{"id":507,"date":"2024-03-01T19:14:25","date_gmt":"2024-03-01T19:14:25","guid":{"rendered":"https:\/\/istanbulbariatrics.com.tr\/?page_id=507"},"modified":"2024-03-01T19:14:25","modified_gmt":"2024-03-01T19:14:25","slug":"mide-by-pass-ameliyati","status":"publish","type":"page","link":"https:\/\/mehmetaliyerdel.com\/?page_id=507","title":{"rendered":"Mide By-Pass Ameliyat\u0131"},"content":{"rendered":"\t\t
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Mide By-Pass<\/span> Ameliyat\u0131<\/h1>\t\t\t\t<\/div>\n\t\t\t\t
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Bu tarz \u201cprimer\u201d morbid obezlerin tedavisinde ilk ameliyat se\u00e7ene\u011fi olarak mide by-pass\u2019\u0131 y\u00f6ntemleri sadece ileri derecede \u015fi\u015fmanl\u0131k durumlar\u0131nda (VK\u0130>60 \u2013 \u201csuper super obezite\u201d) veya tip 2 \u015feker hastal\u0131\u011f\u0131n\u0131n \u00e7ok \u00f6n planda ve \u201ceski\u201d olup art\u0131k uzun s\u00fcredir \u201cins\u00fclin\u201d kullanmak zorunda olan hastalarda tercih edilebilirler.<\/blockquote><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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By-pass Ne Demek?<\/h4>\t\t\t\t<\/div>\n\t\t\t\t
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By \u2013 pass<\/strong> genel anlamda; \u201cnormal ileti yolu \u00fcst\u00fcndeki bir b\u00f6l\u00fcm\u00fcn (oraya u\u011framadan) atlanarak ge\u00e7ilmesi\u201d ve bu sayede devaml\u0131l\u0131\u011f\u0131n sa\u011flanmas\u0131 demektir.<\/p>

Morbid obezite, yani v\u00fccut kitle indeksinin<\/strong> 40\u2019\u0131n \u00fcst\u00fcnde olmas\u0131 durumu zaman\u0131m\u0131z\u0131n en s\u0131k ve \u00f6l\u00fcmc\u00fcl hastal\u0131klar\u0131n\u0131n ba\u015f\u0131nda gelmektedir. \u0130yi haber; bariatrik cerrahi yani \u015fi\u015fmanl\u0131\u011f\u0131 giderici \u201ckapal\u0131\u201d ameliyatlar sayesinde bu denli \u015fi\u015fman olanlar\u0131n yeniden sa\u011fl\u0131klar\u0131na kavu\u015fmalar\u0131n\u0131n m\u00fcmk\u00fcn olabilmesidir.<\/p>

Trafi\u011fin s\u0131k\u0131\u015ft\u0131\u011f\u0131 bir kav\u015fak\/yol, bozuk bir elektrik devresi, t\u0131kal\u0131 bir damar ya da g\u0131dalar\u0131n ge\u00e7memesi istenen bir ba\u011f\u0131rsak b\u00f6l\u00fcm\u00fc by-pass y\u00f6ntemi ile atlanarak; trafi\u011fin , elektri\u011fin, kan\u2019\u0131n veya sindirim i\u00e7eri\u011finin istenmeyen b\u00f6l\u00fcme u\u011framadan ileri ge\u00e7i\u015fi ve dolay\u0131s\u0131 ile \u201cdevaml\u0131l\u0131k\u201d rahatl\u0131kla sa\u011flanabilir.<\/p>

\u00a0<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t

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Mide By-Pass\u2019\u0131 Nedir?<\/h4>\t\t\t\t<\/div>\n\t\t\t\t
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\u015ei\u015fmanl\u0131k cerrahisinde<\/strong> \u201cmide by-pass<\/strong>\u2019<\/strong>\u0131\u201d<\/strong> y\u00f6ntemlerinden bahsetti\u011fimizde ise;\u00a0midenin k\u00fc\u00e7\u00fclt\u00fclmesine<\/strong> ek olarak; ince ba\u011f\u0131rsa\u011f\u0131n en az 1 metrelik en \u00fcstteki (mideye yak\u0131n) k\u0131sm\u0131n\u0131n cerrahi y\u00f6ntemle atlanarak devre d\u0131\u015f\u0131 b\u0131rak\u0131lmas\u0131 s\u00f6z konusudur. Bu sayede mide k\u00fc\u00e7\u00fcltmenin<\/strong> g\u0131da al\u0131n\u0131m\u0131n\u0131 k\u0131s\u0131tlay\u0131c\u0131 etkisine ek olarak, al\u0131nan g\u0131dalar\u0131n emiliminde de azalma sa\u011flan\u0131r ve bu da kilo verdirici bir etki yarat\u0131r. Ayr\u0131ca; atlanarak devre d\u0131\u015f\u0131 b\u0131rak\u0131lan ince ba\u011f\u0131rsak baz\u0131 hormonal etkiler yaratarak tip II \u015feker hastal\u0131\u011f\u0131n\u0131n tedavisine de ek ve \u201cart\u0131\u201d bir fayda sa\u011flayabilmektedir.<\/p>

