{"id":481,"date":"2024-03-01T18:21:01","date_gmt":"2024-03-01T18:21:01","guid":{"rendered":"https:\/\/istanbulbariatrics.com.tr\/?page_id=481"},"modified":"2024-03-01T18:21:01","modified_gmt":"2024-03-01T18:21:01","slug":"obezite-cerrahisi-nedir","status":"publish","type":"page","link":"https:\/\/mehmetaliyerdel.com\/?page_id=481","title":{"rendered":"Obezite Cerrahisi Nedir?"},"content":{"rendered":"\t\t
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Obezite Cerrahisi<\/span> Nedir?<\/h1>\t\t\t\t<\/div>\n\t\t\t\t
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Obezite Cerrahisinin Faydalar\u0131 \u2013 T\u0131ptaki A Kan\u0131t\u0131.<\/h3>\t\t\t\t<\/div>\n\t\t\t\t
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<\/i><\/span>
Obezite cerrahisi morbid obeziteyi gidermek amac\u0131 ile yap\u0131lan cerrahi m\u00fcdahalelerin tamam\u0131na verilen isimdir ve t\u0131pta \u201cbariatrik cerrahi\u201d denilmektedir.<\/blockquote><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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T\u0131p biliminde belli sorulara verilen cevaplar\u0131n g\u00fcvenilirli\u011fi eldeki kan\u0131tlar\u0131n A,B,C gibi kalite d\u00fczeylendirilmesine dayand\u0131r\u0131l\u0131r. Herhangi bir problemin \u00e7\u00f6z\u00fcm y\u00f6nteminin ba\u015far\u0131s\u0131 ile ilgili elimizde \u201cA\u201d d\u00fczeyinde kan\u0131t olmas\u0131 o bilginin mutlak do\u011frulu\u011funa i\u015faret eder gibi d\u00fc\u015f\u00fcnebiliriz. Bariatrik cerrahi (obezite cerrahisi \/ mide k\u00fc\u00e7\u00fcltme ameliyat\u0131)<\/strong>, yani a\u015f\u0131r\u0131 \u015fi\u015fmanl\u0131\u011f\u0131 gidermek amac\u0131 ile yap\u0131lan giri\u015fimlerin tedavi edici etkinliklerinin ba\u015far\u0131s\u0131 ile ilgili olarak elimizde fazlas\u0131 ile \u201cA\u201d d\u00fczeyinde kan\u0131t vard\u0131r. Dolay\u0131s\u0131 ile hem kilo kayb\u0131nda ba\u015far\u0131, hem bu kilo kayb\u0131n\u0131n uzun d\u00f6nemde devam etmesi, hem \u015feker-tansiyon-karaci\u011fer rahats\u0131zl\u0131\u011f\u0131-uyku apnesi gibi ikincil rahats\u0131zl\u0131klar\u0131n giderilmesi, hem enfarkt\u00fcs ve inme riskinin azalt\u0131lmas\u0131, hem baz\u0131 kanserlere yakalanma olas\u0131l\u0131\u011f\u0131n\u0131n d\u00fc\u015f\u00fcr\u00fclmesi ve sonu\u00e7 olarak da en \u00f6nemlisi; ya\u015fam\u0131 uzatmak<\/strong> a\u00e7\u0131s\u0131ndan \u201cobezite cerrahisi\u201d<\/strong> en etkin tedavidir ve bu net bi\u00e7imde kan\u0131tlanm\u0131\u015ft\u0131r.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t

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Obezite Yani \u015ei\u015fmanl\u0131k Cerrahisi Tam Olarak Nedir?<\/h4>\t\t\t\t<\/div>\n\t\t\t\t
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\u201cObezite cerrahisi\u201d Laparoskopik bir giri\u015fimdir.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t

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Mide K\u00fc\u00e7\u00fcltme \/ Obezite Cerrahisi.<\/h4>\t\t\t\t<\/div>\n\t\t\t\t
\n\t\t\t\t\t\t\t\t\tMide k\u00fc\u00e7\u00fcltme \/ Obezite cerrahisi her ge\u00e7en g\u00fcn daha da geli\u015fen bir dizi laparoskopik yani \u201ckapal\u0131\u201d giri\u015fim olarak \u00f6zetlenebilir. Yani her hastaya \u015fu ya da bu giri\u015fim uygulan\u0131yor ve tek ve en iyi y\u00f6ntem budur denilebilecek \u201cstandart\u201d ve tek bir m\u00fcdahaleden bahsedilemez. \u00d6zellikle son 25 y\u0131ld\u0131r laparoskopinin devreye girmesi ve teknolojideki ilerlemelere de paralel olarak ciddi bir ivme ile kazan\u0131lan t\u00fcm deneyimin \u0131\u015f\u0131\u011f\u0131nda dinamik bir de\u011fi\u015fim s\u00fcrecinden ge\u00e7en, bir k\u0131sm\u0131 \u00f6n plana \u00e7\u0131karken bir k\u0131sm\u0131 giderek daha az uygulanmakta olan bir dizi \u201ckapal\u0131\u201d giri\u015fimden bahsetmemiz gerekmektedir.\n\nBurada en \u00f6nemli konu; zaman\u0131m\u0131zdaki t\u00fcm bariatrik giri\u015fimlerin laparoskopik olarak yani b\u00fcy\u00fck kar\u0131n kesisi olmadan, \u201ckapal\u0131\u201d ameliyatla yap\u0131l\u0131yor olmas\u0131d\u0131r. Bu ameliyatlarda b\u00fcy\u00fck bir kar\u0131n kesisi yap\u0131lmaz ve giri\u015fimler milimetrik deliklerden bat\u0131n i\u00e7ine ula\u015f\u0131larak ger\u00e7ekle\u015ftirilir. Dolay\u0131s\u0131 ile laparoskopik ameliyatlar\u0131n t\u00fcm avantajlar\u0131 obezite cerrahisinde de aynen s\u00f6z konusudur. Ameliyat sonras\u0131 a\u011fr\u0131 ciddi bir problem olmaz ve basit a\u011fr\u0131 kesicilerin ilk g\u00fcn kullan\u0131lmas\u0131 yeterli olur. Sonu\u00e7 olarak hastalar ayn\u0131 g\u00fcn aya\u011fa kalk\u0131p, birka\u00e7 g\u00fcn i\u00e7inde taburcu olurlar ve i\u015f ve g\u00fc\u00e7lerine hem de kesileri de olmadan bir hafta i\u00e7inde d\u00f6nebilirler. Kesi olmad\u0131\u011f\u0131ndan estetik sonu\u00e7 da m\u00fckemmeldir ve kesi iltihaplanmas\u0131, kesi f\u0131t\u0131\u011f\u0131 gibi komplikasyonlar da son derece nadirdir.\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t
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Hangi \u015ei\u015fmanlar Obezite Cerrahisi Aday\u0131d\u0131r?<\/h4>\t\t\t\t<\/div>\n\t\t\t\t
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A\u015f\u0131r\u0131 \u015fi\u015fmanl\u0131\u011f\u0131n en etkin tedavisinin mide k\u00fc\u00e7\u00fcltme \/ obezite cerrahisi<\/strong> oldu\u011fu kesin olmakla birlikte, i\u015fin salt ameliyatla bitmeyece\u011finin t\u00fcm hastalar\u0131m\u0131z taraf\u0131ndan \u00e7ok iyi anla\u015f\u0131lmas\u0131 uzun d\u00f6nemde ba\u015far\u0131 a\u00e7\u0131s\u0131ndan b\u00fcy\u00fck \u00f6nem ta\u015f\u0131maktad\u0131r. Bu ba\u011flamda \u015fi\u015fmanl\u0131k ameliyatlar\u0131n\u0131 hastalara sunulan bir \u201calt\u0131n anahtar\u201d olarak g\u00f6rebiliriz. Bu anahtar sayesinde morbid obezler kendi ba\u015flar\u0131na hi\u00e7bir \u015fekilde a\u00e7amad\u0131klar\u0131 bir kap\u0131y\u0131 mutlaka a\u00e7arlar ve ilk 1 \u2013 1.5 y\u0131l i\u00e7inde ciddi bi\u00e7imde kilo verirler. Ancak ama\u00e7 mide k\u00fc\u00e7\u00fcltme \/ obezite cerrahisi<\/strong> sonras\u0131 kilo kayb\u0131n\u0131n \u00f6m\u00fcr boyu korunmas\u0131 oldu\u011fundan, bu kap\u0131y\u0131 a\u00e7\u0131p ileriye do\u011fru ve hem de \u201czay\u0131flayarak\u201d y\u00fcr\u00fcmeye ba\u015flad\u0131klar\u0131nda hastalar\u0131m\u0131za da \u00e7ok \u00f6nemli g\u00f6revler d\u00fc\u015fmektedir.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t

