The widespread use of laparoscopic obesity surgery has left both emergency physicians and general surgeons faced with acute and chronic complications of bariatric surgery. Patients who have undergone bariatric surgery should take a phased approach should they encounter any emergency.

Resuscitation attempts are the same as for patients who have not undergone bariatric surgery. Therefore, consultation with a bariatric surgeon should be provided early. Surgery-specific complications must be taken into consideration in the differential diagnosis.

APPROACH TO THE PATIENT UNDERGOING OBESITY SURGERY

Acute band slippage is one of the most common complications of gastric banding (clamp). Before making diagnoses such as “stomach cold” and “food poisoning” in a band patient who complains of pain and vomiting, it must be proven that this complication does not exist. Sleeve gastrectomy and gastric bypass surgeries; It carries the risk of complications such as stapler leakage or bleeding in the stapler line, which can be life-threatening.

Gastric bypass and biliopancreatic diversion surgeries carry risks such as bleeding, perforation or serious stenosis, especially marginal ulcer in the anastomosis line. Intestinal obstructions may occur due to internal hernias, sometimes trocar site hernias, intussusception (obstruction as a result of the intestine herniating into itself), adhesions, folds and clots.

In case of any emergency, ABC (Airway – Breathing and Circulation) principles should be followed during intervention to the bariatric patient. A patient history about the bariatric procedure performed is essential. However, consultation with a bariatric surgeon must be ensured during the evaluation.

Often patients are unaware of the details of the surgical procedure they have undergone. Knowing the bariatric procedure is the basis for focusing and making a diagnosis.

Disturbance in vital signs should bring to mind the possibility of pulmonary embolism and sepsis. The most common cause of death among bariatric surgery patients is pulmonary embolism. Many cases of venous thromboembolism also develop after discharge from the hospital. Fever, low blood pressure, tachycardia, decreased urine output, tachypnea and hypoxia are the most important symptoms of infection. These symptoms should alert the physician about the causes of infection-sepsis caused by bariatric surgery. Therefore, information about the surgery will be a guide in the differential diagnosis of procedure-related septic complications.

Complaints such as abdominal pain, nausea and vomiting, especially digestive system bleeding, are among the complications specific to the surgery. Symptoms of dehydration, that is, not being able to take in enough fluid or compensate for the loss, are tachycardia, dry skin, pale mucous membranes and a decrease in the amount of urine. Resuscitation should be initiated immediately with appropriate glucose-free fluids.

Since these patients often show atypical features, they require special attention in the evaluation of signs and symptoms. Full recumbent position should be avoided as excess skin and fatty tissue will cause breathing problems. If endotracheal tube placement is required, the anesthesiologist should be alert to potential intubation difficulties. It should not be forgotten that the anatomy of the upper digestive system changes when placing a nasogastric or orogastric tube.

Specific Acute Complications After Laparoscopic Adjustable Gastric Banding

Laparoscopic gastric band surgery is one of the most commonly used methods in the world. The probability of complications is quite low in the short and medium term. However, long-term data indicate a higher incidence of postoperative complications leading to band repositioning or removal. The major complications are band slippage, acute or chronic pouch dilatation, erosion, and permanent or recurrent outflow obstruction.

Band Slippage: The most common adjustable gastric band complication is slippage. Band shift; Chronic pouch dilatation manifests itself as gradually progressing symptoms of food intolerance, dysphagia, decreased feeling of satiety and restriction. Acute band slippage is characterized by persistent abdominal pain, vomiting and obstruction symptoms. Radiological diagnosis can be easily made by distorting the orientation of the band on the plain abdominal radiograph. Nausea, vomiting and restriction of oral intake can lead to severe dehydration with changes in cardiovascular status and vital signs.

Gastric Obstruction: Obstruction caused by a poorly chewed and quickly swallowed bite can lead to acute and persistent dysphagia. This condition is treated conservatively, similar to acute band slippage. If treatment is successful, the patient is directed to receive nutritional support and see his or her bariatric surgeon.

Complicated Intragastric Band Migration

Band migration can usually be detected during radiological or endoscopic controls. Although normally a chronic complication, port infections usually begin in the first months of surgery. Trauma to the posterior wall of the stomach during surgery and tight band placement may be the cause of early erosions.

Removing the tape; It is mandatory due to complications such as bleeding or perforation. When signs of acute port infection such as redness, swelling, abscess or fistula formation are observed at the port site, if there is an abscess, it should be drained urgently and the patient should be referred to the bariatric center for further examination and treatment.

Specific Acute Complications After Laparoscopic Sleeve Gastrectomy (Stomach Tube) Surgery

Sleeve gastrectomy surgery, which has been used for many years as the first step of biliopancreatic diversion and duodenal switch surgery, is now considered a stand-alone procedure. Laparoscopic Sleeve Gastrectomy is the most popular bariatric surgery method performed today.

Early complications arising from the stapler line are rare but the most feared complications. Today, many surgical procedures, including sleeve gastrectomy, can be performed as standard.

Stapler Line Leaks

Leak rates after laparoscopic sleeve gastrectomy vary depending on study series and patient characteristics. Signs of local or widespread peritonitis seen in a patient who has recently undergone bariatric surgery are likely due to a late fistula. In all suspicious cases, tomography should be performed.

The tomography to be taken usually shows three possible pictures;

High level staple line fistula and left subdiaphragmatic fluid accumulation at the esophagogastric junction

Perigastric fluid accumulation in the perigastric fat tissue close to the stapler line without air bubbles and contrast material leakage

Multiple leaks and widespread fluid accumulation

Leaks are successfully treated with a wide variety of interventions performed on the patient using endoscopic methods and catheters placed through the skin under computerized tomography. The most important reason for failure here is delay in diagnosis and late treatment. Delay in diagnosis may occur due to poor patient follow-up, or due to the patient’s own negligence, escaping control, or not coming to the surgeon who performed the surgery for a check-up. Therefore, it is vital that these surgeries are performed by teams that take care of their work, complete post-operative follow-up and treatment, and have the ability and experience to perform all kinds of interventions after diagnosis. Many methods are used endoscopically, such as gastric clip (OTSC), esophagoduodenal stent, internal drainage, and pylorus botox application. In this way, leaks are closed in 6-8 weeks. Sleeve leaks that cannot be corrected by endoscopic method should be corrected by surgery. For this purpose, primary repair, conversion to bypass surgery, fistulojejunostomy and total gastrectomy surgeries are treatment options. The important point here is to make the diagnosis early and start the treatment as soon as possible.

