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Duodenal Switch

Duodenal Switch

Duodenal Switch is both a restrictive and malabsorptive bariatric surgery procedure intended for weight loss. The restrictive part of the operation involves the removal of approximately 70-75% of the stomach and a large proportion of the duodenum. For this restriction, first the left side of the patient’s stomach is removed. As a result, the stomach turns into a thin, long sleeve. This is an irrevocable step of the procedure. The most important step of the procedure involves the rerouting of a long section of the small intestine, in such a way as to create two separate paths and a joint channel. The shorter one of these two paths created is the portion of the small intestine that will deliver things coming from the stomach to the channel. The longer portion of the small intestine is the part that leads to greater absorption, where bile and other digestive enzymes get mix with foods. In short, these regulations are intended to selectively limit the fat absorption, by shortening the time of the body’s caloric intake from the foods in the small intestine. Within 2 years after Duodenal Switch surgery, patients lose two-thirds of their excess weight. This is a surgical procedure more invasive than other bariatric procedures. However, more effective weight losses are observed thanks to this procedure.

What can I eat after Duodenal Switch?

You can eat small frequent meals after Duodanal Switch. This is because your new and small stomach cannot intake big meals.  Similarly, your stomach cannot tolerate large amounts of fat, alcohol or sugar. Therefore, if you want to get through the surgery with minimal complications, you will need to definitely reduce your fat intake and consume less fast foods, sugar-containing cakes, frozen foods, desserts, cookies and candies.

How much weight will I be able lose after Duodenal Switch?

Within two years (on average) after Duodenal Switch surgery, you lose two-thirds of your excess weight. This is a surgical procedure more invasive than other bariatric procedures. However, it provides more effective weight loss than other procedures.

What are the advantages of Duodenal Switch surgery?

Since the stomach is given a tubular shape, food intake becomes limited after surgery; and since the last 250 cm of the small intestine is used for food passage, absorption becomes limited as well. In this way, you have the advantage of achieving more effective weight loss. Since the valve at the exit of the stomach will be kept intact, bile leakage and the associated gastric ulcer will not be experienced. Because this valve is preserved, signs such as low blood pressure, fainting and vomiting due to the passage of foods into the small intestine, i.e. Damping Syndrome will not be seen. The inaccessible nonfunctional portion of the stomach is not left in the body, as in other bypass operations. Duodenal Switch operations are known to be one of the most effective procedures for the treatment of morbid obesity and control of diabetes. Switching to this procedure will be very simple for those who regain weight over a long term after sleeve gastrectomy.

Does Duodenal Switch surgery have any disadvantage? If so, what are they?

As in all malabsorptive procedures, electrolyte and vitamin deficiencies can also be seen in this surgical procedure.

Sleeve Gastrectomy

Sleeve Gastrectomy

Sleeve Gastrectomy is also known as Gastric Sleeve In the surgical procedure, a large portion of the stomach (approximately 80%) is removed with intent to reduce the gastric volume. Since the food intake is limited with the stomach reduction, the patient loses weight. The stomach that normally looks like a sac will take the shape of a thin and long sleeve after this procedure. The surgically removed part of the stomach is taken out of the body, in an irrevocable way. This surgically removed part of the stomach includes the part producing ghrelin, i.e. the hunger hormone that stimulates the hypothalamus region of the brain. In this way, the patient’s feeling of hunger will decrease but will not be lost completely. In sleeve gastrectomy operations, the stomach valves called the ‘pyloric valves’, which regulate the emptying of the stomach, are preserved. Since these valves are preserved, there will be no change in the digestive system. However, you will experience the feeling of satiety more quickly, by eating less amount of food. People who have undergone sleeve gastrectomy can reach the feeling of fullness by eating less than normal, thanks to their reduced stomach. Sleeve gastrectomy surgery is intended to enable the person to lose weight by eating less and consuming healthier foods. Sleeve gastrectomy can be performed with both open and closed methods.

What are the points that I need to take into consideration before sleeve gastrectomy?