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\u015ei\u015fmanl\u0131k Cerrahisine Aday Bir Hasta Olman\u0131n \u00d6n Ko\u015fullar\u0131:<\/h5>\t\t\t\t<\/div>\n\t\t\t\t
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  1. Obezite ameliyat\u0131 sonras\u0131nda kendisine sunaca\u011f\u0131m\u0131z diyet ve egzersiz protokollerine uyum sa\u011flayaca\u011f\u0131, ona \u00f6m\u00fcr boyu destek vermekle y\u00fck\u00fcml\u00fc ekibimizin (psikolog-diyetisyen ve cerrahi ekip) kontrollerine zaman\u0131nda gelece\u011fi gibi \u201cya\u015fam\u0131 boyu s\u00fcrecek\u201d birtak\u0131m ciddi hayat tarz\u0131 de\u011fi\u015fiklikleri konular\u0131nda ki\u015fi \u00e7ok istekli olmal\u0131 ve ileri bir psikiyatrik hastal\u0131\u011f\u0131 da bulunmamal\u0131d\u0131r.<\/li>
  2. Cerrahinin muhtemel yan etki ve riskleri \u00e7ok iyi anla\u015f\u0131lm\u0131\u015f olmal\u0131d\u0131r.<\/li>
  3. A\u015f\u0131r\u0131 \u015fi\u015fmanl\u0131k probleminin hormonal ya da ba\u015fka t\u0131bbi hastal\u0131klar nedeni ile olmad\u0131\u011f\u0131n\u0131n giri\u015fim \u00f6ncesi testlerle kan\u0131tlanm\u0131\u015f olmas\u0131 gerekmektedir. Yani \u015fi\u015fmanl\u0131k \u201cekzojen\u201d nedenlerden (\u00e7ok yiyerek d\u0131\u015far\u0131dan a\u015f\u0131r\u0131 kalori almak sonucunda) ortaya \u00e7\u0131km\u0131\u015f olmal\u0131, ba\u015fka bir \u015fi\u015fmanl\u0131k olu\u015fturucu \u00f6zel hastal\u0131k bulunmamal\u0131d\u0131r. \u015ei\u015fmanl\u0131k yap\u0131c\u0131 i\u00e7 hastal\u0131klar (\u00f6rn: Cushing) son derece nadirdir ve merkezimize ba\u015fvuran t\u00fcm hastalarda b\u00f6yle bir durumun olmad\u0131\u011f\u0131 ameliyat \u00f6ncesinde detayl\u0131 bi\u00e7imde ortaya konulmaktad\u0131r.<\/li>
  4. \u00d6nceden mutlaka \u201cdiyet\u201d se\u00e7ene\u011fi hem de en az iki kez ve en az 6\u2019\u015far ay s\u00fcre ile denenmi\u015f ancak uzun d\u00f6nemde sonu\u00e7suz kalm\u0131\u015f olmal\u0131d\u0131r.<\/li>
  5. Genel anestezi alt\u0131nda birka\u00e7 saat s\u00fcrebilecek bir ameliyat olmaya mani bir kalp, akci\u011fer hastal\u0131\u011f\u0131 ya da ba\u015fka bir ciddi \u201ckronik\u201d rahats\u0131zl\u0131k bulunmamal\u0131d\u0131r. Bu a\u00e7\u0131dan da merkezimiz t\u00fcm ba\u015fvuran hastalar\u0131n de\u011ferlendirilmesinde A dan Z \u2018ye hizmet vermektedir.<\/li>
  6. Ergenlik \u00e7a\u011f\u0131 tamamlanm\u0131\u015f ve tercihan 70 ya\u015f\u0131n alt\u0131nda olunmal\u0131d\u0131r. Bizim serimizdeki en gen\u00e7 hastam\u0131z 14 en ya\u015fl\u0131 hastam\u0131z ise 65 ya\u015f\u0131ndad\u0131r. Artan deneyime paralel olarak zaman\u0131m\u0131zda \u00fcst ya\u015f s\u0131n\u0131r\u0131 giderek daha ileri ya\u015flara \u00e7ekilmekte ve hatta art\u0131k neredeyse \u00f6nemsenmemektedir.<\/li>
  7. Hangi d\u00fczeyde \u015fi\u015fman olman\u0131n ameliyat gerektirdi\u011fi a\u00e7\u0131s\u0131ndan ise t\u00fcm d\u00fcnyada V\u00fccut Kitle \u0130ndeksi (VK\u0130) de\u011ferine g\u00f6re karar verilmektedir. Bu ba\u011flamda kimlerde \u201cmutlak\u201d kimlerde ise \u201cg\u00f6receli\u201d ameliyat endikasyonu oldu\u011fu a\u015fa\u011f\u0131da detayl\u0131 bi\u00e7imde sunulmu\u015ftur.<\/li><\/ol>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t
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    V\u00fccut Kitle Indeksi (VK\u0130).<\/h4>\t\t\t\t<\/div>\n\t\t\t\t
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    V\u00fccut kitle indeksi (VK\u0130) \u015fi\u015fman ki\u015filere hangi a\u015famada ameliyat yap\u0131lmas\u0131 gerekti\u011fini belirleyen en \u00f6nemli parametredir!<\/strong><\/p>

