Bariatric and Metabolic Surgery

Obesity is not simply a weight problem; it is directly linked to type 2 diabetes, hypertension, sleep apnoea, fatty liver disease, joint disorders and certain cancers. Where diet, exercise and medical treatment fail to produce a lasting result in advanced obesity, surgery is today accepted as the most effective treatment option. This page sets out in detail who bariatric surgery is for, which procedures exist, and how preparation and follow-up work.

Who Is Eligible?

The internationally accepted criteria are:

• A body mass index (BMI) of 40 or above
• A BMI between 35 and 40 together with at least one obesity-related condition such as type 2 diabetes, hypertension, sleep apnoea or fatty liver disease
• Generally an age between 18 and 65
• Failure to achieve lasting weight loss despite diet, exercise and medical treatment

These numbers do not decide on their own. Age, eating habits, previous weight-loss attempts, psychological readiness and general health are weighed together. You can work out your own body mass index on the BMI calculator page, but that figure is only a starting point; the decision follows examination.

Who is not a candidate?

Surgery is deferred or not considered at all in the following situations:

• Active alcohol or substance dependence
• Untreated severe psychiatric illness and uncontrolled eating disorders
• Advanced cardiac or pulmonary disease making anaesthetic risk very high
• Inability to comply with the post-operative diet and follow-up schedule
• Pregnancy, or plans to conceive in the near term

The Procedures

Sleeve gastrectomy

Roughly 75-80 per cent of the stomach along the greater curvature is removed laparoscopically, leaving a narrow gastric tube. The effect is twofold: the reduced volume means satiety with far less food, and the removed portion produces most of ghrelin, the hunger hormone, so appetite also falls. It is the most commonly performed bariatric operation worldwide and in Turkey.

Gastric bypass (Roux-en-Y)

A small gastric pouch is created and part of the small intestine is bypassed. It works through both restriction and reduced absorption. Because the metabolic effect is stronger, it comes to the fore in patients with type 2 diabetes and significant reflux.

Mini gastric bypass and transit bipartition

These are considered in selected patients, particularly at very high BMI values and with a heavy metabolic burden. The mini gastric bypass uses a single anastomosis and is technically quicker; transit bipartition adds an intestinal rearrangement to a sleeve gastrectomy to strengthen the metabolic effect.

Revisional (re-do) bariatric surgery

These are second operations for patients who have had bariatric surgery before and have not lost enough weight, have regained weight, or have developed severe reflux. They are markedly more demanding than a first operation; adhesions and altered anatomy call for separate experience.

Endoscopic procedures

The gastric balloon and gastric botox are considered for patients who have not reached the surgical threshold or are not suitable for an operation. They require no incision, their effect is temporary and they create no permanent anatomical change.

How Do the Procedures Compare?

The decision is made by weighing BMI, associated conditions, the presence of reflux, eating habits and the patient's expectations together. No single procedure is best for everyone.

Metabolic Surgery and Type 2 Diabetes

Bariatric surgery is known to act directly on type 2 diabetes and not only through weight loss. The effect also arises from changes in gut hormones after surgery; indeed, in most patients blood glucose begins to improve within days of the operation, before any weight is lost. For this reason procedures that include an intestinal rearrangement, such as gastric bypass and transit bipartition, come to the fore in patients with type 2 diabetes. Duration of disease, insulin use and pancreatic reserve are the main factors affecting the outcome.

Preparation

Bariatric surgery is teamwork, and the thoroughness of preparation directly affects the result. The following are usually completed beforehand:

• Surgical consultation and choice of procedure
• Endocrinology assessment and thyroid function tests
• Dietetic counselling
• Psychiatric assessment
• Gastroscopy, abdominal ultrasound, extensive blood tests, ECG and chest X-ray
• Where needed, cardiology and respiratory review and a sleep apnoea study

About two weeks before surgery a liver-reducing pre-operative diet is started. A fatty, enlarged liver makes access to the stomach difficult, so this diet makes the laparoscopic operation both easier and safer. Smokers should stop at least four weeks beforehand, which matters for wound healing and pulmonary complications.

After Surgery

Hospital stay is usually 2-3 days. Nutrition progresses in stages:

• Weeks 1-2: clear liquids, then full liquids
• Weeks 3-4: puréed food
• Weeks 5-6: soft solids
• From week 6: gradual return to normal solid food in small portions

Protein comes first at every meal. Fluids are taken between meals rather than with them. Weight loss is fastest in the first six months and plateaus at 12-18 months; on average 60-70 per cent of excess weight is lost.

After surgery, vitamin B12, iron, vitamin D, calcium and folic acid supplements must be taken regularly. This is not a temporary measure: the altered gastric anatomy permanently limits absorption of these nutrients. Blood tests are recommended at 1, 3, 6 and 12 months in the first year, then annually.

Lasting results come from a change in lifestyle. At least 150 minutes of physical activity a week, portion control and regular follow-up are as decisive as the operation itself in keeping the weight off.

Risks and Possible Problems

Bariatric surgery is performed safely in experienced centres today, but like any operation it carries risk. The main points to be aware of:

• Early: bleeding, leak, infection, pulmonary embolism
• Late: reflux (particularly after sleeve gastrectomy), stricture, vitamin and mineral deficiencies, gallstone formation
• Specific to gastric bypass: dumping syndrome, internal hernia, ulcer
• Temporary hair loss and loose skin following rapid weight loss

Most of these are picked up early and managed through regular follow-up. Keeping to the follow-up schedule matters as much as the decision to operate.

Insurance Cover

The Turkish state health insurance scheme SGK covers bariatric surgery for patients meeting certain criteria. Since cover varies with the procedure, the hospital and current regulations, it is best confirmed before booking. VM Medicalpark Mersin Hospital works with SGK and with many private insurers.

Patients Travelling from Outside Mersin

Bariatric surgery is an operation for which patients are willing to travel beyond their own city. For patients coming from neighbouring provinces such as Adana, Antalya, Tarsus, Osmaniye, Hatay and Karaman, the process runs as follows: you can send any investigations you already have via WhatsApp beforehand; the first consultation and any missing tests are completed in Mersin. Consultation, surgery and post-operative checks all take place at VM Medicalpark Mersin Hospital. How long you need to stay depends on the procedure and on your recovery, and is confirmed after examination. Follow-up once you are back home continues via WhatsApp.

Disclaimer. This page is provided for general information only. It does not constitute medical advice, diagnosis or a treatment recommendation, and it is not a substitute for examination, diagnosis and treatment by a physician. The content is not tailored to any individual and is not intended as advertising. Which method is suitable for you can only be determined after examination and the necessary investigations. Consult your own doctor about any decision concerning your health.