Frequently asked questions

How do I know if I am a candidate for bariatric surgery?


There are several factors that determine whether a person is a candidate for bariatric surgery or not. Firstly, the person must have tried dieting seriously beforehand. Those who could not succeed in losing weight permanently after two separate episodes of at least 6 months of dieting are considered candidates for weight reduction surgery. Serious dieting should always be the first treatment option. But, unfortunately, studies have shown that only %5 of morbidly obese people is able to achieve permanent weight loss with diet. Still, surgery must be the second alternative to dieting—and it should be considered only for those who cannot lose weight with diet.

Furthermore, certain BMI requirements are needed to be a candidate for surgery.

The classical indication for bariatric surgery is when the BMI of a patient is greater than 40. Such a patient is a candidate, regardless of the presence of any co-morbidities (obesity related illnesses).

Research supports the benefits of weight loss surgery also for those with a BMI between 35 and 40, provided that at least two of the co-morbidities, such as type 2 diabetes (or insulin resistance), sleep apnea, high-blood pressure, fatty liver, severe joint problems, and polycystic ovary syndrome are present.

Recently, patients with class 1 obesity (BMI = 30 – 35) have also become candidates in case they have new onset of type 2 diabetes or metabolic syndrome.




What is “body mass index” (BMI)?


Body mass index is the weight in kilograms divided by the square of the height in meters.

BMI = weight in Kgs / height in meters2

i.e.: If you are 100 Kgs in weight and 2 meters in height, then your BMI will be 100/22 = 25

WHO (World Health Organization) Classification of Obesity according to your BMI :

BMI

20 – 25 Normal

25 – 30 Overweight

30 – 35 Class 1 Obesity

35 – 40 Class 2 Obesity

40 < Class 3 Obesity (Morbid obesity)

50 < Super obesity

60 < Super-super obesity




Which bariatric surgery procedure will be the best for me?


At Istanbul Bariatrics, we offer a comprehensive range of weight loss surgery options. The patients are informed about the pros and cons of each option, and together with their surgeons, they decide on the type of the surgery suitable for them. A patient’s BMI as well as current medical condition determine the type of the procedure.

In our clinic, the most common operation performed for uncomplicated primary cases is “sleeve gastrectomy”. For re-do’s or for the patients that have Barrett’s disease, “gastric by-pass” can also be an option. For patients with super-super obesity (BMI>60), “duodenal switch” can sometimes be the first option.




Is there an age limit for obesity surgery?


After puberty, all patients can be operated, and there is no upper age limit for surgery. Every case is handled individually depending on the cardio-pulmonary risks. The lower age limit, which used to be 18, is no more valid.




What are the benefits of bariatric surgery?


Bariatric surgery not only increases the life quality of patients, but more importantly, extends their life expectancy for about 15 years. Two important researches, Swedish Obese Subjects (SOS) study and the study of Ted Adams from UTAH, US, provided evidence that weight reduction surgery extends life. Longevity is maintained with the deceleration of atherosclerosis, which in turn leads to less coronary and carotid occlusions. In other words, the risk of myocardial infarction and stroke significantly decreases after surgery. Furthermore, in women, it has been shown that deaths from breast cancer decrease as a result of weight reduction surgery. The same may also be true for other obesity related cancers like colon, bladder, prostate and pancreas.

All co-morbidities such as type 2 diabetes, hypertension and fatty liver highly benefit from bariatric surgery. Many orthopedic and genito-urinary problems, and possibly the problems concerning dyslipidemia will also improve with surgery. Actually, the mainstay treatment of sleep apnea and polycystic ovarian syndrome is weight loss, which will also be achieved through bariatric procedures.

The aesthetic benefit should be considered a “fringe” benefit.

"Bariatric procedures should not be and are not performed merely for aesthetic concerns."




What are the risks of bariatric surgery?


Just as any other surgery, weight loss procedures have some risks. However, since the associated risks are far less than their benefits, bariatric procedures are gaining popularity worldwide. The cumulative risks of morbid obesity are much greater than the risks of the surgery itself.

Major complications of these procedures are rare but can occur in about 2-3% of the cases. Leak (1%), bleeding that requires re-intervention (1%) and deep venous thrombosis with or without pulmonary emboli (<1%) are the main complications specific to bariatric surgery. The only long-term problem that may need intervention is a narrowed sleeve, which is experienced in about 1% of the patients. Endoscopic balloon dilatation may be required in such a case. The incidence of death (mortality) following bariatric operations is around 0.1%.

Complications, for their most part, are treatable, provided that they are immediately diagnosed and promptly taken care of.

