In order to decide on the surgery to be performed in obesity surgery, it is necessary to obtain information about the patient's health status and to talk about his/her expectations after obesity surgery. What is clear is that no matter which obesity surgery is performed, changes in nutrition and physical activity should not be compromised for the continuation of success.

Which Method to Use in Obesity Surgery?

Obesity surgeries can be of the restrictive type, in which the volume of the stomach is reduced, or of the restrictive and absorption-reducing type, which aims to reduce the volume of the stomach and reduce food and calorie intake. Which surgery will be performed is decided by the patient's body mass index, evaluation of comorbidities, success rates, and detailed discussion of risks. There is no obesity surgery accepted as the gold standard. However, sleeve gastrectomy surgery has become the most applied method in recent years. However, the surgeon will make recommendations to the patient in choosing surgery, taking into account the characteristics of the patient. For example, Roux-en-Y gastric bypass may be the first choice in a patient with severe gastroesophageal reflux.

What Are the Surgical Options Applied in Obesity Surgery?

• Sleeve Gastrectomy

Sleeve gastrectomy is the process of reducing the volume of the stomach. Approximately 80 percent of the stomach is cut and removed. The remaining stomach takes the form of a tube. With this surgery, the stomach volume is reduced and the biggest source of our body's hunger hormone ghrelin is removed from the body. Patients get rid of their excess weight both by feeding in less volume and by eliminating the feeling of hunger. The deterioration in vitamin and mineral absorption is less than in gastric bypass surgery. Since the anatomical continuity of the stomach is preserved, it does not pose an obstacle when endoscopic interventions are required in later years. Compared to gastric bypass surgeries, the effect of sleeve gastrectomy surgery on the healing of additional diseases is somewhat less. Weight regain is higher compared to bypass surgeries. The rate of being morbidly obese again is below 5 percent. After sleeve gastrectomy, it is possible to convert to other surgeries when necessary.

• Roux-En-Y Gastric Bypass Surgery

Gastric bypass surgery is the process of reducing the volume of the stomach and removing a part of the small intestine and adding the shrunken stomach to the small intestine. In gastric bypass surgery, the stomach is divided into two, but no part is cut and removed from the body as in the sleeve gastrectomy. With this intestinal attachment, the part of the intestine that carries the bile secretions that will reach the new stomach is cut and separated, and reconnected to the small intestine in the further section. Thus, bile is prevented from reaching the stomach. In addition to shrinking the stomach, reducing the absorption power of the intestine increases the weight loss effect of the surgery. At the same time, this change in the intestine provides additional advantages in the treatment of type 2 diabetes with a metabolic effect. Although it is rarely needed, it is a reversible surgery.

Roux-en-Y gastric bypass surgery is the most commonly used method for many years and its long-term safety and success have been proven. Although the effect of surgery in terms of weight loss and getting rid of additional diseases is stronger than sleeve gastrectomy, the need for vitamin and mineral support is higher than sleeve gastrectomy.

• Mini-gastric Bypass Surgery

In the mini-gastric bypass procedure, the volume of the stomach is reduced and it is added to the small intestine, but there is no division in the intestine and the patient has only one attachment site. This is a slightly more metabolically effective surgery than the Roux-en-Y gastric bypass. The nutrients reach the attachment site in a more distant part of the small intestine. A small number of patients may develop complaints related to bile reflux. As with all bypass methods, the need for minerals and vitamins is higher than in the sleeve gastrectomy procedure.

• Small Intestine Bypass Surgery with Gastric Sleeve

In this method called duodenal switch with biliopancreatic diversion, while the stomach is turned into a tube, an important part of the small intestine is bypassed and added to the outlet of the newly formed stomach. Its weight loss effect is more than other surgeries. The probability of malnutrition, and vitamin, and mineral deficiencies in patients is higher than in other surgeries.