    Kabaca; VK\u0130\u2019nin 35\u2019in \u00fcst\u00fcnde oldu\u011fu ki\u015fileri ileri \u015fi\u015fman, alt\u0131nda olan kilolu ki\u015fileri ise sadece \u015fi\u015fman ya da kilolu olarak kabul etmekteyiz. \u015ei\u015fmanl\u0131k ile m\u00fccadelede; diyet\/egzersiz ve psikolojik destek VK\u0130 35\u2019in alt\u0131ndaki ki\u015filerde ana tedavi yakla\u015f\u0131m\u0131d\u0131r. Bu durumda, hangi \u015fi\u015fmanl\u0131k durumlar\u0131nda tart\u0131\u015fmas\u0131z bi\u00e7imde ameliyata gerek vard\u0131r ? \u015ei\u015fmanl\u0131k ameliyat\u0131 gereklili\u011fi a\u00e7\u0131s\u0131ndan bir gri alandan s\u00f6z edilebilir mi ? Bu sorulara kategorik olarak cevap verirsek:<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t

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    1. MUTLAK AMEL\u0130YAT GEREKS\u0130N\u0130M\u0130 (END\u0130KASYONU)\n\n
    <\/br>VK\u0130>40 (Morbid obezite)<\/h5>\t\t\t\t<\/div>\n\t\t\t\t
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    VK\u0130\u2019nin 40\u2019\u0131n \u00fcst\u00fcnde oldu\u011fu ki\u015filer, yani morbid obezler hastal\u0131kl\u0131 \u015fi\u015fmand\u0131r ve bunlarda obezite ameliyat\u0131<\/strong> endikasyonu tart\u0131\u015fmas\u0131z bi\u00e7imde mutlak, net ve elzemdir! \u015ei\u015fmanl\u0131k sebebi ile ortaya \u00e7\u0131kabilen yanda\u015f hastal\u0131klardan hi\u00e7biri hen\u00fcz bulunmasa da \u201cmorbid obez\u201d olarak tan\u0131mlanan bu ki\u015filer d\u00f6rt d\u00f6rtl\u00fck ve \u201cmutlak\u201d ameliyat aday\u0131d\u0131r. Genel anestezi alt\u0131nda ameliyat olmalar\u0131na kalp, akci\u011fer ve hormonal a\u00e7\u0131dan bir engel yoksa ve en az iki diyet giri\u015fimi ba\u015far\u0131s\u0131z olmu\u015f ise bu ki\u015filerde ameliyat \u00f6nermemek ya da geciktirmek t\u0131bbi bir hata ve etik d\u0131\u015f\u0131 bir yakla\u015f\u0131md\u0131r. Morbid obezite \u00f6l\u00fcmc\u00fcl bir hastal\u0131kt\u0131r ve \u015fi\u015fmanl\u0131k giderici ameliyatlar\u0131n bu hastalarda ya\u015fam\u0131 uzatt\u0131\u011f\u0131 bilimsel olarak net bi\u00e7imde kan\u0131tlanm\u0131\u015ft\u0131r.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t

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    2. MUTLAK AMEL\u0130YAT GEREKS\u0130N\u0130M\u0130 (END\u0130KASYONU) \n\n

    35 < VK\u0130 < 40 ( + \u015fi\u015fmanl\u0131\u011fa ba\u011fl\u0131 en az iki yanda\u015f hastal\u0131k varsa)<\/h5>\t\t\t\t<\/div>\n\t\t\t\t
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    VK\u0130\u2019nin 35\u201340 aras\u0131 oldu\u011fu saptanan ileri \u015fi\u015fman ki\u015filer; e\u011fer \u015fi\u015fmanl\u0131k sebebiyle geli\u015febilen ve kitap\u00e7\u0131\u011f\u0131m\u0131z\u0131n ilgili sayfalar\u0131nda yer alan \u201cyanda\u015f\u201d problemlerden en az ikisine sahiplerse bunlarda da cerrahi tedavi gereksinimi tart\u0131\u015fmas\u0131z bi\u00e7imde net ve mutlakt\u0131r ! (\u0130leri \u015fi\u015fmanl\u0131k neden tehlikelidir ?)<\/p>

    32 ya\u015f\u0131nda, birka\u00e7 senedir tip II \u015feker hastal\u0131\u011f\u0131 ve karaci\u011fer ya\u011flanmas\u0131 bulunan ve VK\u0130\u2019si 35.5 olan bir gen\u00e7 hasta e\u011fer \u00f6nceden iki kez de diyet giri\u015fiminde bulunmu\u015f ve ba\u015far\u0131s\u0131z olmu\u015f ise fazla oyalanmadan ameliyat edilmelidir. \u00c7\u00fcnk\u00fc bu hasta grubunda cerrahi tedavi gerek kilo kayb\u0131ndaki kal\u0131c\u0131 ba\u015far\u0131s\u0131 ve gerekse \u015feker hastal\u0131\u011f\u0131 ve karaci\u011fer ya\u011flanmas\u0131n\u0131 da ortadan kald\u0131rmas\u0131 bak\u0131mlar\u0131ndan en etkin ve g\u00fcvenli tedavi se\u00e7ene\u011fidir.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t

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    3. G\u00d6RECEL\u0130 AMEL\u0130YAT GEREKS\u0130N\u0130M\u0130 (END\u0130KASYONU) \n

    GR\u0130 ALAN.<\/h5>\t\t\t\t<\/div>\n\t\t\t\t
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    VK\u0130\u2018nin 35-40 aras\u0131nda olup da hen\u00fcz hi\u00e7bir yanda\u015f hastal\u0131\u011f\u0131 olmayan ya da VK\u0130\u2019nin 30-35 aras\u0131nda olup da \u015fi\u015fmanl\u0131\u011fa ba\u011fl\u0131 yanda\u015f s\u0131k\u0131nt\u0131lar\u0131n ortaya \u00e7\u0131kt\u0131\u011f\u0131 hastalar ise \u201cgri\u201d alandaki hastalard\u0131r. Gri alandan kastedilen bu durumdaki hastalar\u0131n ameliyat edilmesi gereklili\u011finin mutlak oldu\u011fundan t\u0131p d\u00fcnyas\u0131n\u0131n da hen\u00fcz % 100 emin olmamas\u0131d\u0131r.<\/p>