Stenosis After Gastric Sleeve

Sleeve gastrectomy calibration through a very narrow tube leads to the development of mid-gastric stenosis at a rate of 4 percent. In these patients, persistent vomiting and food intolerance can often be observed. After conservative treatment of dehydration, patients should be referred to the bariatric center for endoscopic dilation. Generally, 3-4 endoscopic dilatations that do not require hospitalization are sufficient. In case of unsuccessful dilatation, effective gastric bypass revision may be required.

Specific Acute Complications That May Occur After Gastric Bypass

Gastric bypass is considered the gold standard in the surgical treatment of morbid obesity, especially in America. Using linear staplers, a small gastric pouch with a volume of 25-30 ml is created just below the esophagus.

Anastomotic Leak

Anastomotic leakage after gastric bypass is also considered a life-threatening complication. Early or late leakage may present a clinical picture ranging from subclinical leakage to sepsis. During the diagnosis phase, passage film with gastrografin, tomography and blood count should be performed.

Emergency surgical treatment should be considered in hemodynamically unstable patients with severe and persistent symptoms. The abdomen should be washed extensively and multiple drains should be placed. Compared to sleeve gastrectomy, bypass leaks are closed much faster and easier since the pressure in the anastomosis area is lower.

Complicated Marginal Ulcer

Marginal ulcer is a peptic ulcer that occurs in the mucosa at the edge of the gastrojejunal anastomosis. It can be seen early (1-3 months) or late after gastric bypass.
The most common symptoms are pain and bleeding.

Specific acute complications after biliopancreatic diversion and duodenal switch

Biliopancreatic diversion is the most effective bariatric metabolic procedure compared to other techniques. Due to the anatomical and physiological changes that occur in their digestive systems, these patients require special attention, especially in emergency situations.

Many complications are situations that are noted at the beginning and require a general surgeon’s attention in the emergency room. It is often possible to stabilize patients for transfer to a bariatric center.

Specific Acute Complications After Laparoscopic Gastric Plication

Gastric plication (stomach folding) is an operation that has begun to be abandoned today due to its unsuccessful results and high rates of weight regain. Knowledge and experience regarding the management of its complications is limited.Gastric obstruction is the most common reason for reoperation. Conservative treatment (anti-edema and stomach-protecting drugs) can be tried initially. If vomiting does not improve, the layer causing the obstruction should be opened by endoscopy.

Acute Complications Unrelated to Surgery Type

Bleeding: Bleeding may result from staple lines or another focus. Trocar site bleeding, spleen injury, or retractor-related liver injury are rare but possible sources of bleeding. These complications usually occur within the first 48 hours after surgery. During this process, the patient is usually under the supervision of the bariatric center.

If the endoscopist has sufficient experience and is accustomed to the anatomical changes created by bariatric surgery; Endoscopy can help find the bleeding focus on the inside of the staple line and stop it with adrenaline injection, electrocoagulation or endoclips.

Small Bowel Obstructions After Bariatric Surgeries: One of the most common situations that general surgeons and emergency physicians encounter is the evaluation and treatment of small bowel obstructions.The standard approach algorithm for small bowel obstructions begins with nonsurgical approaches such as nasogastric decompression, bowel rest, fluid resuscitation, and close monitoring. Most patients can be treated with these conservative approaches unless there are signs of vascular malnutrition.

Trocar site hernias are an uncommon complication of laparoscopic surgery. However, it should be taken into consideration that high BMI values ​​​​create a significant risk factor and this possibility is higher in bariatric patients. Diagnosis can be made by clinical findings, plain abdominal radiographs and upper digestive system examinations.

Gallbladder and Tract Stones After Bariatric Surgery: Gallstones are usually seen in the first 6 months after surgery.Gallstones presenting with symptoms such as acute cholecystitis in a patient with a history of bariatric surgery do not pose a problem for a general surgeon. Diagnosis can be made by ultrasound, tomography or MR-cholangiography. When common bile duct obstruction is detected, endoscopic or surgical treatment depends entirely on the surgeon’s experience and the patient’s condition.

Gastro-esophageal Reflux Disease After Bariatric Surgery: Patients who have undergone bariatric surgery may present to the emergency department with severe epigastric pain, burning pain in the chest, or chest pain. Severe gastroesophageal burning may occur at a high rate. This condition is often due to reflux disease that is overlooked before bariatric surgery.

Aggressive dissection and closure of the hiatal defect are very important for hiatal hernia during surgery. Reflux symptoms after sleeve gastrectomy usually occur in the first postoperative year. The second peak of reflux may occur at a later stage. Proton pump inhibitor drugs constitute the first step of treatment in patients with new-onset gastroesophageal reflux symptoms after sleeve gastrectomy. In such a case, the patient should be referred to a bariatric center whenever possible.

Gastric sleeve surgery is one of the most frequently performed procedures in obesity surgery. Gastric sleeve surgery, which reduces obesity-related risks by providing a strong weight loss, also improves the patient’s quality of life in a short time.

What is Gastric Sleeve Surgery?

Gastric Sleeve Surgery, medically known as ‘Sleeve Gastrectomy’, is popularly known as stomach reduction surgery and is one of the most popular surgical procedures performed worldwide. Gastric sleeve surgery is the surgical transformation of the stomach into a tube. It is not possible to insert a foreign object into the abdomen as in gastric band surgery. The purpose here is; By reducing the feeling of hunger, patients eat less and lose weight.

Is Gastric Reduction Surgery Dangerous?

‘Sleeve Gastrectomy’, also known as sleeve gastrectomy, has some risks, as with all major surgical operations. The risk factor posed by the surgery varies depending on the patient’s age and weight. The risk of complications after surgery is generally between 3 and 5 percent. These are infection, pneumonia and bleeding. In such cases, immediate intervention is required by a surgical team without delay. Risks such as fatty liver, kidney diseases, diabetes or high blood pressure are minimized in people who have sleeve gastrectomy surgery.

The adaptation process to the gastric sleeve is generally better than gastric banding and bypass. Side effects of stomach reduction surgery; It is less than gastric bypass and larger surgeries. The postoperative period is more comfortable thanks to laparoscopic surgery. Weight loss will begin in patients as the feeling of hunger decreases. After a week, patients can return to their normal work. For those who have heavy work, the restriction lasts until the 3rd week after the surgery. In the first 1 and a half year after the surgery, the patient loses approximately 80 percent of his excess weight. Most of this weight is lost within the first four months.

