One of the fundamental goals of our association is to eliminate the confusion between Metabolic Surgery and Obesity Surgery. This confusion, which is present both in public and among doctors, finds presence in medical community with the unfortunate statement of ‘This operation, too, can treat diabetes’
Our association accepts providing the public with understandable, simplified information regarding long term results, complication rates and additional therapy requirements of obesity surgery as its duty.
Understanding all possible treatment options with all their details will optimize the results and strengthen the consistence between the patient, doctor and the treatment of choice.
OBESITY SURGERY PROCEDURES
Jejuno-ileal Bypass and Vertical Banded Gastroplasty procedures are only of historical importance, which are not performed by any doctor or institution and they will only be mentioned by name in this section.
Obesity surgery procedures which are still in clinical practice can be inspected in 3 categories
1) Restrictive Operations
Gastric band, gastric plication and sleeve gastrectomy operations can be counted in this category.
Purpose of gastric band procedure is to provide weight control with the principle of reducing the stomach’s volume by putting a band on the upper section of the stomach to narrow passage. Long term results of this operation, which decreased in practice in the last 10 years in many centers, are unfortunately not very bright. Various scientific studies show that one of every three patients undergo surgery second time because of complications caused by gastric band and weight loss in 10 years is about %50. Also, in this procedure patient compliance is extremely important.
Although sleeve gastrectomy operation is presented as a restrictive procedure, it has been shown that this operation also increases the release of GLP-1 from distal bowel. In this respect, it is not right to categorize sleeve gastrectomy solely as a restrictive operation. In terms of long period results, it has been shown that a weight loss rate of %65-70 can be achieved, but type 2 diabetes remission rate remains at around %50-55. Presented as ‘diabetes operation’ by many centers in our day, sleeve gastrectomy is an obesity surgery procedure and even for obese type 2 diabetes patients who undergo this operation, blood sugar control could be established only on half of the patients.
Sleeve gastrectomy can be offered as a treatment option to obese diabetic patients only if their insulin reserves and insulin activity are at an optimal level. However, it should be kept in mind that the effectiveness of this procedure is about %50.
In this technique, left side stomach wall is freed, then plicated on itself with 2 or 3 line non-absorbable sutures. The purpose is to limit the stomach volume. Any hormonal change caused by this procedure has not been recorded so far. Long term weight loss and control rate of diabetes is similar to gastric band.
2) Combined Operations
Most important prototype of combined operations is gastric bypass. This procedure can be performed either by removing bile passage from stomach (Roux-Y Bypass), or by keeping it intact (Mini-Gastric Bypass). It has been stated that while short term weight loss and blood sugar control level of these procedures depend on stomach volume, long term results depend on small bowel bypass. Still accepted as the golden standard obesity surgery operation in the world, it is arguable that whether gastric bypass deserves this title or not. For long term follow-up results of multi-centered studies show that type 2 diabetes reappears on about %40 of patients who underwent gastric bypass. Also one of every four patients may require revision surgery, also known as re-do, in the long term. The fact that the patients become dependent on vitamin, iron and minerals for the rest of their lives following this operation is another important argument on its own.
3) Malabsorptive Operations
Biliopancreatic Diversion (BPD) and Duodenal Switch (DS) are the most effective obesity procedures ever known. On obese type 2 diabetes patients, weight and diabetes control rate in the long term is above %90. However, these patients become dependent on iron, vitamin, mineral and calcium for the rest of their lives. Also, change of toilet habits and socialization problems which will be brought by absorption disorders in the long term should be emphasized.