    \u00d6te yandan bu guruplara giren hastalara d\u00fcnyadaki genel yakla\u015f\u0131m \u00f6zellikle son y\u0131llarda s\u00fcratle de\u011fi\u015fmektedir. Bu de\u011fi\u015fimde ku\u015fkusuz en \u00f6nemli pay mide k\u00fc\u00e7\u00fcltme \/ obezite cerrahisi<\/strong> ile ilgili deneyimin giderek artmas\u0131 olmu\u015ftur. \u015ei\u015fmanl\u0131k ameliyatlar\u0131n<\/strong>tamamen laparoskopik yani kapal\u0131 olarak yap\u0131labilmesi, cerrahi teknik ve teknolojilerin h\u0131zla ilerlemesi ve en \u00f6nemlisi uzun d\u00f6nem sonu\u00e7lar\u0131n yeni a\u00e7\u0131\u011fa \u00e7\u0131kmas\u0131 gibi fakt\u00f6rler \u201cg\u00f6receli ameliyat endikasyonu\u201d kavram\u0131 ve dolay\u0131s\u0131 ile \u201cgri alan\u0131n\u201d giderek daralmas\u0131na yol a\u00e7\u0131yor gibi g\u00f6z\u00fckmektedir..<\/p>

    Yani bu gruplara giren hastalara eskiden obezite ameliyat\u0131<\/strong> hi\u00e7 \u00f6nerilmemekte iken art\u0131k A.B.D. ve \u0130ngiltere dahil bu konuda ba\u015f\u0131 \u00e7eken bir\u00e7ok \u00fclkede bu hastalar da ameliyat aday\u0131 olabilmektedirler. \u00d6zellikle son 5 y\u0131ll\u0131k literat\u00fcr klasik ve mutlak ameliyat endikasyonu bulunmayan daha d\u00fc\u015f\u00fck VK\u0130\u2019ne sahip kilolularda da obezite cerrahisi<\/strong> tedavi se\u00e7ene\u011finin \u00e7ok etkili oldu\u011funu kan\u0131tlamaya y\u00f6nelik bir\u00e7ok yay\u0131n i\u00e7ermektedir.<\/p>

    \u00c7ok yeni olarak; VK\u0130 30 \u2013 35 aras\u0131nda olup, tip 2 \u015fekerin ciddi problem oldu\u011fu ve \u201cmetabolik sendrom\u201d olarak bilinen \u015fi\u015fmanl\u0131\u011fa ba\u011fl\u0131 bir\u00e7ok yanda\u015f hastal\u0131\u011f\u0131n ortaya \u00e7\u0131km\u0131\u015f oldu\u011fu ki\u015filerde de art\u0131k ameliyat gereklili\u011fi art\u0131k bir k\u0131lavuz bilgisi olmu\u015ftur.<\/p><\/div><\/div>

    V\u00fccut kitle indeksiniz hesaplamak i\u00e7in t\u0131klay\u0131n\u0131z.<\/p><\/div><\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t

    \n\t\t\t\t\t
    Hangi Morbid Obezlerde Cerrahi Tedavi Yap\u0131lamaz?<\/h5>\t\t\t\t<\/div>\n\t\t\t\t
    \n\t\t\t\t\t\t\t\t\t
    1. O ya da bu nedenden cerrahi riskin kabul edilemeyecek kadar y\u00fcksek oldu\u011fu kronik hastal\u0131klar\u0131n bulundu\u011fu durumlar (kanserler, ileri kalp ve akci\u011fer hastal\u0131klar\u0131, ileri kronik karaci\u011fer hastal\u0131\u011f\u0131 (siroz) gibi).<\/li>
    2. Hastan\u0131n ameliyat sonras\u0131nda kendini bekleyen hayat tarz\u0131 ve davran\u0131\u015f de\u011fi\u015fikliklerine, s\u00fcrekli takip ve kontrol protokollerine, diyet ve egzersiz deste\u011fine haz\u0131rl\u0131kl\u0131 olmamas\u0131.<\/li>
    3. Ciddi alkol ya da madde ba\u011f\u0131ml\u0131l\u0131\u011f\u0131.<\/li>
    4. Hayat\u0131 boyunca diyeti hi\u00e7 denememi\u015f olmak.<\/li>
    5. Ciddi ve tedavi edilemeyen psikiyatrik hastal\u0131klar ve tedavi edilemeyen yeme hastal\u0131klar\u0131. Merkezimizde t\u00fcm ameliyat aday\u0131 hastalar\u0131 \u00f6ncelikle konusunda yetkin bir psikolog ve diyet uzman\u0131 bu durumlar\u0131n net olarak ayd\u0131nlat\u0131lmas\u0131 i\u00e7in \u201crutin\u201d olarak g\u00f6rmektedir. Ayr\u0131ca yasal bir zorunluluk olarak obezite cerrahisi adaylar\u0131 psikiyatrik muayeneden ge\u00e7mekte ve ameliyata engel bir psikiyatrik bozuklu\u011fu olmad\u0131\u011f\u0131na dair rapor al\u0131nmaktad\u0131r.<\/li>
    6. Ergenlik \u00e7a\u011f\u0131ndan k\u00fc\u00e7\u00fck ya da 70 ya\u015f\u0131ndan b\u00fcy\u00fck olmak. Ya\u015f s\u0131n\u0131r\u0131 t\u00fcm d\u00fcnyada giderek daha y\u00fckseklere \u00e7ekilmekte olup baz\u0131 merkezlerde kronolojik \u00fcst ya\u015f s\u0131n\u0131r\u0131 ortadan kalkm\u0131\u015ft\u0131r.<\/li><\/ol><\/div><\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t
      \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\"\"\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t
      \n\t\t\t\t\t
      Laparoskopik Mide K\u00fc\u00e7\u00fcltme \/ Obezite Cerrahisi Nas\u0131l Etkili Oluyor?<\/h5>\t\t\t\t<\/div>\n\t\t\t\t
      \n\t\t\t\t\t\t\t\t\t

      Bu soruya cevap vermeden \u00f6nce t\u00fcm sindirim sistemi anatomi ve yap\u0131lanmas\u0131n\u0131 basit bir anlat\u0131mla g\u00f6zden ge\u00e7irmek \u00e7ok yard\u0131mc\u0131 olacakt\u0131r.<\/p>

      Anatomi:\u00a0<\/strong><\/p>

      Sindirim sistemini a\u011f\u0131zda ba\u015flayan ve an\u00fcsde sonlanan upuzun bir boru olarak d\u00fc\u015f\u00fcnebiliriz. A\u011fz\u0131m\u0131z sindirim sisteminin g\u0131dalar\u0131 ilk olarak ald\u0131\u011f\u0131m\u0131z , di\u015flerimizle mekanik olarak ve t\u00fck\u00fcr\u00fc\u011f\u00fcm\u00fcz\u00fcn de \u201cenzimatik\u201d katk\u0131s\u0131 ile \u00f6\u011f\u00fctt\u00fc\u011f\u00fcm\u00fcz ba\u015flang\u0131\u00e7 k\u0131sm\u0131d\u0131r. \u015eekerlerin sindirimi t\u00fck\u00fcr\u00fck amilaz\u0131n\u0131n etkisi ile a\u011f\u0131zda ba\u015flamaktad\u0131r. Al\u0131nan g\u0131dalar a\u011f\u0131zda \u00f6\u011f\u00fct\u00fclerek \u201cyutak\u201d kanal\u0131 ile yutma borusuna (\u00f6sefagus) ve buradan da midemize aktar\u0131l\u0131rlar.<\/p>

