Bariatrics - Richmond Health

About Obesity

Obesity is a chronic disease caused by excessive fat accumulation in the body, triggered by genetic base and environmental factors.

The existence of obesity is not depending on one single cause. The most frequently causes are eating and drinking disorders, hormonal problems, sedentary lifestyle, psychological problems, genetic predispositions and many other factors.

If this persists for a long time, the excess of calories will turn into fatty tissue and cause excessive weight problems.

Obesity is treated according to its degree by a surgical or non-surgical approach.

Who is eligible for bariatric surgery?

Obesity surgery, often known as bariatric surgery, has a wide range of alternatives.

After a series of preoperative interviews and tests, the proper surgical procedure for each patient is determined. The person’s eating habits and expectations following the procedure are determinants in identifying the optimal surgical approach.

The existence of several obesity related comorbidities (reflux, high blood pressure, diabetes, joint pain, fatty liver, high cholesterol, migraine, PCOS, asthma, COPD, dyspnea, snoring etc.)
The body mass index must be at least 30
No drug or alcohol abuse
No liver cirrhosis
No ongoing oncological status
No AMI (heart attack) in the past year
No advanced heart failure

Central Nervous System

Open visitation with only two visitors in a room at any given time. No one under 12 years of age may.

Allergic Disorders

Open visitation with only two visitors in a room at any given time. No one under 12 years of age may.

Neoplastic Disorders

Open visitation with only two visitors in a room at any given time. No one under 12 years of age may.

Obesity Surgery - Pre-operative investigations

The pre-operative time for bariatric surgery is just as crucial as the surgeon’s overall experience and the decision-making process for the best operation type for the best patient. We schedule pre-operative investigations when a patient agrees to have surgery.

Laboratory test
Gastroscopy
Abdominal ultrasound
Chest X-ray
Lung function test
Cardiology consultation electrocardiogram and ultrasound
Psychiatry consultation
Dietician consultation
Internal medicine or endocrinology consultation
Upper gastrointestinal tract barium test (in case of revisional surgery)

Bariatric Surgery Stages

Evaluation of the investigations

The evaluation of these test is finished within one week. In case of need for treatment before the procedure, the necessary (drug) treatment is applied in the weeks before the operation.

Pre-operative diet

A vegetarian diet with a protein supplement is recommended before surgery. With this short (2-4 weeks) diet, the aim is to lose some weight before the procedure.

Pre-operative diet aims to reduce the fat in the abdominal cavity and the liversize of the patient. The weight that is lost in a short time has also a lot of benefits for the cardiovascular and respiratory system of the patient.

Thus, the operation becomes easier for the surgeon and therefore for the patient and the operational risks are reduced. In addition, with this diet, it is possible to reduce the operation time. This results in a faster recovery postoperatively.

Duration of the hospital stay

Postoperative, patients are accommodated in comfortable single rooms where patients’ needs are prioritized. Under normal circumstances there is no need for observation at the intensive care unit.
Patients coming from other cities or from abroad; they enter the hospital 1 day before the scheduled operation day and they stay 3 nights. They can return home on the third postoperative day.

Work Disability

Depending on the patient’s profession; if the patient doesn’t work under severe physical conditions, the patient can restart working within 7-10 days.

What is sleeve gastrectomy (tube stomach) surgery?

Sleeve gastrectomy (sleeve gastrectomy) is a surgical procedure that allows obese patients to lose weight by removing the majority of their stomach. Tube stomach is the name given to the leftover stomach since it is in the shape of a tube. In 1988, the first Sleeve gastrectomy (sleeve gastrectomy) surgery was conducted as part of an open duodenal switch operation.

First time, it was applied closed in 1999. In overweight people, the first stage was surgically applied before gastric bypass surgery after 2001. Its popularity progressively grew after 2009, and it was beginning to be used as a stand-alone surgical procedure.

This operation has grown highly popular, especially since the advent of laparoscopic application, due to the reduction in hospitalization duration, recovery time, scarring, and the risk of surgical site hernia.

Which Patients Is Gastric Bypass Surgery Applied?

It can be used on obese people who are unable to reduce weight or who are experiencing symptoms such as insulin resistance and joint discomfort as a result of their obesity.

It was generally used as a first step operation before gastric bypass surgery in highly obese individuals till 10 years ago.

The patients’ weight was lowered in this way, and subsequently bypass surgery was conducted. However, further observations and study reveal that the majority of individuals do not require a second surgery, resulting in sufficient and long-term weight loss.

Similarly, when it was shown that diabetes was as successful as bypasses in preventing problems like high blood pressure, its use became more common. Nowadays, it has become the most common obesity surgery.

How is sleeve gastrectomy (tube stomach) surgery performed?

The entire treatment is carried out through laparoscopic (closed) surgery. Laparoscopic surgery is done through a series of tiny incisions. Hand instruments can reach the abdomen through the ports placed through these incisions. One is a surgical telescope with a video camera, while the others are used to introduce specialist surgical instruments. On a television monitor, the surgeon observes the operation. An experienced laparoscopic surgeon may perform many procedures laparoscopically, exactly like in open surgery, with expertise.

In 1988, the first Sleeve gastrectomy (sleeve gastrectomy) surgery was conducted as part of an open duodenal switch surgery. For the first time, it was applied closed in 1999. In overweight people, the first stage was surgically applied before gastric bypass surgery after 2001. Its popularity progressively grew after 2009, and it was beginning to be used as a stand-alone surgical procedure. This operation has grown highly popular, especially since the advent of laparoscopic application, due to the reduction in hospitalization duration, recovery time, scarring, and the risk of surgical site hernia.

Injecting co2 gas into the abdomen inflates the abdomen. The inside of the abdomen is then accessed using trocars, which are specific tools. To modify the residual stomach breadth, a guiding silicone tube is put from the mouth to the stomach exit. It is separated from the fat tissue that surrounds the stomach, the arteries, and the spleen, which is its immediate neighbor. The excess stomach tissue is then sliced and separated using staplers, which are specific equipment. There is about 80-150 ml of stomach capacity left. The divided section of the abdomen is removed and sent to pathology. The bleeding in the cut and stapled area is then controlled.

Additional metal clips or sutures, if necessary, can be utilized to accomplish this. In order to reduce bleeding, several particular medications can be applied to the wound site if necessary. Then, to evacuate the collected fluids, a silicone drain is put in the operation area. The wounds are beautifully closed, and the procedure is completed.

What are the advantages of sleeve gastrectomy (sleeve gastrectomy) over Gastric Bypass Surgery?

Mineral deficits are caused by a lack of vitamins (especially deficiencies in vitamin B12, iron, calcium, and folate).
It necessitates less lifelong vitamin and mineral pills as well as follow-up.
Again, there are a plethora of intervention strategies available for weight gain.
When a problem arises, endoscopy can be used to intervene in the bile ducts and pancreatic duct. Procedures like ERCP and biopsy are simple to do.
There is always the possibility of being managed by endoscopy because there is no stomach tissue that has been closed and left.
The appetite diminishes even more if the fundus region of the stomach, which secretes Gharlin (appetite hormone), is destroyed.