How Does Gastric Sleeve Surgery Show Its Effect?

Gastric sleeve surgery, which is an effective surgical method for safe weight loss for patients with high Body Mass Index (BMI) and high risk, is the process of removing a large part of the stomach body. During the operation, the part of the stomach that stretches and expands the most and controls appetite is removed. This surgery aims to reduce the amount of food consumed by reducing the stomach volume. Since the natural flow of the digestive system is not interfered with, digestion and absorption continue normally after gastric sleeve surgery.

How much weight is lost after gastric sleeve surgery?

After sleeve gastrectomy surgery; Depending on the patient’s changing eating habits, it is generally aimed to lose 70 – 80 percent of the excess weight.

After Sleeve Gastrectomy, the patient loses excess weight;

First 3 months; 35 – 40%,

First 6 months; 50 – 60%,

In the first year, he can reach his target lowest weight by losing 60 – 70%.

How is Gastric Sleeve Surgery Performed?

Gastric sleeve surgery; It is a type of surgery performed using laparoscopic methods under general anesthesia. For this reason, the patient’s consciousness remains closed during the surgery. In the operation performed under general anesthesia, the surgeon performs the treatment by sending the camera and treatment tools to the abdominal area through 0.5 cm holes opened in the patient’s abdomen. Gastric sleeve surgery is the practice of entering the abdomen laparoscopically and removing 75 – 80 percent of the stomach. During the operation, which takes approximately 1 hour, a small tube is placed inside the stomach, thus preserving the thinness of the stomach. Hospitalization period is 2 or 3 days.

Will There Be Much Pain After the Surgery?

All major surgical procedures involve some degree of pain. However, pain is minimal in laparoscopic procedures. Since there is less pain due to small incisions, the healing process is also quite fast.

What is the Follow-Up Process After Gastric Sleeve Surgery?

As with all other methods of obesity surgery, the success rate in sleeve gastrectomy surgery increases directly with strict post-operative controls. Therefore, your first check-up is performed by your doctor approximately 10 days after the surgery. In this first check-up, clues about the early complications of the surgery will be investigated and it will be determined whether post-operative nutrition and other life functions are normal.

Your routine checks will be carried out in your 1st, 3rd, 6th, 12th, 18th and 24th months. During these checks, blood tests and sugar, insulin, liver enzymes, kidney function tests, vitamin and mineral levels are checked. If any deficiency is detected, special supportive treatments are started.

Who is Suitable for Gastric Sleeve Surgery?

According to the criteria of the World Association of Obesity and Metabolism Surgery (IFSO), sleeve gastrectomy surgery is not recommended for people under the age of 35 unless absolutely necessary.It is not done. It is also a very important factor that the person does not have diabetes. Those who benefit from this surgery are generally people who consume a lot of pastries, alcohol and fatty foods and therefore gain a lot of weight.

In what cases is gastric sleeve surgery not performed?

Since sleeve gastrectomy surgery is a serious operation that affects the person’s entire immune system, the patient’s general health history must first be thoroughly scanned and evaluated. Patients for whom gastric sleeve surgery is not suitable;

Psychological problems and mental instability,

Having drug or harmful substance addictions,

Anesthesia application poses a major risk factor,

The patient does not have a realistic perspective,

These are listed as the patient’s lack of physical and psychological support after the surgery and the patient’s eating disorders such as bulimia cannot be controlled.

What are the advantages of Gastric Sleeve Surgery?

The most important gain in sleeve gastrectomy surgery; There is no change in the natural path of the digestive system. The main advantages of sleeve gastrectomy surgery:

Due to the decrease in stomach volume, satiety is achieved with less food.

By removing Ghrelin, known as the hunger hormone, the desire to eat decreases.

Since no procedure is performed on the intestines, there are no risks such as bleeding, leakage and obstruction.

It takes less time than other obesity surgeries and takes approximately 1 hour.

The hospital stay after surgery is quite short.

There is no foreign object placed in the body.

Since absorption is not interfered with, vitamin and mineral deficiencies occur less frequently.

The amount of portions that can be eaten has decreased compared to before the surgery.

What are the Disadvantages of Gastric Sleeve Surgery?

The main disadvantages of sleeve gastrectomy surgery:

Since a large part of the stomach has been destroyed, it is not possible for the stomach to return to its original state.

Some patients may experience increased reflux after surgery.

Gastric sleeve surgery is not the first choice for patients with hiatal hernia.

When preferred in patients with a sweet tooth, the possibility of gaining weight is higher than intestinal-related operations.

After the operation, patients must be fed liquids for a while.

What are the Prices of Gastric Sleeve Surgery?

There are several factors that determine the price of gastric sleeve surgery, which is an obesity surgery technique that reduces stomach volume through laparoscopic surgery. For this reason, it is very important to choose a well-equipped hospital for complications that may occur after sleeve gastrectomy surgery. In addition, the length of stay in the hospital and intensive care unit after the surgery is among the main factors affecting the price of sleeve gastrectomy surgery.

THINGS TO CONSIDER AFTER GASTRIC REDUCTION SURGERY

In order for sleeve gastrectomy surgery to be fully effective, it is extremely important for the patient to stick to the diet program, pay attention to their nutrition, and take vitamin and mineral supplements regularly when necessary.

How to Eat After Gastric Sleeve Surgery?

In the success of sleeve gastrectomy surgery, it is of great importance that the patient not only adopts the new lifestyle, but also complies with the diet program created in cooperation with metabolism and endocrinology specialists and, if necessary, regularly uses nutritional, vitamin and mineral supplements. For this reason, nutrition and lifestyle changes after sleeve gastrectomy surgery are among the most important factors. The main rules to be considered in nutrition after gastric sleeve surgery are as follows.

Carbonated drinks are prohibited for life.

After gastric sleeve surgery, liquid nutrition is required, especially for the first 14 days.

Liquid and solid foods should never be consumed at the same time.

Salad consisting of vegetables and greens, fruits and nuts should definitely not be neglected in the diet.

Foods high in animal or vegetable protein should be consumed.

Care should be taken to eat at least 3 main meals and 2 snacks a day.

What should be the diet after gastric sleeve surgery?

After gastric sleeve surgery, patients are generally asked to avoid low-fat foods and fried foods. Carbonated drinks and alcohol, especially refined sugar, should be strictly avoided.

