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Bariatric Surgery

Obesity is a major health problem worldwide and has reached an epidemic proportion in the Western society. Evidence continues to accumulate that obesity is a major risk factor for many diseases and is associated with significant morbidity and mortality.

The most widely accepted measure of obesity is the body mass index (BMI). This number is calculated by dividing a patient’s mass (kg) by his or her height (m2). A normal BMI is considered in the range of 18.5-24.9 kg/m2. A BMI of 25-29.9 kg/m2 is considered overweight. A BMI of 30 kg/m2 or greater is classified as obese

18.5-24.9 kg/m2   normal

25-29.9 kg/m2          overweight

30 kg/m2<             Obese

40 kg/m2<             Morbid obese

Considering other factors (eg, total muscle mass, waist circumference) besides the BMI may be important. For example, an extremely muscular individual may have an elevated BMI without being considered overweight. A circumference of greater than 88 cm (35 in.) in women or greater than 102 cm (40 in.) in men strongly correlates with an increased risk of obesity-related disease.

Obesity is a complex, multifactorial chronic disease influenced by the interaction of several factors, such as genetic, endocrine, metabolic, environmental (social and cultural), behavioral, and psychological components. The basic mechanism involves energy intake that exceeds energy output

The number of overweight individuals in the world is estimated at 1.7 billion. In the United States, the problem is at epidemic proportions. As much as two thirds of the population in the United States is overweight, and half of the people in this group can be classified as obese

 

In 1954, Kremen and Linner introduced jejunoileal bypass, the first effective surgery for obesity in the United States. In this procedure, the proximal jejunum was connected directly to the distal ileum

Modifications in the original procedures and the development of new techniques led to the following three basic concepts for bariatric surgery

Gastric restriction (adjustable gastric banding, sleeve gastrectomy)

  • Gastric restriction with mild malabsorption (Roux-en-Y gastric bypass)
  • Combination of mild gastric restriction and malabsorption (duodenal switch)

 

Indications for obesity surgery:

We decide the surgery  according to the following criteria.

  1. BMI ≥ 40, or more than
  2. BMI ≥35 and at least one or more obesity-related co-morbidities such as type II diabetes (T2DM), hypertension, sleep apnea and other respiratory disorders, non-alcoholic fatty liver disease, osteoarthritis, lipid abnormalities, gastrointestinal disorders, or heart disease.
  3. Inability to achieve a healthy weight loss sustained for a period of time with prior weight loss efforts.
  1. Obesity has been present for at least 3 years
  2. No hormonal diseases (Hypothyroidism, adrenal disorders)
  3. Not being alcohol or drug addicted
  4. The patient understands the method to be applied and is able to adapt after the operation