Obesity Surgery in Turkey

Obesity is one of the greatest problems of our era is spreading every day. Obesity is a serious and risky health problem that can cause other serious health problems and death. Individuals must fight against this problem with an expert doctor. There are some non-surgical and surgical alternatives among bariatric treatment. Here are the most effective operations in weight loss…

The excessive weight problem is defined as excessive fat accumulation on the body due to high-calorie intake. These individuals need medical treatment to eliminate obesity. Patients who are afraid of surgical methods or want to lose weight faster and more effectively generally choose non-surgical methods. It is noted that the most effective methods for morbidly obese and super obese individuals are surgical methods.

gastric sleeve turkey

Gastric Sleeve

Gastric sleeve operation is the most demanded and most common bariatric surgery operation among obesity surgery alternatives. This intervention is applied with laparoscopic methods and some part of the stomach is removed. Remaining part of the stomach is shaped like a tube. This operation will lead the patient to feel full of smaller portions and to have healthier lifestyle.

gastric balloon turkey

Gastric Balloon

Obesity is one of the most common problems around the world. In recent years, we can even see obesity among children. This is known as childhood obesity. In most cases, individuals with childhood obesity experience this problem in the future. With advancements in medicine and technology, it is possible to solve this problem. There are different obesity treatments like gastric balloon.

stomach botox turkey

Stomach Botox

Excessive weight has always been a problem. Without noticing, we can gain weight. But being overweight or obese has different healthy risks. To help weight losing process, stomach Botox has been applied to different patients.

I. Obesity is a fat overload.

This overload is due to the inflation of the fat stock because of an imbalance between the energy contributions and the expenses of the organism, the contributions exceeding the expenses. The contributions are exclusively represented by the diet but this includes, of course, drinks (sweetened, alcoholic, etc.).

Why this imbalance?

First and especially because of an excess: the contributions are too abundant. This is the major cause. Explaining why some people “eat too much”, however, is not always easy: eating habits often acquired in childhood, compensation diet stress feeling, personal “discomfort” are, nevertheless, the factors most often encountered. But the qualitative defect is also very often in question. Rather than “eating too much”, they are people who “eat badly”: their diet contains too many sugars and fats, not enough green vegetables, vegetables, vegetable fibers. Finally, many nibble, which maintains a renewed hunger and stimulates the “storage” of food in the greasy sector. In this area, it is true, and everyone has seen around him, that we are not all equal Our organisms do not all work the same way: in quantity and quality equal some are gaining weight, others remain lean. Family factors, genetic, are certainly involved, as personal factors that remain to be elucidated. However, and as “unfair” as it may be felt, this does not change the fact that for a given organism, the weight gain results from an excess of contributions compared to the expenses of this organism. Because, and it is the 2nd cause of imbalance between contributions and expenses, it is necessary to underline that the sedentarity, the absence of regular physical activity, practice of a sport favors, by the fall of the expenses of the organization, the constitution of overweight.

After long thought that there was a simple and straightforward relationship between intakes and weight, including in severe obesity, doctors now know that things are more complex. And now we see severe obesity as a true “autonomous” disease, that is to say, as a self-sustaining pathological situation. Multiple hormonal mechanisms are now partly elucidated, explaining the sort of gear in which these patients are locked up, and the usual impossibility to get out by returning only to “normal” contributions. In morbid obesity installed, the fat mass has become the first endocrine gland of the body: this means that, contrary to what we thought, it is not only passive, but plays a role in its own right. the metabolism.

II. Who is obese?

Several formulas exist to define an ideal weight and, from there, a rate or level of excess weight defining obesity. A widely used, simple standard is body mass index or BMI (synonyms: Quetelet Index and English Body Mass Index or BMI).

It is obtained by dividing the measured weight in kilograms by the square of the size expressed in meters:

BMI = Weight (in kg) / Size x height (in meter)

Obesity is defined in this standard by an index greater than 30, morbid obesity by an index greater than 40.

