Obesity Surgery in Children

Obesity, defined as the disease of our age, is increasing every day in our country and around the world, even among young people and children, due to unhealthy eating habits, insufficient physical activity, and individual and social lifestyles.

The diagnosis of obesity in children is different from that in adults. In adults, diagnosis is based on Body Mass Index (BMI). However, percentile curves have been developed for children based on age and gender. According to these curves, if a child's BMI is above the 85th percentile for their age and gender, they are considered overweight, and if it is above the 95th percentile, they are considered obese.

Unlike in adults, treatment does not focus solely on weight loss, but also takes into account that children are in a stage of growth and development.

The priorities in treatment are regulating nutrition (energy intake), regulating daily activity (exercise), and regulating the psychological and social environment and lifestyle.

However, it should not be forgotten that surgery is also an option for individuals in whom treatment in this manner has not been successful.

Suitable Candidates for Obesity Surgery Under the Age of 18

BMI over 35;

• Type 2 diabetes
• Severe fatty liver disease
• Severe sleep apnea syndrome (apnea-hypopnea index over 15)
• Those with pseudotumor cerebri

BMI over 40;

• Insulin resistance
• Hypertension
• Dyslipidemia (high cholesterol and triglycerides)
• Depression

Obesity surgery may be performed on patients with mild to moderate sleep apnea syndrome (apnea-hypopnea index above 5).

Obesity surgery should be performed with extreme caution in girls under the age of 13 and boys under the age of 15, as it may negatively affect growth.

According to published studies, the rates of weight loss and resolution of obesity-related comorbidities in patients under 18 years of age who undergo bariatric surgery are better than in adult patients who undergo surgery. In obese patients under 18 years of age, gastric sleeve surgery should be performed as it does not disrupt physiology.

What is Gastric Sleeve Surgery? How is it performed?

It is a metabolic surgery method applied when obese patients cannot lose weight through diet and exercise. The aim of this method is to reduce the volume capacity of the stomach. Approximately 80% of the stomach is removed through laparoscopic surgery. Since the esophagus width, i.e., the tube-shaped stomach, remains, it is also called tube stomach or stomach reduction surgery.

How is gastric sleeve surgery (stomach reduction surgery) performed?

The surgery is performed laparoscopically (closed) under general anesthesia. The stomach's blood vessels are tied off using special instruments, then a tube is inserted into the stomach through the mouth, and the stomach is cut using an instrument called a stapler. The removed portion is taken out through the incision in the abdominal wall. The stapler is sutured with special stitches. After bleeding is controlled, a drain is placed inside the abdomen, and the procedure is completed.

 

What are the advantages of laparoscopic sleeve gastrectomy over other obesity surgeries?

• It does not disrupt the anatomical structure or the natural flow of nutrients.
• Compared to other methods, the technique is simpler and the complication rate is lower.
• Anatomy, intestinal structure, and the physiological flow of nutrients are not disrupted.
• There is no dumping syndrome or ulceration.
• The secretion of the appetite hormone ghrelin decreases, and appetite decreases from the first day.
• There is no need for lifelong vitamin and mineral supplementation.
• The entire stomach can be visualized using endoscopy in any situation.
• Since the pyloric sphincter of the stomach is preserved, a sense of fullness and satiety is maintained.

What are the disadvantages of gastric bypass surgery?

It is less common than other obesity and metabolic surgery procedures.

These include:

• It is irreversible.
• Its effect on weight loss and relief from comorbidities is weaker than that of gastric bypass and duodenal switch, which cause malabsorption.

Who is eligible for gastric sleeve surgery? (Gastric sleeve surgery requirements)

• It can be performed on patients of all ages, especially those who have completed their development (between the ages of 18 and 60).
• In special cases and upon the decision of the board, patients under the age of 18 and over the age of 65 may also undergo gastric bypass surgery.
• Those with a body mass index above 35,
• Those with a BMI between 30 and 35 who also have weight-related comorbidities (hypertension, high cholesterol, diabetes, sleep apnea, heart failure, metabolic syndrome, etc.),
• Those who have tried other weight loss methods unsuccessfully,
• Those who are able to tolerate surgery and anesthesia may undergo gastric bypass surgery.

Who is not eligible for gastric sleeve surgery?

• Those with serious psychiatric illnesses that are not being treated,
• Those with substance or alcohol addiction,
• Patients with serious hormonal and endocrine disorders,
• Patients who are unable to follow a post-operative diet and make the necessary lifestyle changes,
• Those with illnesses that prevent them from receiving anesthesia,
• Cancer patients,

What are the risks of gastric sleeve surgery?

