What is obesity?
Obesity is the accumulation of excessive and abnormal fat in the body to such an extent that it impairs health. Obesity is a chronic disease that is becoming increasingly common worldwide and is one of the main causes of health problems in most countries. It occurs in 18% of males and 20% of females in developed countries. "Body mass index", used in identification of obesity, is calculated by dividing body weight (kg) by height squared (m²). According to BMI, people are classified as low weight, normal weight, overweight, obese and morbidly obese.
- Overweight people are people with a BMI in the range of 25 - 29.9,
- Obese people are people with a BMI in the range of 30 - 40,
- Morbid obese people are people with a BMI over 40.
What are the health problems caused by obesity?
Some health problems caused by obesity include:
- High cholesterol
- Heart diseases (heart attack, etc.)
- Sleep apnea syndrome (intermittent breathing during sleep)
- Increased risk of cancer
Does obesity shorten a person's life span?
Yes, studies show that obese people die at a younger age compared to fit people.
What should we do to protect ourselves from such problems caused by obesity?
Weight loss should be achieved through a range of measures ranging from changes in diet and lifestyle to medication. Obese patients who cannot lose weight by using these methods are candidates for bariatric surgery, which enables intake of less calories and nutrients. Bariatric Surgery can be applied to patients
- With a BMI >40 who do not respond to dieting, exercise and medications,
- With a BMI of 35 – 40 who have health problems such as obesity-induced diabetes, heart diseases and HT, etc.
Are there different surgical methods?
Yes, many surgical methods are used. Among these, the most common surgical methods are:
- Gastric bypass – is the short name for Roux-en-Y gastric bypass (RYGB) method. In this method, a large portion of the stomach is closed, leaving a small chamber for food. Then, the stomach with reduced volume is joined to the middle portion of the small intestine. This procedure provides a new route in which smaller amount of food can be taken in and less food is absorbed between the stomach and small intestine.
- Sleeve gastrectomy - In this method, a large portion of the stomach is taken and turned into a narrow tube, which allows less food to be taken at once.
- Gastric balloon - In this method, a special balloon is inserted into the stomach by endoscopy. The balloon can remain in the stomach for up to 6 weeks. The amount of food that can be eaten is limited because there is less space left for food during the time the balloon remains in the stomach.
How is surgery performed?
Gastric bypass and gastric sleeve can be performed by open, laparoscopic or robotic methods. In open surgery, a long incision is made in the midline of the patient's abdomen. Laparoscopic method is performed with the help of camera and flat and thin instruments placed through small incisions made in the abdominal wall. Robotic surgery is a more advanced version of laparoscopic method.
What is robotic surgery?
In the Da Vinci robotic surgical system, surgery is performed through small channels called ports placed through small incisions, as in laparoscopy. The surgeon performs the surgery by sitting in the console of the robotic system, and the surgical instruments of the robot perform the surgeon's commands simultaneously.
What are the advantages of robotic surgery?
The Da Vinci robotic surgery system has two cameras, each displaying separate images. Thus, unlike laparoscopy, which provides 2-dimensional images, surgery is performed under 3-dimensional images with a sense of depth. In addition, the operation area is enlarged by 10-12 times with these cameras. Since the camera is under the control of the surgeon, magnified images of the anatomical structures in deep and narrow areas can be obtained. Injuries that may occur during surgery can be minimized.
In contrast to laparoscopy using straight and non-twist instruments, the instruments on the arms of the robotic surgery system have the ability to move freely in 7 steps. The ends of these instruments can rotate 540 degrees around their axes and simulate the wrist movements of the human hand thanks to the 'endowrist' system.
With these instruments, surgery can be performed in very narrow and deep areas. In addition, with the "tremor scaling" feature of the robotic surgical system, possible hand shakes are not transmitted to the instruments in the operation area during the operation and errors related to human hands can be reduced in the interventions to be performed in risky areas.
Operation of Obesity Patients using Robotic Surgery System
In obese individuals, the fact that the intraabdominal fatty tissue is too high makes the operations technically difficult and increases the risk of switching to open surgery. Robotic surgery enables the obesity surgery to be performed more safely and effectively thanks to its advantages mentioned above.
How are different surgical methods compared?
Each method to be chosen has benefits and disadvantages.
- Gastric bypass enables faster and a higher amount of weight loss, but it's the most complicated surgical procedure. It may cause problems in the absorption of nutrients and may result in insufficiency of some important nutrients.
- Sleeve gastrectomy is a safer method because it does not change the course of food or because no new connections are made between the stomach and the intestine. Lack of important nutrients occurs to a lesser extent.
- Gastric balloon method has become more popular in weight loss. It is safer and easier to apply because it involves no incision or suture in the stomach or intestine. However, it cannot enable as much weight loss as surgical methods do.
The patient and the surgeon discuss the patient's expectations from the operation, the method to be chosen and associated risks and come to a conclusion before the surgery.
What are the benefits of surgery?
In addition to providing weight loss, it helps resolution of health problems such as diabetes, hypertension, sleep apnea syndrome.
Is it necessary to change diet after surgery?
Yes, the diet of the patient is arranged with the nutritionist.