The table below sets out this standard illustrated with examples:

BMI standard Examples

  • 20-25 Normal subject 1m70 – 65 kg: 65 / 1,7×1,7 = 65 / 2,89 = 22,50
  • 25-30 Overweight 1m70 – 80 kg: 80 / 2,89 = 28
  • 30-40 Obesity 1m70 – 90 kg: 90 / 2,89 = 31
  • > 40 morbid obesity 1m70 – 130 kg: 130/2, 89 = 45
  • > 50 Super obesity
  • > 60 Super super obesity

III. Consequences of obesity.

They are both psychosocial and organic in nature. The psychosocial impact is often at the forefront. In the twentieth century, in the West, fashion has banished the curves of the body, unlike other eras and other cultures. Obese often develop a negative image of their own body. Paradoxically, this negative image can be a cause of aggravation of obesity, the obese compensating his grief to be obese while eating. Morbid obesity perceived as a monstrosity by the subject, directly or through the eyes of others, is sometimes a source of social exclusion (difficulties in finding a job for example), family difficulties

On the organic side, the list of complications often induced by obesity is important.

It ranges from premature cartilage wear, which causes osteoarthritis, therefore pain, to cardiovascular complications, high blood pressure, high risk of infarction, increased risk of cancers, including the colon and breast, as well as diabetes, respiratory disorders, Pickwick’s syndrome, sleep apnea syndrome, etc. So that the risk of early death is much higher with a BMI greater than 40, with a BMI between 20 and 40.

This is why it is necessary to treat morbid obesities (also called massive obesities).

As the reduction of overweight, the treatment of moderate obesity stem from the desire to conform to an ambient fashion, or to “feel better about one’s skin”, as the treatment of morbid obesity comes from a need most often medically justified.

Several high-level scientific publications on large population studies, comparing obese-control subjects (non-operated) and obese surgery (mostly by-pass), have shown that the weight reduction achieved by Surgery significantly reduced arterial hypertension, diabetes and especially significantly reduced, in the short, medium and long-term mortality of the surgical population (compared to non-operated controls).

IV. How to treat?

The change in behaviors that led to obesity is obviously the treatment of choice: overall drop in intake, qualitative changes, increased spending, through regular physical activity, daily. It is simple to state, much more difficult to implement and especially to observe in a sustainable way. This always requires medical support, nutritionist, psychologist. This single change in behavior should be enough to treat obesities not too severe and not too old.

Unfortunately, this classic, necessary and indispensable path in all cases is frequently marked by failures and relapses. Major efforts, tense, are followed by abandonment, discouragement leading in a few weeks or months to the return of lost pounds.

It is the failure of these “medical” treatments, the rule in morbid, massive obesity, which has led to the research and development of surgical procedures, and has been for many years.

Currently, it is recognized, as we have seen above, that beyond a certain overload, its sustainability for years, and that after successful attempts, even serious, well monitored and effective behavior change (loss of 20, 30 or even 50 kilos), a “simple” change in behavior by a regime is doomed to failure.

This is the classic yoyo effect: weight loss, superior recovery from the slightest relaxation of effort.

Thus beyond a certain threshold, only a surgical solution is likely to break this cycle which leads to growing obesity more and more. However, and this is essential, we will see it again, the operation does not “do” everything. Active, enlightened, prolonged, indefinite medical surveillance is essential to ensure a good long-term outcome.

V. Surgical procedures.

Bariatric surgery was born in the 1960s in the USA and has continued to grow. Even today, there are many opportunities for active clinical research.

The principle of interventions is based on the creation of either a restriction (reduction of stomach volume limits intakes) or malabsorption (the bypass or “bypass” changes the absorption of nutrients in the blood), a restrictive and malabsorbing combined effect.

