Obesity is one of the most important health problems in developed and developing countries today and is generally defined as the increase in body weight in relation to the height above the desired level due to a significant increase in body fat mass. It is a disease caused by the accumulation of excess fat in the body that occurs when the amount of energy taken from food exceeds the amount of energy consumed by metabolism and physical activity. It negatively affects the quality of life, as well as the cardiovascular system, respiratory system, hormonal and digestive system, and paves the way for many important diseases.

Obesity is usually measured using the BMI and measuring the waist circumference. Body weight (kg) is calculated by dividing it into square height (m²). This value is independent and is not affected by factors such as age and gender. Based on this value, it is determined whether or not the person is obese. An important factor is where fat accumulates in the body. The accumulation of fat around the abdomen may pose a greater risk than the accumulation of fat in the hips and other areas of the body.

Despite the inability to accurately determine the factors leading to obesity, excessive intake of fat and lack of physical activity are among the most important causes of obesity. Besides these factors, many factors, genetic, environmental, neurological, physiological, biological, social, cultural and psychological, cause obesity. Environmental factors are considered the main factor causing obesity, especially in the world, because the increase in obesity among children is too great to be explained only by changes in the genetic structure.

Many obese people resort to exercise and healthy food programs, but these methods usually do not cause weight loss more than 10%, and the weight lost by the patient can be regained very quickly so the patient must resort to simple surgical methods that cause weight loss more effectively and prevent Weight loss is quickly restored and it also helps to improve the patient’s psychological state. In this article, we will talk about the best methods of gastric surgery to eliminate the problem of obesity.

Gastric sleeve process:

 In general, surgery to shrink the size of the stomach is performed to eliminate the problem of excessive obesity and allow the patient to lose excess weight and stay at the required normal weight. And a surgical method used to treat patients with obesity problems that cannot be treated through diet, exercise, and medication. The most effective method for permanent treatment of obesity is these surgeries. This process allows the patient to lose between 40 to 100 pounds of extra weight and weight gain is prevented again. It can also protect the patient from the risk of developing diabetes and cardiovascular diseases and more than 40 diseases that people who suffer from overweight often complain of.

Preparing for Surgery:

  • The patient must undergo several pre-operative laboratory tests and analyzes such as biochemical blood analysis, hormonal testing, hepatitis examination, ultrasound scan (Eco) of the abdominal area, gastroscopy (under the supervision of an anesthesiologist), an electrocardiogram, a picture of the lungs, a breath test. After all these tests, anesthesiologists, internal medicine, cardiology, and endocrinologists will perform the necessary checks and examinations. As a result of these checks, first, it is checked if there is any underlying disease that may lead to an overweight of the patient. if necessary, the experts involved will make recommendations about which treatments should be applied. In this way, problems that may occur during and after surgery are reduced.
  • In the event that the patient uses blood thinners, such as aspirin, a doctor should be consulted before surgery because this type of medicine may affect the bleeding and clotting process during the operation.
  • If a patient has diabetes, he should consult the doctor in charge of his insulin program because he may require adjustments to the insulin use plan before the operation.
  • The patient must stop drinking cigarettes for two months before the operation as the high nicotine level may affect the results of the surgery.
  • Refrain from eating some foods and drinks before the operation, according to what the doctor recommends.

Types of bariatric surgery:

Each type of bariatric surgery has its pros and cons. The patient  should see a doctor to determine the process that best suits his condition. Here is a look at common types of obesity surgery:

Roux-en-Y gastric bypass : It is a type of gastric bypass surgery, and the most common way to shrink a stomach. This surgery is usually not reversible, meaning that the stomach cannot be returned to its normal shape before the operation. It works by reducing the amount of food that can be eaten in one sitting and reducing the absorption of nutrients. Where the surgeon cuts the upper part of the patient’s stomach, and closes it from the rest of the stomach. The resulting portion is the size of a walnut and can only accommodate 200 grams of food. Usually, the stomach can hold about 2 liters of food. Then, the surgeon cuts the small intestine and sews a part of it directly to the rest of the stomach. Where food goes to this small part of the stomach, then directly to the small intestine sewn into it. Food transcends most of the stomach and the first part of the small intestine, and instead directly enters the middle part of the small intestine.

Biliopancreatic diversion with duodenal switch : This is another type of stomach surgery. In this procedure, about 80 percent of the stomach is removed. The valve that transports food to the small intestine (the duodenum) remains, along with a limited part of the small intestine that usually connects to the stomach (duodenum). Surgery bypasses the majority of the intestine by connecting the last part of the intestine to the duodenum near the stomach (the key to the duodenum and pancreatic transfer). This surgery limits the amount that can be eaten and reduces the absorption of nutrients. Although it is very effective, it carries greater risks, including malnutrition and lack of vitamins. It is generally used for people with a BMI greater than 50.

