Endoscopic and Surgical Treatment of Obesity

Although endoscopic procedures and surgical methods used in the treatment of obesity are well known, they are some misunderstandings about ‘before’ and ‘after’ operation. The most concerned topic is nutrition. We’ve searched these confusing issues for you.

It has been revealed by scientific studies that obesity, which has become the common problem of the whole world, causes serious health problems, decreases the quality of life and even causes deaths. Obesity causes many diseases such as heart problems, high blood pressure, type 2 diabetes and cancer.

In Turkey, despite diet and exercise, there are 2.5 million people whose Body Mass Index (BMI) is 40 and cannot lose weight. Experts recommend bariatric surgery options for these people.

Tube stomach and gastric bypass are the most common bariatric operations. There are also endoscopic techniques that reduce stomach volume, such as Intra Gastric Balloon and Gastric Botox.


Endoscopic Procedures to Reduce Stomach Volume

The purpose of these methods is to reduce the amount of food a person eats.

Gastric Balloon: It is a weight-loss procedure that involves placing a saline-filled silicone balloon in your stomach. This helps you lose weight by limiting how much you can eat and making you feel fuller faster.

Gastric Botox: Botox which is injected into the stomach wall temporarily relaxes the stomach muscles and a key nerve that controls feelings of hunger and satiety is blocked. As a result, the patient feels full more quickly and for longer than usual.

Bariatric Surgical Procedures

These procedures provide permanent weight loss in obese patients where non-surgical weight loss methods are not effective.

Tube stomach: It is aimed to reduce the amount of food consumed at one time by reducing the stomach size by 80 percent. It does not have a negative effect on nutrient absorption. Although a person consumes small amounts of food, he feels full for a longer time. In addition, secretion of the hunger hormone Ghrelin is prevented.

Gastric Bypass: With this surgery, the stomach is turned into a small pouch and sewn into the small intestine. The aim is to reduce both the food to be consumed and the amount of fat and calories absorbed.


Potential Candidates for Bariatric Surgery

  • Those with more than 40 BMI
  • Those who gain 35 kg (women) and 45 kg (men) more than their ideal weight
  • People with 35 or more BMI’s and also have obesity associted diseases such as type 2 diabetes, sleep apnea and heart problems.


Health problems that can be eliminated through bariatric surgery

  • Type 2 diabetes
  • High blood pressure and high cholesterol
  • Sleep apnea
  • Cardiological disorders


All bariatric operations fall under the category of major surgeries. Possible risks are:

  • Infection
  • Embolism
  • Pneumonia
  • Ulcer
  • Gallstone development
  • Clogging sensation when food cannot be chewed
  • Nausea or vomiting
  • Poor nutrition

Weight loss surgery is not a miracle solution, needs to be supported by a healthy diet and exercise


Preoperative process

  • Your doctor will explain the procedure and answer any questions you may have.
  • You will be asked to sign a consent form for the process to be carried out, read it carefully and do not forget to ask questions that are not clear in your mind.
  • In addition to a complete medical history, a physical examination is required. Your doctor can also ask for various tests.
  • It is important to avoid all food and drink at least eight hours prior to surgery.
  • If you are allergic to anything, don’t forget to tell your doctor.
  • Give information about all your prescripted drugs, including herbal supplements that you take.
  • If you have a history of bleeding disorder and using blood medication, talk to your doctor.


After the surgery

  • Weight loss surgery usually requires hospitalization for several days. You may use pain killers for a few days.
  • Your doctor will ask you to start moving right after the operation. Moving around lowers your chance of developing a blood clot. 
  • An IV feeding is required for the couple of days. After the first three days, you will start to consume liquids such as broth and fruit juice. By 4 to 6 weeks after your procedure, you may be eating solid foods. 
  • You will be instructed about taking nutritional supplements to replace the nutrients lost due to the reconstruction of the digestive tract.