\u00d6te yandan mide by-pass<\/strong>\u2019<\/strong>\u0131<\/strong> giri\u015fimleri standart \u201ct\u00fcp mide \/ mide k\u00fc\u00e7\u00fcltme\u201d ameliyat\u0131na<\/strong> oranla daha zor, zaman al\u0131c\u0131 ve biraz daha risklidir. Ayr\u0131ca al\u0131nan g\u0131dalar\u0131n \u00fcst sindirim sistemine u\u011framamas\u0131 neticesinde; ba\u015fta kalsiyum (Ca), demir (Fe) olmak \u00fczere baz\u0131 mineral ve vitamin eksiklikleri daha s\u0131k g\u00f6zlenir. Bu nedenle mide by-pass<\/strong>\u2019<\/strong>\u0131<\/strong> giri\u015fimleri sonras\u0131nda hastalar daha yak\u0131n takibe al\u0131nmal\u0131d\u0131r ve s\u0131kl\u0131kla t\u00fcm hastalar \u00f6m\u00fcrleri boyunca ek mineral ve vitamin almak zorunda kal\u0131rlar.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t

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Mide By-Pass\u2019\u0131 Ameliyat\u0131 Kimin \u0130\u00e7in Uygundur?<\/h4>\t\t\t\t<\/div>\n\t\t\t\t
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Mide by-pass<\/strong>\u2019<\/strong>\u0131<\/strong> giri\u015fimleri art\u0131 ve eksileri ile de olsa; baz\u0131 \u00f6zel morbid obezite<\/strong> olgular\u0131nda halen paha bi\u00e7ilmez y\u00f6ntemler olarak kullan\u0131lmaya devam etmektedir. Ne var ki; bir morbid obezite hastas\u0131na \u015fi\u015fmanl\u0131\u011f\u0131 giderici ilk giri\u015fim olarak uygulanma s\u0131kl\u0131klar\u0131 giderek azalmaktad\u0131r.<\/p>

Bu tarz \u201cprimer\u201d morbid obezlerin tedavisinde ilk ameliyat se\u00e7ene\u011fi olarak mide by-pass<\/strong>\u2019<\/strong>\u0131<\/strong> y\u00f6ntemleri sadece ileri derecede \u015fi\u015fmanl\u0131k durumlar\u0131nda (VK\u0130<\/strong>>60 \u2013 \u201csuper super obezite\u201d) veya tip 2 \u015feker hastal\u0131\u011f\u0131n\u0131n \u00e7ok \u00f6n planda ve \u201ceski\u201d olup art\u0131k uzun s\u00fcredir \u201cins\u00fclin\u201d kullanmak zorunda olan hastalarda tercih edilebilirler.<\/p>

\u00d6nceden t\u00fcp mide \/ mide k\u00fc\u00e7\u00fcltme ameliyat\u0131\u00a0<\/strong>olup y\u0131llar sonra yeniden kilo al\u0131p tekrar morbid obez olan hastalara ikinci bir \u015fans verebilmek ad\u0131na ise \u201cmide by-pass\u201d\u0131 HAYAT\u0130 \u00d6NEM\u0130<\/strong> olan bir giri\u015fimdir. \u00d6zetle \u201cre-do\u201d yani tekrar ameliyat s\u00f6z konusu oldu\u011funda by-pass y\u00f6ntemleri hastalar\u0131n TEK tedavi se\u00e7ene\u011fi olmaktad\u0131r. \u00c7\u00fcnk\u00fc t\u00fcp mide giri\u015fimi by-pass\u2019a kolayl\u0131kla \u00e7evrilebilir ancak bunun tersi do\u011fru de\u011fildir. Di\u011fer bir deyi\u015fle; ilk ameliyat olarak by-pass uygulanm\u0131\u015f birine ileriki y\u0131llarda bir ba\u015fka giri\u015fim uygulamak neredeyse imkans\u0131z iken, ilk ameliyat\u0131n t\u00fcp mide olmas\u0131 durumunda bunun by-pass\u2019a \u00e7evrilmesi rahatl\u0131kla olas\u0131d\u0131r.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t

