Bariatrik Cerrahi
Özet
Obezite, dünya genelinde sıklığı artan ve ciddi sağlık sorunlarına yol açan kronik bir hastalıktır. Vücut kitle indeksi (VKİ) artışıyla ölüm oranı arasında pozitif korelasyon bulunmakta; diyabet, hipertansiyon ve Obstrüktif Uyku Apne Sendromu (OSAS) gibi morbiditeler risk oluşturmaktadır. Diyet ve egzersiz gibi geleneksel yöntemlerle kilo veremeyen hastalar için bariatrik cerrahi, kanıtlanmış en etkili ve kalıcı tedavi yöntemidir. Cerrahi prosedürler arasında Roux-en-Y Gastrik Bypass (RYGB), Sleeve Gastrektomi (SG), Ayarlanabilir Mide Bandı (AGB) ve Duodenal Switch (BPD-DS) yer almaktadır. Bu ameliyatlar, hastaların yaşam kalitesini artırırken OSAS semptomlarında ve Apne-Hipopne İndeksinde (AHİ) dramatik düşüşler sağlar. Ameliyat öncesinde hastaların polisomnografi ile OSAS açısından taranması ve multidisipliner bir ekip tarafından değerlendirilmesi gerekir. Cerrahi sonrası dönemde ise sızıntı, kanama veya darlık gibi erken ve geç komplikasyonların takibi kritik önem taşır. Ayrıca değişen gastrointestinal anatomi nedeniyle hastaların yaşam boyu vitamin, mineral ve protein takviyesi alması, mevcut ilaç dozlarının ise yeni anatomiye göre yeniden düzenlenmesi zorunludur. Sonuç olarak bariatrik cerrahi, hem morbid obezitenin hem de ilişkili komorbiditelerin tedavisinde güvenilir bir yöntemdir.
Obesity is a chronic disease increasing globally and causing severe health problems. An increase in Body Mass Index (BMI) is positively correlated with mortality, posing high risks for diabetes, hypertension, and Obstructive Sleep Apnea Syndrome (OSAS). For patients who fail with conventional methods like diet and exercise, bariatric surgery stands as the only proven, effective treatment for long-term weight loss. Commonly performed procedures include Roux-en-Y Gastric Bypass (RYGB), Sleeve Gastrectomy (SG), Adjustable Gastric Banding (AGB), and Duodenal Switch (BPD-DS). These surgeries significantly improve patients' quality of life and provide a dramatic decrease in Apnea-Hypopnea Index (AHI) levels. Preoperatively, candidates must be screened for OSAS using polysomnography and evaluated by a multidisciplinary team. Postoperatively, close monitoring is essential for early and late complications such as leaks, bleeding, or strictures. Furthermore, due to the altered gastrointestinal anatomy, lifelong vitamin, mineral, and protein supplementation is mandatory, and preoperative medications must be carefully readjusted. Consequently, bariatric surgery is a highly effective and safe method for treating both morbid obesity and its associated comorbidities.
Referanslar
Ogden CL, Carroll MD, Kit BK, Flegal KM. (2012) Prevalence of obesity in the United States, 2009–2010. NCHS Data Brief (82): 1–8.
World Health Organization. Fact Sheet. Obesity and overweight. Available at: http://www.who.int/mediacentre/factsheets/fs311/en/Updated June 2021
Whitlock G, Lewington S, Sherliker P, et al. Prospective Studies Collaboration. Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies. Lancet. 2009; 373(9669):1083–1096
Guidelines for Clinical Application of Laparoscopic Bariatric Surgery. Available at: http://www.sages.org/publications/guidelines/ guidelines-for-clinical-application-of-laparoscopic-bariatric-surgery/Accepted: 25 March 2008 ©SAGES 2008
International Federation for the Surgery of Obesity and Metabolic Disorders. Are you a candidate. Selection criteria. Available at: http://www.ifso.com/are-you-a-candidate/ ©2014
National Institutes of Health (1991) Gastrointestinal surgery for severe obesity. National Institutes of Health Consensus Development Conference Draft Statement. Obes Surg1:257–265
Ikramuddin S, Korner J, Lee WJ, et al. Roux-en-Y gastric bypass vs. intensive medical management for the control of type 2 diabetes, hypertension, and hyperlipidemia: the diabetes surgery study randomized clinical trial. JAMA. 2013;309(21):2240-2249.
Buchwald H, Estok R, Fahrbach K, et al. Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med. 2009;122(3):248-256.
Kriwanek S, Schermann M, Ali Abdullah S, Roka R. Band slippage a potentially life threatening complication after laparoscopic adjustable gastric banding. Obes Surg. 2006;15(1):133-136.
Carrodeguas L, Szomstein S, Zundel N, Lo Menzo E, Rosenthal R. Gastrojejunal anastomotic strictures following laparoscopic Roux-en-Y gastric bypass surgery: analysis of 1291 patients. Surg Obes Relat Dis. 2006;2(2):92-97.
Angrisani L, Santonicola A, Iovino P, Formisano G, Buchwald H, Scopinaro N. Bariatric surgery worldwide 2013. Obes Surg. 2015. Apr 4 Epub ahead of print.
