GASTRIC BYPASS SURGERY:

It was the most preferred method in America until 2012. However, with the spread of sleeve gastrectomy, it has become preferred in second place. In gastric bypass surgery, the stomach is divided into two parts just below the entrance to the esophagus, a small gastric bag is created. In gastric bypass surgery, no part of the stomach is removed, as in sleeve gastrectomy. By connecting to the new small stomach created by the small intestine, food bypasses the first part of the small intestine and the large stomach. In this way, it is aimed to saturate with less food and absorb less of the foods eaten.

The main reason why we do not prefer this method in the first place is that both the intestine and the stomach are used together in surgery. All patients who have undergone bariatric surgery have a risk of gaining weight again. For this reason, first of all, it is thought that it is more appropriate to perform surgery on the small intestines to reduce the stomach and trigger weight loss without any operation on the intestines, if those who have had bariatric surgery gain weight again over time.

GASTRİC CLAMP SURGERY:

In this method, an inflatable silicone clamp is attached to the upper part of the stomach. Thanks to this clamp, the stomach fills up in a few bites and excess food is prevented from being consumed. These clamps can be enlarged or reduced from their chambers left under the skin. As with sleeve gastrectomy, it is an operation performed without the need for any large incision.

STOMACH FOLDING SURGERY:

This surgery is a lower cost tube stomach method compared to other stomach surgery methods. The operation takes place in the form of folding the anterior-posterior wall or folding the anterior wall, no foreign object is inserted into the stomach. It was hoped that this method would eliminate the risk of leaks from the incision, rupture or leakage. However, as the method was applied, excessive nausea and vomiting in the first days after surgery began to be less preferred despite its low cost, as leaks due to some tearing occurred in the seams. Finally, it was almost completely abandoned except for a few centers that do it, because it has lower weight loss compared to other surgeries.

Tube stomach surgery is mostly applied to people who have advanced obesity problems and cannot lose weight permanently by methods such as sports or diet. The so-called ‘body mass index’, which is obtained by directly proportioning the weight/height, is most often used to calculate the degree of obesity. For example, the calculation of the BMI of a person who weighs 160 kilograms and is 2 meters tall:

• The square of his height 2×2=4
• The square of his weight/height is 160/4=40

is determined as follows.

It is normal for BMI to change according to age. Between 19-25 is considered the normal. Those over 252 are considered overweight, those over 302 are considered first-degree obese, those over 35 are considered second-degree obese, and those over 40 are considered third-degree obese. If there are other diseases in those with a BMI of 35 and above, and in those with a body mass index of 40 and above, they are evaluated as patients eligible for surgical intervention, even if there are no other diseases. The body mass index alone can be misleading in people with a lot of muscle mass. The situation is controversial in those with a BMI between 30-35 and those with an obesity disease. The “American Society for Metabolic and Bariatric Surgery” one of the authoritative associations related to this, recommending that patients with BMI in the range of 30-35 be given special evaluation by experienced surgeons for each patient.

When the question of who is having a tube stomach surgery is evaluated in terms of age; the age range suitable for a tube stomach surgery is between 13-65 years. However, it is known that tube stomach surgery is also performed for patients over the age of 70 whose condition is appropriate. In children, provided that they are not younger than 13 years old, it is approved by clinics experienced in obesity surgery to perform gastric tube surgery.

In psychiatric diseases, tube stomach surgery can be performed on people whose disease is under control, provided that the approval of the psychiatrist is obtained.

It requires a stay in the hospital for several days depending on the patient’s condition after a gastric tube operation, that must be performed by an experienced surgeon. A few days after leaving the hospital, the patient should rest and not do heavy work. After that, the patient can continue his/her social life and work life. After a gastric tube operation, there is a very serious decrease in the patient’s appetite. Patients who started nourishment with liquid after surgery, then switched to feeding with puree, could then begin consuming solid food by their 8^th week. After tube stomach surgery patients effectively lose weight in 6 months with planned nutrition. Nutrition after gastric tube surgery is again programmed together with dietitians. In patients who have returned to their old eating habits after surgery, it is possible to gain weight again without re-expansion of the stomach. If this weight gain cannot be controlled by diet, a tube stomach operation or a “bypass” type surgery that also reduces food absorption can be performed as revision surgery.

In the early period after the tube stomach surgery, nutrition begins with textured and clear liquids. After the tube stomach surgery, the transition from light liquid to heavy liquid is constant from the beginning of nutrient intake. This process covers the first two weeks. In the later 3^rd and 4^th week, it is carried on in the form of puree and a soft solid period. Nutrition after tube stomach surgery is a regulated transition process to normal nutrition in the first month.

Protein sources are the most desirable group to consume in nutrition after gastric tube surgery. Therefore, the consumption of protein in the liquid period is given great importance. The patient is first given water and 100% apple juice. Then unsweetened light tea and is continued with chicken/beef broth. After leaving the hospital, the consumption of liquid with the same clarity as in the hospital should be continued in the first 7 days at home. Addition to this, in these first days at home, lactose-free or light milk, green yogurt juice, light yogurt juice and diluted half-fat yogurt juice can be consumed. After the fifth day at home, you can start with strained soups with no tomato paste, 100% juices, flour and unsweetened compostes . After tube stomach surgery, during the liquid consumption period in the 2^nd week the patient can start consuming textured liquids. After the first week, dairy products can also be consumed without dilution. Protein powder should be used to meet the protein needs after tube stomach surgery. During this period, soft cheese, soft-boiled eggs, omelettes and similar soft solids are evaluated according to the patient’s ability to tolerate the trials. Soups without chicken pieces and solid meat (After 10^th day can be tried) provided that it is blenderized, can be preferred.

After tube stomach surgery covering the 3^rd and 4^th week time period is called the puree period. During the puree period, low-fat blenderized foods can be started. They should be fed with vegetable purees enriched with chicken and meat juices and continue the protein powder. Also, chicken and meat pieces should not be blenderized and consumed. Of the meat products, starting the 3^rd week onwards, fish meat that is soft can be consumed.

Foods that are not recommended to be consumed at an early stage after bariatric surgery are divided into two groups as foods that are difficult to digest and foods that negatively affect recovery. Caffeinated coffee, Turkish coffee, carbonated-bubbly drinks, fatty foods, oil, sugary foods, sugar, spices, hot sauce and solid foods that are difficult to digest such as chicken, meat, raw vegetables, and dried legumes should not be consumed. Changes in the sense of taste after obesity surgery can be controlled with recipes. It is very important at this point that you act in cooperation with your dietitian.

Tube stomach surgeries aim is to reduce the volume of the stomach. Thanks to this, a feeling of fullness is formed and the amount of food intake is significantly reduced. After tube stomach surgery, food consumption decreases to about a quarter. Although the stomach does not expand again after surgery, weight gain may occur if the nutrition diet is not paid attention to. In order for this condition not to occur, the patient should be followed up by a professional team after surgery. In order to achieve the goal, as well as a successful operation, a proper and regular follow-up is necessary after a tube stomach surgery.