What are the differences in the methods used in the surgical treatment of obesity?
Tube stomach
Sleeve gastrectomy is popularly known as “stomach reduction surgery”. During gastric sleeve surgery, the stomach becomes a long, thin tube like a banana. 80 percent of the stomach is excised and removed laparoscopically, that is, with a closed surgical approach. Therefore, the food intake of the stomach is restricted. In addition, sleeve gastrectomy surgery has the effect of reducing food absorption, albeit at very low levels. It helps to reduce appetite in patients who have gastric sleeve surgery and to break insulin resistance without losing weight. The process is completed in an average of one and a half hours. After sleeve gastrectomy, the risk is low as the exit and entrance parts of the stomach are protected and the continuity of the digestive system is ensured.
Who can have gastric sleeve surgery?
People diagnosed with morbidly obese
Those who have obesity-related type 2 diabetes, hypertension, sleep apnea problems
People with metabolic disorders
Gastric sleeve surgery is a suitable procedure for people between the ages of 18-65. In order for the person to be a good candidate for gastric surgery, the Body Mass Index (BMI) value determined by the World Health Organization should be 35 and above. Obesity level is important for those under the age of 18. If the patient is deemed appropriate as a result of parental approval and doctor’s decision, the procedure can be applied.
Weight regain after sleeve gastrectomy surgery is approximately 15 percent. The probability of being morbidly obese again despite the surgery is 5-10 percent. For this reason, close follow-up of patients by specialists is important to prevent weight gain in patients who have undergone sleeve gastrectomy.
Gastric Bypass
Gastric bypass, also known as gastric bypass surgery; It is one of the most preferred surgical procedures in bariatric surgery. Although the stomach volume is reduced with this process, the absorption of nutrients decreases as the path through the small intestine is shortened. The part where the stomach starts is separated from the others and approximately 30-50 cc is left. Part of the small intestine is also bypassed and connected to the newly formed small stomach. In this way, patients can reach fullness quickly with much smaller portion sizes.
It also inhibits the absorption of most high-calorie foods. With this method, effective and permanent weight loss can be achieved. Similar to volume restriction procedures, patients can quickly feel full with a smaller portion due to the reduction in the new gastric pouch. Gastric bypass surgery has positive results in the surgical management of patients with uncontrolled type 2 diabetes. After the application, the patients are kept under observation in the hospital for 4-6 days.
In the first year, obesity surgeons as well as endocrinologists, psychiatrists and nutritionists should be followed closely. Weight loss occurs gradually, the fastest in the first months. For maximum weight loss, one and a half – two years may be required. 70-80% of the excess weight is lost during this period.
Gastric sleeve or bidet bypass?
The frequency of gastric bypass surgery is gradually decreasing. Studies show that there is no significant difference between bypass and sleeve gastrectomy in terms of superiority to each other. However, sleeve gastrectomy surgery is more preferred due to technical and postoperative problems. We can summarize the differences between the two operations as follows.
1. In gastric bypass surgery, since the beginning of the stomach and small intestine is closed to food intake, patients must take lifelong vitamin and mineral supplements.
2. In gastric bypass, the stomach is not removed and left in place. However, it is an area closed to endoscopic procedures. In other words, even a simple endoscopic procedure is not possible.
3. The risk of excessive weight loss is much higher than sleeve gastrectomy.
4. In case of weight gain again or any complication that may occur after the surgery, the chance of correction of the patient is almost impossible.
Gastric bypass surgery, which is technically more difficult and has a higher risk of complications, does not have a clear advantage over sleeve gastrectomy, so sleeve gastrectomy is the first priority in obese patients.
