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1- I really want to undergo the surgery, but I’m scared. Are bariatric surgeries too risky?

Every surgical procedure in the field of medicine naturally includes a risk. However, contrary to what is believed, the risk of bariatric surgeries is not too different from other intra-abdominal surgeries. The risk of mortality due to bariatric surgeries is 0.1%. Bleeding (2%), leakage from the anastomosis line of the stomach (1-2%) and clot formation in the leg veins (0.1%) are other procedure-specific complications. The most important parameter to minimize these complication rates is the experience of surgical team. It should not be forgotten that the risk of bariatric surgeries is much lower than the risk of being morbidly obese.

2- Will I have too much pain after the surgery?

Today, bariatric surgeries are performed by using the video-laparoscopic technology, also known as the closed technique colloquially. In other words, it is performed through 5-6 mm holes, using special equipment. Therefore, postoperative pain is much less than that of the surgeries in which large incisions are made on the abdomen. Postoperative pain is usually felt only at the first night and can be easily controlled by drugs administered intravenously. The majority of our patients do not need a painkiller after the second day.

3- How will I be nourished after the surgery?

There is a gradual diet pattern, beginning with clear liquids after the surgery and switched into solid foods. Sketchily, in the first week; clear liquids that we can see through when we put them in a glass (water, fruit juice, herbal teas, meat-chicken broth, diluted ayran … etc.), in the second week; more viscous soups and drinks, in the third week; mashed foods (mashed vegetables, fish, soft cheese, etc.) and in the fourth week; solid foods. For diet programs after the first month, we provide patient-specific diet programs depending on the taste and eating habit of each patient under the supervision of our dietician in our clinic.

4- Do diseases such as diabetes, hypertension and sleep apnea pose an obstacle for these surgeries?

It should be known that none of these diseases pose any obstacle for surgery, on the contrary, these diseases can be completely eliminated after the surgery. Type 2 diabetes mellitus improves by 70-95% depending on the duration and severity of the disease, hypertension improves by 50-90% and sleep apnea improves by 90-99%. (see Do my diseases pose an obstacle for the surgery?)

5- What kind of tests are done before the surgery?

In our centre, preoperative routine blood tests, cardiology, thoracic diseases and anaesthesia examination, respiratory function tests, cardiac echo are performed by specialists in their fields and patients are carefully assessed in terms of undergoing general anaesthesia. When necessary, patients are assessed by our expert psychologist and prepared for the surgery (see preoperative period).

7- When can I take a shower after the surgery?

You can take a shower minimum an hour after the drain inserted in the body for the postoperative bleeding control is removed. A waterproof tape is applied on your sutures before having shower. The water you take shower should not be too hot. You need to take a shower with lukewarm water. In the period when you are discharged, you should also apply a waterproof tape on your sutures for the first bath you will have at home. You do not need to cover up your sutures during your next shower.

8- When can I return to my normal life?

After a procedure carried out using the closed laparoscopic technique, the return to normal life is also quicker. You can easily return to your normal life in the period when you are discharged. Of course, there are some points to be paid attention based on the surgical procedure. First of all, when you are discharged, you are able to meet your own needs. You can do all the work you do in your everyday life. What we want from you is that you will not tire yourself a lot for the first 10 days during this fast recovery process. For example, you should not lift heavy in the first 10 days. For example, you should carry your child on your lap for 15 days if you have children. Except that, we also do not recommend lifting a weight of over 4 kilograms in this 10-day period. Housewives can do their routine daily works that they have been doing at home. If you have a desk job, or if your job does not require to spend energy using the body, you can return to work from the 7th day. (The reason for the 7th day is that you are getting used to the period of liquid diet. In some cases, our patients could return their works on the 4th and 5th day. What is important here is that you feel yourself good) .If you are working using your body or have a tiring job, we recommend to have rest in the first 10 days. Sexual intercourse is allowed after the postoperative 15th day.

9- How often will I go for a check-up after the surgery?

Your first postoperative check-up will be in the 1st month. Your should have the blood tests requested from you done during your first month and visit for check-up with their results. During this one-month period, we will continuously be in contact with you via phone. You will be called by our dietician and nurse. Since this surgery is not a doctor-dependent surgery, we do not necessarily set a first-month check-up condition for our patients coming from outside the city. In such cases, we want from our patients to have blood tests done and send us the results. Apart from that, you should have check-up at three-month intervals. You need to have blood tests done on the 1st – 3rd – 6th – 9th and 12th months, and report to us and visit for check-up. After your first year, you should repeat these blood tests once a year.

10- When can I do exercise after the surgery?

First of all, we recommend minimum 20 minutes of walking every day on a regular basis, once you are discharged. You can start swimming after the 15th day. You are recommended swim more actively and begin normal swimming after the 45th day. Especially backstroke maintains the body posture (the position in which you hold your body upright) in the process of weight loss. After the 45th day, you can start to saloon sports. These are: fitness, echo cardio, pilates etc.

11- I underwent sleeve gastrectomy, can I fast?