      Midemiz sindirim sistemini olu\u015fturan uzun borunun ciddi bi\u00e7imde geni\u015flemi\u015f oldu\u011fu ve yo\u011fun bi\u00e7imde asit ve baz\u0131 protein eritici enzimler salg\u0131layan k\u0131sm\u0131d\u0131r. Mide yuttu\u011fumuz her\u015feyin kar\u0131n i\u00e7indeki ilk dura\u011f\u0131d\u0131r ve al\u0131nan g\u0131dalar burada asit ve enzimlerin de katk\u0131s\u0131 ile ve mekanik olarak tam anlam\u0131 ile \u00f6\u011f\u00fct\u00fcl\u00fcp t\u0131pta \u201ckimus\u201d olarak bilinen k\u0131vama getirilirler. Proteinlerin sindirimi midede ba\u015flamaktad\u0131r. Mide ayr\u0131ca ; \u201cmukus\u201d olarak bilinen ve kendi \u00fcretti\u011fi asitten kendini korumas\u0131n\u0131 sa\u011flayan s\u00fcm\u00fcks\u00fc bir salg\u0131, bir dizi hormon (\u00d6rne\u011fin : Ghrelin, Gastrin ) ve B 12 ve folik asit gibi baz\u0131 vitaminlerin ba\u011f\u0131rsaklardan emilmesini sa\u011flayan \u201c\u0130ntrensek Fakt\u00f6r\u201d gibi maddeleri de salg\u0131layan bir \u201cendokrin organ\u201d olarak da i\u015flev g\u00f6rmektedir. Yemek yenildi\u011finde \u201cdoyma\u201d hissi ile ilgili uyaranlar\u0131n ba\u015f\u0131nda midenin dolarak gerginle\u015fmesi gelmektedir. Ayr\u0131ca gene mide bo\u015fken \u201cfundus\u201d olarak bilinen kubbesinden salg\u0131lanan \u201cGhrelin\u201d hormonu sayesinde \u201ca\u00e7l\u0131k\u201d alg\u0131s\u0131 olu\u015fmaktad\u0131r. Kandaki Ghrelin seviyesindeki d\u00fc\u015fme ise direk olarak \u0130\u015eTAH AZALMASINA yol a\u00e7maktad\u0131r.<\/p>

      Midenin fundus b\u00f6l\u00fcm\u00fcn\u00fcn \u00e7\u0131kart\u0131ld\u0131\u011f\u0131 \u201ct\u00fcp mide (mide k\u00fc\u00e7\u00fcltme)\u201d<\/strong> ve fundus\u2019un by-pass\u2019land\u0131\u011f\u0131 \u201cmide \u2013 bypass\u2019\u0131\u201d ameliyatlar\u0131ndan\u00a0<\/strong>sonra i\u015ftahtaki 24 saat boyunca dramatik azalman\u0131n \u00f6nemli bir nedeni ; kandaki Ghrelin seviyesindeki d\u00fc\u015fmedir. Gene bu ameliyatlar; mevcut mide vol\u00fcm\u00fcn\u00fc de hat\u0131r\u0131 say\u0131l\u0131r bi\u00e7imde azaltarak g\u0131da al\u0131n\u0131m\u0131n\u0131 k\u0131s\u0131tlay\u0131c\u0131 etki de yaratmaktad\u0131rlar. Bu sayede ufac\u0131k bir lokma yenildi\u011finde bile; geride k\u00fc\u00e7\u00fcltt\u00fcr\u00fclerek b\u0131rak\u0131lm\u0131\u015f mide derhal gerginle\u015ferek hemen doyma ve tokluk hissi olu\u015facakt\u0131r. Ghrelin seviyesindeki d\u00fc\u015fme ise tokluk hissinin uzun s\u00fcrmesine yani genel manada \u201ci\u015ftah\u201d azalmas\u0131na yol a\u00e7acakt\u0131r.<\/p>

      Sindirim sisteminde g\u0131dalar\u0131n mideden sonra ge\u00e7tikleri k\u0131s\u0131m ince ba\u011f\u0131rsakt\u0131r. \u0130nce ba\u011f\u0131rsa\u011f\u0131n mideden sonraki ilk 15-20 cm \u2018lik b\u00f6l\u00fcm\u00fcne t\u0131pta \u201cduodenum\u201d ya da oniki parmak ba\u011f\u0131rsa\u011f\u0131 denilmektedir ve \u00f6zellikle demir (Fe) ve kalsiyum (Ca) emilimi bu b\u00f6lgede ger\u00e7ekle\u015fir. \u0130nce ba\u011f\u0131rsak yakla\u015f\u0131k 4-5 metre uzunluktad\u0131r ve gerek proteinlerin ve gerekse ya\u011flar\u0131n ve ayn\u0131 zamanda da \u015fekerlerin tam anlam\u0131 ile emilimlerinin yani sindirimlerinin ger\u00e7ekle\u015fip tamamland\u0131\u011f\u0131 k\u0131s\u0131md\u0131r. Gene ince ba\u011f\u0131rsa\u011f\u0131n ilk b\u00f6l\u00fcm\u00fc olan onikiparmak ba\u011f\u0131rsa\u011f\u0131na; karaci\u011ferde \u00fcretilen safra ve t\u00fcm pankreas enzimleri salg\u0131lanmaktad\u0131r ve \u00f6zellikle ya\u011flar\u0131n sindirimi ve emilimi bu salg\u0131lar sayesinde ger\u00e7ekle\u015fir. \u00d6te yandan t\u00fcm ince ba\u011f\u0131rsaktan bir dizi hormon da salg\u0131lan\u0131r ve ince ba\u011f\u0131rsa\u011f\u0131 da adeta bir endokrin organ olarak d\u00fc\u015f\u00fcnmek yerinde olacakt\u0131r.<\/p>

      Mide by-pass\u2019\u0131<\/strong> yap\u0131ld\u0131\u011f\u0131nda; g\u0131dalar\u0131n ince ba\u011f\u0131rsa\u011f\u0131n ilk b\u00f6l\u00fcmlerine, \u201cduodenal switch\u201d ameliyat\u0131 yap\u0131ld\u0131\u011f\u0131nda ise g\u0131dalar\u0131n ince ba\u011f\u0131rsa\u011f\u0131n neredeyse 4\/5 \u2018lik \u00fcst k\u0131sm\u0131na u\u011framadan direk olarak daha a\u015fa\u011f\u0131daki ince ba\u011f\u0131rsa\u011fa ge\u00e7mesi sa\u011flanm\u0131\u015f olmaktad\u0131r. Bu nedenle al\u0131nan g\u0131dalar\u0131n emilmesi de bu ameliyatlarla sekteye u\u011frar ve bu da daha fazla kilo kayb\u0131n\u0131 destekler.<\/p>