Currently, three major interventions are considered: the gastric band, the sleeve type gastrectomy and the gastric bypass. It should be understood that the “mini-bypass”, which is an intervention producing a major biliary-pancreatic intestinal short circuit (contrary to what the denomination would suggest), is not part of the arsenal because it does not is not yet officially validated by French learned societies.

Adjustable ring gastroplasty

Adjustable ring gastroplastyDeveloped in the early 1990s, laparoscopically performed for the first time in 1992, it results from a conceptual evolution of gastroplasty described above.

The strapping is done by a silicone ring internally lined with an inflatable balloon, connected by a very fine pipe to a filling chamber that is placed under the skin. Thus, the upper part of the stomach, which receives the food, is reduced to a small pocket of 15 to 20 ml. It communicates through a narrow orifice, and variable, adjustable by the inflation of the balloon, with the underlying stomach.

In practice

You understand that this is not a “miracle”, “minute” operation, but a potential solution to a complex, long-standing, unresolved problem for which you agree to take some risks . It is therefore essential that the operative decision is carefully considered.

This is why you will not be set up immediately after the first consultation.

On the contrary, you will be asked to inform yourself, to think and to consult an endocrinologist, a nutritionist and a psychiatrist, perhaps to begin psychological care. In this way, you should be able to weigh your decision.

You will come to one of our informational meetings (duration of 2 hours) led by a surgeon and a nutritionist.

Examinations will be made in search of an associated pathology, cardiac, respiratory etc. justifying special precautions.

You will therefore perform blood tests, a chest X-ray, a gastroscopic fibroscopy, an abdominal ultrasound and an electrocardiogram and a search for sleep apnea.

At the end of this “course” your file will be presented at a multidisciplinary meeting (RCP), a regulatory body involving specialists from at least 3 different disciplines. Its mission is to clarify and specify the operational indication and to retain, as appropriate, the type of operation to offer.

To summarize clearly, Obesity Surgery

  • Bariatric surgery brings a certain benefit, both in terms of comfort and life expectancy.
  • It is effective, whatever the chosen technique, that by the constraint that it weighs in a very prolonged, even indefinite way.
  • Even if it takes place laparoscopically, in expert hands, it is not without risks, including vital ones.
  • It can only be decided after careful consideration and multidisciplinary consultation (endocrinologist, nutritionist, psychiatrist or psychologist).
  • When the principle of surgery is retained, the choice of the operation must be made carefully taking into account several criteria, including the level of BMI, eating behavior, co-pathologies, age.
  • It requires monitoring, medical monitoring (and often psychological) indefinite.
  • When the indications are well laid, the success rate must exceed 80% at five years.
  • Smoking increases the risk of surgical complications of any surgery.
  • Stopping smoking 6-8 weeks before the procedure eliminates this additional risk.
  • If you smoke, talk to your doctor, surgeon, and anesthetist, or call Tobacco-Info-Service at 3989 to help reduce risk and put you at risk.

Most effective non-surgical operations in weight loss

Non-surgical medical operations that enable the most effective weight loss are divided into two as a gastric balloon and stomach Botox.

Gastric Balloon: This is a non-surgical weight loss method for fast and healthy weight loss of morbidly obese patients and effective weight loss in advanced obese individuals. Individuals who have a body mass index of 25 or higher, individuals with weight loss problems can have this operation if they do not have any stomach problem, took long-term cortisone treatment and are not pregnant. This method helps to lose approximately 10-25 kg and it is completed in 15 minutes.

After sedating or applying general anesthesia to the patient, a deflated intragastric balloon is placed in the stomach with endoscopic methods. After placing the balloon to the stomach, this balloon is inflated with air until reaching 500-900 ml volume or with blue dyed serum until reaching 450-500 cc volume. Stomach spasm and mild spasm for the first 3 days is perfectly normal and temporary. After the operation, the patient needs to follow a special diet and exercise program. Otherwise, all lost weights can be regained. The intragastric balloon must be removed 6-12 months after the operation. During balloon removal, general anesthesia is applied.

