Who is a candidate for gastric bypass? Indication of bariatric surgery as the best and most definitive and effective methods of treating obesity in obese patients and its complications such as diabetes, sleep apnea, fatty liver and… with a BMI> 30 is the best choice. And in patients with uncomplicated obesity with a BMI> 32.5, they will be candidates for obesity surgery. It should be noted that the type of operation is not related to BMI and the type of operation depends on work conditions, family, eating habits and daily life and the results of tests and endoscopy. Patients have tried different diets many times, but unfortunately have not been able to lose weight and reach their ideal weight, and after the end of the treatment regimen, they have returned to a much heavier weight than their original weight ( yoyo diets).  
This is the best method for sweet eaters that can not undergo the restrictive surgeries and people who have done unsuccessful bonding before.  In case of gastroesophageal reflux in obese patients or people who have already been bandaged and are currently suffering from esophageal dilatation and reflux complications requires that a gastric bypass technique be chosen for the patient. Patients who live abroad or are away from home for a long time and do not have the opportunity to set up a ring or make frequent visits to the surgeon are good candidates for this operation. In diabetic patients, gastric bypass surgery has improved 93% to 90% and reduced mortality from this disease. In gastric bypass surgery, weight loss occurs faster than in other cases. Significant complications such as gastroesophageal reflux disease, stasis ulcers, type 2 diabetes, hyperlibidemia, and hypertension improve by 70 to 90%. 

Indication of bariatric surgery as the best and most definitive and effective methods of treating obesity in obese patients and its complications such as diabetes, sleep apnea, fatty liver and… with a BMI> 30 is the best choice. And in patients with uncomplicated obesity with a BMI> 32.5, they will be candidates for obesity surgery. It should be noted that the type of operation is not related to BMI and the type of operation depends on work conditions, family, eating habits and daily life and the results of tests and endoscopy. Patients have tried different diets many times, but unfortunately have not been able to lose weight and reach their ideal weight, and after the end of the treatment regimen, they have returned to a much heavier weight than their original weight ( yoyo diets). 
This is the best method for sweet eaters that can not undergo the restrictive surgeries and people who have done unsuccessful bonding before.  In case of gastro-esophageal reflux in obese patients or people who have already been bandaged and are currently suffering from esophageal dilatation and reflux complications requires that a gastric bypass technique be chosen for the patient. Patients who live abroad or are away from home for a long time and do not have the opportunity to set up a ring or make frequent visits to the surgeon are good candidates for this operation. In diabetic patients, gastric bypass surgery has improved 93% to 90% and reduced mortality from this disease. In gastric bypass surgery, weight loss occurs faster than in other cases. Significant complications such as gastro-esophageal reflux disease, stasis ulcers, type 2 diabetes, hyperlipidemia, and hypertension improve by 70 to 90%. 

How does gastric bypass bring you to your ideal weight?

This method is a combination of restrictive and malabsorption actions. In this method, not only the stomach volume is reduced to 15 to 20 cc, part of the intestine is removed from the absorption system and as a result, food absorption is reduced. In this method, the patient loses 90% to 93% of overweight within 24 months, and among the various surgical methods mentioned, it is associated with the highest rate of weight loss and the lowest rate of recurrence (reoverweight). Bypass; The golden standard in obesity surgeries : 1.Bypass surgery has the highest rate of weight loss among obesity surgeries. 2.The lowest rate of return in the long run (1% to 3%). 3.It works better in slender, sweet-eating and sedentary people than sleeve and other methods. 4.In case of leakage, it is easier and faster to control than sleeve. 5.This operation is technically easily reversible.

Gastric sleeve surgery  is a type of obesity surgery in which a significant reduction in stomach capacity and a forced and physiological restriction on the amount of food consumed is performed. In this type of surgery, 80% of the elastic part of the stomach, including the part of the stomach that secretes the hormone Ghrelin, a hormone that plays an important role in creating appetite, or the hormone of hunger, is separated from the stomach and the rest of the stomach is punched. The remaining part  of these operations is repaired with titanium stiches and 80% of the gastric tissue is removed from the body.  
Patients after surgery due to significant shrinkage of the stomach and the removal of the hormone ghrelin physiologically, have very little inclination to eat and even if they do not, can not consume too much food. This restriction remains with subtle changes for the rest of your life, and surgery in the first year causes a significant weight loss and then keeps this weight loss the same.  
In this method, which is one of the restrictive methods, after entering the abdomen with laparoscopy, about 80% 
of the stomach volume is removed with a device that performs cutting and sewing at the same time and is removed from the abdomen. Therefore, by removing an area of the stomach that secretes the hunger hormone (Ghrelin), the patient's appetite is normalized and by eating a few tablespoons, fullness and satiety is achieved, and since the above-mentioned hormone acts against insulin, by removing And its sharp decline from a few days after surgery, diabetes begins to control. Among the advantages of this method is the easier surgical technique and shorter length of operation than combined operations. before, it was not possible to perform combined operations on Crohn’s or Ulcerative colitis patients , but now with this method its preferred and an efficient method.  
Sometimes in patients who have too much fat in the abdomen or the size of the liver is too large and heavy due to fat. When entering the abdomen, the surgeon is not able to perform combined operations due to the impossibility of changing the location of the intestine and insufficient vision. So it is done in two stages. In the first stage, the sleeve operation is performed, and after 8 months to a year and weight loss and improvement of intra-abdominal anatomy, the second stage of the 
operation and conversion of the sleeve into one of the combined operations is performed. However, in many cases, the patient responds adequately to the first stage (gastric sleeve) and there is no need to perform the second stage.  
Who will benefit from sleeve surgery? The choice of surgery technique is chosen by the medical team based on preoperative advice, examinations, and review of your preoperative lifestyle, but generally in people with severe and unavoidable binge eating, very high weights, and illness. They have a specific and long metabolism like diabetes, sleeve is not the first option of surgery.  
Disadvantages :  1.In snack-eaters and sweet eaters, it does not initially give the ideal answer. For example, if a person is 50 kg overweight and is more snack-eating or sweet-eating and undergoes sleeve surgery, they may end up with 20 to 25 kg overweight. Lose yourself (about 40 to 50%) and stop losing weight very soon. In these cases, combined operations are recommended. 
2.If not done in the right person, it is associated with a high rate of recurrence of obesity in the long run (after one to two years), which in some statistics is up to 50% is mentioned. Therefore, the surgeon must be very careful in choosing the method. 3.  This method is not recommended for people with gastroesophageal reflux disease (GERD) or heartburn because it makes it worse and may cause esophageal ulcers and other long-term problems. Therefore, in this method, maximum attention should be paid to endoscopy before the patient's operation, so that in case of moderate to severe endoscopic symptoms (esophagitis), other appropriate operations can be used to improve this complication. 4.Since in this method part of the stomach is removed from the body, the gastric sleeve is irreversible.  
5. Since nothing is done on the intestines in the gastric sleeve, and a number of hormones that are anti-insulin and are secreted from the early parts of the small intestine, it has no effect on the treatment of diabetes by combination surgery.

