What is Bariatric Surgery?

What is bariatric surgery? How can we decide suitability for the candidates for bariatric surgery?

Bariatric surgery is a term that refers to surgical procedures that assist in weight loss. We need to pay attention to a number of criteria in patients who will undergo bariatric surgery.

One of the most important criteria is the body mass index (BMI). Body Mass Index is a simple calculation using a person’s height and weight. The formula is BMI = kg/m2 where kg is a person’s weight in kilograms and m2 is their height in metres squared.

BMI = Body weight in kg / the square of the height in meters

For most adults, a BMI of:

• 18.5 to 24.9 means you’re a healthy weight
• 25 to 29.9 means you’re overweight
• 30 to 39.9 means you’re obese
• 40 or above means you’re severely obese

A better measure of excess fat is waist size, which can be used as an additional measure in people who are overweight (with a BMI of 25 to 29.9) or moderately obese (with a BMI of 30 to 34.9).

Generally, men with a waist size of 94 cm or more and women with a waist size of 80 cm or more are more likely to develop obesity-related health problems.

It’s very important to take steps to tackle obesity because, as well as causing obvious physical changes, it can lead to a number of serious and potentially life-threatening obesity related conditions.

These include:

• Type 2 diabetes
• Coronary heart disease
• Some types of cancer, such as uterus, bowel or breast cancer.
• Stroke

Obesity can also affect your quality of life and lead to psychological problems, such as depression and low self-esteem.

Other co-morbidities are hypertension, high cholesterol, high triglyceride, low HDL-(good cholesterol), sleep apnea syndrome, fatty liver disease (NASH), asthma, gastroesohageal reflux disease, venous stasis disease, urinary incontinence, joint deformities secondary to weight.

Weight loss surgery, also called bariatric or metabolic surgery, is used as a treatment for people who are very obese.
It can lead to significant weight loss and help improve many obesity-related conditions mentioned above.
In most cases should only be considered after trying to lose weight through a healthy diet with exercise.

What are the indications of bariatric surgery:

The generally accepted criteria for surgical treatment include a body mass index (BMI) higher than 40 kg/m2 or a BMI higher than 35 kg/m2 in combination with high-risk comorbid conditions(see above)

You are a candidate for bariatric surgery if:

• You have a body mass index (BMI) of 40 or more, or a BMI between 35 and 40 and an obesity-related condition that might improve if you lost weight (such as type 2 diabetes or high blood pressure)
• You’ve tried all other weight loss methods, such as dieting and exercise, but have struggled to lose weight or keep it off
• You agree to long-term follow-up after surgery – such as making healthy lifestyle changes and attending regular check-ups.

All the best.

Burak Kavlakoglu, MD.

Professor of Obesity and Bariatric Surgery

Am I eligible candidate for obesity surgery?

You are eligible candidate for obesity surgery;

• If body mass index is over 35 with significant health problems due to obesity related conditions, such as hypertension or type 2 diabetes;
• Failed weight loss attempts with diet and exercise;
• Between 12 and 70 years of age
• If body mass index is 40 or more.

Is postoperative course painful after sleeve gastrectomy?

There is no serious pain occurs after the surgery because of minimal invasive-laparoscopic surgery. Strong painkillers are given to the patient in the early postoperative period especially first 6 hours.

The patients are able to walk 4-6 hours after the surgery.

Will there be any scars after sleeve gastrectomy?

Since the operation is performed using a closed method, only very small incision marks will be present in the abdominal region after the intervention. These marks will become completely invisible in a few months.

How much weight loss is expected after gastric sleeve surgery?

Expected weight loss is 80% of excess body weight during the 2 years after the surgery. Too many morbidly obese patients lose their excess weight with gastric sleeve surgeries and have never weight regain. But laparoscopic revisional surgery such as by-pass surgery can be performed if failed weight loss after gastric sleeve surgery. Carefully selected patients undergoing revision for weight regain have satisfactory additional weight loss.

Is it possible that the patient will regain weight and return to previous body weight after gastric sleeve surgery?

The risk of weight regain is very low if the patients obey the rules after the gastric sleeve surgery.

Will I have to lose weight before the surgery?

You don’t have to follow a special diet program before the surgery if your body mass index below 60. You don’t have to eat solids only one day before the surgery.

Some details about the procedure:

• Lenght of operation is about 1 hour.
• Postoperative length of hospital stay is around 2-3 days after being follow-up. The length of hospital stay varies from one patient to the other.
• Recovery time: 1-2 weeks.
• Leak test during the procedure: Yes
• When sleeve gastrectomy is unsuitable for me? Uncontrolled Type 2 Diabetes esp requires insulin use; Crohn disease; Barret’s esophagus according to the reflux disease; below 12 and above 75 years of age.

How Is The Follow-Up Process After Sleeve Gastrectomy?

The success rate after gastric sleeve surgery increases depending on strict postoperative controls and observations. Therefore, your first visit will be done 7 days after surgery for early complications.

Your routine controls will be done in the 1st-3rd-6th-12th-18th-24th-36th-48th-60th
postoperative months. Fasting blood sugar and insulin levels, liver enzymes, vitamins and mineral levels as well as renal functions will be checked through blood tests. Supportive treatments will be started if any deficiencies found. Our dietitian will also follow up your body composition.

If you have severe metabolic conditions such as uncontrolled diabetes, your follow up will be done by our endocrinologist. You can send your test results if you are living abroad via whatsapp and face-to-face communication with our team with video conferences.