What are the Reasons?

Among the causes of obesity, there are problems such as genetic factors, sedentary lifestyle, bad eating habits, metabolic disorders, and sleep disorders. Obesity is also increasing in society, especially with the increase in the consumption of processed foods and high-sugar foods.

What are the Symptoms?

The most important symptom of obesity is excessive fatty tissue accumulation in the body. Apart from this, some complaints arise due to obesity. These are;

• Excessive Sweating
• Quick Fatigue
• Shortness of Breath
• Snoring
• Sleep Apnea
• Back Pain
• Joint Pains
• Psychological Problems

What are the Diseases Caused by Obesity?

• Diabetes 
• Insulin Resistance
• Hypertension
• Coronary Artery Disorder
• Gall Bladder Disorders
• Stroke 
• Sleep Apnea
• Asthma
• Psychological Problems 

What is Obesity Surgery (Bariatric Surgery)?

Obesity is a treatable disorder. Favorable results are obtained in the treatment of obesity, especially with obesity surgery. Obesity surgery, or bariatric surgery, with its medical name, is surgical interventions performed on the digestive system to help overweight people lose weight. After bariatric surgery, patients’ weight loss speed is high and the time to return to their daily routine life is short.

 Tube Stomach Surgery (Sleeve Gastrectomy)

Tube stomach surgery, as the name suggests, is the removal of a part of the stomach and turning it into a tube shape. In sleeve gastrectomy, most of the stomach is surgically removed. Thus, the volume of the stomach decreases. Approximate stomach volume is 50-100 ml. Therefore, the amount of food consumed by a person is limited. Thus, the person loses weight. In sleeve gastrectomy, the part of the stomach where appetite hormone is secreted is removed. Thus, appetite decreases in people after surgery.

Gastric Bypass

Bypass means not using one path but using another short path. Gastric bypass means creating a new passageway from the stomach to the intestines. In fact, it is a method used in the treatment of various diseases that obstruct the stomach outlet. In obesity surgery, a large part of the stomach is bypassed and rendered unusable by gastric bypass surgery. A small stomach section with a volume of approximately 30-50 cc is prepared and sutured to the small intestines. In gastric bypass surgery, both the volume of the stomach is reduced and some of the intestines are disabled. By deactivating some of the intestines, some of the food taken is thrown away without being absorbed. Thus, patients are saturated with less food and only a part of the food they take is absorbed.

Obesity yazısı ilk önce Assoc. Professor Soykan Barlas üzerinde ortaya çıktı.

Peritoneal dialysis or hemodialysis?

In fact, both methods have their own advantages and disadvantages. In peritoneal dialysis, where the peritoneum called the peritoneum is used as if it were a dialysis machine, the patient does not need a center, but does his own dialysis at home with the help of a catheter attached to his abdomen. However, in peritoneal dialysis, the clearance of toxic substances in the blood is limited, and there is always the possibility of infection of the abdominal membrane, even with care and proper cleaning.

In hemodialysis, the patient is treated in a dialysis center for 4 hours 3 days a week. The blood, in which toxic substances accumulate, is filtered with the help of a filter and cleaned of substances such as urea, potassium, ammonia and phosphorus, which are normally present in our body but become toxic when accumulated. The most important problem in hemodialysis is that the blood circulating in our body does not flow fast enough to enter dialysis. For this reason, patients can enter hemodialysis through either a fistula formed by joining the arteries and veins in their arms, or artificial vessels called grafts, or catheters attached to the neck or groin.

Since which method is the best method may vary according to the patient and the conditions, it is important to talk to the nephrologist who keeps track of you and decide together when choosing the most appropriate method.

So is it a fistula, graft or catheter when entering dialysis?

Do not do it. Remember, if a renal failure patient cannot be transplanted, they will survive as long as they can undergo dialysis. For this reason, the vein opening for dialysis is also a way of life for you!

Catheters attached to the neck are attached to the large veins that carry blood to the heart. If stenosis develops in these large vessels due to the irritation caused by the catheter, the arm vessels on that side become unusable. In other words, a catheter inserted into the neck of a patient who has just started dialysis renders the veins in the arm that can be dialyzed for 10-15 years inoperable within 1-2 years. Unfortunately, you will suddenly lose many precious years from your life. Therefore, in patients who will start hemodialysis, always;

“Fistula first, graft when no fistula option is left, and catheter as the last option should be preferred.”

What is fistula surgery, how is it performed?

Fistula surgery is roughly connecting a vein with an artery in the arm. The arteries with fast blood flow in our arm are deep and are not suitable for dialysis needle insertion. Blood flow is very slow in the surface veins. Do not forget that we are trying to meet the non-stop filtering and blood purification work done by the kidney 24 hours a day, 7 days a week, with the dialysis process, in which it can enter 4 hours a day, 3 days a week. So how do we do it?