In general, hospitalization 24 hours prior to the time of bariatric surgery is recommended. You should also follow a liquid diet and avoid solid foods for 24 hours before surgery. You should completely stop eating from 12 o’clock at night. You should stop oral liquid intake 8 hours prior to the time of your surgery.

What are the advantages of sleeve gastrectomy?

The advantages sleeve gastrectomy provides are the narrowed the gastric passageway, ability to feel satiety with a small amount of food, reduced appetite, and balanced nutrition. Compared to gastric bypass surgery, sleeve gastrectomy is easier, takes shorter, and requires a shorter hospital stay. Sleeve gastrectomy can also be turned into some other bariatric surgery procedures, when required.

Who are suitable candidates for sleeve gastrectomy?

A person who complains of his/her overweight may be or may not be suitable for having sleeve gastrectomy. For being able to have this surgical procedure, he/she should be aged between 18 and 65, and have a body mass index of above 35-40. The person is considered to be a suitable candidate for sleeve gastrectomy if he/she has cardiovascular diseases, type 2 diabetes, and serious health problems due to his/her excess weight; if he/she is not alcohol and drug addicted; if his/her psychological state does not pose an obstacle to life style change; if he/she is able to overcome surgical stress; if his/her health status is suitable; and if he/she cannot lose weight with any procedure other than surgical procedure.

How much weight will I be able lose after sleeve gastrectomy?

If you eat healthily and do regular exercise after sleeve gastrectomy, you can achieve 65-80% weight loss within 1 year after surgery. However, if you cannot consolidate your eating habits and cannot eat healthily, you may experience 5% weight regain in the course of time.

What will I experience after sleeve gastrectomy?

You can get up 1-2 hours after your transfer from the operating room to your bed. After the first postoperative day, you can take a shower by covering your medical dressing with protective covers. You can return to work after resting about a week after surgery. If you have a job that requires physical activity, you are advised to return to work after 30 days.

Mini Gastric Bypass

Mini Gastric Bypass

Among bariatric surgery procedures, Mini Gastric Bypass is the easiest and most economical surgical procedure that can be performed in the shortest time. Mini Gastric Bypass surgery provides as much weight loss as the other bypass surgeries. It can control certain conditions such as Type 2 diabetes, the leading sign of metabolic syndrome, hyperlipidemia and hypertension. The most basic logic in this surgical procedure is that it reduces the volume of the stomach. However, it also involves the bypass of the portion of the small intestine that provides absorption at the exit of the stomach. The bypass procedure is performed by establishing an anastomotic connection between intestine and the stomach. Bypassing this portion of the small intestine, which provides absorption, supports rapid weight loss, and the treatment of hyper tension, cholesterol, and diabetes. It has favorable effects on elderly patients. Mini Gastric Bypass is a surgical procedure performed completely with closed methods. It involves incisions shorter than 1 centimeter. The laparoscope and other instruments required for surgery are placed into the abdomen through these incisions. These are specially manufactured instruments produced in dimensions allowing for their insertion through these incisions. A small tube is formed at the entrance of the stomach, and is separated from the rest of the stomach. The portion of the stomach to be used after surgery is this part. No organ is cut and removed during surgery. The newly formed stomach is connected to the small intestine to ensure the foods to pass to the intestine by bypassing its upper portion. This constitutes the second part of the operation.

Who are candidates for Mini Gastric Bypass surgery?

For Mini Gastric Bypass surgery, you should have a body mass index of 35 and over. This surgical procedure takes 30 to -60 minutes. You can be discharged 24 hours after surgery.

How can weight lose be achieved with Mini Gastric Bypass?

With Mini Gastric Bypass, it is possible to lose weight in three different ways. These are reduction of the gastric volume, restriction of absorption, and hormonal regulation. With the first way, i.e. the reduction of the gastric volume, the food servings will also be reduced. In the second way, i.e. the restriction of absorption, the upper portion of the small intestine (about 200 cm in length) is excluded from the process of food passage. Bearing bile and other fluids responsible for digestion and absorption is the task of this excluded (bypassed) portion. Thanks to this absorption restriction, you lose weight to a great extent, and maintain the achieved weight for a long time. In the third way, i.e. hormonal regulation, the fact that the stomach remains passive inside has an effect on weight loss. Because the foods eaten cannot pass to this part, it will not be stimulated and consequently lose its effectiveness. As a result, this will reduce the release of ghrelin, the ‘hunger hormone’.

