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Duodenal Switch is a comprehensive weight loss technique among surgical procedures. It is considered the most effective solution in the treatment of patients who eat high-calorie diets, and it has also been observed to be very effective in conditions such as diabetes, high blood pressure and cholesterol.

Unlike biliopancreatic diversion surgery, this surgical procedure involves sleeve gastrectomy. During the procedure, the small intestine, which is cut off by protecting the gastric outlet, is anastomosed to the end of the gastric outlet. On the other hand, it reduces a number of side effects observed in biliopancreatic diversion, by ensuring that the joint canal has a length between 75 cm and 10 cm. In addition, the valve of the stomach called the pyloric valve is preserved, so that the patient does not have indigestion problems.

Since the duodenal switch procedure involves the removal of the part of the stomach that produces ghrelin (hunger hormone), the patient’s feeling of hunger decreases, and as a result, the amount of food intake can be limited. Thus, it becomes easier for the patient to lose weight, thanks to the reduced amount of caloric intake after the procedure. Since this procedure intended to reduce the absorption of fat in particular is specific to patients who consume fatty foods, it is observed to be effective in such patients. However, patients who have undergone a duodenal switch operation have to eat a special diet and take vitamin – mineral support throughout their lives.

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Gastric bypass is a surgical procedure intended to treat morbid obesity, in which excess weight caused by the accumulation of excess fat in the body causes other health problems. Gastric bypass is the most widely performed surgical procedure among all bariatric surgery procedures. In this surgical procedure, diseases such as diabetes, high blood pressure, and bad cholesterol levels, which can be accompanied by metabolic syndrome, can be controlled more easily.

This operation intended to reduce the volume of the stomach and restrict its absorption capacity consists of two stages. At the initial stage of this surgical procedure, which is performed laparoscopically, a small stomach tube with a volume of 30 ml is created at the entrance of the stomach, and the remaining larger part of stomach is then completely separated. This large part of the stomach is removed from the abdomen, and the remaining part continues to produce secretions. In the second stage, the resultant small stomach is anastomosed to the small intestine. This connection allows foods to bypass the stomach and enter the small intestine. As a result of this, the amount of food consumed is restricted. Thus, it can be possible to achieve weight loss because of less eating and less absorption.

There two types of this method that restrict food intake. The process of connecting the small intestine to the stomach with anastomosis without separation is called a mini-gastric bypass. In Roux’s Y gastric bypass, the small intestine is separated and its one end is anastomosed to the stomach and the other end to the small intestine at a certain distance. Both of these procedures contribute to weight loss with results close to each other. In short, after this procedure, the patient consumes less food and can benefit less from the foods he/she consumes.

Compared to a sleeve gastrectomy, gastric bypass can give more obvious results. The person’s feeling of hunger decreases while his/her feeling of satiety increases. As a result of this, the person’s blood sugar level remains stable. Since it is a procedure that restricts food intake after the operation, losing 60 to 80 percent of excess body weight can be observed. However the complication rate of gastric bypass is higher than that of sleeve gastrectomy, and long-term or life-long medication may be needed after the procedure.

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Sleeve Gastrectomy is the surgical removal of the part called the fundus that constitutes 80% of the stomach. By removing the fundus section of the stomach, the secretion of the hunger hormone, which in medicine is called the ghrelin hormone, decreases. The ghrelin hormone is a peptide protein secreted from the fundus. It is also an important stimulus for the feeling of hunger in the brain. As sleeve gastrectomy involves the removal of the fundus part of the stomach, less amount of hormone is secreted, and accordingly, the person feels full. In this way, it can significantly contribute to weight loss by reducing appetite.

Since sleeve gastrectomy has fewer postoperative complications and can be converted to malabsorptive surgery when needed, it is practiced more commonly with every passing day all over the world.

Sleeve gastrectomy is performed by laparoscopic (closed surgery) method under general anesthesia, by making 5-6 half-centimeter incisions. During the operation, a tube is inserted into the stomach. With the help of a stapler, a large part of the stomach is removed through a hole of 2 cm, under the guidance of the inserted tube. At the end of the operation, the suture line is checked for bleeding. In addition, the stomach is inflated with special dyes to check for leaks at the suture line. After the control procedures, the tube placed in the stomach is removed and the procedure is ended by placing a drainage system in the abdomen.

Sleeve gastrectomy It is an irreversible surgical procedure. However, it can also be converted to a bypass surgery if necessary.

Who are Suitable Candidates for Sleeve Gastrectomy?
What is the Appropriate Age Range for Sleeve Gastrectomy?
Does SGK (SSI-Turkish Social Security Institution) Cover the Costs of Sleeve Gastrectomy?
Will I Have Serious Pain After Sleeve Gastrectomy?
Can I Get Pregnant After Sleeve Gastrectomy?
How Long Should I Wait for Pregnancy After Sleeve Gastrectomy?

Who are Suitable Candidates for Sleeve Gastrectomy?

If your Body Mass Index (BMI) is above 35 and you have one or more of the co-morbid diseases such as hypertension, type 2 diabetes, insulin resistance, sleep apnea, and fatty liver, we can say that you are generally a suitable candidate for this surgical procedure.