Stomach Botox: This operation can be applied to anyone with body mass index below 35, below 60 years old and without stomach disease or Botox allergy. This operation approximately takes 20-30 minutes and applied with the endoscopic method when the patient is sedated. This treatment restricts the contraction of stomach muscles, extends the time for food to leave the stomach and helps feeling full for a longer time. This way, weight loss is achieved. The effects of this operation will be visible after 3-7 days. Also, the effects are permanent for 6 months. When this treatment is supported by diet and exercise, it is possible to lose 4-20kg within 6 months. According to literature, stomach Botox can be applied for a maximum of 3 times with 6 months intervals.

Does gastric balloon rupture?

The intragastric balloon does not have to rupture risk but it can leak. This balloon is inflated with blue liquid to detect any leakage. When there is any leakage, the patient’s urine will turn green. This way, it is easier to detect any leakage. When this happens, you need to contact your doctor as balloon location and volume need to be checked.

Do non-surgical operations guarantee weight loss?

Both surgical or non-surgical operations and applications do not guarantee weight loss alone. After the operation, patients need to fully cooperate and follow the personal program. These are the main conditions to lose weight and sustain weight loss after these operations. Otherwise, the patient can fail to lose weight or preserve this weight.

Most effective surgical operations in weight loss

Sleeve Gastrectomy: Sleeve gastrectomy is the common name. This is the most demanded and most commonly applied bariatric alternative. This is among the most effective operation for weight loss. This operation is applied to patients with a body mass index of 36 or higher, who cannot lose weight with diet and exercise, who experience other health issues such as diabetes, hypertension, sleep apnoea and who are between 15-65 years old. This operation is closed. 6 small laparoscopic holes are opened and the hormone production segment of the stomach is removed. Generally, the remaining stomach part has 150-200 cc volume. This part is shaped like a tube. After leakage control, the operation is completed.

Gastric By-Pass: Certain part of the stomach is bypassed. This way, half of the intestines are used for digestion and stomach volume is decreased. This method is limiting and enzyme decreasing method. It can be applied in 3 methods including closed, open and robotic. However, since open operations leave a large scar, this method is rarely preferred.

Silicon Gastric Band: This is also known as stomach staple. This method is applied to a patient with at least 40 kg or more than their ideal weight. The main difference from other operations is that there is no need to dissect and remove the stomach. Silicon band is placed around the stomach to leave 15-20 cc gap on the top part of the stomach. A tunnel is created to prevent this band to slip. Diet and exercise program must be followed after this operation.

Is sleeve gastrectomy risky?

The risk rate in international data shows 0.2-0.4%. This risk rate is the same as any other operation. As in other surgical operations, risks could be decreased with doctor experience, team experience, equipment quality, correct equipment use during sleeve gastrectomy operation. As in all other surgical operations, doctor selection is extremely important in bariatric surgery.

In women, fat or adipose tissue tends to distribute on the thighs and hips. “When fat is distributed in this way, it is called peripheral obesity or ginoid-type obesity. It is what is popularly known as pear-shaped distribution ”, indicates Miguel Angel Rubio, of the Endocrinology and Nutrition Service of the San Carlos Clinical Hospital, Madrid.In men it accumulates especially in the trunk and abdomen. This obesity is called android, central or apple-shaped.Fat distribution depends on hormonal and genetic factors, and can determine the risk of certain diseases. In fact, people with abdominal obesity are more likely to have diabetes, high blood pressure, or cardiovascular disease.

March 15, 2020

Assoc. Dr. Ali DURMUŞ

Assoc. Dr. Ali DURMUŞ was born in Gaziantep. Since his father was a civil servant, he spent the first years of his education in several cities. After completing his high school education, he completed his undergraduate education in Canakkale Education...
read more about: Assoc. Dr. Ali DURMUŞ

E-mail | Twitter | Facebook