WHAT IS THE NUTRITION PROCESS AFTER THE SURGERY?

Immediately After Surgery: A clear liquid diet is followed for at least one week after gastric sleeve surgery. During this period, water, tea, fruit teas and soup with broth can be consumed.

One Week After Surgery: The patient is not allowed to eat soft and solid food for a week after the surgery. Solid foods may cause the stapler line to open and leak after surgery. During this period, liquid foods, low-calorie and low-fat soups, jellies and protein drinks can be taken. Care should be taken to ensure that the liquid foods consumed are low-calorie and fat-free.

2 – 4 Weeks After Surgery: Patients should only consume pureed foods during this period due to the risk of separation at the staple line . Excessive food intake may cause pain and vomiting. Pureed meat, potatoes and all kinds of fruit purees can be consumed 2 – 4 weeks after the surgery. Consuming carbonated drinks is strictly prohibited after surgery.

4 -5 Weeks After Surgery: The patient can switch to soft foods during this period. There should be at least 4 – 5 hours between meals and each meal should be consumed in a minimum of 30 minutes.

4 Months After Surgery: The patient gradually and regularly transitions to a normal diet; can consume meat, eggs, vegetables and legumes. For the first 2 years after surgery, the diet should be restricted to 600 – 800 calories. Most of the excess weight will be lost within the first year. After sufficient weight loss is observed, the number of calories can be increased to 1000 – 1200.

WHAT ARE THE POSSIBLE COMPLICATIONS OF GASTRIC REDUCTION SURGERY?

Leak: The stomach remaining from the tissue cut out in the surgery in question is closed with the help of stapler. Any openness, breakage or leakage that exists or may occur in the stapler line is called a leak. Even if the risk of leakage is 1 percent or lower, it can make the patient seriously ill and reach dangerous levels.

Gastroesophageal Reflux: Gastroesophageal reflux is a condition in which stomach contents leak back into the esophagus. Acids and stomach secretions can cause irritation in the esophagus. This causes an uncomfortable complaint that can be characterized by a burning sensation behind the chest wall, known as heartburn.

Gastric Fistula: A gastrointestinal fistula is an abnormal opening in your digestive tract that allows gastric juices to leak into the lining of your stomach or intestines. When this leaks into your skin or other organs, it can cause infection.

Stoma Stenosis: Stomach reduction surgery may cause stenosis in passage. Stoma is a term that describes the passage between the stomach and intestines. A second surgery may be required to correct this condition.

Surgical Hernias: Surgical hernias may develop in approximately 15 percent of cases. This risk is extremely low in laparoscopic surgeries.

Vitamin and Mineral Absorption: A long-term complication of gastric sleeve surgery is vitamin and mineral malabsorption. This situation can cause serious deficiencies.

Gastric band, popularly known as gastric band, is one of the surgical methods used in the treatment of morbid obesity. This method, also known as gastric banding; It is the process of placing a band around the stomach, approximately 200 mm below the junction of the esophagus and stomach.

The band placed in the stomach is inflated step by step by injecting serum through a port under the skin, 1 month after the surgery. The biggest advantage of this application, as the name suggests, is that it can be adjusted after surgery. The band made of silicone divides the stomach into two compartments like an hourglass. Filling the upper small stomach pouch with food provides a feeling of early satiety. Thus, as a feeling of satiety occurs, food intake is directly reduced.

The basic principle of the gastric band method is to change the patient’s behavioral habits and eating style, as in other surgical methods.

What are the Types of Gastric Bands?

Nowadays, there are many gastric bands with FDA and CE approvals. The main differences between the bands in question are their filling amounts, some formal differences and port structures, especially their literature supports. While some bands have a maximum filling volume of 6 cc, some can reach 9 – 11 cc filling. The widths of the part of the band wrapped around the stomach vary. Some bands have a ‘shape memory’ feature that takes shape directly when passed behind the stomach.

Current gastric bands used in our country;

Lapband (Lap-Band/ Bioenterics Corp, USA),

Swedish Adjustable Band (Allergan – Obtech Medical AG of Switzerland),

Midband (Medical Innovation Development in Lyon, France)

A.M.I Soft Gastric Band Premium (A.M.I Agency of Medical Innovation, Austria) and

Heliogast Advanced (Helioscopie, Lyon, France).

How to Place a Gastric Band?

Gastric banding (clamp; adjustable gastric band; adjustable gastric band; laparoscopic adjustable gastric banding:LAGB) method is applied using laparoscopic interventions in many patients. Making very small incisions during the surgery allows the patient to return to daily life in a short time. The patient loses approximately 60 to 80 percent of his excess weight in the 12 to 24 months following the surgery. If there is no problem with the gastric band, these patients have no risk of gaining weight.

How is Gastric Clamp Surgery Performed?

Gastric band surgery is the method of attaching a silicone band 3 to 4 cm below the part where the esophagus and stomach meet. Since the upper part of the stomach will be smaller, the patient will feel full by consuming less food.
Patient Position: After the patient is placed supine on the operating table, his feet are bent 300° downwards. The operator works between the patient’s legs in the reverse Trendelenburg position.

Insufflation of the Abdomen with Gas: A special needle called Verres is entered through the incision above the navel. Or, if the surgeon has experience, a safer abdominal entry and insufflation is achieved by seeing the layers one by one with an optical trocar (visual trocar). First incision; It is performed approximately 6 fingers below and in the middle part of the breastbone. This incision, through which the optical camera will enter, is approximately 10 mm long. It is filled with carbon dioxide gas so that the intra-abdominal pressure is 15 mmHg. The purpose of this is to push the intestines and abdominal organs back and protect the organs from injuries.

Insertion of Trocars and Hand Instruments: A total of 5 trocars (cannulas through which the instruments will pass) are entered through the existing incisions.

Dissection: The anesthesiologist inserts a nasogastric tube with an inflatable balloon at the end into the stomach. The intragastric balloon is inflated with 2.5 cc of serum and withdrawn. In this way, the balloon is attached to the gastroesophageal junction. This bulge in the stomach also allows the surgeon to decide where to start dissection.

Dissection of the Lesser Curvature: This dissection should be performed as close to the stomach wall as possible, with utmost effort not to damage it, and the laterjet nerve should be protected.

Dissection of the Phrenogastric Ligament: The gastric fundus, that is, the upper part of the stomach, is grasped with a grasper by entering through the outermost trocar and pulled downwards. Thus, the connection between the stomach and the diaphragm, called the phrenogastric ligament, is stretched.