If your Body Mass Index (BMI) is over 40 and your age is over 18, you are generally a suitable candidate for this surgical procedure.

What is the Appropriate Age Range for Sleeve Gastrectomy?

Sleeve Gastrectomy is generally performed on patients between the ages of 18 and 65 years.

Does SGK (SSI-Turkish Social Security Institution) Cover the Costs of Sleeve Gastrectomy?

First of all, your Body Mass Index should be above 40. If you are found eligible after the examinations, a committee report is issued and SGK covers a certain amount of the cost of the sleeve gastrectomy operation performed in a private hospital.

Will I Have Serious Pain After Sleeve Gastrectomy?

Since Sleeve Gastrectomy is a Laparoscopic procedure (closed surgery), the pain it causes is at a low level.

Can I Get Pregnant After Sleeve Gastrectomy?

Yes, you can. Sleeve Gastrectomy has no adverse effects on the pregnancy process. However, it is recommended that people who have just had surgery reach their ideal weight first.

How Long Should I Wait for Pregnancy After Sleeve Gastrectomy?

You should wait for a period of minimum 12 months. The recommended waiting period for pregnancy after surgery is between 18 and 24 months.

When Can I Return to Work After Surgery?
Sexual Intercourse After Sleeve Gastrectomy
Will My Body Sag After Stomach Reduction Surgery (Sleeve Gastrectomy)?
Can I Drink Acidic Drinks After Sleeve Gastrectomy?
Will My Hair Fall Out After Surgery?
Can I Consume Alcohol After Sleeve Gastrectomy?

When Can I Return to Work After Surgery?

We recommend resting at home for 7 to 10 days on average after sleeve gastrectomy. Our patients who work at a desk job can start working after 7 days on average. We recommend that our patients whose job requires physical activity start working after 30 days.

Sexual Intercourse After Sleeve Gastrectomy

We recommend you to avoid activities that require high effort for the first 3 weeks after the Stomach Reduction operation.

Will My Body Sag After Stomach Reduction Surgery (Sleeve Gastrectomy)?

If you regularly do body-shaping sports after surgery, you can minimize the sagging skin problem. If you need aesthetic intervention, we recommend you to have it at least 12 months after your surgery.

Can I Drink Acidic Drinks After Sleeve Gastrectomy?

It is recommended no to consume acidic and carbonated beverages such as coke, soda, soda pop, which adversely affect the healing process of the stomach. We recommend the consumption of mineral water rich in minerals 3 months after the operation on average. You must wait well enough to let any of such products go flat before consuming it.

Will My Hair Fall Out After Surgery?

Hair loss can be observed in some of those who have had tube stomach surgery. Vitamin and mineral deficiency is the main cause of this problem. Hair loss is not a permanent problem. After about 7-8 months, the lost hair grows again. If you pay attention to your diet, vitamin and mineral values, you may avoid encountering this problem.

Can I Consume Alcohol After Sleeve Gastrectomy?

We do not recommend consuming alcohol in the first six postoperative months. After the sixth month after operation, you can limitedly consume low-alcohol drinks.

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Among the treatments intended for losing excess body weight, behavioral change treatment is the most difficult procedure in terms of convincing an individual. This treatment involves not only limiting the eating or prompting the patient to adopt the habit of physical activity, but also changing the entire lifestyle. The main goal of the treatment is to convert all unfavorable behaviors and habits related to eating and physical activity into favorable ones.

The steps of the treatment are;

- The individual’s self-monitoring:
- Stimulus Control:
- Developing alternative behaviors
- Reinforcement, self-rewarding
- Cognitive restructuring:
- Social Support
- Pharmacological treatment.

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In obesity, limited physical activity or lack of movement can be defined as a cause and effect. In addition, although the effect of exercise therapy on weight loss is disputable, increasing mobility and performing physical activities at regular intervals are observed to reduce the excess adipose tissue in the abdominal area. When applied with diet, it prevents loss of muscle mass. For this reason, medical nutrition therapy is given in conjunction with exercise therapy to prevent regaining weight.

It is recommended that an adult should do moderate-intensity exercise for 30 minutes every day to ensure the daily energy consumption (200 kcal). In addition, in the conditions involving obesity, it is aimed to ensure that individuals do physical activity every day and be active throughout the day. Energy consumption may differ depending on the weight and activity intensity of the individual. The most important point to consider when performing this treatment procedure is to keep the risk of injury low while increasing the energy consumption,. It is necessary to take care that the exercises are suitable and applicable to the person.

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The main goal of diet therapy is to reduce the amount of caloric intake. This diet therapy process should be designed under the guidance of a dietitian and physician, because factors such as the metabolic rate, lifestyle, and eating habits vary from person to person. Due to these factors, medical nutrition therapy is of great importance in the treatment of obesity.

