Obesity and Surgical Treatment

OBESITY AND SURGICAL TREATMENT

Obesity is a such a disease that, characterized by creating a serious increase of natural energy levels stored in the fat cells of human body and rises rates of death inevitable.

Obesity Measurement Methods?

Measurement of total body water, Ultrasonography, Computed Tomography, MR, Photon Absorption Methods, Body mass index (BMI)and waist-hip measurement can be counted. Body mass index is the ratio, obtained by dividing body weight by height squared. The classification made by “World Health Organization”according to Body mass index (BMI); under 18.4 is underweight, 18.5-24.9; normal weight, 30-39.9,obese, 40 and upper;morbid obesity, 50 and upper 50; süper morbid obesity

The Effect of Heredity

The influence of genetic factors on obesity is between 25 percent to 40 percent.Two or three times more obesity seen in children (between 3-10 ages) with obese parents when compared to  non-obese people. Up to 5% of the overweight is relative to single gene disorders.

Causes of Obesity

Obesity is common, people who fed high-calorie often and done less physical activity and sport.Apart from those genetic factor,hormonal disorders,psychological problems, and drugs used together  and  in rare cases the low metabolic rate

Health Problems Associated with Obesity?

Type 2 Diabetes Mellitus,Insulin Resistance, Hyperinsulinemia, Cardiovasculer Diseases, Hypertansion, Obstructive Sleep Apnea, Reflux, Galistones, Fatty Liver, Osteoarthritis, Especially  in men esofagus-column- thyroid- kidney cancer, women breast - endometrium cancer. In addition, urogenital and sexual problems are experienced. 

The Treatment of Obesity

The treatment should begin, in childhood. Obesity treatment requires a team of, physicians (endocrinology,cardiology,general surgery) dietitian and physiotherapists The aim of obesity treatment objectives are, to give people adequate and balanced diet and to improve quality of life  by calculating the ideal body weight. Diet, exercise,behavior changes ( psycotherapies) pharmacetical, medical, medicine,surgery, alternative treatments (acupuncture / acupressure,hypnosis) are among the methods used in the treatment of obesity  

Surgical Treatment of obesity divides into three basic methods

  • Methods limit food intake (restrictive).Resection of the stomach, bypass or capacity is reduced narrowing the upper part of the stomach so that people consume less food.For this purpose, sleeve gastrectomy, gastroplasty, gastric bench, gastric balloon and such other methods are used.
  • Surgical methods fort he malabsorption; the length of the small intestine, where the absortion of food is active, is shortened.By this method, the absorption of food area is reduced. Jejunoileal bypass (JIB) and Duodenal switch (ds) are this type of operation.
  •  Restricting food intake and malabsorptive effective combined operations. Roux- en Y gastric bypass (RYGB) biliopancreatic diversion (BPD) biliopancreatic diversion- duedonal switch (BPD/ DS) are these type of surgeries.

Obesity Surgery will not be performed

Advanced heart  disease,drug and alcohol addiction, untreatable depression and pyscohosis, severe hematological disorders,the absence or incompetence of physical and mental  level in the post-operative period.

Preoperative Evaluation

Medical history of obesity surgery candidates must be well taken, psychosocial status must evaluated, physical examination must be done. Additional diseases related to obesity and surgical risks should be determined. Medical problems that are detected must be solved before the surgery.

Particulary, in the postoperative period, the dietician must describe in detail, how to diet. The patient must be informed against the problems encountered about nutrition in the short and medium term.

Also after surgery, the expectations must be discussed with patient and to provide the targets must be realistic.It is required to inform the patient in detail to complications that may occur during this period.

                               

Surgical Methods

Intragastric balloon (stomach balloon), laparoscopic adjustable gastric banding (gastric banding), laparoscopic sleeve gastrectomu (sleeve gastrectomy) laparoscopic Roux-en-Y gastric bypass(RYGB), laparoscopic  mini gastric bypass, duodenal switch  (vertical gastrectomy, biliopancreatric spoofing, also known as DS and BPS-DS)

The Most Commonly Used Surgical Methods; Laparoscopic Sleeve

This operation is a restricting operation method by removing the large portion of the large curvature of the stomach and the stomach takes a shape of a tube form, the volume of the stomach is reduced about 80-100 cc. By this method of operation  and with a good dietitn programme, it is possible to lose 50-70 kg weight, an average  of at the end of a year.In recent publications, it is written to be effective to taking the diabetes under control.

Laparoscopic Roux-En-Y Gastric Bypass(Rygb),

It is a restrictive surgical procedure that effects the absorption. The commonly used methods. method, is creating a small volume of  stomach by leaving an about 30 ml pouch in the  stomach. Then, a new connection is made in the small intestine from the small stomach so that the nutrients are provided to pass the small intestine without touching the larger stomach. By the help of small stomach, the patients receiving less food. As the big part of stomach and and intestine by passed, malabsorption occurs. Patients due to fewer calories with malabsorption. This means more weight loss 

 

What Are The Common Porblems That May Arise in All These Operations

10% of vitamin deficiency, 5% of anemia, 1% to 2 nausea, 1% deep blood clots (DVT), 1% reflux, 1%, pulmonary embolism, 0%, 5 bleeding, 0%, 5 fistula (leakage),% 0, 1 constipation, 0%, 1 death

RESULT

For the treatment of obesity, bariatric-metabolic surgery apply for the appropriate patients.

Currently, the most widely used type of surgery Sleeve Gastrectomy, Roux-en-Y Gastric Bypass, Mini Gastric Bypass. One term frequently used adjustable Gastric Banding is no longer used. Malabsorption (malabsorption) intended surgical techniques cause more weight loss. After surgery, patients should be monitored at regular intervals necessarily. Under a dietitian control, daily nutrition programme, daily calorie units and protein must be adjusted. Physical activity and exercise program should be done, should be identified and developed vitamin and mineral deficiencies that can always be observed.

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