Retrogastric Tunnel: The Endograsp Roticulator or Articulating Dissector is entered through the trocar in the right upper quadrant and advanced through the retrogastric tunnel under direct vision. Then, the instrument is angled so that the phrenogastric ligament is visible in the dissection area, that is, on the opposite side.

Insertion and Placement of the Band: Generally, the tube part of the band is placed into the abdomen through the outermost 10 mm trocar. This end is attached with an endograsp roticulator and is passed behind the stomach at the level of the dissecting area. After the tube of the band is passed through the locking mechanism, the silicone band is placed around the stomach and tightened.

Adjusting the Band Position: The anesthesiologist performs oral g with 15 cc.

People’s daily protein intake should be monitored and blood levels should be measured regularly. Average energy intake should not exceed 1500 calories.

The best source of protein is meat. However, red meat can be difficult to chew and break down. Therefore, fish is easier to chew and many types of fish are much richer in protein. White meat is a food that is relatively easier to chew. Eggs, yogurt and cheese are excellent sources of protein. Apart from animal sources, protein can also be obtained from legumes. Half of the glass should be devoted to proteins, and the other half should consist of fruits or vegetables.

Natural foods that have undergone minimal processing should always be consumed. There is no harm in using spices to flavor foods.

When to Eat?

After stomach surgery, a patient should consume three or fewer meals a day. If the patient is in the green zone – which means his band is adjusted correctly – he will not feel the need to eat between meals. Therefore, patients should be warned not to snack between meals. If hunger is felt in the afternoon, they can have small amounts of high quality food. This could be a piece of vegetable or fruit. If the patient is not in the green zone, he should definitely visit his doctor.

How to Eat?

Food should be eaten in small bites and chewed well. Half a glass of food should be placed on a small plate. Small forks and spoons must be used. Each bite should be chewed for a minimum of 20 seconds. This will ensure that the food is adequately broken down. Patients should be motivated to enjoy eating. Foods should be swallowed only after chewing sufficiently.

Patients should wait until the first bite has completely passed through the band before taking another bite. Normally this requires two or six peristaltic contractions. This corresponds to approximately 1 minute. Therefore, the patient should be warned to chew well, swallow and wait at least 1 minute.

A meal should not take more than 20 minutes. This means 20 small bites, one minute at a time for each bite. The patient will probably not be able to finish half a glass of food during this time. In this case, the food left on the plate should be thrown away. Every patient who undergoes a gastric band should know that they can throw away the food left on their plate.

With optimal band filling and good eating habits, patients do not feel hungry after 20 or fewer bites. If hunger is not felt, eating should definitely be stopped. After having gastric band surgery, patients should not expect to feel bloated after eating. feeling bloated; It means that the food pauses on the belt and the most important part of the LECS is stretched. If this condition becomes chronic, it destroys the LECS mechanism.

If the patient still feels hungry after eating half a glass, this most likely means that he is not in the green zone and needs refilling.

If you have done research on the internet about obesity and surgical treatments of obesity, or talked to your acquaintances or people around you who have received medical services on these issues, you are likely to have heard the term “metabolic surgery” as well as the terms bariatric surgery and obesity surgery.

Surgeons who specialize in the treatment of obesity and metabolic disorders in general provide medical services to their patients in these areas.

Obesity surgery refers to surgical procedures performed to control the weight of obese individuals. Bariatric surgery is its Greek equivalent used to express the medical knowledge, surgical knowledge and techniques used by the surgeon when performing these surgical procedures (Bar-: Weight + treatment: -iatri = Bariatric). So, if obesity surgery describes surgical procedures performed to solve the weight problem, what is metabolic surgery?

In the treatment of metabolic syndrome, regardless of BMI, the surgical procedures performed for the surgical treatment of Type 2 diabetes are called metabolic surgery, and the surgeon who performs these procedures is called metabolic surgery specialist.Bariatric surgery techniques are used in metabolic surgery, just like in obesity surgery. Some of these techniques are special surgical techniques that are performed only on patients deemed suitable after the evaluation of a competent committee in advanced centers. Which of these surgical techniques is suitable for you can only be decided after a one-on-one meeting with your metabolic surgery specialist and after some special tests. Not every surgical method may be suitable for every patient. Individual decision making is essential.

In recent years, especially after the industrial revolution, along with fast food culture, obesity and type 2 diabetes have become an important health problem in society, and metabolic surgery is considered as an option when satisfactory results cannot be obtained with traditional treatment methods. These surgical interventions help control obesity and diabetes by reducing stomach volume, changing the digestive tract, or a combination of both.

As a concept, surgeons who specialize in bariatric surgery techniques and work in the treatment of obesity and metabolic diseases are called “Obesity and Metabolic Surgery” specialists. So how about taking a closer look at metabolic surgery?

Who is a Metabolic Surgery Specialist? Which Diseases Is It Related to Treatment?

Those with type 2 diabetes, those diagnosed with type 2 diabetes due to insulin intolerance due to obesity, are the patient groups that can be cured by metabolic surgery. The first steps in controlling blood sugar levels and eliminating the complex negative effects of type 2 diabetes are a balanced weight, proper nutrition and being physically active. However, it is a common situation that the treatments, diets and medication use are insufficient to provide patients with the life comfort they want. This is where metabolic surgery and therefore metabolic surgery experts come into play.

Metabolic surgery is a surgery used in the treatment of disorders such as hypertension and high cholesterol, which are also metabolic syndrome disorders, in addition to the treatment of type 2 diabetes.

Thanks to the methods developed in the field of metabolic surgery recently, the success rates of this surgery are increasing. It can be said that metabolic surgery is very effective in the treatment of these disorders, especially if they are diagnosed early.

Metabolic Surgery Surgeries

Metabolic surgery operations offer an effective way to treat metabolic diseases such as obesity and type 2 diabetes. These surgeries can be performed in different types depending on the patient’s condition and needs. The most common metabolic surgery operations include sleeve gastrectomy, various gastric bypass techniques (classic Roux-en-Y bypass, Mini Gastric Bypass (MGB, One Anastomosis Gastric Bypass-OAGB), biliopancreatic diversion, duodenal switch, SADI-S (Sleeve gastrectomy + Single Anastomosis Duodeno Ileostomy), transit bipartition, SASI(Single Anastomosis Sleeve Ileostomy), SASJ(Single Anastomosis Sleeve Jejunostomy) and diverted / nondiverted sleeve gastrectomy + ileal interposition, while the stomach volume is reduced in gastric sleeve surgery, and the stomach and small intestine are included in the gastric bypass procedure. A part of the digestive system is bypassed by creating a connection between the two. Biliopancreatic diversion is a procedure that combines reducing the stomach volume and changing the digestive tract. After the metabolic surgery that is most suitable for you, you will quickly quit all the medications you use and say hello to a quality life.