      \u0130nce ba\u011f\u0131rsak, kal\u0131n ba\u011f\u0131rsak olarak devam eder ve sindirim sisteminin bu son 1.5 metrelik b\u00f6l\u00fcm\u00fc t\u0131pta \u201ckolon\u201d olarak bilinir ve \u201crektum\u201d arac\u0131l\u0131\u011f\u0131 ile an\u00fcste sonlan\u0131r. Kolon ya da kal\u0131n ba\u011f\u0131rsak ise sadece su emiliminin yap\u0131ld\u0131\u011f\u0131 ve g\u0131da emiliminin olmad\u0131\u011f\u0131 ve d\u0131\u015fk\u0131n\u0131n kat\u0131 hale getirilip belli aral\u0131klarla bo\u015falt\u0131lmas\u0131n\u0131n sa\u011fland\u0131\u011f\u0131 bir organd\u0131r. \u015ei\u015fmanl\u0131k cerrahisi ile ilgili herhangi bir kolon ameliyat\u0131 da dolay\u0131s\u0131 ile yoktur.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t

      \n\t\t\t\t\t
      Mide K\u00fc\u00e7\u00fcltme \/ Obezite Cerrahisi Etki Mekanizmalar\u0131:<\/h5>\t\t\t\t<\/div>\n\t\t\t\t
      \n\t\t\t\t\t\t\t\t\t

      Temelde obezite cerrahisi<\/strong> ile yap\u0131lan i\u015f \u00fc\u00e7 mekanizma \u00fczerinden \u00e7al\u0131\u015fmaktad\u0131r:<\/p>

      1. T\u00fcm mide k\u00fc\u00e7\u00fcltme \/ obezite ameliyatlar\u0131<\/strong> \u00f6ncelikle midenin g\u0131da alabilme kapasitesini k\u0131s\u0131tlayarak etki g\u00f6stermektedir. Bu etkiye t\u0131pta \u201crestriktif \u201d yani \u201ck\u0131s\u0131tlay\u0131c\u0131\u201d etki denir ve t\u00fcm bariatrik giri\u015fimlerde g\u0131da alabilme kapasitesinin k\u0131s\u0131tlanmas\u0131 asl\u0131nda ortak bir paydad\u0131r . Bu ameliyatlar\u0131 olan ki\u015filer dolay\u0131s\u0131 ile \u00e7ok az yediklerinde bile derhal doyarlar.<\/li>
      2. Baz\u0131 giri\u015fimler ise (duodenal switch, mide by-pass\u2019\u0131<\/strong> ve \u00e7ok daha az oranda t\u00fcp mide \/ mide k\u00fc\u00e7\u00fcltme ameliyat\u0131), k\u0131s\u0131tlay\u0131c\u0131 etkiye ek olarak bir de al\u0131nan g\u0131dalar\u0131n sindirim sistemi i\u00e7inden ge\u00e7erlerken emilimini de azaltarak ek bir zay\u0131flat\u0131c\u0131 etki yaratabilmektedir. Bu etkiye ise t\u0131pta \u201cmalabsorbtif\u201d yani \u201cemilimi bozucu\u201d etki diyoruz.<\/li>
      3. Zaman\u0131m\u0131zda t\u00fcm d\u00fcnyada en \u00e7ok kullan\u0131lan \u00fc\u00e7 bariatrik giri\u015fim olan \u201cmide k\u00fc\u00e7\u00fcltme \/ t\u00fcp mide\u201d (sleeve gastrectomy) , \u201cmide by pass\u2019\u0131\u201d (gastric by-pass) ve \u201ct\u00fcp mide + ince ba\u011f\u0131rsak by pass\u2019\u0131\u201d (duodenal switch)<\/strong> ameliyatlar\u0131n\u0131n bir de mucizevi taraflar\u0131 vard\u0131r ve bu: ameliyatlar sonras\u0131nda i\u015ftah\u0131n da bariz oranda azalmas\u0131 olarak \u00f6zetlenebilir. \u0130\u015ftah azalmas\u0131 etkisi \u201cg\u0131da al\u0131n\u0131m\u0131n\u0131n k\u0131s\u0131tlanmas\u0131\u201d gibi \u00fc\u00e7 y\u00f6ntemin de ortak \u00f6zelli\u011fidir . Dolay\u0131s\u0131 ile bu ameliyatlar (\u201cmide k\u00fc\u00e7\u00fcltme \/ t\u00fcp mide\u201d (sleeve gastrectomy) , \u201cmide by pass\u2019\u0131\u201d (gastric by-pass) ve \u201ct\u00fcp mide + ince ba\u011f\u0131rsak by pass\u2019\u0131\u201d (duodenal switch)) olunduktan sonra kar\u015f\u0131m\u0131zda istese de yiyemeyen de\u011fil, zaten \u00e7ok yemek istemeyen, az\u0131c\u0131k yiyince doyan ki\u015filer olmaktad\u0131r ve rahat kilo kaybedebilmek ad\u0131na bu i\u015ftahtaki azalma paha bi\u00e7ilmez \u00f6nemdedir. Di\u011fer bir de\u011fi\u015fle hastalar \u201ca\u015f ererek\u201d ya da iradelerini zorlay\u0131p yemeyerek de\u011fil, zaten yemek yeme d\u00fcrt\u00fcs\u00fc azalarak ve rahat bi\u00e7imde az yiyerek kilo verirler.<\/li>

      4. \u0130\u015ftahtaki bu azalmay\u0131 mucizevi bir etki olarak yorumlamam\u0131za ek olarak bunun bilimsel temelinden de k\u0131saca bahsetmek yerinde olacakt\u0131r. Mide by-pass<\/strong>\u2019\u0131nda midenin fundus b\u00f6l\u00fcm\u00fc tamamen devre d\u0131\u015f\u0131 b\u0131rak\u0131ld\u0131\u011f\u0131, \u201cmide k\u00fc\u00e7\u00fcltme<\/strong> \/ t\u00fcp mide<\/strong>\u201d ve \u201cduodenal switch<\/strong>\u201d ameliyatlar\u0131 sonras\u0131nda ise midenin fundus b\u00f6l\u00fcm\u00fc tamamen \u00e7\u0131kart\u0131ld\u0131\u011f\u0131 i\u00e7in normal insanlarda midenin \u201cfundus\u201d b\u00f6l\u00fcm\u00fcnden salg\u0131lanan GHREL\u0130N hormonu bu ameliyatlardan sonra \u201ckanda\u201d \u00e7ok d\u00fc\u015f\u00fck seviyelere inmektedir. GHREL\u0130N insano\u011flundaki i\u015ftah\u0131 yaratan hormondur ve kanda azalmas\u0131 i\u015ftahtaki kaybolman\u0131n nedenidir. Yani asl\u0131nda i\u015ftah azalmas\u0131 ger\u00e7ek anlamda bir mucize olmay\u0131p asl\u0131nda bir bilimsel nedeni vard\u0131r. Bu etki fundusun yerinde b\u0131rak\u0131ld\u0131\u011f\u0131 kelep\u00e7e giri\u015fimden sonra ise tabiki g\u00f6zlenmemektedir!!<\/strong><\/p><\/div><\/div>

