Obesity Surgery: What is it, What Diseases Does it Address, and What are the Treatment Methods?

Today, obesity has become a disease that threatens public health. The prevalence of obesity has increased across all age groups, especially in children, and as a result, obesity-related diseases have become more common. Obesity is particularly a condition that seriously threatens cardiovascular health. To prevent diseases associated with obesity, it is essential to treat obesity.

What is Obesity Surgery?

Obesity surgery refers to weight-loss surgeries performed on individuals who clinically suffer from obesity and are at risk of health problems related to excess weight. Also known as bariatric surgery, it is applied to patients who cannot lose weight to the desired level through diet and exercise. With obesity surgery, some methods reduce the person's capacity to eat, while others decrease the amount of nutrients absorbed from the stomach and intestines. In some types of obesity surgery, both procedures may be performed.

Although obesity surgery is an effective method for weight loss, it also comes with certain side effects. To avoid the risks associated with surgery, doctors generally recommend a diet and exercise program first. If patients are unable to lose the desired amount of weight despite following this program, obesity surgery may be considered. After undergoing obesity surgery, patients must pay attention to their diet and engage in regular physical activity, which contributes to maintaining their ideal weight for the rest of their lives.

What Diseases Does Obesity Surgery Address?

Obesity is a complex disease that involves excessive fat accumulation in the body. While some people may view obesity as merely a cosmetic issue related to appearance, it is actually a medical condition that can lead to many diseases. Therefore, obesity must be treated. Obesity surgery primarily deals with obese patients, but it also plays a role in treating individuals who suffer from conditions related to obesity, such as diabetes, heart disease, and sleep apnea.

What are the Treatment Methods in Obesity Surgery?

There are several types of surgeries performed in obesity surgery. The type of surgery performed depends on various factors such as the patient's age, weight, and the conditions associated with obesity. All operations in obesity surgery are performed under general anesthesia, meaning the patient does not feel anything during the procedure. Additionally, patients are intubated to ensure their breathing is supported by devices during surgery.

Most obesity surgeries are performed using the laparoscopic method, also known as minimally invasive surgery. In this method, a few small incisions are made in the patient's abdomen, and thin tubes with cameras at the end are inserted to perform the procedure inside the abdomen. The surgeon performs the operation with the help of these instruments. In the open method, a large incision is made in the abdomen, and the procedure is performed directly.

Different types of surgeries performed in obesity surgery include:

Sleeve Gastrectomy

Also known as sleeve gastrectomy, this method involves removing approximately 80% of the stomach. The remaining portion of the stomach is shaped into a long, narrow tube. This reduces the size of the stomach and prevents it from holding as much food as before. Additionally, the production of the hormone ghrelin, known as the "hunger hormone," is decreased. As a result, the patient's appetite is reduced after surgery. Sleeve gastrectomy helps patients lose a significant amount of weight. One of the biggest advantages of this surgery is that it requires a shorter hospital stay compared to other surgical methods.

Gastric Bypass

Gastric bypass is one of the most commonly performed methods in bariatric surgery. This surgery is generally performed in two steps. First, a small portion of the upper part of the stomach is separated from the rest of the stomach. Then, the beginning portion of the small intestine, where the stomach is connected, is divided. The middle part of the intestine is then connected to the small portion of the stomach that was separated. The remaining large part of the stomach and the beginning of the intestine are reattached to a part of the intestine further down. With gastric bypass, the size of the stomach is reduced, and the patient feels full with a smaller portion of food. Additionally, since the consumed food bypasses the first part of the intestine, nutrient absorption is also reduced.

Robotic Surgery

Robotic surgery is a method used for various obesity surgeries, including gastric bypass. In robotic surgery, the surgeon does not directly perform the procedure on the patient. Instead, the patient is placed under a large, multi-functional device called a robot. The surgeon uses control buttons on the robot to move the arms that will perform the surgery. The difference between robotic surgery and open or laparoscopic surgery is that it allows the surgeon to perform more precise movements.

Gastric Balloon

The gastric balloon procedure involves placing a balloon-like device inside the patient's stomach. This device reduces the stomach's capacity, helping the patient feel full more quickly. The gastric balloon is not a commonly preferred method among obesity surgeries.

Who is Suitable for Obesity Surgery?

Obesity surgery is not a procedure that can be performed on everyone. To undergo these surgeries, the patient must meet certain criteria and be willing to accept the potential complications associated with surgery.

Generally, the patient group eligible for obesity surgery includes:

• Individuals with a Body Mass Index (BMI) of 40 or higher (severe obesity)
• Individuals with a BMI between 35 and 40 who are suffering from obesity-related health issues such as diabetes or sleep apnea
• Individuals with a BMI between 30 and 35 who have serious health problems due to obesity

Even if patients meet the BMI criteria, the decision to undergo obesity surgery is made by the doctor. The severity of the patient's obesity-related health issues plays a role in this decision.

The most common diseases associated with obesity are:

• Heart disease
• Stroke
• High blood pressure
• Sleep apnea
• Type 2 diabetes
• Fatty liver disease

For patients to be suitable candidates for obesity surgery, they must be ready to make permanent lifestyle changes. If the patient does not follow the diet and exercise programs recommended by specialists after surgery, the success achieved through the surgery will not be permanent.

What Are the Risks of Obesity Surgery?

As with any major invasive procedure, obesity surgery comes with certain risks.

Risks associated with the surgical procedure include:

• Excessive bleeding
• Infection
• Adverse reactions to anesthetic agents
• Blood clotting
• Heart and lung problems
• Bowel leakage into the abdominal cavity

Long-term complications that may develop as a result of obesity surgery:

• Bowel obstruction
• Dumping syndrome, which includes symptoms like nausea, vomiting, diarrhea, and dizziness
• Gallstones
• Hernia
• Low blood sugar
• Malnutrition
• Ulcers
• Vomiting
• Reflux
• Leakage from the incision site

Complications that occur either during the surgery or as a result of long-term effects of the surgery can, although rarely, lead to death. Therefore, the decision to undergo obesity surgery should be made carefully. It is beneficial to perform the surgery in a well-equipped hospital, especially in case of emergencies.