Obesity and Metabolic Surgery Specialist Prof. is one of the leading academic physicians in Turkey with his studies in the field of metabolic surgery and obesity surgery. Dr. You can review the links below for more information about the metabolic surgery methods explained by Burak Kavlakoğlu in a language that everyone can understand.

Metabolic Surgery Specialist Istanbul

Beyond changing the anatomy of the digestive system, metabolic surgery refers to physiological and biochemical changes that regulate metabolism.

Istanbul is an important center in the field of health and health tourism not only in Turkey but also in Asia, Europe and the Middle East, where it is located in the center. Highly experienced metabolic surgery specialists and healthcare institutions serving in the field of metabolic surgery You can receive extremely good healthcare services in this field in Istanbul.

Are There Any Harms or Risks of Metabolic Surgery?

As with every surgical procedure, metabolic surgery also involves certain risks. The main risks include infection, bleeding, anesthesia reactions and wound healing problems. Additionally, one of the important points to consider after metabolic surgery is the change in nutrition pattern. Vitamin and mineral deficiencies may occur if proper nutrition is not provided after surgery. For this reason, the metabolic surgery specialist informs and monitors his patients in detail before and after the surgery.

Insulin resistance is a condition in which normal concentrations of insulin produce less than normal biological response. Or it can also be called a state of resistance to the metabolic effects of insulin. The metabolic effects of insulin are the suppression of endogenously produced glucose, stimulation of peripheral glucose retention (predominantly in muscles) and gluconeogenesis, and suppression of lipolysis in adipose tissue.

Normally, insulin suppresses the production of glucose (sugar) in the liver by inhibiting gluconeogenesis (converting other substances into sugar) and glycogenolysis (converting glycogen, which is a storage sugar, into sugar). It also transports glucose to peripheral tissues such as muscle and fat tissue, where it is either stored as glycogen or oxidized to produce energy. So the net result is that blood sugar FALLS. In insulin resistance

Resistance to these effects of insulin in the liver, muscle and fat tissue occurs, and the glucose-lowering effect of the liver is impaired. Insulin-mediated glucose retention in muscle and fat tissue also decreases. In this case, the insulin in the environment tries to reduce blood sugar by increasing insulin enough to meet this resistance. Thus, to lower blood sugar, Puncreatic beta cells constantly increase insulin secretion. As a result, while the normal sugar level is maintained, the insulin level is 2 times higher than normal. This causes the pancreas to work at excessive capacity.

Although insulin resistance is common in type 2 diabetes and obesity, it has been detected in 25% of healthy individuals who are not obese and have a normal OGTT and in 25% of patients with essential hypertension (insulin resistance). Therefore, insulin resistance is a common and common condition in society. In 1988, Reaven observed that obesity, diabetes, hypertension, hyperlipidemia and atherosclerotic heart diseases were found in the same patient more frequently than coincidence, and suggested that they were caused by the same metabolic disorder. Based on this, Reaven described the insulin resistance syndrome (syndrome This group of diseases was later named metabolic syndrome, among which non-insulin-dependent diabetes, essential hypertension and coronary heart disease are increasingly responsible for morbidity and mortality, but the connection between them and insulin resistance has only been partially elucidated.

There must be some criteria to be able to say insulin resistance. These:

Hyperinsulinemia (upper 1/4 of the nondiabetic population)

Positivity of two or more of the following:

Fasting plasma glucose > 110 mg/dl

Blood pressure > 140/90 mmHg

TG (Triglyceride) > 200 mg/dl

HDL < 50 mg/dl

Waist circumference > 94 cm (male)

Waist circumference > 80 cm (female)

The coexistence of various risk factors that play a role in the development of cardiovascular diseases and are thought to share a common etiopathogenesis is called metabolic syndrome. Metabolic syndrome is among the most important and common causes of atherosclerotic diseases and type 2 diabetes.

For the first time in 1988, Reaven drew attention to the frequent coexistence of various risk factors and stated that this association, which he called syndrome It has been suggested that insulin resistance plays a central role in this picture. Insulin sensitivity indicates the responsiveness of insulin to glucose uptake in various insulin-dependent tissues, especially skeletal muscle, and its ability to suppress lipolysis in adipose tissue and gluconeogenesis in the liver. Obesity, sedentary lifestyle, smoking, low birth weight and perinatal malnutrition have also been associated with the development of insulin resistance. Adipose tissue and the hormones secreted from this tissue, hypothalamic-pituitary-adrenal axis disorders, advancing age, genetic and environmental reasons are among other factors that play a role. Recent data show that low-grade inflammation is involved in various components of the metabolic syndrome, such as obesity, insulin resistance, cardiovascular diseases, type 2 diabetes and hypertension.2

The frequency of metabolic syndrome increases with advancing age and body weight increase, and it also varies according to the societies examined. In the United States, the prevalence of metabolic syndrome in people aged 20 and over was found to be 27%, and it was found that the frequency of metabolic syndrome was increasing more rapidly in women.3 In our country, according to the results of METSAR (Turkey Metabolic Syndrome Research) conducted in 2004, metabolic syndrome in adults aged 20 and over was found to be 27%. The syndrome frequency was found to be 35%. In this study, the frequency of metabolic syndrome in women was found to be higher than in men (41.1% in women, 28.8% in men).4 These results are based on the data obtained from the evaluation of waist circumference limits of 102 cm in men and 88 cm in women. When the 94-88 cm limits accepted today are taken into account, the rate increases even more.
The most widely accepted definition criteria for metabolic syndrome are:

Abdominal obesity: waist circumference >94 (or >102) cm in men, >80 (or >88) cm in women,

High triglyceride (≥150 mg/dl),

Low HDL cholesterol (<40 mg/dl in men, <50 mg/dl in women),

High blood sugar (fasting plasma glucose ≥100 mg/dl), High blood pressure (≥135/80 mmHg)

The presence of any three of these criteria in a person is considered metabolic syndrome.5 In the definition of the International Diabetes Federation, one of these three criteria must be abdominal obesity. 6 In our country, it is more appropriate to take the waist circumference of 94 cm for men and 84 cm for women as the limits for abdominal obesity.
Although it is not among the diagnostic criteria, proinflammatory and prothrombotic conditions are also included under the title of metabolic syndrome.

