WHAT IS BARIATRIC SURGERY?
Bariatric is divided into its root and suffixes as “bar-iatr-ic”. The root of the word, bar, means weight in Greek. One of the production suffixes -iatr means treatment, and -ic means something. So bariatric surgery means surgery on weight treatment.
When bariatric surgery is mentioned, there are more than one method, not a single operation method. These methods aim to either reduce the stomach capacity and reduce the amount of food the patient receives, or shorten the intestinal surface where the food is absorbed, or provide both effects together. If we list these methods from simple to complex: intra-gastric balloon applications, gastric band, sleeve gastrectomy surgery and various bypass surgeries can be counted. In fact, we can group these surgeries under four headings:
1. Restrictive surgeries: typical examples of gastric band that frequently used in the past and sleeve gastrectomy surgeries. The main goal in these surgeries is to limit the daily food volume that the patient receives, thereby reducing calorie intake. However, a person can also take high calories with low volume. Especially in the case of nutrition with carbohydrate and fat-rich foods, a person can take high calories in low volume. For example, sugary liquids (juice, coke, alcohol) or fat-rich foods (fries, chips, snacks, burgers). Since the way and physiology of the digestive system are not changed in these surgeries, the vitamin-mineral deficiencies that the person will experience are mild and generally temporary.
2. Malabsorptive surgeries: Typical examples are biliopancreatic diversion (BPD) and duodenalswitch (DS). The passage of food into the small intestine after gastric outlet is changed to shorten the time it encounters pancreatic and bile enzymes to absorb the food taken after these operations. Therefore, although the patient continues to eat high-calorie, he may not gain weight again. However, these surgeries also have heavy costs. Absorption of not only calorie foods, but also vitamins and minerals is significantly reduced after these operations. For this reason, patients with these surgeries must use 6 pills of vitamin-mineral supplements daily for life.
3. Mixed-effect surgeries: In these surgeries, which you often call as bypass surgeries, the stomach capacity is reduced and the absorption is reduced to some extent by disabling roughly the first 2 meters of the small intestine even though it varies according to the type of surgery. Since vitamin-mineral absorption is permanently impaired in these surgeries, the patient has to use 3 pills of supplements daily for life. In mixed-effect surgeries have two disadvantages theoretically. Endoscopic follow-up of the rest stomach is not possible, and endoscopic treatment chance of the biliary tract problems in the patient will be lost.
4. Operations aimed at regulating metabolic problems such as high blood sugar level, hypercholesterolemia or high blood pressure rather than losing weight: methods that are not widely used, such as ilealinterposition, transit bipartition, or jejuno-ileal bypass, but we know that they are good at short and long term.
Intragastric balloon applications aim to limit the patient's eating capacity with the effect of a balloon placed temporarily in the stomach. However, due to the elastic structure of the stomach, the stomach expands over time and the patient can gain old eating capacity. Also, since these balloons cannot be kept in the stomach for life, they must be removed after a while. For these reasons, these methods cannot provide permanent treatment. They are used to reduce the risks associated with surgery by giving the patient some weight before other bariatric surgery applications in individuals called super-supermorbid obese and whose body mass index is above sixty.
The gastric band application aims to reduce the patient's eating capacity by wrapping a silicone band around the stomach, leaving a stomach volume of 20-30 ml at the entrance to the stomach from the esophagus. Although it has been a popular method in Europe and our country for a period, it is now a largely abandoned method due to the problems caused by the silicone band wrapped around the stomach. However, it can still be used safely in suitable patients.
In sleeve gastrectomy, the outer side of the stomach is largely removed and a banana-shaped stomach with a volume of approximately 50-60 ml is left behind. It was originally used as the first stage of a two-stage surgery to reduce the surgical risks of bypass surgeries in overweight patients. However, later on, it was started to be used as a standalone bariatric surgery method since it was understood that most of the weight lost with this method was not reversible. In addition, although it was accepted as an operation that only restricts the volume of the stomach, it was later understood that this surgery also had hormonal effects on the understanding that the part of the stomach secreting the appetite hormone was removed. Due to the easy application of the method, it quickly became popular and became the most applied method of bariatric surgery all over the world.
There are many methods of bypass surgery, which are performed using different techniques. These kinds of bariatric surgery both reduce the volume of the stomach and reduce the absorptive surface of small intestine by changing the connection point of the small intestine to the stomach. These surgeries are more complex, requiring more experience and time. In addition, since intestinal absorptive surface decreases, they cause more vitamin-mineral deficiencies. Therefore, they are preferred in some special patient groups. The first of these is the so-called “sweet eaters”, who cannot remove sugary liquids (such as juice, coke) or sweets from their daily lives. In addition, due to the bypass performed during these surgeries, since the food passes into the small intestine without going through the duodenum, it has effects on lowering blood sugar. Due to these effects, they are preferred especially in patients with insulin dependent type-2 diabetes.
There are idioms that we use frequently in medicine: “there is no disease; there are patients”, and “there is nothing as two and two is four in medicine”. For this reason, there are more than one methods in the treatment of many diseases and the selection of these methods is made individually according to the characteristics of the patient. Candidates for bariatric surgery should also meet with physicians interested in bariatric surgery and determine the most appropriate treatment for them.