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
• Restrictive Procedures

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.

Sleeve gastrectomy (reduction of the stomach into a tube) is another restrictive procedure. The stomach is reduced laparoscopically using special instruments. It is less simple 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 ask removal of the balloon before getting adjusted to it.

• 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.

• Restrictive Plus Malabsorptive Procedures

A common form of these procedures is gastric bypass surgery. It is one of the most efficacious methods used in 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 the stomach and intestines are intervened.

• 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 stomach 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.

Which procedure is the best?

Each method to be chosen has benefits and disadvantages.

• Gastric bypass enables faster and a higher amount of weight loss, but it’s the most complicated surgical procedure. It may cause problems in the absorption of nutrients and may result in insufficiency of some important nutrients.
• Sleeve gastrectomy is a safer method because it does not change the course of food or because no new connections are made between the stomach and the intestine. Lack of important nutrients occurs to a lesser extent.
• Gastric balloon method has become more popular in weight loss. It is safer and easier to apply because it involves no incision or suture in the stomach or intestine. However, it cannot enable as much weight loss as surgical methods do.

The patient and the surgeon discuss the patient’s expectations from the operation, the method to be chosen and associated risks and come to a conclusion before the surgery.