Fasting during the month of Ramadan may cause difficulties in patients underwent bariatric surgery, especially during the first year. Again, hot and long summer months make this process even more difficult. Many bariatric methods significantly restrict the amount of food and liquid that can be taken once, therefore, patients are recommended to take liquids frequently between meals throughout the day. Fasting on long summer days naturally poses the risk of dehydration (deficit of total body fluid) for these patients. Moreover, due to increased appetite at the iftar time after fasting for a long time, the desire to get food and liquid in the greatest amount possible may cause vomiting, leading to increased dehydration and malnutrition. In a telephone follow-up study conducted in Kuwait, the amount of liquid and food intake of 230 patients (207 sleeve, 13 gastric bypass, 7 gastric band) fasting between 20 July and 19 August 2012 was compared with the amount taken in normal period of 4 weeks without fasting after the month of Ramadan. Interestingly, there was no difference in total fluid intake during these two periods, whereas it has been found that 18% less calorie and 41% less protein intake was present during the fasting period. The group published the study emphasizes that those with diabetes and those underwent surgeries using methods with more absorption-disruptive effects, such as duodenal switch, should be more careful, especially on long summer days. In conclusion, although there is no evidence-based scientific study in this field, according to clinical experiences, it is recommended to avoid fasting especially during the first months after bariatric surgery. Especially patients with diabetes or underwent a surgery using an absorption-disruptive method, such as duodenal switch, are recommended not to fast for the first 12 to 18 months.

12- Will I regularly use drugs after the surgery?

You will use it for 3 months after the surgery, and you will be prescribed a drug that will suppress the gastric acid. Your blood tests will be performed at regular intervals for 1 year after sleeve gastrectomy surgery and if necessary, supportive treatment will be provided. Absorption-disruptive surgeries, such as gastric bypass and duodenal switch, require lifelong vitamin-mineral supplements.

13- Will my skin sag too much after weight loss?

Patient’s age, the rate of weight loss and regular exercise after the surgery are the factors affecting whether or not the skin will sag after bariatric surgery. Regular exercise after surgery is the most important factor preventing possible sagging skin in the process of weight loss. We recommend our patients minimum 45 minutes of indoor sports and swimming for 4-5 days per week. (see postoperative sports) According to our experience, sagging skin requiring cosmetic surgery is very rare in our patients who are under the age of 45 and regularly exercise in the process of weight loss.

14- Will there be hair loss after the surgery?

We may encounter a little hair loss between the postoperative 6th-9th months. It is generally assumed to be due trace element and vitamin deficiency. The studies conducted have shown that the follicle of the hair was intact and hair fell out by splitting from the deeper parts. It can be regarded as a defence of the body for energy storage in the process of weight loss. In other words, the body reduces the hair growth to store the minerals and vitamins necessary for hair. This condition is 100% permanent since hair follicles are intact, and hair loss usually stops after the 9th month.

15- Which type of surgery is suitable for me? Are there any criteria for choosing the type of surgery?

This decision is entirely related to the experience of surgical team and some characteristics of patient. Therefore, sleeve gastrectomy is first preferred for some patients, while for some patients, the first surgery option may be gastric bypass. Some overweight patients (super obese patients with a BMI of over 50) are recommended to have gastric balloon or special and short-term diets prior to laparoscopic bariatric intervention. Does the patient have diabetes and is diabetes at advanced stages? Did any diabetes-related complication arise? Is there a psychological eating problem and if so, to what extent? How does the abdomen of patient appear while lying on the examination table? Does the fatty abdomen expand towards the two sides and flatten or is there a curved, swollen and non-expanding abdomen/belly appearance? Experienced bariatric teams take all these factors into consideration, and after informing patient about each subject, they actually choose the type of surgery with an active communication with patient.

16- I will come from out of Istanbul, how many days after the surgery can I return home?

Approximately 20-25% of our patients come from out of the city or from different countries. Preoperative examinations (see preoperative) end in about 2-3 hours in company with a nurse from our team. Therefore, it is enough for you to arrive one day before. After the 5th day from the surgery, you can have a 2-hour flight. We recommend our patients coming from abroad to return after the 7th day.

17- How much weight can I lose and how long does it take?

The process of weight loss after bariatric surgery is about 12-18 months. The fastest part of this process is the first 6 months. Although it changes depending on the type of surgery performed, an average of 60-80% of excess weight is expected to be lost. For example, if a person, who should weigh 70 kg, weighes 170 kg, that means s/he has 100 kg excess weight. It is expected to lose about 70 kg within 12-18 months after the surgery. In the case of less than 50% loss of excess weight, it is regarded as a surgical failure and a revision surgery can be planned (see revision surgery)

18- Can you tell about your experience in bariatric surgery?

My bariatric surgery adventure began with my visit to Prof. Koray Tekin, MD at the Denizli Pamukkale University thanks to a referral from Prof. Mehmet Ali Yerdel, MD in 2009. At that time, I was intensely working in a centre where laparoscopic upper gastrointestinal surgeries (reflux, achalasia, endoscopy of the digestive system) were carried out. My interest in bariatric surgery has risen profoundly. We performed about 600 bariatric surgeries with Prof. Koray Tekin, MD. Later in the United States of America, I did studies on revisional bariatric surgery and duodenal switch surgeries with Mitchell Roslin, MD, a global expert in bariatric surgery. Since 2013, I have been serving as a freelance physician in Istanbul. Our friendship began with Koray Tekin, MD has continued in Istanbul as well, and we still perform all our surgeries together.