        A\u015f\u0131r\u0131 \u015fi\u015fmanl\u0131k bir salg\u0131n hastal\u0131k. Ama 40 y\u0131l \u00f6nce oldu\u011fu gibi bu ki\u015filer art\u0131k kaderlerine mahkum de\u011filller. \u015ei\u015fmanl\u0131\u011f\u0131 giderici ameliyatlar olarak tan\u0131mlayabilece\u011fimiz \u201cbariatrik\u201d cerrahi sayesinde morbid obezler art\u0131k 10-15 y\u0131l kadar daha uzun ve kaliteli ya\u015fayabilmekteler.<\/p><\/div><\/div><\/li><\/ol>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t

        \n\t\t\t\t\t
        \u015ei\u015fmanl\u0131k \/ Obezite Cerrahisinde Kullan\u0131lan T\u00fcm Y\u00f6ntemler Nelerdir?<\/h5>\t\t\t\t<\/div>\n\t\t\t\t
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        1. Mide band\u0131 (Kelep\u00e7e) y\u00f6ntemi:<\/strong> Laparoskopik (kapal\u0131) olarak mide giri\u015fine mide band\u0131 tak\u0131lmas\u0131n\u0131 i\u00e7eren ancak kullan\u0131m\u0131 giderek azalan ve neredeyse terk edilmek \u00fczere olan bir giri\u015fimdir. Merkezimizde bu y\u00f6ntem y\u0131llard\u0131r kullan\u0131lmamaktad\u0131r.<\/li>
        2. T\u00fcp mide veya mide k\u00fc\u00e7\u00fcltme ameliyat\u0131:<\/strong> T\u00fcm d\u00fcnya merkezlerinin ve bizim de en \u00e7ok kulland\u0131\u011f\u0131m\u0131z ve t\u0131pta \u201csleeve gastrectomy\u201d olarak bilinen laparoskopik (kapal\u0131) bir ameliyatt\u0131r.<\/li>
        3. Mide by-pass\u2019\u0131 ameliyat\u0131:<\/strong> En uzun d\u00f6nem sonu\u00e7lar\u0131 elimizde olan ve t\u0131pta \u201cRoux-en-Y gastric by-pass\u201d olarak bilinen laparoskopik (kapal\u0131) bir ameliyatt\u0131r.<\/li>
        4. T\u00fcp mide + \u0130nce ba\u011f\u0131rsak by-pass\u2019\u0131 ameliyat\u0131:<\/strong> T\u0131pta \u201cduodenal switch\u201d olarak bilinen ve \u201ct\u00fcp mide\u201d giri\u015fimine ek olarak oniki parmak ba\u011f\u0131rsa\u011f\u0131 (duodenum) \u2018 n\u0131 da i\u00e7erecek \u015fekilde t\u00fcm ince ba\u011f\u0131rsa\u011f\u0131n 4\/5 \u2018lik b\u00f6l\u00fcm\u00fcn\u00fcn tamam\u0131n\u0131n da by-pass\u2019lanarak devre d\u0131\u015f\u0131 b\u0131rak\u0131ld\u0131\u011f\u0131 laparoskopik (kapal\u0131) bir giri\u015fimdir. \u201cDuodenal switch\u201d baz\u0131 \u00f6zel durumlarda \u00e7ok etkin olan ve yap\u0131lma s\u0131kl\u0131\u011f\u0131 giderek artan bir giri\u015fimdir.<\/li>
        5. Midenin bir b\u00f6l\u00fcm\u00fcn\u00fcn \u00e7\u0131kar\u0131lmadan \u201cplike edilerek\u201d \u00fcst \u00fcste dikilmesi ya da \u201cmini\u201d gastrik by-pass<\/strong> gibi asl\u0131nda ba\u015fka y\u00f6ntemler de var olmakla birlikte bunlar d\u00fcnya genelinde \u00e7ok kabul g\u00f6ren y\u00f6ntemler de\u011fildirler ve biz de bunlar\u0131 kullanmamaktay\u0131z.<\/li><\/ol>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t
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          Bant Y\u00f6ntemi (Lap. Band).<\/h5>\t\t\t\t<\/div>\n\t\t\t\t
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          Halk aras\u0131nda \u201ckelep\u00e7e\u201d y\u00f6ntemi olarak bilinen ve mide giri\u015fine laparoskopik olarak \u015fi\u015firilebilir bir mide band\u0131 tak\u0131lmas\u0131n\u0131 i\u00e7eren, art\u0131k pop\u00fclaritesini h\u0131zla kaybetmekte olan en ilkel laparoskopik \u015fi\u015fmanl\u0131k \/ obezite cerrahisi\u00a0<\/strong>y\u00f6ntemidir. G\u0131da al\u0131n\u0131m\u0131n\u0131 k\u0131s\u0131tlayarak ve erken doyma yaratarak etkili olur ve bu da kilo kayb\u0131 ile sonu\u00e7lan\u0131r. Ancak \u201cmaalesef\u201d \u0130\u015eTAH hi\u00e7bir zaman tam anlam\u0131 ile azalmaz. Bu y\u00f6ntemin olumlu taraf\u0131 mide band\u0131 tak\u0131lmas\u0131 i\u015fleminin riskinin, yani cerrahi riskin \u00e7ok az olu\u015fu, h\u0131zl\u0131 bir \u015fekilde yap\u0131labilmesi ve geri d\u00f6n\u00fc\u015f\u00fc m\u00fcmk\u00fcn bir giri\u015fim olmas\u0131ndan kaynaklanmaktad\u0131r. Yani \u00f6nceden hi\u00e7bir giri\u015fimde bulunulmam\u0131\u015f bir morbid obeze laparoskopik mide band\u0131 takma durumunda deneyimli ellerde hastan\u0131n o ameliyat i\u00e7in ald\u0131\u011f\u0131 \u00f6l\u00fcmc\u00fcl risk % 0.1\u2019den d\u00fc\u015f\u00fckt\u00fcr. \u00d6te yandan bu mide band\u0131lar 15 y\u0131l kadar \u00f6nce ilk \u00e7\u0131kt\u0131\u011f\u0131nda ortaya \u00e7\u0131kan olumlu hava son 10 y\u0131ld\u0131r giderek de\u011fi\u015fmi\u015ftir ve neredeyse mide band\u0131 y\u00f6ntemi \u00e7ok s\u0131n\u0131rl\u0131 bir hasta gurubunun d\u0131\u015f\u0131nda terk edilmek \u00fczeredir. Mide band\u0131 daha pratik ve geri d\u00f6n\u00fc\u015fl\u00fc g\u00f6z\u00fckmesine kar\u015f\u0131n uzun d\u00f6nem takiplerde hi\u00e7 de sorunsuz olmad\u0131\u011f\u0131 g\u00f6r\u00fclm\u00fc\u015ft\u00fcr. Bu konuda en deneyimli Bel\u00e7ika\u2019l\u0131 cerrahlar\u0131n 12 y\u0131ll\u0131k takiplerinde %50 ba\u015far\u0131s\u0131zl\u0131k bildirmeleri bu tekni\u011fe olan g\u00fcvenin ciddi bi\u00e7imde sorgulanmas\u0131na yol a\u00e7m\u0131\u015ft\u0131r.<\/p>