Under local anesthesia, small incisions of 2-3 cm are made in the appropriate places decided by ultrasound on the arm, and the artery and vein are connected to each other. Thus, the blood in the arteries quickly passes into the superficial veins. Within 4-6 weeks, to adapt to this rapid blood flow, the vein both expands, and its wall thickens to accommodate the insertion of the dialysis needle. The preparations of the patient who comes to the hospital in the morning are completed. The operation takes about 45 minutes. As anesthesia is not given, the patient rests for 2 hours as a precaution, after making sure that there is no problem, a short training is given and sent home the same day.

How is graft (artificial vein) surgery performed?

If the vein that can be used for dialysis in your arms is not found or is no longer used, the second-best option is to perform surgery using grafts. Pre-surgery preparations of the patient who comes to the hospital in the morning are completed. The appropriate vessels to which the graft will be connected are determined by performing an ultrasound before the operation. If there are suitable vessels, the graft can be placed on the inner surface of the arm both below the elbow level and above the elbow level. It is placed just under the skin of the patient with a special tool and one end is connected to the artery and the other end to the vein that will take blood to the heart. The operation takes about one and a half hours. This time, the procedure is more comfortable for the patient by giving a sedative drug intravenously together with local anesthesia. After the operation, the patient is rested in his room for about 4 hours, after making sure that there is no problem, he is sent to his home after a short training.

What are the problems that can be seen after these surgeries?

One of the most common problems is that the fistula or the graft does not work. With a good preoperative planning in experienced centers, this rate can be reduced to less than 5% in fistulas and 10% in grafts. Another problem is bleeding due to blood thinners such as aspirin or heparin used. More often, infection may occur due to the foreign body used after graft surgery. The most troublesome situation is the low blood flow to the hand, which causes ischemia in the hand after surgery. Both fistula and graft surgeries are actually the process of stealing blood that normally goes to the hand and giving it to the vascular access created for dialysis. Therefore, disorders in the arterial structure of the patient or directing excessive blood to the dialysis vasculature may cause the blood supply of the hand to deteriorate.

Dialysis and Vascular Access Surgery yazısı ilk önce Assoc. Professor Soykan Barlas üzerinde ortaya çıktı.

Which Treatment Modality Should I Choose?

There are several options for patients with end-stage renal disease to remove toxic substances from their bodies and continue their lives.  These are peritoneal dialysis, in which a catheter is inserted into the abdomen and the patient can apply alone at home, hemodialysis in which they can undergo dialysis at a dialysis center for three days a week through the vascular access to their arms, and kidney transplantation.Currently, kidney transplantation is the most important option for suitable patients in terms of both providing a long life span and providing high quality of life. On the other hand, other methods are extremely important alternatives in patients who do not have kidney transplantation in the early stage. You should choose the most appropriate treatment method that can maintain the tasks performed by the kidney by talking to your nephrologist.

What is Kidney Transplant?

Kidney transplant is roughly described as the removal of a kidney from one person and transplantation to another.  The donor can be a cadaver donor or a living donor. In a kidney transplant with a cadaver donor, a transplant is made from a patient after brain death occurs. Every Turkish citizen with end-stage renal disease has the right to be included cadaver organ waiting list. In this case, the patient registers the surgery on the list of the transplant center he / she wants to have surgery. It is preferred that the transplant center is close to where the patient lives.  As a result of a series of complex calculations that include the age of the patient, the duration of dialysis, the histocompatibility of the patient with the organ to be taken, and the center where the organ originates, the National Coordination Center under the Ministry of Health determines whom the organ will be transplanted to, and the organ is delivered to the transplant center.

My relative wants to donate me a kidney. Can I receive it?

In a living donor kidney transplant, she applies to the transplant center with a relative who wants to donate a kidney to him / her. According to the laws of the Republic of Turkey, being a maximum 4th degree relative to donate one organ to a patient. If there is no kinship, the donor must enter a central ethics committee and must demonstrate a sincere relationship with the recipient. The donor and recipient are health screened for eligibility for kidney transplant. Living donor kidney transplantation can be applied to couples who are physically and mentally healthy.  You can apply to Florence Nightingale Hospital Kidney Transplant Center for free detailed information and examinations.

How is Kidney Transplant Surgery Performed?

In a living donor kidney transplant, the donor and the recipient are operated simultaneously. After the kidney removed from the donor, kidney is washed with special solutions and is transplanted to the recipient waiting in ready condition in the other room. The kidney would have been kept outside the body for 45-60 minutes in ice. In a kidney transplant with a cadaver donor, after the kidney is removed from the donor, it is washed with special solutions, put on ice and transferred to the center where the recipient is located. Tests and preparations can take an average of 8-12 hours. Even if the kidney is transported from another city, this period may take up to 24 hours.

In live donor transplants, donors leave the hospital within 2-3 days, and recipients in 5-6 days after the transplant. In transplants with cadaver donors, the duration of hospital stay is 7-10 days, but this process may be prolonged according to the functioning time of the implanted kidney.

Kidney Transplant yazısı ilk önce Assoc. Professor Soykan Barlas üzerinde ortaya çıktı.