How are the stomach and the small intestine connected to each other?

The stomach and the small intestine are connected to each other with special staples.  These staples are specially produces tools suitable for closed method. They connect the stomach to the intestine in such a way as to create an opening between them for food passage. This newly created opening is called anastomosis.

When can I be discharged after mini gastric bypass surgery?

You can stand up 4 hours after the Mini Gastric Bypass surgery, and can begin to take nourishment orally after the first postoperative 24 hours. If the results of your follow-ups and examinations do not indicate any problem, you can be discharged after given dietary instructions 3 days after surgery.

How should I take nourishment after the mini- gastric bypass surgery?

After the Mini Gastric Bypass, you will need to follow your personal diet program prepared by your dietitian. In general, small amounts of water, apple juice or fruit juices can be given the next day after surgery. Liquid or semi-liquid foods, fat-free milk and yoghurt, soups prepared with yoghurt, fruit purees prepared with yoghurt, fruit purees prepared with yoghurt, mashed legumes, saucepan-cooked dishes, cornflakes prepared with skimmed milk, and fat-free cheeses can be consumed for approximately a month after surgery. In addition, chocolate, honey, cake, dessert, sherbet, ice cream, soda, alcoholic beverage and all sugary foods should be avoided because they cause vomiting.

Gastric Bypass

Gastric Bypass

Gastric Bypass is a surgical weight loss procedure. This procedure is performed under general anesthesia in an operating room. Before undergoing the operation, the patient should have a fasting period of about 8 hours. A day before surgery, blood thinners are administered in adequate doses to prevent blood clotting. A urinary catheter is placed after the patient is anesthetized by the anesthesiologist. Gastric bypass surgery is performed with the laparoscopic method, known as a closed method. A laparoscope, a thin tube equipped with a tiny video camera (30 cm in length) is inserted through several incisions (5 to 10-mm in lengths) made on the skin. Long rods with a structure thinner than a pen are inserted into the abdomen. With the help of these rods and staples, a gastric pouch (3 cm in width and 3 cm in length) is formed in the stomach part adjacent to the esophagus. A point on the small bowel about 200 cm distal to the ligament of Treitz is anastomosed to the gastric pouch (i.e. up to 200cm of the upper part of the intestine is bypassed), with intent to reduce the digestion. The anesthesiologist performs a test called ‘leak test’ by inflating the stomach with blue-stained liquid, to see the firmness of the staple line created between the new stomach pouch and the intestine. This test is also performed with air and sometimes with both air and liquid. The operation is ended without removing any part of the stomach, by suturing the incision sites on the skin.

What is the short description of Gastric Bypass?

Gastric Bypass surgery is one of the most commonly performed surgical procedures in the world. This surgical procedure is performed to enable people to lose weight with two mechanisms. In a Gastric Bypass surgery, a small stomach volume is created. In addition, the resultant small stomach is anastomosed to the small intestine. The foods coming from the mouth bypass the big stomach and directly pass through the small intestine. This procedure is called Gastric Bypass.

Is gastric bypass a suitable surgical procedure for me?

Gastric Bypass is a surgical procedure suitable for patients with a body mass index of over 35, diabetic patients, and patients who mainly consume sugary foods, alcohol, high calorie snacks and coke.

How long will I stay in the hospital after the gastric bypass surgery?

After surgery, patients usually stay in hospital for a period of 2 to 3 days. After consuming water and liquid foods during this period, you can be discharged if your doctor deems it appropriate.

What will I experience after gastric bypass?

After surgery, you can easily feel full with small amounts of food intake. This fullness will turn into satiety and loss of appetite over time. The needed vitamin and mineral supplements will be taken in accordance with the instructions of the surgeons and dietitians. In this way, you can lose weight very comfortably, without vitamin and mineral deficiencies.

How much weight will I be able lose after the gastric bypass surgery?

