Bariatric Surgery

OBESITY SURGERY CENTEREfficient outcomes are obtained in surgeries carried out with laparoscopic method in the Obesity Center of Medistate Hospital Obesity. Most appropriate surgical method is applied using cutting-edge technology and multi-disciplinary approach in conjunction with experience and specialization in the field of obesity (bariatric) surgery. Methods used in obesity surgery:Gastric BandSleeve GastrectomyGastric By-pass (Roux-Y)Mini-gastric By-passGastric Plication OBESITY CENTEREfficient outcomes are obtained in surgeries carried out with laparoscopic method in the Obesity Center of Medistate Hospital Obesity. Most appropriate surgical method is applied using cutting-edge technology and multi-disciplinary approach in conjunction with experience and specialization in the field of obesity (bariatric) surgery.Since laparoscopic method is used for obesity surgeries performed under supervision of Prof. Emin Ersoy, M.D., President of the Turkish Association of Endoscopic and Laparoscopic Surgery, smaller incision and quicker return to social life are ensured. WHICH METHODS ARE USED IN OBESITY SURGERY?Gastric banding, sleeve gastrectomy, gastric by-pass and gastric plication surgeries are used in obesity surgery. A diet program is prepared in pre-operative period in order to reduce body fat percentage, conserve muscle tissue and make patient ready for post-operative treatment. √ Gastric BandGastric banding surgeries are done with laparoscopic method. A small gastric pouch is created with a band placed 3 to 4 cm caudal to the cardia. Since the band is adjustable, tension can be increased or decreased in response to patient’s condition. A subcutaneous port is placed to make adjustments. Band migration, band erosion, difficulty swallowing, damage to band and port insertion problems are among possible postoperative conditions.√ Sleeve GastrectomySleeve gastrectomy is the most preferred modality among obesity surgeries. Surgery can be successfully carried out with laparoscopic method. A large portion of the stomach is surgically removed and about 25-30 percent of total vol­ume of stomach is left. Gastric fundus, the superior part of the stomach, is also surgically removed. Therefore, level of ghrelin hormone, also known as “hunger hormone” that is secreted from gastric fundus decreases and appetite is more easily regulated. Although gastric capacity is decreased in this surgery, gastric functions are not impaired. In addition, risk of gastric ulcer reduces. When it is compared to long-term outcomes of gastric by-pass surgeries, weight loss rates are same. This is the surgical modality that causes the least impairment in our physiology. √ Gastric By-pass (Roux-Y)In gastric by-pass surgery, a pouch, measuring approximately 25-30 cc in volume, is formed at cardia and it is con­nected to a segment of small intestine at 100- to 150-cm distance to the stomach. Surgery restricts food intake, while it also decreases absorption of nutrients. Long-term outcomes are similar to that of sleeve gastrectomy; therefore, sleeve gastrectomy is, recently, somewhat more preferable. Possible postoperative complications are dumping syndromes and ulcer formation at the new passageway. Probability of vitamin deficiencies is higher in comparison to other surgeries. √ Mini-gastric By-passThis is another type of gastric by-pass surgeries; since this surgery is performed under the name of gastric-bypass, it does not, in fact, draw attention. Unlike usual gastric by-pass surgeries, 1- A longer and larger gastric volume is created. 2- Small intestinal bypass allows biliary and pancreatic enzymes pass through the stomach to intestines. (loop small intestine). In the long run, reflux disease and conditions caused by bile in the gastric lumen are probable. √ Gastric PlicationStomach wall is folded inwards on the greater curvature, starting from the dome to the gastric outlet. It reduces volume of the stomach. There is no risk of leakage or bleeding, since no incision is made. It has gradually been popu­lar. It is usually preferred as secondary surgery for patients, who has already undergone gastric banding surgery. Outcomes are similar to that of sleeve gastrectomy in experienced centers. Laparoscopic technique is used for all surgeries in the Obesity Center of Medistate Hospital and open surgeries are avoided, unless it is absolutely indicated. The most suitable method is determined for each patient by the surgeon in the light of preoperative laboratory and radiologic examinations.