Gastric bypass surgery is one of the oldest types of obesity surgery. It is based on the principle of preventing the absorption of nutrients by bypassing some of the small intestine after the stomach volume is reduced. Gastric bypass was the most common method of obesity surgery before gastric sleeve surgery taking the lead. Compared to gastric sleeve surgery, its weight loss effect is slightly more.
Its effect on metabolic diseases is also slightly higher. Among its undesirable effects is impaired nutrient absorption due to bypassed small intestine. Patients have to get support for these deficiencies. In addition, it is not possible to enter the bile ducts endoscopically. As a result of the evaluations made on these disadvantages, transit bipartition surgery has been recommended and the frequency of its application is increasing today.
Gastric sleeve surgery starts after the patient is taken under general anesthesia. After the patient is placed in the proper position, the surgeon takes his place and begins to create the necessary holes.
After the first hole is completed, the inside of the abdomen is filled with CO2 gas and inflated. Using long and thin instruments, the stomach is reduced to a small volume.
The small intestine section to be bypassed is prepared and connected to the stomach. The small intestine segment containing bile and pancreatic fluids is reconnected at a point farther from the stomach pouch.
The reason for this reunification process is to prevent the digestion, together with the fact that bile containing fluid may cause unwanted complaints in the stomach.
Unlike gastric bypass surgery, the gastric pouch is left longer and this pouch is connected to the small intestine.
As such, mini gastric bypass is technically easier and has shorter surgery time.
The effects of both operations on weight loss and metabolic diseases are close to each other. Considering the advantages and disadvantages of both operations, the decision should be made with the patient.
Transit bipartition is one of the obesity and metabolic surgery methods. This surgery is often applied to type 2 diabetes patients with poor blood glucose control. This surgery is applied with high success in well selected patients. The advantage of this surgery over bypass surgery is that, operations that may need to be performed orally, such as ERCP, remain possible.
In transit bipartition surgery, primarily the stomach is brought in the form of a tube similar to the gastric sleeve surgery. The difference in this surgery is that it is applied by adjusting the tube width. The main focus is on removing the fundus section of the stomach. This process is called BMI adjusted gastric sleeve.
After this process is completed, the small intestine is connected to an area near the exit hole (pylor) of the stomach. Thus, 2 outlets are formed from the stomach. It is aimed that some of the nutrients coming to the stomach will quickly move to the distal part of the small intestine and create hormonal effects here. In this surgery, the pressure in the gastric tube decreases and the risk of leakage is reduced.
In addition, the risk of late complications such as twisting or overangulation of the tube is decreased.
The term revision surgery alone does not indicate a type of surgery. These operations are either the re-application or conversion of obesity and metabolic surgeries.
After all obesity surgeries, a certain amount of weight gain can be seen. Revision surgery may be considered when the weight regain occurs. This situation usually arises when patients regain 15-20 kilograms over their lowest weight. Each patient should be evaluated according to their characteristics.
This issue is debated among bariatric surgeons. It is important to determine the main reason why patients regain weight. Determining the reason under the weight regain prevents the application of unnecessary or inappropriate treatments. It is often observed that patients experience weight regain for 2 reasons.
The first, inappropriately performed previous surgery (such as a improper sleeve, unremoved fundus, improper bypass or anastomosis lengths). Re-intervention for the source of the problem may be considered in these patients. Gastric re-sleeve surgery is frequently performed in patients whose stomach sleeve is improper, enlarged or the fundus area has never been removed. In patients whose surgery is correct but still gain weight, operations that disrupt absorption more such as omega bypass or gastric bypass may be considered. One of the most important points of obesity surgery is to lose weight by keeping the malabsorption at minimum.
Second population who suffers from a weight regain problem is those who cannot provide proper nutrition and correct lifestyle changes after surgery. When such patients apply to us, they are taken into the PPS program again and observed. By this way success can be achieved in a large number of patients.
This issue is still controversial, but as a result of the studies performed, it has been shown that pre-operative endoscopies may cause changes in terms of changing the type of surgery or applying additional repairs by detection of accompanying reflux disease. Therefore, we recommend performing endoscopy before surgery.
We want patients to drink fluids alone for 1 week. At this stage, patients usually have an expectaiton that they will feel hunger so much. Since the stomach volume remains very small, patients reach the feeling of satiety with small amounts of food. Even in later stages, we strongly recommend that patients do not take fluid with meals because they may not get the nutrients they need by reaching a feeling of satiety with only fluid. After one week, we allow patients to switch to mashed foods, then soft foods, and then gradually to normal foods.
Since absorbable stitches are applied, your stitches will be absorbed over time.
Our patients start taking a bath the day after surgery.
The effects of both operations on weight loss and additional diseases are reported closely. Considering the advantages and disadvantages of both operations, the decision should be made by evaluating with the patient.