Bellanger DE, Greenway FL. Laparoscopic sleeve gastrectomy, 529 cases without a leak: short term results and technical considerations. Obes Surg. 2011;21(2):146-150.
Weiner RA, El-Sayes IA, Theodoridou S, Weiner SR, Scheffel O. Early post-operative complications: incidence, management, and impact on length of hospital stay. A retrospective comparison between laparoscopic gastric bypass and sleeve gastrectomy. Obes Surg. 2013;23(12):2004-2012.
Dixon JB, Straznicky NE, Lambert EA, Schlaich MP, Lambert GW. Laparoscopic adjustable gastric banding and other devices for the management of obesity. Circulation. 2012;126(6):774-785.
Dixon AF, Dixon JB, O’Brien PE. Laparoscopic adjustable gastric banding induces prolonged satiety: a randomized blind crossover study. J Clin Endocrinol Metab. 2005;90(2):813-819.
Scopinaro N, Marinari G, Camerini GB, et al. Specific effect of biliopancreatic diversion on the major components of metabolic syndrom: a long-term follow-up study. Diabetes Care. 2005;28:2406-2411.
Strain GW, Gagner M, Pomp A, Dakin G, Inabnet WB, Saif T. Comparison of fat-free mass in super obesity (BMI >/= 50 kg/m2) and morbid obesity (BMI < 50 kg/m2) in response to different weight loss surgeries. Surg Obes Relat Dis. 2012;8(3):255-259.
Nanni G, Familiari P, Mor A, et al. Effectiveness of the Transoral Endoscopic Vertical Gastroplasty (TOGa®): a good balance between weight loss and complications, if compared with gastric bypass and biliopancreatic diversion. Obes Surg. 2012;22:1897-1902.
Ibrahim AM, Ghaferi AA, Thumma JR, Dimick JB. Variation in outcomes at bariatric surgery centers of excellence. JAMA Surg. Published online April 26, 2017. https://doi.org/10.1001/ jamasurg.2017.0542.
Coblijn UK, et al. Predicting postoperative complications after bariatric surgery: the Bariatric Surgery Index for Complications, BASIC Surg Endosc 2017. https://doi.org/10.1007/s00464- 017-5494-0. [Epub ahead of print].
Lim RB. Complications of gastric bypass and repair. In: Fischer JE, editor. Fischer’s mastery of surgery. 6th ed. Philadelphia: Lippincott Williams & Wilkins; 2012.
Aghajani E, Nergaard BJ, Leifson BG, et al. The mesenteric defects in laparoscopic roux-en- Y gastric bypass: 5 years follow-up of non-closure versus closure using the stapler technique. Surg Endosc. 2017. Published online February 15, 2017. https://doi.org/10.1007/ s00464-017-5415-2.
Gebhart A, Young M, Phelan M, Nguyen NT. Impact of accreditation in bariatric surgery. Surg Obes Relat Dis. 2014;10(5):767–73.
Telem DA, et al. Rates and risk factors for unplanned emergency department utilization and hospital readmission following bariatric surgery. Ann Surg. 2016;263(5):956–60.
Kushner R. Managing the obese patient after bariatric surgery: a case report of severe malnutrition and review of the literature. JPEN J Parenter Enteral Nutr. 2000;24(2):126-132.
Mechanick JI, Youdim A, Jones DB, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient—2013 update: cosponsored by American Association of Clinical Endocrinologists, the Obesity Society, and American Society for Metabolic and Bariatric Surgery. Surg Obes Rel Dis. 2013;9(2):159-191.
Wood GC, Chu X, Manney C, Sgtrodel W, Petrick A, Gabrielsen J, et al. An electronic health record-enabled obesity database. BMC Med Inform Decis Mak. 2012;12:45. https://doi.org/10.1186/1472-6947-12-45.
Schwartz, A.R., Patil, S.P., Laffan, A.M. et al. (2008). Obesity and obstructive sleep apnoea: pathogenic mechanisms and therapeutic approaches. Proc Am Thorac Soc 5(2): 185–192.
Schwartz, A.R., Gold, A.R., Schubert, N. et al. (1991). Effect of weight loss on upper airway collapsibility in obstructive sleep apnoea. Am Rev Respir Dis 144(3 Pt 1): 494–498.
Ashrafian H, Toma T, Rowland SP, et al. Bariatric surgery or non-surgical weight loss for obstructive sleep apnoea? A systematic review and comparison of meta-analyses. Obes Surg. 2015;25(7):1239–1250
Ravesloot MJ, Hilgevoord AA, van Wagensveld BA, de Vries N. Assessment of the effect of bariatric surgery on obstructive sleep apnea at two postoperative intervals. Obes Surg. 2014; 24(1):22–31
Buchwald, H., Avidor, Y., Braunwald, E. et al. (2004). Bariatric surgery: a systematic review and meta-analysis. JAMA 292(14): 1724–1737.
Varela, J.E., Hinojosa, M.W., Nguyen, N.T. (2007). Resolution of obstructive sleep apnoea after laparoscopic gastric bypass. Obes Surg 17(10):1279–1282.
Dixon, J.B., Schachter, L.M., O’Brien, P.E. (2001). Sleep disturbance and obesity: changes following surgically induced weight loss. Arch Intern Med 161(1): 102–106.