Types of Obesity surgeries: Restrictive actions Combined actions (limiting + malabsorption) Absorption practices  
Restrictive surgeries: In these methods, they only cause weight loss by restricting the entry of food into the body.     
Gastric band : In this method, an adjustable silicone ring is placed around the first part of the stomach, slightly below the junction of the esophagus to the stomach, and a reservoir is placed under the skin of the abdominal wall for further adjustments, which is injected from the outside with sterile distilled water. Inside this tank, the ring becomes narrower, thus limiting the amount of incoming food.  
Gastrectomy or gastric sleeve: In this method, which is one of the restrictive methods, after entering the abdomen with laparoscopy, about 80% of the stomach volume is removed with a device that performs cutting and sewing at the same time and is removed from the abdomen. Therefore, by removing the area of the stomach that secretes the hunger hormone (ghrelin), the patient's appetite is normalized and by eating a few tablespoons, fullness and satiety is achieved, and since the above-mentioned hormone acts against insulin, by removing it And its hard decline from a few days after surgery, diabetes begins to control.   
Classic gastric bypass combination surgery: First of all, it refers to combination surgeries that, in addition to reducing and limiting food intake, also have an effect on calorie absorption in the intestines, so it has more weight loss power and slimming will be faster and longer lasting. In addition, due to the effect on both the secretion of hunger hormones from the stomach and anti-insulin from the intestine, they have a greater effect on metabolic syndrome and complications such as diabetes, fatty liver, hyperlipidemia, hypertension, etc.  
Classic gastric bypass: This method is a combination of restrictive and malabsorption methods. In this method, not only the stomach volume is reduced to 15 to 20 cc, part of the intestine is removed from the absorption system and as a result, food absorption is reduced. In this method, the patient loses 90% to 93% of overweight within 24 months, and among the various surgical methods mentioned, it is associated with the highest rate of weight loss and the lowest rate of recurrence (reoverweight).   
Mini Gastric Bypass In the Mini Gastric Bypass method, the small intestine is not cut. In this method, the reduced stomach is connected to 150 to 200 cm of the small intestine. This new bypass method has fewer complications than the old method, but the probability of bile reflux in this method is higher.  
SINGLE ANASTOMOSIS SLEEVE ILEOSTOMY OR SASI : It is a combination of restrictive and malabsorption surgeries.  
SINGLE ANASTOMOSIS DUODENO-ILEAL BYPASS  WITH SLEEVE GASTRECTOMY : It is also a combination of restrictive and malabsorption surgeries.  
Absorption surgery :  Intestinal bypass Duodenal switch 

Classification of obesity: Body Mass Index BMI is a simple indicator of weight-to-height ratio that is commonly used to classify obesity and overweight in adults. This index is obtained by dividing the weight by the height square. According to the World Health Organization definition for obesity and overweight, people with a body mass index of less than 18.5 are underweight, between 18.5 and 25 are normal weight, between 25 and 30 are overweight and more than 30 are obese. Overweight and Obesity Classification (NIH)  
Based on BMI : Less than 18/5: Low weight Between 5/18 to 9/24: Normal Between 25 and 9/29: Overweight Between 30 and 9/34: Grade 1 obesity Between 35 and 9/39: Grade 2 obesity Between 40 and 50: Grade 3 obesity More than 50: Fatal obesity  
Of course, it should be noted that this index does not apply to all people. In other words, BMI can not be used for pregnant and lactating women and professional athletes or bodybuilders with high muscle mass.  
Waist circumference is the distance between the lowest rib and the iliac spine in a person who is standing in light clothing and has completely emptied his breath. Waist size more than 102 cm in men, and more than 88 cm in women are used to define abdominal obesity. Waist size is now accepted by the WHO as an indicator of health and mortality. BMI-independent waistline provides more information on mortality and health risk, but the NIH uses a combination of both.   
Topical treatments for obesity of the trunk and limbs:  
For the treatment of localized obesity and regional removal of fats, several topical treatments have been introduced. It should be noted that the patients who are suitable for these methods are as follows:  
1.Patients with a BMI <30 and a constant weight for at least one year. 2.Patients who need these methods after bariatric surgery to prevent wrinkles and body lines. 3.Patients who, despite their ideal weight, have an abnormal accumulation of brown fat in the buttocks or limbs that do not respond to any non-intervention method such as diet.