          Bunun da asl\u0131nda iki nedeni vard\u0131r.<\/p>

          Birincisi; ameliyat sonras\u0131nda olu\u015fan kilo kayb\u0131 etkisinin uzun d\u00f6nemde devam etmemesi ve hastalar\u0131n tekrar kilo almalar\u0131 ve tekrar kilo alma miktar\u0131n\u0131n da kabul edilemeyecek d\u00fczeyde olu\u015fudur. Bant tak\u0131ld\u0131ktan 10 y\u0131l sonra ba\u015far\u0131 ile kilo verme durumu malesef hastalar\u0131n % 20\u2019sinden az\u0131nda g\u00f6zlenmektedir. Bant y\u00f6ntemine ait \u00e7ok \u00f6nemli ilk problem bu giri\u015fimin i\u015ftah azalt\u0131c\u0131 etkisinin \u00f6n planda olmamas\u0131ndan kaynaklanmaktad\u0131r. G\u0131da al\u0131n\u0131m\u0131 k\u0131s\u0131tlanmas\u0131na ve az yemekle doyma hissi k\u0131sa s\u00fcreli\u011fine olu\u015fmas\u0131na kar\u015f\u0131n bant tak\u0131lm\u0131\u015f ki\u015filer s\u00fcrekli ac\u0131kmaya devam ederler ve a\u015f erme durumu devam etti\u011finden band\u0131 kand\u0131rman\u0131n yollar\u0131n\u0131 arar ve bunu da s\u0131kl\u0131kla ba\u015far\u0131rlar.<\/p>

          \u0130kincisi ise tak\u0131lan bantlar\u0131n neredeyse % 40\u2019lara varan oranda uzun d\u00f6nemde birtak\u0131m ciddi, hatta hayati komplikasyonlara yol a\u00e7arak tekrar ameliyatla \u00e7\u0131kart\u0131lmalar\u0131na gerek olmas\u0131d\u0131r. Bu ikinci durum \u00f6nceden tabiki bilinmiyordu ve ne yaz\u0131k ki binlerce bant geri \u00e7\u0131kart\u0131lmak zorunda kal\u0131nd\u0131 y\u0131llar i\u00e7erisinde. Dolay\u0131s\u0131 ile zaman\u0131n testine tabi tutuldu\u011funda, bant y\u00f6nteminin asl\u0131nda ilk tak\u0131ld\u0131\u011f\u0131 ameliyat esnas\u0131nda y\u00fcksek bir risk i\u00e7ermemesine kar\u015f\u0131n, uzun d\u00f6nemde \u00e7ok ciddi hatta ya\u015fam\u0131 etkileyebilecek d\u00fczeyde komplikasyonlara yol a\u00e7abildi\u011fi ger\u00e7e\u011fi ortaya \u00e7\u0131km\u0131\u015ft\u0131r. Bunlar\u0131n ba\u015f\u0131nda da t\u0131pta \u201cbant kaymas\u0131, erozyonu ya da migrasyonu\u201d olarak bilinen ve tak\u0131lan band\u0131n mide ya da yutma borusu i\u00e7ine do\u011fru dokular\u0131 keserek ilerlemesi gelmektedir.<\/p>

          Bant y\u00f6ntemi i\u015fte bu nedenlerle t\u00fcm d\u00fcnya obezite uzmanlar\u0131nca giderek azalan oranda ya da hi\u00e7 kullan\u0131lmamaktad\u0131r. Biz ise bant\u0131 sadece di\u011fer ameliyatlar\u0131 kategorik olarak red eden, mutlaka geri d\u00f6n\u00fc\u015f\u00fcml\u00fc bir metodu tercih eden ve t\u00fcm komplikasyon ve uzun d\u00f6nemdeki ba\u015far\u0131s\u0131zl\u0131k oranlar\u0131 konusunda bildirim yap\u0131lmas\u0131na kar\u015f\u0131n tak\u0131lmas\u0131na yaz\u0131l\u0131 olarak onay veren hastalarda kullanmak e\u011filimindeyiz. Bunun d\u0131\u015f\u0131nda bizim de terk etti\u011fimiz bir y\u00f6ntemdir.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

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          \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\"\"\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t
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          Ameliyat<\/strong>, size tek ba\u015f\u0131n\u0131za ba\u015faramayaca\u011f\u0131n\u0131z kilo hedefinize ula\u015fmaya yard\u0131m ediyor.<\/p>

          Bu ba\u015far\u0131y\u0131, sa\u011fl\u0131kl\u0131 bir \u015fekilde s\u00fcrd\u00fcrebilmenizde profesyonel ekibimiz<\/em><\/strong>, size \u00f6m\u00fcr boyu destek<\/strong> sunuyor.<\/p>

          Amac\u0131m\u0131z; sizi her daim sa\u011fl\u0131kl\u0131, mutlu<\/strong> ve fit<\/strong> g\u00f6rmek.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"

          Obezite Cerrahisi Nedir? Obezite Cerrahisinin Faydalar\u0131 \u2013 T\u0131ptaki A Kan\u0131t\u0131. Obezite cerrahisi morbid obeziteyi gidermek amac\u0131 ile yap\u0131lan cerrahi m\u00fcdahalelerin tamam\u0131na verilen isimdir ve t\u0131pta \u201cbariatrik [\u2026]<\/span><\/p>\n","protected":false},"author":1,"featured_media":0,"parent":479,"menu_order":0,"comment_status":"open","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-481","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/mehmetaliyerdel.com\/index.php?rest_route=\/wp\/v2\/pages\/481","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/mehmetaliyerdel.com\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/mehmetaliyerdel.com\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/mehmetaliyerdel.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/mehmetaliyerdel.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=481"}],"version-history":[{"count":0,"href":"https:\/\/mehmetaliyerdel.com\/index.php?rest_route=\/wp\/v2\/pages\/481\/revisions"}],"up":[{"embeddable":true,"href":"https:\/\/mehmetaliyerdel.com\/index.php?rest_route=\/wp\/v2\/pages\/479"}],"wp:attachment":[{"href":"https:\/\/mehmetaliyerdel.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=481"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}