The World Health Organization defines obesity as abnormal and excessive accumulation of fat in the body fat tissues, which is harmful to health. The waist circumference exceeding 88 cm in women and 102 cm in men is an indicator of obesity. Body mass index (BMI) is used to define obesity. BMI is the weight divided by the square of the height; and when the resulting number exceeds 30 kg/m2, it means obesity. The treatment of obesity primarily involves lifestyle changes along with a diet, regular exercise and medication, if needed. However, after obesity occurs, the possibility of permanent weight loss using such methods is 2-3%. Obesity surgery is performed on suitable obese people who are unable lose weight through such methods. Obesity surgery has changed a lot from past to present. For the last 20-25 years, obesity operations have been performed laparoscopically. Nowadays, the most common method of surgery is the tube stomach. 75% of the stomach is removed. Since there will no longer be secretion of the appetite hormone called ghrelin, which is secreted by the removed section, the appetite will decrease compared to the past. As the stomach volume decreases, it will feel full with less food. In this way, patients lose approximately 70-80% of their excess weight at the end of the first year. In addition to weight loss, additional diseases associated with obesity completely resolve by 60-95%.
Type 2 diabetes is a disease that occurs in middle aged and older people and is usually caused by the body’s development of resistance to insulin. The cause is obesity for 90%. Diabetes can lead to cardiovascular diseases, renal failure and vision loss. The treatment first requires life-style changes, diet and physical exercise. Usually, drugs that increase insulin production or reduce insulin resistance are used. In advancing cases, insulin is used. Diabetes surgeries are performed on patients whose blood sugar levels do not drop to normal levels despite the treatment, who use insulin or who starts suffering from damage to additional organs. Obesity and diabetes surgeries are intertwined. It is not possible to separate the two or distinguish them. The method of surgery is determined by taking into account the age of the patient, the duration of the diabetes, the treatment received, the presence of additional organ damage, and the insulin reserve in the pancreas. Diabetes surgeries are performed laparoscopically like obesity surgeries. As with gastric tube surgery, the stomach is reduced. The first and last parts of the small intestine is swapped over. Thus, since the food, which is not fully digested by the stomach, comes directly into the last part of the small intestine without exposure to pancreatic enzymes, the hormone GLP-1 is produced there. This hormone increases the secretion of insulin by the pancreas and the effectiveness of the secreted insulin in the tissues. This way, 90-95% of diabetes disease is completely treated.
Obesity and diabetes surgeries require a multidisciplinary approach. Patient selection is very important for success. Postoperative follow-up is as important as the surgery.
- Laparoscopic (Closed Method) Gastric Surgery
- Laparoscopic Gastric Bypass Surgery,
- Laparoscopic Sadi-S Surgery (obesity and diabetes surgery),
- Laparoscopic Transit Bipartition Surgery (diabetes surgery),
- Laparoscopic ileal interposition surgery (diabetes surgery)