The primary approach in metabolic syndrome, which is a disease that occurs under the influence of environmental factors as well as genetic characteristics, should be the regulation of lifestyle. The aim is to prevent diabetes and cardiovascular diseases. Weight loss achieved through an appropriate nutrition and exercise program has a corrective effect on all disorders observed in metabolic syndrome. It has been shown that overall and cardiovascular mortality can be reduced with this approach.7

It is obvious that smoking and alcohol use in patients with metabolic syndrome will increase cardiovascular, metabolic and hepatic complications. Therefore, the issue of smoking and alcohol should also be emphasized when explaining lifestyle changes.

In cases where lifestyle changes are insufficient, pharmacological treatment is required. Lowering LDL cholesterol is the primary goal in the treatment of dyslipidemia. Statins are used for this purpose.8 Fibrate therapy may be considered for high triglyceride and low HDL cholesterol.9

Metformin and thiazolidinediones have effects on reducing insulin resistance. The effects of thiazolidinediones that cause weight gain prevent their use in metabolic syndrome. Metformin may be suitable for clinical use.

However, pharmacological treatment is not yet recommended solely to reduce insulin resistance in individuals without hyperglycemia.

Studies conducted with rimonobant, which targets endogenous cannabinoid receptors, showed weight loss and improvement in metabolic parameters.10 However, this drug was withdrawn from clinical use due to its psychiatric side effects.

In patients with metabolic syndrome, the effects of antihypertensive drugs on metabolic parameters as well as their effects on blood pressure should be taken into consideration. Antihypertensive treatment’s blood pressureIt is expected to control blood pressure, prevent target organ damage, positively affect metabolic parameters, or at least not negatively affect them.
In order to prevent atherothrombotic complications, low dose, 75–100 mg daily aspirin is recommended in high-risk patients.

RESOURCES
1 Reaven GM. Role of insulin resistance in human disease. Diabetes 37:1595-1607, 1988
2 Das UN. Minireview: Is metabolic syndrome X an inflammatory condition? Exp Biol Med 227: 989-997, 2002
3 Earl S. Ford ES, Giles WH, Mokdad AH. Increasing Prevalence of the Metabolic Syndrome Among U.S. Adults. Diabetes Care 27(10):2444-2449, 2004
4 Metabolic Syndrome Research Group. METSAR results. XXth National Cardiology Congress. Antalya, 2004.
5 Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, Gordon DJ, Krauss RM, Savage PJ, Smith SC Jr, Spertus JA, Costa F; American Heart Association;

National Heart, Lung, and Blood Institute. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation 2005;112(17):2735-52.
6 Zimmet P, Magliano D, Matsuzawa Y, Alberti G, Shaw J. The metabolic syndrome: a global public health problem and a new definition. J Atheroscler Thromb. 2005;12(6):295-300
7 Gregg EW, Cauley JA, Stone K, Thompson TJ, Bauer DC, Cummings SR, et al., for the Study of Osteoporotic Fractures Research Group. Relationship of changes in physical activity and mortality among older women. JAMA;289:2379-86, 2003
8 Grundy SM et al. for the Coordinating Committee of the National Cholesterol Education Program. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines. Circulation Jul 13; 110:227-39, 2004
9 Rubins HB, Robins SJ, Collins D, et al. Gemfibrozil for the secondary prevention of coronary heart disease in men with low levels of highdensity lipoprotein cholesterol. Veterans Affairs High-Density Lipoprotein Cholesterol Intervention Trial Study Group. N Engl J Med.;341:410–418, 1999
10 Pi-Sunyer FX, Aronne LJ, Heshmati HM, et al. Effect of rimonabant, a cannabinoid-1 receptor blocker, on weight and cardiometabolic risk factors in overweight or obese patients. RIO-North America: A randomized controlled trial. JAMA 295:761-775, 2006.

Metabolic syndrome is a bundle of cardiometabolic risk factors that develop in common genetic and environmental environments and are characterized by waist circumference, high blood pressure, qualitative and quantitative disorders in blood lipids, and high blood sugar. In people with metabolic syndrome, the risk of developing type 2 diabetes in the future is 5 times higher and the risk of developing atherosclerotic cardiovascular disease is 2 times higher than in people without metabolic syndrome.

Non-alcoholic fatty liver disease, polycystic ovary syndrome, sleep apnea syndrome, gallstones, gastroesophageal reflux, depression and asthma are also among the conditions associated with metabolic syndrome. In addition to classical findings such as high blood sugar, hypertriglyceridemia, low HDL cholesterol, high hepatic transaminase, hyperuricemia, microalbuminuria, high CRP and plasminogen activator inhibitor-1 are among the laboratory findings of metabolic syndrome.Considering metabolic syndrome, which is considered a global epidemic, as a clinical entity will be beneficial in identifying high-risk individuals for the development of type 2 diabetes and atherosclerotic cardiovascular disease and in determining common preventive approaches.

Diagnosis of Metabolic Syndrome

Metabolic syndrome has different definitions for different organizations. The basic components of these definitions are waist circumference, insulin resistance, high blood pressure and dyslipidemia (high triglyceride, low HDL cholesterol). The most recently agreed upon diagnostic criteria for metabolic syndrome are; increased waist circumference (society and country specific), high triglycerides, low HDL cholesterol, high blood pressure and high fasting blood glucose. For diagnosis, the presence of at least 3 of these parameters is required.

Metabolic syndrome in our country

Metabolic syndrome is an important public health problem affecting 20% ​​to 30% of the adult population in many countries. Epidemiological studies show that the frequency of metabolic syndrome in Turkish adults is very high and tends to increase. In the Metabolic Syndrome Prevalence (METSAR) study, Turkish adults aged 20 and over; It was reported that 33.9% of the patients (39.6% in women, 28% in men) had metabolic syndrome according to ATP III criteria, and 42.6% (51.1% in women, 33.9% in men) according to the International Diabetes Federation (IDF) criteria.

Why is the Frequency of Metabolic Syndrome Increasing?

