New Criteria for Stomach Reduction Surgery

A circular on bariatric surgery practices was recently published. It is shared in the press under the name of new criteria for stomach reduction surgery.

The death of a young person, Özge Şeker, after a stomach reduction surgery was covered in the press, especially emphasizing that she was underweight for the surgery. This was not the first bad news, but as a result of Ayşe Arman's raising the issue on the agenda, the Ministry of Health had to publish a circular on obesity surgery practices.

The purpose of this circular is to protect both patients and surgeons, in other words, to ensure that safe obesity surgeries are performed under more favorable conditions. This step is very important, of course, and it was necessary. But as a surgeon who has spent years in this business, I could not stay away from commenting on this important issue.

Obesity surgery is a method recommended for those who are obese at the disease level, this condition is called morbid obesity. If your weight is too much for your height, you may be morbidly obese. It is easy to calculate, you divide your weight by the square of your height.

For example, if a person is 177cm tall and weighs 98Kg, 98/1.77x1.77=32. This result is called BMI, 32 means first degree obesity, i.e. a mild form of obesity. If the BMI is 40 and above, the person is morbidly obese, that is, if the person weighs 126Kg or more. If 126Kg and above, it is said that the person can have weight loss surgery. If it is 100Kg, it cannot. They are not morbidly obese at that weight, but most people are not happy at that weight. Imagine that there is no gym where that person has not been on a diet for five years, but he cannot lose weight. He wants to have surgery, but they tell him that he does not meet the surgical criteria.

In the new circular, the surgeon decides together with the psychiatrist, internist and anesthesiologist. In this case, the hospital where the bariatric surgeon works is intended to be a full-fledged institution. Patients are already evaluated by internal medicine, cardiology, pulmonology if necessary, and routine endoscopy before surgery. Psychiatric evaluation was requested when necessary. Here, it was evaluated whether the patient would have problems adapting to the new nutritional principles after surgery.

An advanced intensive care unit is also required.

The other item to be emphasized is that the general surgeon who will perform bariatric surgery must be experienced in the field. The biggest difficulty seems to be here. In our country, obesity surgery is not yet a separate subspecialty. In this case, it becomes difficult to evaluate how experienced the surgeon is. There are already a few possibilities:

These surgeries may be performed in the clinic where he/she is doing his/her general surgery residency. This provides a serious advantage.
There are short domestic and international courses. It is possible to learn the basics and principles in these courses, but it cannot be said to be completely sufficient.
Working abroad or in a bariatric surgery clinic in the country for a while. This method is person and clinic dependent. There may be variable results. there is no standard.
If you want to become a bariatric surgeon in the USA, you need to receive 2 years of upper specialization training on general surgery specialization. A diploma is obtained after this fellowship program. This provides the surgeon with a standardized training opportunity, increases quality and reduces complication rates. It also increases success in complication management.

I remember the days when we were trying to get a license for organ transplantation. Both the center and the surgeon were given separate licenses. All cases were reported to a national database. An incredible quality of control was achieved. If you pay attention, there is almost no bad news about organ transplantation in the press. Our organ transplant centers are competing with Europe. A similar model can be applied to obesity surgery. It significantly increases safety and control. We would have the chance to create statistics on obesity surgery in our country.

Let's come to another important issue:

Can Surgery be Performed at Low Weight?

This was the issue Ayşe Arman emphasized the most in her article. ASMBS (American Society for Metabolic and Bariatric Surgery) advised this issue as follows:

Class 1 obesity (BMI 30-35) is a well-defined disease that increases the likelihood of or can cause a number of chronic co-morbidities and shortens life expectancy and impairs quality of life. It must therefore be treated effectively.
Non-surgical methods of treating Class 1 obesity often fail to achieve effective and permanent weight loss.
Selected patients in the Class 1 obesity group who cannot be effectively treated with non-surgical treatments and who have comorbidities may benefit from bariatric surgery. 26 years ago, Class 1 obesity was excluded from the criteria for bariatric surgery, but today there is no medical evidence to support not treating it surgically.