In medical nutrition treatment, the table created with intent to reduce the amount of caloric intake of an individual includes predominantly vegetable foods and is also supplemented with low-fat foods. Thus, the person is also given the habit of proper nutrition during the treatment process. With this treatment, it is aimed at reducing the ratio of body weight and height to the appropriate level. These goals set at the initial stage can be the ideal weight, as well as slightly above it. When the target weight is reached in the treatment, it is very important to prevent regaining weight and to ensure maintaining the lost weight.

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Metabolic syndrome, a disease of modern life, is a condition that develops with insulin resistance and is observed together with systemic factors such as abdominal obesity, diabetes mellitus or glucose intolerance, dyslipidemia, coronary artery disease, and hypertension. The incidence of metabolic syndrome, also called insulin-resistance, polymetabolic syndrome, syndrome X, civilization syndrome and the “deadly quartet”, increases in parallel with obesity.

Type ll diabetes and heart failure are often observed in the presence of metabolic syndrome. Some of the causes of the disease include overweight or obesity, diet (excessive sugar consumption), coronary artery disease, type II diabetes, stress, genetic factors, advanced age, rheumatological diseases, psychological and psychiatric factors, and factors such as alcohol use.

In Turkey, approximately one third of the population over 20 years of age has metabolic syndrome. Therefore, attention should be paid to the symptoms of this disease. The symptoms of the disease include;

Increase in waist circumference
High blood pressure
High blood sugar
High cholesterol.

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As a chronic disease, it also leads to many diseases such as diabetes mellitus, ischemic heart disease, gallbladder disease and hypertension.

Although there are many other factors, excessive eating and high calorie diet, as well as inadequate exercise and physical activity in daily life are considered to be the most obvious causes. Besides these factors, many physiological, genetic, environmental and psychological factors are also among the related causes of obesity, and predisposition to obesity, endocrine diseases and antipsychotic drugs can also be considered among other hidden causes of obesity.

As a result of the research conducted today, it was ascertained that it is impossible to explain the causes of obesity only by genetic changes, because of the increased incidence of childhood obesity. Therefore, environmental factors are prioritized among the underlying causes of obesity. The main underlying causes of obesity include;

Excessive eating and high calorie diet
Inadequate exercise and physical activity
Psychological factors
Genetic factors
Medications being used
Frequent and low-calorie diets
Age
Gender
Educational level
Social and cultural factors.

There is an increase in obesity in society due to less use of body power as a result of today’s developing technology. It is possible to explain this with the spread of means of transportation and the restriction of daily movements. In addition, the widespread consumption of high-calorie fast-foods contributes to the development of this situation. For this reason, a person’s eating habits and maintaining them are very important. Many documents published by UNICEF emphasizes the importance of breastfeeding up to 6 months and the continuation of breastfeeding combined with complementary foods from the age of 6 months. Continuing breastfeeding for 2 years is reported to significantly reduce the risks of obesity and chronic diseases.

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The World Health Organization defines obesity as abnormal or excessive fat accumulation that presents a risk to health In obesity evaluated based on the gender, women have a Body Mass Index (BMI) of 20 to 30 or more and men have a BMI of 25 or more.

To define obesity more comprehensively, we can say it is a condition that causes abnormal fat accumulation in the person’s body, leading to the a great variety of diseases in later stages, which arises due to conditions under which certain factors pave the way for it. These factors are the followings:

Environmental
Social
Economic
Genetic

This condition, which leads to the development of chronic diseases in later stages, may also result in death. The distribution of fat accumulation caused by obesity in the body is very important in terms of the risks that it will cause in the later stages. Excess fat accumulation in the trunk and abdominal region rather than in the arms and legs carries a risk in terms of metabolic syndrome (a group of diseases including risk factors that considerably increase the likelihood of having a heart attack).

According to the data provided by the World Health Organization, the number of obese people has doubled in the 20th and 21st centuries. These data show that people aged 20 years and over are obese, while the current data obtained today show that children under 5 years of age are also overweight and obese. Obesity, which used to be defined as a disease of developed countries in the past years, is now considered as a major disease problem even in undeveloped countries.

Obesity that affects a person’s life expectancy and poses a significant threat to his or her health is considered to be the most risky factor as a cause of death. More than 3 million people who die each year a s a result of being overweight or obese. Obesity, which is a preventable and curable disease, can be prevented by improving improper eating habits, genetic factors, hormonal disorders, and physical activities.

In the treatment process, the person’s body mass index (BMI) is calculated and the ratio of weight to height square meter is then taken into account. If the BMI is 40 kg/m2 and above, the person is considered to be obese at the level of disease, and the treatment is started based on this ratio. Body mass index is calculated by dividing the body weight in kilograms by height in meters squared.

What is Body Mass Index?

Body Mass Index (BMI) = Body Weight (kg) / Height Squared (m)

Body Mass Index and Corresponding Weights
18.5 kg/m2 Below	Underweight
18.5 – 24.9 kg/m2 Between	Normal Weight
25 – 29.9 kg/m2 Between	Over Weight
30 – 34.9 kg/m2 Between	Obese Class I
35 – 39.9 k2/m2 Between	Obese Class II
Over 40 kg/m2	Obese Class III