Obesity surgery is a surgical intervention performed by laparoscopic method aimed at increasing weight loss in overweight individuals. These surgical procedures aspire to provide solutions to health problems that generally occur or are at risk due to obesity. These health problems involve various diseases i.e. hypertension, Type 2 Diabetes, high cholesterol, sleep apnea syndrome, lumbar bone and joint diseases. Methods such as gastric by-pass, sleeve gastrectomy ensure weight loss by reducing the volume of the stomach, altering the absorption capacity of the digestive system and regulating the release of hormones effective on appetite. Therewithal it has the potential to heal metabolic disorders such as type 2 diabetes and hypertension caused by obesity by diminishing excess accumulated adipose tissue in the body.
*Gastric by-pass;
Gastric by-pass is a kind of obesity surgery and involves shrinking the stomach and rearranging the intestines. Its main objective is to improve the metabolic status by regulating the digestive system hormones that are efficient on appetite while providing weight loss. Hereby, it enhances obesity-associated health problems along with weight loss. The basic principles of gastric bypass are as follows:
1. Stomach Shrinkage: During surgical operation, the stomach is reduced to a smaller size. This ensures that the individual eats less and the feeling of fullness occurs more quickly.
2. Bowel Rearrangement: The shrinking stomach is attached directly to the final part of the small intestines. This procures nutrients to quickly enter the final part of the digestive system unchanged, both reducing absorption and altering the secretion rate of some digestive hormones that are efficient in regulating blood glucose. Thus, both the absorption of calorie-causing nutrients diminishes and the secretion of hormones that have beneficial effects on blood glucose and metabolism enhances.
Gastric by-pass ensures both a restrictive (reducing stomach volume) and malabsorptive (reducing nutrient absorption) effect. This combination both stimulates weight loss and may contribute to the recovery of metabolic diseases such as type 2 diabetes and hypertension.
Sleeve gastrectomy, alias Sleeve Gastrectomy or Sleeve, in a word, is a type of surgery in obesity and metabolic surgery. During this procedure, the stomach is shrunk to a tube-shaped structure. The basic principles of Sleeve Gastrectomy are as follows:
1. Stomach Shrinkage: During the surgery, the stomach is cut into a horizontal tube, which greatly reduces stomach volume. This ensure that the individual eats less.
2. Diminished Stomach Capacity: Following sleeve gastrectomy, the amount of food that the person can consume and therefore the amount of calories taken diminishes. This induces weight loss.
3. In the part of the stomach that is taken out and deactivated, the secretion of grehlin hormone, known as the appetite hormone, which is secreted from the stomach and goes to the brain and increases appetite, reduces. Since therefore, a poor appetite occurs subsequent to surgery and nutrient intake decreases.
Sleeve Gastrectomy both ensures a restrictive effect by reducing stomach volume and controls appetite by causing hormonal changes.
Biliopancreatic diversion surgery is a kind of obesity surgery and is a rarely utilized procedure. This surgery includes shrinking the stomach and regulating the small intestines. The basic principles of biliopancreatic diverticulum surgery are as follows
1. Stomach Shrinkage: During surgery, the stomach is reduced to a smaller size. This ensure that the individual eats less.
2. Bowel Regulation: Specific changes are performed on the small intestines. This stimulates weight loss by controlling nutrient absorption.
3. Alterations Related to the Pancreas: Surgery may affect access to some enzymes secreted from the pancreas, which may diminish nutrient absorption.
Biliopancreatic diversion surgery procures both a restrictive (reducing stomach volume) and malabsorptive (reducing nutrient absorption) effect. However, this surgery is less frequently utilized as other methods of obesity surgery are often preferred. It may be preferred especially in people with Type 2 diabetes who have been diagnosed with sensory malnutrition, who may have challenge in complying with postoperative diet and exercise rules, and who have uncontrolled Type 2 diabetes.
This surgical procedure is performed by placing an adjustable band via laparoscopic method just below the junction of the stomach with the esophagus. The basic principles of this surgery are as follows:
1. Band Placement: Throughout the surgery, a slim band is placed around the top of the stomach. This band divides the stomach into two parts, creating a smaller upper section and a larger lower section.
2. Band Being Adjustable: The band is made adjustable outside the body via an external port (controller). This allows the tightness of the tape to be adjusted.
3. Nutrition Control: The band fills the upper part of the stomach, ensuring the person eats more quickly and eat less. This encourages weight loss.
Laparoscopic adjustable gastric band surgery is a less invasive procedure compared to other methods of obesity surgery. Nevertheless, its efficacy is lower than other methods and adjustments may need to be performed regularly.
The ingestible gastric balloon is a non-surgical temporary method utilized in order for the treatment of obesity. It consists of a balloon placed inside the stomach to support weight loss by temporarily reducing the stomach volume along with the diet and exercise program. The basic principles of swallowable gastric balloon are as follows:
1. It is placed in the stomach by swallowing with a glass of water without the necessity for endoscopic method and anesthesia. Surgical incisions or sutures are not required.
2. Inflating the Balloon: Subsequent to it being placed in the stomach, it is inflated with the special fluid given through the thin catheter to which the balloon is attached, afterward confirming that it is in the stomach with a Scopy. Thus, it decreases the volume of the stomach and allows the person to be full more quickly.
3. Inducing Weight Loss: The gastric balloon encourages weight loss by limiting the person’s food intake. Nonetheless, this process is impermanent. The balloon remains in the stomach for 16 weeks. At the end of this course, it melts spontaneously and disappears. Some of them leave the body by passing through the intestinal lumen. Hence, no extra process is required to remove it.
The swallowable gastric balloon might be considered an alternative that may aid weight loss without surgical intervention. The effect is short and depends on the individual’s diet and exercise compliance. It is essential for the person to adapt to lifestyle changes in order to be efficient. This method is eligible for mildly overweight people who do not have excess weight, however, whose body mass index is not normal to think about surgery.
Eligible applicants for bariatric surgery are usually individuals who have the following characteristics:
1. Body Mass Index (BMI): In general, individuals with a BMI above 40 or both with a BMI above 35 and obesity-related health problems (such as type 2 diabetes, hypertension) can be taken into account.
2. Failed Diet and Exercise Experiences: Obesity surgery is considered for individuals who cannot accomplish or maintain weight loss in spite of diet and exercise programs.
3. Metabolic Problems: People with obesity-induced metabolic diseases i.e. type 2 diabetes, hypertension, sleep apnea may be among the candidates for obesity surgery.
4. Psychological Assessment: Candidates should be assessed by a specialist to evaluate their psychological stability, which can adapt to postoperative lifestyle changes.
5. General Health Status: It must be remembered that surgery is a surgical intervention. The general health status of the applicants must be at a level that can undergo a surgery under anesthesia.
The pre-obesity surgery process involves physician evaluation, psychological evaluation, diet and exercise program, preparation tests, smoking and alcohol restrictions, pre-surgical diet. This process can be personalized for each patient and aims to assess preoperative eligibility.
The obesity post-operative process includes a short follow-up period in the hospital. Afterwards, diet and lifestyle changes, regular follow-up checks, exercise programs, nutritional supplements, and psychological support if necessary come into play. Nevertheless, the process may differ depending on the type of surgery and the patient’s requirements.
The main objective in obesity surgery is to diminish excess weight and to provide solutions to metabolic diseases such as diabetes as a secondary objective. In other respects, metabolic surgery primarily intends to eliminate metabolic diseases and then aims to control excess weight. Differences between the two surgical approaches are due to priority intervention targets, as weight loss is at the forefront in obesity surgery, whereas metabolic surgery focuses on metabolic health problems.