Follow-up care at home

  • You will need to take care of the incision area dry and clean as it heals. Your doctor will give specific details about the bath time.
  • You may feel pain in incision area and abdominal muscles due to deep breathing, coughing and exertion. You can get a pain killer which recommended by your doctor.
  • You should continue to do breathing exercises.
  • You need to increase your physical activity gradually. It may take several weeks to gain your strength back.
  • You must avoid lifting heavy items for several months.
  • It is normal to feel tired.


You should notify your doctor as soon as possible, if you feel any of the following:

  • Fever or chills
  • Redness, swelling, bleeding and increasing pain around the incision area


Get help from a dietitian

After bariatric procedures, you must adopt a healthy diet and lifestyle. You should learn what to eat or avoid after surgery from a qualified dietitian.


Gastric Balloon Surgery

  • The liquid diet is required for the first three days in order to help adaptation of the balloon and lower the risks of dehydration, pain, cramp, nausea and vomiting.
  • After that you start drinking water, vegetable-fruit juices, tea, lactose-free milk, yoghurt, grained soups and protein supplements.
  • You should drink 1. 5oo liter of water per day. You should be sure that the liquids you drink are not too hot or cold. Sipping liquids is important to avoid problems such as burning, pain, nausea, vomiting and bloating.
  • Your doctor will recommend pureed diet for 4-10 days. To learn how to consume small amounts of food and chewing well can help during the transition to solid foods. In addition to your liquid diet, you can mash vegetables and fruits, whole grains, eggs, cheese, ground beef, chicken, fish, and turkey in puree.
  • If you do not have any nutritional problems after 10 days, you can return to your daily diet. You should plan a nutrition program with your dietitian including at least 4 meals per a day. That way your stomach won’t be empty for more than 3-4 hours. with your As long as the balloon is in your stomach, you should avoid carbonated drinks and take care not to consume sugary, creamy and alcoholic liquids.
  • The water you drink by sipping after meals prevents the balloon to stick to the foods and helps to reduce burping complaints. You should prefer foods which cooked in oven, grilled, boiled, steamed instead of fried and roasted. You should add healthy oils to your daily diet.


After Stomach Botox

Liquid feeding is generally recommended fort he first 3 days after the procedure. A personalized diet program is required for the patient. The patient must drink 2 liters of water and walk 40 minutes per a day.


Tube Stomach Surgery

  • A five-stage diet is recommended after this surgery to help body to adopt healthy eating habits. The patient is fed with frequent but small portions.
  • Liquid diet is a must for the first two weeks.This diet will prevent complications such as diarrhea, constipation and dehydration and provides time for body to heal.
  • Protein is especially important after surgery. Due to rapid weight loss, you should take at least 60 grams protein per a day to avoid muscle destruction. Multiple vitamins are also recommended in order to avoid complaints such as hair loss, sleep problems and fatigue.
  • On the third week, you can consume foods as mashed. Taking 60-80 gram of protein is also important.
  • On the fourth week, patient learns to chew well and eat slowly. Solid and liquid foods cannot be taken the same time.
  • On the fifth week, patient can return to his/her daily diet. Consuming enough protein and vegetables are very important The patient should be warned about forbidden foods.


Diet Plan After Gastric Bypass

  • The diet plan consists of several stages. Your doctor will determine how long each stage will take and what to eat. Controlling food portions can help you manage your eating habits for the rest of your life.
  • Fort the first few days, you can only drink a few sips of liquid at a time. This will help your stomach to heal. When your doctor decides that you’re ready, you can move onto stage two.
  • This step consists of pureed food.
  • Spices can be disturbing so avoid them completely. Do not eat fruits that contain too much seeds, such as strawberries and kiwi. Broccoli and cauliflower are not recommend either.
  • You probably won’t be able to eat anything but pureed food for several weeks.
  • The fourth stage of the gastric bypass diet involves the re-consumption of solid food. It starts about two months after surgery. You need to cut or chop foods into small pieces. Large amounts of food can cause blockage. A blockage can lead to pain, nausea and vomiting.

Vitamin and mineral supplements are important. Your doctor will give you the information about that.

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