Risk Rates Published in International Literature on Gastric Bypass Surgery;

• Risk of leakage complications in a good center: 1-2%
• Risk of bleeding: 2-3%
• Risk of death: 0.2%

How is follow-up care provided after gastric sleeve surgery?

• 5 years of dietitian follow-up,
• 5 years of doctor check-ups included
• Unless otherwise specified, monthly planned obesity group support therapy meetings are included.

Frequently Asked Questions:

Should I go on a diet before obesity surgery?

If your weight is not excessively high or you do not have a large fatty liver, there is no need to follow a diet before obesity surgery. In cases of high weight, a low-carbohydrate, low-fat liver-reducing diet may be recommended by the doctor and prepared by the dietitian team specifically for the patient, to be followed for a few weeks to reduce risk and facilitate the surgery.

How Much Weight Will I Lose After Surgery?

The greatest weight loss occurs in the first 6 months after surgery. On average, you will lose 40% or more of your pre-surgery weight by the end of the first year.

How Much Weight Will I Lose After Gastric Sleeve Surgery?

After gastric sleeve surgery, patients can lose an average of 10% of their total weight, or 10-20 pounds, in the first month. However, weight changes of up to 30 pounds may occur in the first month, depending on the individual. Following the first month, weight loss continues at a slower pace, and by the end of 1-1.5 years, patients who have undergone obesity and metabolic surgery lose 80% of their excess weight or all of their excess weight in varying proportions, stabilizing their weight. The rate and amount of weight loss after gastric sleeve surgery or obesity and metabolic surgery varies greatly from person to person, depending on lifestyle, eating habits, daily activities, gender, and age.

Weight loss is generally higher in men than in women, and higher in younger individuals than in older adults. Additionally, physical activity and muscle mass during youth play a significant role in positively influencing weight loss. In women, weight loss rate after gastric bypass surgery is slower and less significant in menopause and older age compared to younger individuals. At these ages, excess weight is prioritized for health reasons rather than aesthetic concerns.

How many days will I stay in the hospital?

The internationally recommended hospitalization period for obesity surgery is 3 days.

When can I return to my normal life after the surgery?

Gastric sleeve surgery is not a very serious surgery, and most of our patients return to their normal active lives within 7-10 days.

When can I take a shower after the surgery?

When you are discharged home, you can shower with warm water without using a loofah or sponge on the surgical sites.

When Can I Start Eating Normally After Gastric Bypass Surgery?

At the end of the first month, you can gradually start eating normal foods under the guidance of our Inter Bariatrics team dietitian.

When Can I Start Exercising After Tubal Gastric Surgery?

• Ten days after tubal gastric surgery, you can start walking and swimming at a gentle pace.

• By the end of the month, you can gradually begin doing sports that require weight-bearing exercises.

Exercise is crucial for patients after obesity and metabolic surgery to adopt a healthy lifestyle, accelerate their metabolism, and establish an active lifestyle in the new phase. Patients who adopt a healthy and active lifestyle within the first 6 months, when weight loss is at its peak, experience better weight loss and a much higher rate of weight maintenance. Exercise is also crucial for preventing obesity, increasing metabolic rate, and maintaining hormonal balance.

After gastric bypass surgery, patients can begin light to moderate walking and swimming from the 10th day onwards and can return to school within an average of 5 days.

Will I Have Sagging Skin After Gastric Bypass Surgery? How Can I Reduce Sagging?

Sagging after gastric bypass surgery varies greatly depending on the individual's gender, skin type, age, lifestyle, genetic makeup, whether they have given birth, and how often they gain and lose weight. To minimize sagging, we recommend incorporating exercise into your lifestyle quickly and permanently to maintain your muscle mass after surgery.

Should I take vitamins after surgery?

You must take minerals for the first 6 months after surgery. After that, the decision is made based on the results of post-surgery tests and the patient's progress.

Can children have gastric bypass surgery?

Children aged 13 and older can have surgery based on special criteria and evaluations, subject to the decision of the checkup team.

Will I Gain Weight Again After Surgery?

There is a possibility of weight gain after surgery. The most important factors affecting weight gain are, first of all, having undergone surgery with sufficient and good surgical technique by a skilled surgeon, and secondly, having made lifestyle changes. The rate of weight gain is between 5-15%, which is considered quite low in medicine.

How Long After Gastric Sleeve Surgery Can I Have a Tummy Tuck?

For sagging skin after gastric sleeve surgery, we recommend waiting 1-1.5 years to undergo aesthetic surgery, as it is more appropriate to wait until you have reached your ideal weight.

