Current approaches in Bariatric Surgery
Obesity surgeries are surgical procedures that have been performed with open methods since the 1950s. However, the greatest advances in bariatric surgery have been achieved in the last 20 years, when surgeons performed these operations with minimally invasive methods, namely laparoscopic or robotic methods. In general, we can divide obesity surgeries into two groups as restrictive and absorption-reducing procedures.
While restrictive surgeries cause a decrease in food intake and an increase in satiety after meals, surgeries that reduce absorption have an effect by reducing the absorption of calories, protein and other nutrients. The two most common surgical procedures today are sleeve gastrectomy and gastric bypass. While sleeve gastrectomy is a restrictive surgery, gastric bypass is both restrictive and absorption-reducing.
Sleeve gastrectomy or colloquially known as sleeve gastrectomy surgery is the removal of the left side of the stomach. The surgery is performed under general anesthesia. After the left lateral part of the stomach is released from the bottom up to the fundus, suturing and then cutting is performed with the help of automatic staplers, which we call staplers. Then, the remaining stomach part of the patient is sutured with a second suture and the procedure is completed.
The surgery can be performed both laparoscopically and robotically. The mechanism of action of sleeve gastrectomy is primarily dependent on the reduction of gastric volume, that is, its restrictive function. The stomach, which has a normal volume of 1.5-2 liters, becomes 150-200 mL after this surgery and causes a decrease in the patient's food intake. Apart from this, since a hormone called ghrelin, which is called the hunger hormone, is mostly released from the removed part of the stomach called the fundus, the decrease in ghrelin levels causes a decrease in the feeling of hunger in the patient.
Gastric bypass surgery is the most frequently performed surgical procedure in the United States, where bariatric surgery is the most intensive. The surgery is performed under general anesthesia. First of all, the operation starts with the small intestine anastomosis, in which the 150 cm small intestine part is disabled for absorption.
Then, a new pouch with the size of a 30 milliliter egg is created in the stomach. The surgery is ended with a second anastomosis made between the feeding leg of the small intestine and this new stomach pouch. Gastric bypass surgery can be performed both laparoscopically and robotically. Gastric bypass surgery is both a restrictive and absorption-reducing procedure.
Since the volume of the stomach is reduced, the patient's food intake is reduced. In addition, the absorption of total calories, protein and other nutrients in the patient decreases as a result of the elimination of an average of 150 cm of intestine. Therefore, gastric bypass is more successful in terms of long-term results.
Gastric bypass surgery is an effective, safe and sustainable procedure and has been defined as a gold standard procedure by IFSO (International Federation for the Surgery of Obesity and Metabolic Diseases), ASMBS (American Society of Metabolic and Bariatric Surgery) and NIH (National Institutes of Health). The majority of the patient group in our series consists of patients who underwent gastric bypass surgery with robotic and laparoscopic methods.