Patients should ask their doctors about their clinic’s mortality and complication rates. In specialized bariatric units, the mortality and complication rates must be within the acceptable limits.

To date, Istanbul Bariatrics has operated on around 1000 patients. Among all, only one life-threatening complication, a leak, was experienced; and was promptly taken care of. Our clinic’s current leak rate is <0.2%. The bleeding rate is 0.2%, too. So far, our team have never encountered any venous thrombosis or pulmonary emboli, and have not lost any of their patients. Having zero mortality and no conversion to open surgery and very low complication rates, İstanbul Bariatrics has become known as an outstanding bariatric center, and it has recently been awarded the “Center of Excellence” certificate from IFSO.

During the evaluation process, our patients are informed about all possible risks, how these risks are avoided, and in case of an unexpected complication, how they are immediately taken care of.




Is bariatric surgery a long-term solution to obesity?


It should be noted that in 10% of the cases, weight reduction surgery will not be able to permanently solve the obesity problem. The studies show that around 5–10% of patients will need a second operation years after the first procedure. So, weight regain (recidivism) is one of the most important problems, still being discussed worldwide. Patients who are willing to participate in the post-op groups, change their dietary habits, stay away from alcohol, and routinely exercise are the ones likely to benefit most from the bariatric procedures. The following-up of patients, especially during the first 5 years after surgery is extremely important to achieve the best long-term results.




What kind of medical tests are performed before bariatric surgery, and why?


After being accepted as a candidate for bariatric surgery, a patient will undergo several tests and consultations regardless of his/her age or BMI. A complete blood count, detailed biochemical panel, dexametasone suppression test, urinalysis, gastroscopic evaluation, cardio-pulmonary consultations with functional and echocardiographic assessment, a psychiatric evaluation, a dietary consultation, an abdominal ultrasound are the routine procedures in all patients. After the patients’ medical conditions are examined and evaluated, our team may add some extra tests if required.

These tests are performed to assess the candidates’ health conditions accurately and thoroughly. This way, the risks of post-operative complications are minimized.




Why do I need a psychological evaluation before bariatric surgery?


Weight loss surgery is a life-changing decision. So, it is of vital importance to ensure that you are prepared not only physically but also mentally for this operation. It is during the first preoperative psychological assessment that contraindications to surgery, such as schizophrenia, substance dependence and alcoholism are identified. Also, emotional eating disorders frequently present in morbidly obese patients are identified. Patients are then followed-up and given specific counseling for their eating disorders during the post-operative period. The psychological support, especially during the first couple of years after surgery, is known to positively affect the long-term maintenance of weight loss.




Will I have to go on a diet before I have surgery?


Yes! It is strictly recommended to lose weight, especially for morbidly obese people, prior to bariatric surgery. The reason is to shrink your liver and reduce the fat in the abdomen. This helps reduce complication risks, surgery duration and recovery time after surgery. Our nutritionists will be providing customized diet plans for you before the operation.




If I travel from another country, how long will I stay before and after surgery?


If you are flying for less than 5 hours, you will have to stay in Istanbul for 10 days, maximum. If your flight duration is more than 5 hours, we recommend you to stay about 2 weeks before flying back home.




How much weight should I expect to lose after the surgery?


Scientific literature shows that around 60% of excess body weight will be lost 5 years after surgery. In İstanbul Bariatrics, this rate is higher: around 70 – 75%.

Patients with a higher BMI generally lose more weight compared to patients with a lower BMI. Also, compliance with the post-op requirements, such as routine exercising and attendance to patient support groups is associated with better weight loss outcomes. Avoiding excessive alcohol as well as “empty calories”, and overcoming emotional eating disorders often result in sustainable weight loss.

So, obviously, the answer to this question varies among different patients. The amount of weight you lose depends on a number of factors, such as dietary habits, routine exercising, and lifestyle changes. Also, biological factors such as your gender, age, current weight, hormonal status, menopause and metabolic rate all play a role in the amount of weight loss.




How long does the actual obesity surgery take?


Generally, the sleeve gastrectomy operation takes 1-1.5 hours in primary cases. Re-do’s however, are always difficult and may take 3-4 hours.




Is there any pain after the surgery?


It is normal to have some discomfort after surgery. However, as almost all bariatric surgeries are laparoscopic, pain is usually minimal. In laparoscopic operations, the incisions (cuts) are quite small. This means less pain and swift recovery. Patients usually return to work one week after surgery.

Following the surgery, some patients may experience mild shoulder pain, a problem that can be handled easily by basic pain killers. In 20% of the cases, patients suffer from nausea for a couple of days.




How long will I be hospitalized after the surgery?


Three nights of stay is required after the surgery.




Do I need a companion at the hospital?