Will my stomach expand again after gastric bypass surgery?

When gastric sleeve surgery is performed by an experienced obesity surgery team using good techniques, and if you follow these guidelines afterwards:

• Adhere to the solid-liquid rule,

• Do not overeat after feeling full, especially during the first 6 months,

• Do not consume carbonated beverages, including soda,

Stomach expansion is not expected to occur.

What is a leak? How is a leak treated?

A leak is a complication that occurs after gastric sleeve surgery, the most commonly performed obesity and metabolic surgery worldwide. A leak is the leakage of stomach contents from the stomach suture line into the abdominal cavity, causing abscesses and infections. In a good center, this rate is less than 1%. Early diagnosis is crucial in leak complications. The first 10 days after gastric bypass surgery are high-risk, but leaks are rarely seen afterward.

What Are the Symptoms of a Leak Complication?

High fever, palpitations, and persistent abdominal pain. In such a case, it is crucial to contact your obesity surgeon or obesity surgery center promptly for early diagnosis and rapid treatment of the complication.

When diagnosed early, leakage is a complication that can be overcome with effective and rapid treatment. If the infection has spread extensively within the abdomen, a laparoscopic procedure is performed to clean the abdomen. If the infection has not spread, it is managed and treated with a simpler intervention.

Leakage treatment can vary in duration depending on the individual and the extent of infection spread, ranging from 1-2 weeks to 3-4 months.

Can precautions be taken against complications?

Since your stomach will be cut and stitched lengthwise after the surgery, it is very important and sufficient to strictly follow the diet recommended by your specialist dietitian and doctor for the first month and not to consume any solid foods.

How Should Nutrition Be After Gastric Sleeve Surgery?

Nutrition after gastric sleeve surgery: A 5-week stomach-protective diet is recommended to facilitate adaptation to the new stomach and enable a faster transition to normal nutrition.

The diet for the first week consists entirely of clear liquids.

The diet for the second week consists of thick, smooth liquids in addition to those in the first week.

The third week's diet consists entirely of smooth, pureed foods. During this period, foods such as vegetable purees, fruit purees, eggs, and cheese are included.

The fourth week's diet requires thorough chewing and is the period when the transition to normal eating is most noticeable.

In the fifth week, fiber-rich, grain-based foods are added to the diet, completing the transition to a normal eating pattern.

To prevent or minimize muscle breakdown during the first two weeks of the liquid phase, we recommend that our patients use a protein powder that is a special medical product for patients who have undergone obesity surgery. In addition to protein powder, the vitamins and minerals we add to the diet, such as multivitamins and iron, help our patients stay fit and energetic with minimal nutrition. Although we do not recommend continuing protein powder consumption after the liquid phase ends, we request regular monitoring of vitamins for the first 6 months to prevent any vitamin deficiencies in the patient.

There are two important factors to consider after gastric sleeve surgery:

1. Solid and liquid foods should not be consumed at the same time. Taking 30-minute breaks between consuming solid and liquid foods will help maintain your stomach volume and keep your stomach small.

2. Carbonated beverages, including cola and mineral water, should not be consumed. Carbonated beverages are not recommended because they are high in calories and their bubbly texture causes the stomach to expand.

What is the Solid-Liquid Rule After Gastric Sleeve Surgery?

The solid-liquid rule after gastric sleeve surgery is a recommended diet and lifestyle following gastric sleeve surgery, one of the bariatric surgeries, to ensure that solid foods remain in your stomach—which has been reshaped into a thick tube—for a longer period, thereby prolonging the feeling of fullness and creating a sense of satiety in the brain. You should not consume any liquids, including water and soup, half an hour before and half an hour after meals. Otherwise, the liquid intake will cause solid foods to pass through the stomach, which has transformed into a long, thick tube after gastric sleeve surgery, more quickly and without being digested, resulting in a short-lived feeling of fullness. You should always consume liquids between meals.

How Are Post-Gastric Bypass Surgery Checkups Conducted?

The first checkup is conducted on the 10th day after gastric bypass surgery. During your first month checkup, your general condition, any issues related to the surgery, and any questions or concerns you may have regarding nutrition will be evaluated, but no blood tests will be performed.

At 3 months, 6 months, 1 year, and thereafter, unless otherwise specified, the following tests should be performed annually on an empty stomach in the morning:

What Tests Should Be Performed After Gastric Bypass Surgery?

