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Treatments

March 4, 2020

Diabetic Surgery

The incidence of diabetes among morbidly obese patients is over 25%. The most effective treatment for overweight people with type 2 diabetes is metabolic and bariatric surgery. About 80% of type 2 diabetic patients undergoing bariatric or metabolic surgery get rid of this disease without any need to use the medicine. Metabolic surgery changes the level of many hormones such as GLP-1 (glu**gon-like peptid-1), PYY( peptide-YY) and ghrelin secreted from the intestinal system and regulating glucose metabolism. GLP-1 (glu**gon-like peptide-1) is secreted from L cells stimulated with the food at the ending part of small intestines and in the colon. GLP-1 (glu**gon-like peptide-1) hormone increases glucose-dependent insu**n release, glucose tolerance and insu**n sensitivity of cells. In addition, it reduces glu**gon (increases glucose) release and food discharge from the stomach. Patient undergoing gastric bypass operation face a significant increase at GLP-1 level starting from the 2nd day of operation, indicating that the effect of gastric bypass surgery on diabetes is independent of weight loss. No change is seen at GLP-1 level in gastric band operations. In dietary treatment, there is no increase at GLP-1 level with weight loss and even GLP-1 level tends to decrease, which paves the way for diabetes. Ghrelin hormone is specially released from the stomach. It increases the feeling of hunger, thereby increasing food intake. It decreases insu**n release and causes diabetes by suppressing adiponectin release, which increases the sensitivity against insu**n hormone. Ghrelin hormone level increases when patients try to lose weight by following a diet program. Therefore, both the feeling of hunger increases and it may lead up to diabetes. Since the feeling of hunger increases, the diet becomes unsustainable after a certain point. The serious reduction is seen at the ghrelin level after gastric bypass and sleeve gastrectomy operations. In gastric band procedure, ghrelin level and its response do not change. PYY (peptide YY) hormone is secreted from L cells of the intestine with GLP-1. PYY hormone reduces the feeling of hunger and restricts food intake; moreover, it recovers insu**n resistance with a direct effect. PYY hormone increases after gastric bypass and sleeve gastrectomy operations. Contact Form
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March 4, 2020

Sleeve Gastrecromy Operation

Laparoscopic Sleeve Gastrectomy operation is one of the primary methods in obesity operations (in other words, bariatric surgery interventions), which are the worldwide treatment of being overweight. As is known, obesity is an important risk factor for hypertension, coronary heart disease, type 2 diabetes, resistance, osteoarthritis (rheumatism), sleep apnoea syndrome, depression, liver steatosis, liver cirrhosis, gallstones, stroke/palsy, some dermatological diseases, mental diseases, asthma, muscular and skeletal system problems, prostate and such cancers as breast, uterus and colon cancer. Sleeve gastrectomy operation is performed by laparoscopically opening small holes on the abdomen and extracting the stomach by 80% to 85% from these holes with the help of a camera. It is a restrictive operation method reducing the food intake capacity of the stomach. Since the operation is performed with a closed method, the patient is protected from the risk of pain, hernia and wound infection. The suitable age range for this operation is between 18 and 65. Laparoscopic method (closed method or without incision) that is preferred for the operation shortens the anesthesia process compared to traditional open surgery; and it enables the patient to have a less painful, more comfortable process and to recover faster. Sleeve gastrectomy operation targets weight loss by shrinking the stomach. If it is necessary to evaluate all the methods of obesity surgery, 50-75% loss of excess weight on average is a successful and possible target. This target is reached at the end of 1 year. However, the weight loss rate and the process afterward are highly relevant to the patient’s age, sex, concomitant diseases and eating habits. To manage the postoperative period effectively and to realize the lifestyle changes will lead you to the desired result. Contact Form
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March 4, 2020

