Which Procedure?

Several diverse methods have been employed for treatment of obesity. To have an insight about these procedures, we need to understand structure and functions of the digestive system.

The Journey of Food:

Food that we eat are liquified by the saliva after they are broken down into pieces by the teeth. Then, the process of swallowing starts where voluntary and involuntary movements are combined. During that process, the tongue moves up and down to propel food along the esophagus. The movements after this phase are entirely controlled reflexively. Epiglottis moves to shut the passage to the trachea while soft palate rises to close off the nasopharynx (nasal cavity) in order to ensure that food passes down the esophagus. Another factor which ensures that food passes down the esophagus is the pressure difference (approximately 60 mmHg).

After the food passes down the esophagus, it is propelled down to the stomach, where waves ensure that contents of stomach in bolus of food are broken into small particles. While stomach has a certain function of digestion, main absoption takes place in the small intestine. Functions such as absoption of water and storage of stool are carried out by the large intestine.

How Do We Have Feeling of Satiety?

Feeling of satiety depends on many factors. It is influenced by social, cultural and personal factors. Physiological studies that have been conducted recently showed that the feeling of satiety is induced by some hormons resulting from the contraction and relaxation of the stomach, leading to the feeling of fullness in the hypothalamus region of the brain.

Obesity surgeries are also called BARIATRIC SURGERY (baro=weight; -iatric = a branch of medicine).

The procedures used for treatment of obesity can be divided into four categories:

  • Restrictive procedures
  • Malabsorptive procedures
  • Both restrictive and malabsorptive procedures
  • Procedures effective on the center of satiety

1. Restrictive Procedures

The gastric banding is the most common restrictive procedure. Commonly known as stomach stapling, it helps with weight loss by restricting the size of the entrance to stomach and providing an early feeling of fullness. Gastric banding procedure can be performed both laparoscopically or openly. Laparoscopic procedure is the ideal one.

There are a few points that should be understood about gastric banding;

Sleeve gastrectomy (reduction of the stomach into a tube) is another restrictive procedure. The stomach is reduced laparoscopically using special instruments. It is less simpler than gastric banding. It is used as an alternative to the gastric banding in super morbid obese patients. Although it provides good outcomes, gastric volume may get enhanced over time from time to time, resulting in weight regain.
Recently wide use of gastric balloons help to decrease the amount of gastric space in order to restrict the amount of food that can be eaten. Gastric balloon procedure is difficult to comply with. In the first postoperative days or weeks, nausea and vomiting are common. There is a noteworthy number of patients who asks removal of the balloon before getting adjusted to it.

2. Malabsorptive Procedures

These procedures are not widely used anymore. In these procedures, the upper part of the small intestine is rerouted to allow food to reach the large intestine so that small intestine is bypassed. These procedures are no longer performed.

3. Restrictive Plus Malabsorptive Procedures

A common form of these procedures is gastric bypass surgery. It is one of the most efficacious methods used in the morbid obesity surgery. However, it requires a very experienced team as it is a very complicated technique. It is an irreversible technique as flow direction of stomach and intestines are intervened.

4. Procedures Effective on The Center of Satiety

Such procedures are becoming widely accepted. The most known and common technique is the use of an adjustable prosthesis implanted on the fundus area of the stomach (ENDOGAST). It is much less discomforting to the patient compared to the balloon technique, where a balloon is swallowed into the stomac with fluid. Nausea and pain are the most common problems in patients who are treated with gastric balloon. These problems which are observed during the first adaptation period (complaints are reduced within 3 to 5 days although it may extend up to 2 weeks) are not experienced in gastric prosthesis. No complaints are observed as it is only 7 grams in weight. It is endoscopically placed and removed. It is the most commonly used procedure in our clinic.


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