It is thought that the increase in the frequency of metabolic syndrome may be due to the increase in the frequency of abdominal obesity triggered by physical inactivity, sedentary lifestyle and overnutrition, as well as the high frequency of metabolic syndrome components such as hypertension, glucose metabolism disorder and dyslipidemia. In the PURE Turkey Health Study, it was observed that Turkish adults spend approximately 6 hours of the day sitting on weekdays and weekends, regardless of rural or urban areas, and their daily energy intake was found to be as high as 2483.7 kcal. These findings suggest that unhealthy lifestyles are the most important factors in the increase in metabolic syndrome and abdominal obesity in our population.

What’s the situation around the waist?

Increasing data reveal that waist circumference is one of the most important predictors of cardiometabolic risk. According to IDF criteria (waist circumference limit is taken as >94 cm in men and >80 cm in women), the frequency of waist circumference in our country was found to be 73.8% in women and 43.2% in men.

The frequency of metabolic syndrome is increasing rapidly: how should we take precautions?

Regulation of lifestyle is the most priority and effective approach in the prevention and treatment of metabolic syndrome.

Exercise: Regular exercise reduces body weight and fat, lowers HbA1c, LDL cholesterol and triglycerides, increases HDL cholesterol. Recommended exercises include swimming, cycling, brisk walking and running. For this purpose, it is recommended to do these moderate-intensity exercises for at least 30 minutes a day, most days of the week, ideally every day. The Diabetes Prevention Study showed that a 7% weight loss achieved through diet and moderate-intensity physical activity reduced the development of metabolic syndrome by 41%.

Nutrition: Regulation of nutrition is effective not only in the treatment of obesity, but also in correcting blood pressure, glycemia and lipid profile, and in preventing diabetes and cardiovascular complications. A diet limited in saturated fats and rich in complex carbohydrates is a recommended diet model for people with metabolic syndrome. Recently, it has been reported that balanced dietary patterns such as the Mediterranean diet are associated with a decrease in the frequency of metabolic disorders such as obesity, dyslipidemia and high blood pressure, as well as coronary heart disease and different types of cancer. The Mediterranean diet is a diet rich in fiber, complex carbohydrates and monounsaturated fats such as vegetables, fruits, legumes, olive oil, walnuts, hazelnuts and grapes, and low in saturated fats. Mediterranean diet reduces body fatIn addition to reducing blood lipid levels, it has been shown to have a positive effect on blood lipid profile (especially HDL cholesterol and oxidized LDL cholesterol), endothelial function and insulin resistance, reduce the risk of thrombosis and reduce plasma homocysteine ​​levels. It has been shown that the Mediterranean diet reduces the development of MetS by 20%, regardless of age, gender, physical activity, lipid and blood pressure levels.

Conclusion:

Metabolic syndrome is an important public health problem. Approximately one-third of Turkish adults have metabolic syndrome, and the rate is higher in women.The goal of treating metabolic syndrome is to reduce the future risk of developing type 2 diabetes and cardiovascular disease. For this reason, the most reasonable solution seems to be to spread healthy life awareness to the whole society, which includes balanced nutrition and increasing physical activity.

In order for insulin to have its effect, after it is secreted from the pancreas, it must go to the cells where it will act and bind. These points in the cells to which insulin binds are called receptors. Three main mechanisms play a role in the development of insulin resistance. The first is the pre-receptor level, the second is the receptor level, and the third is the post-receptor level.

Resistance at the pre-receptor level can be explained by the fact that insulin cannot have an effect even if it binds to the receptor, or cannot reach the receptor due to insufficient blood flow, due to reasons such as defective insulin secretion, insufficient blood flow in the target tissues.

Resistance at the receptor level occurs as a result of a decrease in the number of receptors or genetic mutation of the receptors. In this way, no matter how much insulin is released, it cannot have its effect because it cannot bind to the cell.

At the post-receptor level, insulin arrives normally and binds to the receptor, but it must send orders into the cell. Meanwhile, there is a malfunction in some of the signal arms on duty. As a result, it cannot have a blood sugar lowering effect.

Two mechanisms are used in obesity surgery. The first of these is a volume restricting mechanism, and the second is a mechanism that both restricts and impairs absorption from the small intestines. Adjustable gastric banding (clamp), one of the volume restricting methods, is rarely used today due to the complications it creates.

Today, we most commonly perform Sleeve Gastrectomy surgery, which we translate into Turkish as sleeve gastrectomy or stomach reduction surgery, as volume restricting surgery. The advantage of this surgery is that since there is no change in location in the digestive system and there is no need for vitamins and trace elements in the long term, more physiological results are obtained. Today, the most common malabsorption surgery is the one we call gastric bypass. In this surgery, both volume is restricted and absorption is impaired. As a result, while effective weight loss is achieved, vitamin and trace element supplements are necessary in the long term. If these patients who undergo surgery for the treatment of obesity have comorbid diabetes, an improvement of 40-60% can be achieved.

In the metabolic surgery methods we use in the treatment of type 2 diabetes, where obesity is not at the forefront, the healing effect of small intestine hormones is used. The fact that insulin resistance and type 2 diabetes are more common today than in primitive times is due to eating refined foods in parallel with industrialization. Digestion of refined foods is completed in the 70-80 cm jejunum section of the small intestine, close to the stomach. Small intestinal hormones that organize insulin release, which we call incretins, are secreted from the part of the small intestine that is closer to the large intestine, namely the ileum. The pulp of the digested and absorbed food reaching the ileum cannot ensure the release of incretins. As a result, ileum hormones that regulate insulin secretion, such as GLP-1, peptide YY, and oxyntomodulin, are not released sufficiently, and as a result, insulin resistance and subsequent type 2 diabetes occur. Therefore, in the metabolic surgery methods we use in the treatment of type two diabetes, it is aimed to connect the small intestine, which is closer to the large intestine, to the stomach, and as a result, to secrete an effective amount of small intestine hormones that will break insulin resistance. For this purpose, transit bipartition and ileal interposition surgeries are performed. The recovery rates in patients who undergo metabolic surgery for type 2 diabetes are much higher (85-95%) compared to obesity surgery.

Here, selection of patients who will benefit from metabolic surgery is very important. With a number of tests performed before the surgery, it is decided whether candidates with diabetes will benefit from metabolic surgery. Our target organs damaged by diabetes are primarily the eyes, kidneys, heart and nervous system. Our patients are informed about whether the damage to these organs will be reversible through the tests we will perform before the surgery. Therefore, individuals with type 2 diabetes should not live with diabetes for many years and should get rid of this disease by undergoing surgery as soon as possible.