings, boiled and strained cereals, protein liquids are consumed.

Stage 3: Pureed Diet

At this stage, patients consume solid foods in a pureed form (pure without grain at the beginning). Begin with very small portion sizes of food. This amount is gradually increased under the supervision of a dietitian. Food should be well chewed at this stage. Liquid and solid foods should not be consumed at the same time. Food should be taken frequently and in small amounts.

Low-fat yogurt, low-fat feta cheese, minced meat, soft boneless fish, pureed vegetables and fruits can be consumed. Foods high in protein should be preferred.

Foods with high calorie content such as fried foods, cream soups and desserts should be avoided.

Stage 4: Solid Foods:

In the solid foods stage, suitable solid foods (such as well-cooked meat and foods with high protein content) are added to the patient’s diet under the control of a dietitian. Liquids and solids should not be taken together.

Whole grain foods, vegetables, fruits, adequate protein should be taken. It is very important to comply with your diet list prepared in accordance with your lifestyle.

Sugar, creamy soups, sauces, fried foods should be avoided. The amount of caffeine should be limited.

Is Every Food Consumed After Obesity Surgery ?

After the solid foods stage, all foods can be consumed in certain portions. However, there are some foods that should be avoided in order for the surgery to be successful:

• carbonated drinks
• Sugar, sugar-containing foods and drinks
• Foods that are fried or contain a lot of fat
• Carbs including white bread, rice, pasta and dough
• Dry beans
• spicy food
• Nuts
• Alcohol
• fruit juices
• carbonated drinks
• Caffeine

When can sports be done after obesity operation?

The patient returns to his daily life within the first week after the operation. At the end of the second week, he can walk at a slow pace. At the end of the first month, he can start exercises such as walking, jogging and swimming. In the following period, he can increase his exercises, provided that they are not heavy.

When Will Weight Loss Begin After Obesity Surgery?

After weight loss surgeries, a serious decrease in stomach volume is observed. The weight loss process starts immediately after the surgery. It should be followed by a dietitian with a personalized nutrition program.

Will there be sagging in the body after the obesity operation ?

After obesity surgery, sagging occurs in the abdomen, trunk, hips, arms and legs. These saggings are corrected by plastic surgery. For these surgeries, it is recommended to pass at least 1 year after the obesity surgery.

How Much Weight Is Losed After Obesity Surgery?

Although it differs from person to person, patients lose 60% of their excess weight on average. This rate may vary depending on the compliance with the postoperative diet.

What Should Be Done Before Obesity Surgery?

Before the obesity surgery (slimming surgery), the general health status of the patient should be evaluated. Weighing and body analysis should be done by revealing nutritional status and lifestyle in detail, and body composition should be revealed. The health status of the patient should be considered from many aspects. First of all, the patient should be evaluated by an endocrinology specialist with detailed biochemical and hormonal tests. After determining that he is a suitable candidate for surgery, he should be evaluated in terms of the general risks of surgery and heart-lung problems, and important tests such as cardiac echo and pulmonary function tests should be performed.

The patient should be explained in detail the operation process, the rules to be followed after the operation and the nutrition program. The patient should be informed in detail about the results and risks of the surgery. At the same time, it is very important that the patient is psychologically ready for the surgery. For this reason, a consultation with a psychologist should be made before the operation. Smoking should be stopped and alcohol consumption should be limited.

What is the Price of Obesity Surgery?

Obesity surgeries (weight loss surgeries) are advanced surgeries that require specialist experience. Hospitals where these surgeries are performed should have high-level equipment in terms of infrastructure, technology and equipment. In addition, auxiliary personnel such as nurses, operating nurses and staff experienced in bariatric surgery are needed. Apart from this, it is necessary to use the highest quality materials in critical stages such as gastric closure. Extreme care should be taken in the post-operative care and follow-up of the patient. For this reason, bariatric surgery prices vary according to the hospital type, which shows the level of development of the hospital, and the materials used. In addition, postoperative hospital stay and examinations,