You may have a companion if you’d like, but in case you prefer to be alone, our professional staff will take good care of you during your stay in the hospital.




Will I be admitted to the Intensive Care Unit (ICU) after the surgery?


Very rarely, your blood pressure may become unstable after surgery. In that case, you may need to be admitted to the ICU. The term “ICU” may scare some people, but actually, the goal is just to monitor you more closely, stabilize your blood pressure and make sure you are well taken care of.




How soon will I be able to return to work/school after bariatric surgery?


Usually, patients are able to return to their daily activities within 6-7 days after surgery. As for returning to work, it depends on its type and intensity. Even though you feel strong enough to do anything, for the first 1.5 months, you should avoid heavy work such as lifting, carrying or pushing loads.




What effect will weight loss surgery have on my current medications and therapies? Do I need to take a special drug or pill after sleeve gastrectomy?


Your general health will be much better following the weight loss. The best treatment for sleep apnea and polycystic ovaries is weight reduction. A few months after surgery, there will be no need for medications and CPAP. Also, for hypertensive patients, the need for medications will be considerably reduced, or even eliminated as their blood pressure drops. Depending on the intact pancreatic B-cell function in different patients, type 2 diabetes also improves, and it is likely that full remission can be achieved. Interestingly, there is a direct effect of weight loss surgery on the treatment of diabetes. The anti-diabetic effect is often experienced quickly following the operation. Thanks to bariatric surgeries, since orthopedic, urologic and psychological problems are also handled, many treatment modalities including drugs and operations will all be

totally eliminated. Most patients get rid of medications, which have lots of side effects, after the weight loss procedures.

After sleeve gastrectomy, your doctor will prescribe you with a single multi-vitamin pill, and nothing else. After by-pass procedures however, you may need closer monitoring and a few more supplements as vitamins or trace elements.




When can I start exercising after bariatric surgery and how should I exercise?


Starting exercising soon after surgery plays an important role in sustaining your weight loss goals. Exercising also helps fast recovery. During the first week, you can start walking slowly and increase your pace as you feel stronger.

At Istanbul Bariatrics, a fitness coach, who is one of our professional team members, will work with you to develop a suitable training program for you.

Generally speaking, during the first couple of months, activities like walking, swimming and cycling are encouraged. Later, muscle building exercises with low or moderate weights are also encouraged to avoid the loss of muscle mass. Besides their cosmetic benefits, such exercises will help maintain your weight.




Do you have support group meetings?


Yes, we do have support group meetings once a month. It has been scientifically proven that attendance to support groups is associated with better long-term weight loss maintenance. These meetings routinely take place on the first Saturday of each month at 12.00 at Acıbadem Fulya Hospital. These meetings provide an opportunity to share experiences as patients discuss common issues, stresses, successes, and most importantly, ways of avoiding weight regain. Patients are all welcomed both before and after the bariatric surgery. These meetings are very informative as patients can ask all sorts of questions to our surgeons, nutritionists and psychologists.




Will I have to limit my social life after bariatric surgery?


No, you don’t need to. We expect you to continue your regular social life and daily routine. If you limit your social life, you may feel lonely and depressed. Adapting your new eating behavior into your new life is important.




How often will I see the doctor after my bariatric surgery?


After your surgery, we expect to see you on a regular basis. Especially, visits on the third and the twelfth month are very important. Then, a yearly follow-up for five years is essential. These follow-up visits are to protect your health and ensure your weight loss maintenance.

Apart from these regular follow-up visits, you can contact our team members anytime you wish.




Is it safe to get pregnant after bariatric surgery?


Scientific studies show that pregnancy after weight loss surgery is easier and safer. In other words, weight reduction surgery increases fertility.

Yet, for a healthy pregnancy, you should wait at least one year for your weight loss to stabilize.




Will I need plastic surgery after my bariatric surgery? What is the best time to do it?


Not everybody will require plastic surgery. Factors such as your age, BMI and personal preferences determine such a decision. Aesthetic operations are not performed for health reasons. So, if a patient chooses to have one, it is reccommend that he/she waits until the weight loss stops, and stabilizes for at least 2-3 months. This generally happens 1.5 years after surgery.




When will I start eating solid foods after surgery?


You will eat only liquid or pureed food for 2-3 weeks after surgery. Then, each week, the form of foods will get more solid. After 4-5 weeks, most of our patients start eating chicken, fish, lentils and cooked vegetables. Only large pieces of meat must be avoided during the first 3-4 months after surgery. For this reason, all patients must absolutely use protein supplements during that time. It is very important to introduce new textures gradually and carefully. Our dietitian will work with you closely, and help you plan the most suitable diet for you.





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