Laparoscopic adjustable gastric banding : In this weight loss surgery, the surgeon places a band containing an inflatable balloon around the upper part of the stomach and fixed in place. When the band is inflated, it presses against the stomach, like a tight belt. This results in the stomach being separated into two parts, with the very small upper part connecting to the rest of the stomach through a channel created by the band. The small upper part limits the amount of food that can be eaten. The band can be adjusted to restrict food more or less. Because of its relative simplicity, (LAGB) is one of the most common weight loss surgeries. However, this may lead to less weight loss than other procedures, and the patient may need to adjust the band periodically.

Sleeve gastrectomy: This process is performed under the supervision of the surgeon, who removes the left side of the stomach, staples the stomach using an automatic stapler and then cuts the large part of it. After completing this step, the doctor stitch the stomach, and this process takes approximately two hours and is under general anesthesia so that the patient does not feel any pain. The significance of this process is to reduce the size of the stomach. In its natural state, the stomach absorbs between 1 to 2 liters, but after the operation, its absorption capacity does not exceed 200 milliliters, as the final stomach size becomes an egg size of 30 millimeters, which reduces the patient’s ability to eat food. Hence losing weight.  The surgeon also cuts 150 centimeters of the small intestine to disrupt its ability to absorb nutrients from proteins, fats and others, which reduces the number of calories gained, in addition to reduce the hormone that causes hunger, which is known as ghrelin, is largely secreted from the bottom of the stomach for that and after removing the bottom of the stomach from the body, the secretion of this hormone will decrease, and consequently the feeling of hunger will decrease too.

Stomach balloon: Stomach balloon is the procedure by which an inflatable balloon is placed inside a patient’s stomach that works by restricting the amount of food that he can eat at one time. This process also requires general anesthesia, but it does not require incisions. Stomach balloon is an increasingly common choice because it is relatively safe, easy to perform and does not require any anatomical changes. Also causes weight loss about 25 to 38 percent of extra weight. After removing the balloon, some but not all patients can still losing weight. In addition, the use of stomach balloon for weight loss was approved by the American Society for Metabolic Surgery and Obesity.

Gastric Botox Injections : It is a relatively new method for weight loss based on endoscopic botulinum toxin (Botox) injection into certain parts of the stomach. In this method, the contraction of the stomach muscles is limited and the time to empty the stomach from the nutrients is delayed, which leads to the patient losing an appetite; thus, weight loss is achieved.

The surgeon will consider several factors, including the patient’s BMI, nutritional habits, health problems, any previous surgeries and the risks of each procedure.

What happens after gastric sleeve:

After the operation, the doctor closes the wounds and then places the patient under supervision and medical care in the hospital for at least 1-2 weeks. Often, during hospital stay, the doctor connects a special tube between the patient’s nose and abdomen, to help the stomach get rid of any fluids that may be present in the stomach, and relieve the patient’s sense of nausea.

The patient gets his food during the convalescence period intravenously, allowing him to eat and drink normally.

After the operation is over, the patient will generally not be allowed to eat for one to two days until his stomach and digestive system can heal. After that, the patient must have a specific diet for about 12 weeks. The diet begins with liquids only, then moves to light or soft foods, and finally to regular foods. He may have many restrictions on how much he can eat and drink.

The patient must also undergo frequent medical examinations to monitor his health in the first few months after surgery. In addition, he may need laboratory tests.

The patient may experience changes as his body reacts to rapid weight loss in the first three or six months after gastrectomy or any other weight loss surgery, including:

  • Pain in several areas of the body
  • Feeling tired, as if the patient has the flu
  • feeling cold
  • Dry skin
  • Hair loss
  • Changes in mood
  • Extra folds of skin occur and the patient may need surgery to remove these folds
  • Not getting enough vitamins and minerals from the diet
  • Gallstones (small hard stones forming in the gallbladder)

Does the patient feel pain after gastric sleeve surgery?

Since the procedure is performed accurately and through small incisions, i.e. through the mm holes, the postoperative pain is minimal and the aesthetic result is excellent as some small scars appear. After a few months, these scars will become almost invisible.

What are the risks of obesity surgery?

All surgeries have certain risks. Depending on the type of procedure selected and the patient’s health condition, these risks may be less or more than usual. Before deciding on the operation, the specialist doctor will inform the patient in detail about the operation and can then know all the possible risks and their degrees.

Will the patient have to lose weight before surgery?

Your doctor may order a special diet program for two weeks before surgery. This could be a diet based on fluid nutrition. This will help the patient lose weight and learn about the type of fluid feeding that needs to be followed after surgery.

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