Post-Bariatric Surgery

What is Bariatric (Obesity) Surgery?

Bariatric surgery or obesity surgery is the surgical procedure that is performed on the patients who cannot lose weight despite dietary restrictions or other treatments and whose body mass index (BMI) is higher than 40; or on patients whose BMI is higher than 35 and have chronic illnesses and therefore suffer from significant physical health problems. These surgical procedures play an important role in the treatment of obesity by helping people to return to their normal weight, thus eliminating the health problems that had arisen due to unhealthy weight gain.

What is Obesity?

The condition defined as the accumulation of excess fat throughout the body, which causes health problems to arise is called obesity. Generally, it is the situation of an adult female to have fat more than 30%, and an adult male to have fat more than 25% of their body weight. Obesity is one of the most critical health problems, which affects more and more people worldwide. Obesity surgery is performed both to help the patient to get an aesthetic appearance and to contribute in the prevention of the conditions and their unfavourable effects such as diabetes, coronary artery disease, hypertension, heart failure, respiratory disorders, gastroesophageal reflux, infertility, menstrual disorders, impotence, joint diseases, varicose veins, cerebral hemorrhagia, stroke and depression.

Who can be a Candidate for Obesity Surgery?

Currently, the Body Mass Index (BMI) is used for the diagnosis of obesity. BMI is calculated by dividing the body weight (in kilograms) by the square of height (in meters). If an individual’s BMI is 35 or higher and that individual is unable to lose weight by diet, exercise and medical treatment, obesity surgery is recommended.

• Individuals between the ages of 18-60,
• Individuals with BMI of at least 40 kg/m2,
• Individuals with a BMI between 35-40 kg/m2 and also have a condition such as diabetes, heart problems, respiratory problems and joint diseases may be a candidate to undergo obesity surgery.

What are the Types of Bariatric Obesity Surgery?

There are two different methods of approach to obesity surgery. These are;

• Reducing the stomach volume (Sleeve gastrectomy, mini gastric bypass)
• Preventing the absorption of food in some stages of digestion (Biliopancreatic diversion, Duodenal Switch)

The type of surgical procedure to be performed varies depending on the patient. The procedures that aim to reduce stomach volume are performed by reducing the size of the stomach. However, due to the possibility of the enlargement in size over time, the patient must follow the instructions given by the doctor and the dietician and have a proper diet. The procedures aiming limited absorption, both the size of the stomach is reduced and the absorption through the intestines is reduced. Since the absorption will be reduced, including the beneficial nutrients, necessary supplements should be provided under regular monitoring by the doctor.

What are the Bariatric Obesity Surgery Techniques?

Sleeve Gastrectomy (Tube Stomach):
The stomach is cut longitudinally and the remaining part is resected. Thus, the remnant stomach becomes a tube of approximately 2 cm in diameter. The volume of the remnant stomach is about the amount of a tea cup; therefore, the feeling of satiety will be experienced much earlier than normal. With the resection of a certain part of the stomach, cells that secrete “Ghrelin” (the appetite hormone) will also be removed, and the patient will not have an appetite problem.

Mini Gastric Bypass (MGB):
A tube is created from the stomach with a thickness of 2 cm and the volume of 4 tablespoonfuls of water. This tube-shaped stomach is anastomosed to a region in the middle part of the small intestine. In this technique, the integrity of the intestines is not impaired and the process is completed in a single area.

Biliopancreatic Diversion (BPD):
With this technique, the aim is to disrupt the absorption of fat and polysaccharide through the intestine. The size of the stomach is not reduced much compared to the other techniques. Two-thirds of the stomach is resected, the remnant part is anastomosed to the junction area of the small intestine and large intestine. The intestine, the part in which the absorption ability is restricted, is anastomosed 50 cm away from the same area.

Duodenal Switch:
The stomach is cut longitudinally, and part of the stomach is resected. The procedure is completed without bypassing the first part of the duodenum. Thus, dumping syndrome is unusual and iron absorption is less impaired.

Body Contouring after Bariatric Obesity Surgery (Post Bariatric Surgery)

Due to the weight loss, the possibility of sagging of the skin is high. However, by performing additional plastic surgery techniques, the body can be shaped, and excessive fat and loose skin can be removed.

The procedures that can be performed for body contouring after obesity treatment are as follows:

● Abdominoplasty (tummy tuck)
● Mammoplasty (breast lift)
● Gynecomastia/breast sagging
● Upper arm lift
● Upper leg lift
● Lower body lifting
● Liposuction
● Facial rejuvenation
● Genital rejuvenation

Post-Bariatric Surgery Frequently Asked Questions

What is the cost of post-bariatric surgery?

It is against the law in Turkey for the healthcare organisations including private practices to indicate prices online for procedures, treatments or consultations. Please contact us by calling or texting ?+90 541 334 3484 (WhatsApp available) or ☏ +90 212 257 1515 for the average cost of the procedure or any other enquiries related to the procedure. You need to send some photos to the Patient Care Coordinator to be examined by Professor Yazar to get the exact all-inclusive price.

Can the patients eat whatever they want after the surgery?