Hemogram

HbA1c

Fasting blood sugar

Electrolytes (Na, K, Cl)

Urea

Uric acid

Creatinine

Calcium

Total protein

Albumin

Total bilirubin

Direct bilirubin

AST

ALT

Lipid profile (TG, cholesterol, HDL, LDL)

Fasting insulin

Iron

Ferritin

Vitamin B12

Folic acid

Vitamin D

Phosphorus

Alkaline phosphatase

Intact PTH

TSH

Free T4

GGT

Tüp Mide Ameliyatı Sonrası Tekrar Kilo Alınır mı?

Tüp mide ameliyatı sonrası %15 oranında hastada yaşam stili, beslenme alışkanlıklarını değiştiremedikleri için geri kilo alımı değişen oranlarda yaşanabilmektedir. Tüp mide ameliyatı sonrası geri kilo alımı genellikle eski kiloya kadar ulaşmamaktadır, çoğunlukla 5-10 kilo kadar alınıp eski kiloya ulaşmadan durmaktadır. Eski kiloya ulaşma oransal olarak çok nadir görülmektedir.

Tüp Mide Ameliyatından Sonra Ömür Boyu Yasaklar Var mı?

Tüp mide ameliyatından sonra tıkanma duygusu yaratması ve doygunluk hissinin uzun sürmesi için katı yiyecekleri sıvı yiyeceklerle aynı anda almamaya özen göstermek ameliyat başarısını olumlu yönde etkilemektedir Küçük hacimli yüksek kalorili kuruyemiş, çikolata gibi yiyecekler sadece tüp mide ameliyatının değil, tüm obezite ve metabolik cerrahi ameliyat tekniklerin baş düşmanı olup ameliyatların etkisini azaltan yiyeceklerdir, uzak durmak gerekir. Gazlı içeceklerden, soda dahil kabarcıklı yapısının midenin üst kısmında genişlemeye neden olabileceği için ömür boyu uzak durulması tavsiye edilmektedir. Sadece tüp mide ameliyatı sonrası değil, tüm obezite ve metabolik cerrahi ameliyatları sonrasında alkol tüketiminin de sık olması ml sindeki kalori miktarı nedeniyle önerilmemektedir.

Tüp Mide Ameliyatı Sonrası Saç Dökülmesi

Obezite ve metabolik cerrahi ameliyatları sonrasında hastaların ilk aylardaki mutluluğuna ve motivasyonuna gölge düşüren nedendir “Saç Kaybı”. Genel olarak saçlar bir taraftan çıkarken bir taraftan da doğası gereği belli sayıda dökülmek zorundadır. Bu doğal bir süreçtir. Ancak tüp mide veya mide bypass ya da diğer obezite ve metabolik cerrahi ameliyatları sonrası 2-3. Aydan itibaren başlayan saç kayıpları hastadan hastaya değişmekle birlikte az veya çok mutlaka görülür. Saç kaybı ciddiyeti her ameliyat olan hastada farklılık gösterebilir, kimi hastada çok az olurken kimi hastada çok daha şiddetli ve fazla olabilir, uzun sürebilir.

Ameliyat Öncesi Aşağıdaki Problemleri Yaşayan Hastalarda Ameliyat Sonrası Saç Dökülmesi Daha Fazla Görülür!

Bunlar;

• Ameliyatstresi, psikolojik travma,
• Kronik hastalıklar (karaciğer, otoimmün hastalıklar),
• Hormonal bozukluklar,
• Sert diyetler, protein alım yetersizliği, blumia, anoreksia,
• Demir yetersizliği,
• A vitamini fazlalığı,
• Genetik yatkınlık, olarak sıralanabilir.

Saç dökülmesi, ameliyat sonrası ortalama 3. Ayda başlar, yetersiz beslenme, yetersiz protein alımı, demir yetersizliği, spesifik multivitamin alınmaması, altta yatan tiroit fonksiyon bozukluğu ve genetik yatkınlığın da eklenmesi ile 6. Aya kadar saçların %5-15’ i kaybedilir.

Eğer, altta yatan genetik faktörler yoksa ve kronik bir hastalık veya yetersizlik yoksa 6. Aydan itibaren saçlar geri döner!

*** Burada verilen bilgiler, internet sitesinin içeriği ziyaretçiyi özellikle aileleri bilgilendirme amacı ile düzenlenmiştir. Hiçbir bilgi ziyaretçiler tarafından tavsiye olarak değerlendirilip hiçbir karar veya eyleme neden olmamalıdır. Konu ile ilgili hastasını mutlaka bir çocuk cerrahisi uzmanına muayene ettirmeli, onunla görüşerek birebir bilgisine başvurarak karar vermelidir.