The decision for surgical treatment is made in cases of severe obesity (BMI > 40) and persistent obesity (more than 5 years) and as long as the previous conservative treatments with diets and drugs have not worked. Sometimes surgical treatment is also indicated in milder forms of obesity (BMI > 35) when there are accompanying problems such as diabetes mellitus, hypertension, hypopnea syndrome, etc. and there will be significant weight loss benefit. The age should be between 18 and 65 years and the patient should understand the lifestyle changes.
The choice of the most appropriate operation in each case depends on many factors such as BMI, gender, age, medical history, dietary habits, social life, and the patient’s environment. The choice will be made with the guidance of the specialized surgeon after the patient has fully understood the changes that the surgery will bring to his life. This point is very important because the cooperation of the patient after the operation is necessary. The greater the excess weight, the more drastic the surgery should be. Restrictive surgeries hardly achieve a weight loss of more than 60 kg, which is why they are considered rather inadequate in severe obesity (BMI > 55). These patients will benefit most from a malabsorption procedure. In extremely severe forms of obesity, a multistage approach can be designed. In other words, to initially perform a restrictive type operation and after losing enough weight, follow, if necessary, a second intestinal bypass operation.
Complications in obesity surgery can be distinguished in:
- a) perioperative, i.e. those that may occur in the operating room and within the first 30 days after surgery and
- b) remote, related to the type of operation.
The rate of perioperative complications is generally low when the operation is performed with the correct technique and the indications are followed. In the vast majority of them, the complications are treated successfully.
Further complications appear much later, months or years after the operation, and cannot always be avoided. Patient cooperation plays an important role in preventing some of these complications.
Medical follow-up must be regular over a long period. However, its frequency and duration depend on the type of operation. Sleeve gastrectomy is the only one that does not require long-term follow-up. The gastric ring requires more frequent follow-up because of the adjustments that need to be made, especially in the first year. Gastric bypass operations require long-term follow-up as the physiological changeWhat will my diet after the operation?
For one month after surgery, the diet includes liquids and soft foods. After the first month, patients can gradually be fed solid foods by chewing each bite well and eating slowly, until they feel full. For best weight loss results, patients should avoid eating liquid and soft foods with high fat or sugar content. These foods do not create satiety.
All patients who undergo surgery receive a few days of treatment that includes antibiotics, anticoagulants, anti-inflammatory drugs, possibly painkillers, and some protein preparations.
Bariatric surgeries, especially if they have been performed laparoscopically, do not limit exercise post-operatively. On the contrary, it is encouraged to increase the metabolism. After a laparoscopic operation, the patient can start light exercise after 2 weeks, and after an open operation after 8 weeks.
Vomiting is more common with the gastric band. Patients should take enough time to eat and chew food very well. However, occasional episodes of vomiting may occur from indigestible, poorly chewed food or excessive tightening of the ring
This depends on the operation that has been performed, but also on the patient’s compliance with the post-operative instructions and the particularities of each operation. In general, gastric banding procedures usually result in a loss of 45-65% of excess weight in 12 months. Malabsorptive procedures produce greater weight loss (70-90% of excess weight) with very few dietary restrictions
When the excess weight is more than 40 kg, the skin usually loses its elasticity and cannot recover. Another factor that contributes to relaxation is age (over 25 years). Loosening is successfully treated.
Pregnancy is generally better to happen after a year or so. A pregnant woman who has undergone bariatric surgery should be closely monitored in addition to her gynecologist and surgeon.