The patients who undergo obesity surgery must follow guidelines for a healthy diet and regular exercise. There is a strict nutritional program that should be implemented very carefully after the surgery for 6-8 weeks. Afterwards, the patients can switch to a normal diet.

What are the risks of obesity surgery?

Although observed quite rare, obesity surgery has some risks like other surgical procedures. These can be listed as follows:

• The mortality rate of obesity surgery varies between 0.1-0.4%.
• Although very rare, the anaesthesia administered for the surgery has general risks.
• Pulmonary embolism and clot formation in the legs may occur.
• The risk of bleeding is 1-2%.

Currently, obesity surgery is performed at many obesity treatment centres, but as observed in every other disease and treatment process, the experience and skill of the surgeon are essential factors that increase the chances of success.

Which areas require aesthetic procedures after obesity surgery?

After bariatric surgery, aesthetic procedures should be performed on the following parts of the body:

• Breast area:
  Breast lift is performed to women who experience volume loss and sagging in the breasts after weight loss. In order to increase the volume of the breasts, the patient’s tissue or implants can be used depending on the patient desire. For males, loose tissues are removed from the breast area, and breasts are positioned to their standard location. Additionally, excessive sagging skin at the side of the breasts is removed and the contouring of the area completes the procedure.
• Arm area:
  After losing weight, the skin on the upper arm (from the axillary region to the elbow) can loosen. Sometimes this excessive sagging skin can extend along to the anterior chest wall. An arm lift or liposuction can be performed to the patients who experience these problems. Sometimes these two techniques can be combined.
• Abdominal area and pubis area:
  The belly button slides down, and excessive sagging and deformities can be observed in the abdominal and pubic regions. With the abdominoplasty procedure, the excessive skin is removed, and a flat look is achieved in that area. The belly button is reconstructed and repositioned. The excessive sagging skin is also removed from the pubis area.
• Back area:
  After weight loss, excess sagging skin and folds are also observed in the back area. This excess skin is removed, and the folded appearance is corrected. A waist gap is also reconstructed.
• Leg area:
  Especially on the inner sides of the legs, skin looseness and severe sagging are observed. These are removed with surgery, and contouring is done. In this procedure, sutures are in the groin area or at the inner part of the legs or both.
• Gluteal area:
  Following the weight loss, flattening and deformities occur in the gluteal region. After removing the excess sagging skin and stretching, contouring procedures, including lifting and adding volume can be performed. For this process, the patient’s tissue or implants can be used.

Is there a certain age limit to undergo obesity surgery?

Anyone between the age of 18 and 65 who suffers from obesity can undergo obesity surgery. Patients who are between the ages 13 and 17 and have serious health problems due to obesity can also undergo surgery, but skilled and experienced surgeons should perform the surgery.

What is the preparation process before obesity surgery?

What to do before obesity surgery and body contouring aesthetic surgery can be listed as follows:

• A detailed assessment is done by questioning the patient’s medical history.
• Specific blood tests are performed, and the patient is checked for possible contradictory pre-existing conditions to surgery.
• The patient undergoes a psychological examination.
• The patient undergoes gastroscopy and upper abdominal ultrasonography.
• Patients do not need to apply enema or take laxatives or shave before surgery.
• No food should be consumed after 11:00 pm the night before the surgery.

What are the changes that occur after obesity surgery?

Patients start to lose weight rapidly after obesity surgery. With the weight loss, excessive skin sagging and deformities are observed. The sagging occurs mostly on the arms, breasts, side of the breasts, back, abdomen, lateral parts of the abdomen, legs, and inner part of the legs. The gluteal area loses volume.

How is the recovery period after obesity surgery?

Since the incisions needed for obesity surgery are not large, the pain experienced after the surgery is not much. Some patients suffer from nausea for the first 1-2 days. This situation lasts a maximum of 36 hours. After the surgery, patients are encouraged to stand up and walk after 3-4 hours. Compression stockings and anticoagulants are used to prevent clot formation in the legs. Patients are usually discharged on the 3rd day. After a week, the patient can easily return to work or school. After about 1.5 years, weight loss stops. The patient must be under follow-up not to gain weight again.

What are the things that need attention after post-bariatric surgery body shaping procedures?7

In body shaping procedures that are performed after obesity surgery, a large amount of skin tissue is removed from the body. With the loss of the skin tissue, blood, protein, electrolyte and fluid loss occur. For this reason, the procedure must be performed by experienced surgeons in well-equipped operating theatre conditions in a hospital where intensive care is provided.

How long after the obesity surgery can the body shaping procedures be performed?

First of all, the weight loss process must be completed. The period for this ranges from 1.5 to 2 years on average. The duration is determined by the nutritionists/dietitians and the surgeon.

What can be done for the scars after body contouring procedures?

Since post-obesity surgery body shaping procedures generally need to be performed with larger incisions, the scars will also be large. For these scars, gels, silicone bandages or massage can be applied. For the scar formations with swelling, steroid injections can be made as well as laser treatments to minimise scarring.

Consultant Plastic, Reconstructive and Aesthetic Surgeon Professor Yazar is available in his private practice based in Nisantasi, Istanbul for appointments to provide detailed and tailored information on the procedure.