You can lose 50-100% of your excess weight within 1 to 2 years after a Gastric Bypass surgery. Your success in weight loss is proportional to your compliance with the post-operative diet and exercise program. After a Gastric Bypass surgery, for example a patient who was 124 kg while entering into the operating room, can lose approximately 50 to 60 kg.

Intragastric Balloon

Intragastric Balloon

Intragastric balloon is a balloon made of silicone, which is endoscopically placed into the stomach. This balloon helps a patient lose approximately 15-20% of his/her body weigh over time. It is the easiest, reliable and non-surgical procedure among procedures performed in the struggle with obesity. Obesity paves the way for high blood pressure, heart failure, joint problems, vascular diseases, stroke and psychological problems rather than aesthetic problems. Therefore, the use of the intragastric balloon has become more common in the treatment of obesity. Intragastric balloon is preferred in super-obese patients with a BMI over 50, for making the surgical site more operable before bariatric surgery and enabling patients to lose 20 to 30 kg. Intragastric balloon treatment is performed by endoscopically placing an inflatable (with liquid of air) balloon into the stomach under anesthesia. The patient is anesthetized during the procedure. This is a simple and effective procedure that takes about 20 minutes. Before the procedure, the patient should have a fasting period of about 8 hours. Before the performance of the intragastric balloon procedure, the patient’s esophagus, stomach and duodenum are endoscopically examined to see whether there is any problem. If the results of the examination are considered to be normal, the process is continued. After this step after, first the deflated intragastric balloon is lubricated with gel and then is delivered into the stomach. The location of the balloon is endoscopically controlled. It is then inflated with 500-700 ml saline plus 10 ml methylene blue, and the process is ended. After the procedure, the patient is kept under medical observation for several hours and then is allowed to go home. With nutrition training, patients begin to eat less and lose weight quickly. After losing adequate weigh to an adequate extent, the balloon in the stomach is endoscopically deflated. After the completion of the treatment process, the intragastric balloon is removed with special endoscopic equipment.

What are the benefits of intragastric balloon?

The intragastric balloon procedure is a non-surgical procedure with a very low risk. It is possible to leave the hospital on the same day, immediately after the procedure. It is not a procedure that will leave a scar on your body. Weight gain after a surgical operation would be a problem because a second operation would be more difficult than the first one. However, such problem is not experienced in the intragastric balloon procedure. If you regain weight after the removal after the balloon, the procedure can be repeated. An intragastric balloon can be adjusted in accordance with the patient’s needs. When deemed necessary, it is possible to increase or decrease the volume of the balloon.

In which conditions the intragastric balloon procedure is not performed?

The intragastric balloon procedure should not be performed in people with psychiatric disorders, alcohol and drug addictions, active stomach and small intestine diseases or gastric ulcer, inflammatory intestinal diseases, intestinal cancer, hematological disorders, severe heart and kidney diseases, and those who use anti‐blood clotting drugs, high-dose anti-inflammatory drugs, and steroids. In addition, intragastric balloon is not used in patients under 18 years of age and over 65 years of age.

How much weight will I be able lose after an intragastric balloon?

An intragastric balloon can make it possible to lose approximately 20 to 25 kg over a period of 6 months.
The most important condition for losing weight with an intragastric balloon is to carry out the procedure definitely in conjunction with a support program. Placing an intragastric balloon will not alone lead to an adequate weight loss. You can achieve this success very easily. by gaining a proper dietary habit.

What will I experience after the placement of the intragastric balloon?

An intragastric balloon is used as a temporary treatment of obesity. It helps lose weight and prevent regaining the weight that has been lost. An intragastric balloon should be left in the stomach for a period not longer than 6 months. After removal of the balloon, the patient should adopt a diet and exercise program suitable for him/her. First of all, he/she should take important steps for a healthy life, by gaining proper dietary habits. If these are not ensured, weight gain may be experienced again.

Will I feel the intragastric balloon after its placement? Will it restrict my ability to eat?

You may experience mild discomforts for a few days after the placement of the intragastric balloon. However, the balloon will then become completely harmonious with your body. There will be no dietary restriction after the procedure? You will notice your inability to eat as much as you previously you did, because of effect of the balloon.