Gastric Bypass Operation

Gastric Bypass is the most popular operation among the operations for the surgical treatment of obesity. It is a method that can be considered as absorption reducing and restricting intervention. The most common types of gastric bypass operations are Mini Gastric Bypass and Roux en Y Gastric Bypass (RYGB). Surgical Procedure Applied in Gastric Bypass Operations Gastric Bypass operation is a method which is based on reducing the amount of food that patient can take by shrinking the stomach and shortening the absorption path of the food in the small intestine. Roux en Y Gastric Bypass (RYGB) In this method, stomach volume is reduced up to about 15-30 cc and food intake is decreased. Since a large portion of the stomach, duodenum and starting part of the small intestine (jejunum) are bypassed; absorption of the consumed food (especially high-calory sugary food) is prevented. Mini Gastric Bypass Operation The weight loss mechanism of mini gastric bypass operation works as in RYGB operation but technically different. It is initiated by creating a small gastric tube at the entrance of the stomach and this part is completely spared from the rest of the stomach. However, the spared part of the stomach is not cut and discarded. The residue large portion of the stomach is inactively in its place and continues to procedure the necessary secretions. This newly-formed small gastric tube is connected to the stomach close to the middle part of the small intestine by leaping a certain distance from the starting point of the small intestine, in order to enable to food to pass from the stomach into the intestines. The stomach and intestines are anastomosed by using special tools and a gap is created between them for the food transfer. Thanks to the new small stomach, which is formed by mini-gastric bypass operation, the amount of food intake is reduced. In addition, thanks to the connection between the new stomach and small intestine, the eaten food passes into the small intestine from a further part without passing through large stomach and duodenum, thereby preventing the absorption of food. The biggest advantage of Mini Gastric Bypass surgery compared to the RNYG method is that it reduces the operation duration, much better recovery is provided in concomitant disease with more successful weight loss and it is technically easier to apply. What Should Patient Consider After Gastric Bypass Operations? Patients should certainly continue their [...]
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March 4, 2020

Duodenal Switch Operation

Duodenal Switch, also known as biliopancreatic diversion surgery, which highly prevents absorption and partially limits the volume, is applied to super obese people. It is a surgical procedure performed in patients whose body mass index is over 50 and who have previously undergone sleeve gastrectomy operation but gained all the weight again. It can also be performed for uncontrolled diabetes situations. The surgery is performed with the laparoscopic method. In this operation, sleeve gastrectomy is performed first, the stomach size is reduced and then the last 200-250 cm of the small intestine is anastomosed by counting from the section close to the large intestine. Thus, food is directly directed to the small intestine. A strong malabsorption and absorption restriction is created in a way to bypass about 2/3 of the small intestine. In other words, the main effect of the operation is to create weight loss by using the power of metabolic activity. As in all other absorption-destructive procedures, since absorption is excessively impaired; burping, abdominal pain, undigested food and related odorous diarrhea that may disrupt life comfort can be seen. Patients should consume high protein since protein absorption is disrupted. These patients suffer from serious vitamin deficiency and anaemia. This operation is performed quite successfully both in our country and around the world. Contact Form
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March 4, 2020

Body mass index

Who Are Considered Obese? There are various methods to identify obesity, but the most common measurement method approved by WHO (World Health Organization) is the body mass index (BMI). BMI is calculated by dividing weight in pounds by height in inches squared. Value of body mass index Classification <18,5 kg/m²’nin Underweight 18.5 – 24,9 kg/m² Normal weight 25 – 29,9 kg/m² Overweight 30 – 39,9 kg/m² Obese 40 – 50 kg/m² Morbidly Obese 50 – 60 kg/m² Super Obese >60 kg/m² Super Super-Obese Eligible candidates for bariatric surgery can be accepted according to the following criteria: Patients with >40 BMI but without concomitant disease Patients with 35-39 BMI and any concomitant disease Type-2 diabetes patients with 30-34 BMI and failure of sufficient glucose regulation despite insulin treatment. It is not correct to just look at the body mass index in order to evaluate a patient as obese. That is because it might cause misleading results in very muscular people. For this reason, it is much healthier to evaluate body mass index with the body fat ratio. Obesity is a result of lifestyle.   A pre-operative patient consultation with dietician support is especially very important. It should also be emphasized that patients should change their lifestyle after surgery. In this way, it is possible to ensure healthier and permanent weight loss. Lifestyle and diet changes help people to be healthier after the operation. Obesity reduces the average life expectancy by around 9 years for women and 12 years for men. As listed below, it causes many diseases ranging from cancer and heart diseases to diabetes mellitus. Type 2 diabetes • Hypertension, coronary artery disease, heart failure • Respiration disorders • Metabolic syndrome, insulin resistance, high cholesterol and lipid • Menstrual irregularities, infertility, birth difficulties, polycystic ovary syndrome, excessive hair • Sleep apnea, sleep disorders • Gastroesophageal reflux • Depression, social discomfort • Osteoarthritis (bone and joint disease) • Varicose • Cerebral bleeding and palsy, • Gallstone Some types of cancer as breast cancer (high cholesterol in blood causes estrogen exposure in breasts), colon cancer and prostate cancer Urinary inconsistency Apart from many reasons listed above, there are sometimes many social factors such as the shoes being tied by someone else, not being able to cross your legs, not being able to find suitable clothes in shops, the feeling that people are staring at you, and not being able to attract attention [...]
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