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Mide By-Pass\u2019\u0131 Ameliyat\u0131 (Gastric By-Pass) Nedir?<\/h4>\t\t\t\t<\/div>\n\t\t\t\t
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Hem g\u0131da al\u0131n\u0131m\u0131n\u0131 k\u0131s\u0131tlay\u0131c\u0131 ve hem de al\u0131nan g\u0131dalar\u0131n emilimini bozucu etki yaratarak, morbid obezite tedavisinde uzun bir d\u00f6nem \u201calt\u0131n standart\u201d olarak kabul edilmi\u015f , laparoskopik yani kapal\u0131 teknikle yap\u0131lan bir giri\u015fimdir. T\u0131pta \u201cRoux-en-Y gastric by-pass\u201d<\/strong> olarak bilinir. \u201cT\u00fcp mide\u201d ameliyat\u0131n\u0131n<\/strong> giderek yayg\u0131nla\u015ft\u0131\u011f\u0131 zaman\u0131m\u0131zda; \u00f6zellikle komplike olmayan primer morbid obezitenin tedavisinde mide by-pass\u2019\u0131<\/strong> uygulanma s\u0131kl\u0131\u011f\u0131 giderek azalm\u0131\u015ft\u0131r.<\/p>

Bu ameliyat obeziteye t\u00fcm mekanizmalarla birden etki ederek , \u201ci\u015ftah\u201d \u2018\u0131n da bariz bi\u00e7imde ortadan kalkmas\u0131 ile hastan\u0131n s\u00fcratle kilo vermesini sa\u011flayabilir. Kilo verme durumunun devaml\u0131l\u0131\u011f\u0131, yani uzun d\u00f6nem ba\u015far\u0131 a\u00e7\u0131s\u0131ndan en etkin y\u00f6ntemlerdendir. G\u00fcncel \u00e7al\u0131\u015fmalar g\u00f6steriyor ki; uzun d\u00f6nem takip edilen hastalarda mide by-pass y\u00f6nteminin Tip II \u015feker hastal\u0131\u011f\u0131 ve verilmi\u015f kilolar\u0131n korunmas\u0131nda t\u00fcp mide ameliyat\u0131 ile etkinli\u011fi benzerdir. Bu sebeple kronik bir hastal\u0131k kabul edilen ve ameliyatl\u0131 tedavilere ra\u011fmen tekrarlama riski olan morbid obezitenin tedavisinde ilk etap ameliyat olarak mide by-pass ameliyat\u0131n\u0131n kullan\u0131lmas\u0131 giderek azalmaktad\u0131r.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t

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Mide By-Pass\u2019\u0131 Ameliyat\u0131n\u0131n Cerrahi Tekni\u011fi.<\/h4>\t\t\t\t<\/div>\n\t\t\t\t
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Mide by-pass\u2019\u0131 ameliyat\u0131nda yap\u0131lan \u015fudur: \u00d6ncelikle mide; yutma borusu ile birle\u015fti\u011fi en \u00fcst b\u00f6l\u00fcm\u00fcnden yutma borusu taraf\u0131nda ufak bir mide k\u0131sm\u0131 (t\u00fcm midenin % 5-10\u2019u) b\u0131rak\u0131lacak \u015fekilde kapat\u0131l\u0131p kesilerek ayr\u0131l\u0131r. Bu ameliyatta midenin herhangi bir b\u00f6l\u00fcm\u00fc \u201ct\u00fcp mide\u201d ameliyat\u0131n\u0131n aksine \u00e7\u0131kart\u0131lmaz ve yerinde b\u0131rak\u0131l\u0131r. \u0130kinci a\u015fama ise by-pass a\u015famas\u0131d\u0131r. Bu etapta \u00f6ncelikle ince ba\u011f\u0131rsak belli uzakl\u0131ktan enine olarak kesilip her iki ucu kapat\u0131larak ayr\u0131l\u0131r. Bu iki u\u00e7tan a\u015fa\u011f\u0131da olan\u0131 yukar\u0131 \u00e7ekilerek yutma borusu taraf\u0131nda kalan ufak mide par\u00e7as\u0131na \u00f6zel baz\u0131 tekniklerle a\u011f\u0131zla\u015ft\u0131r\u0131larak birle\u015ftirilir. Son a\u015famada ise kesilmi\u015f olan ince ba\u011f\u0131rsa\u011f\u0131n \u00fcst ucu belli bir uzakl\u0131kta yeniden ince ba\u011f\u0131rsa\u011fa birle\u015ftirilerek a\u011f\u0131zla\u015ft\u0131r\u0131l\u0131r ve sindirim sisteminin b\u00fct\u00fcnl\u00fc\u011f\u00fc bu \u015fekilde yeniden sa\u011flanm\u0131\u015f olunur. T\u00fcm bu kesme, ay\u0131rma, birle\u015ftirme ve a\u011f\u0131zla\u015ft\u0131rma i\u015flemleri tamamen ileri teknoloji \u00fcr\u00fcn\u00fc olan, tek kullan\u0131ml\u0131k ve \u201cstapler\u201d olarak bilinen \u00f6zel aletler ile ger\u00e7ekle\u015ftirilmektedir.<\/p>

Bu \u015fekilde midenin neredeyse % 95\u2019lik b\u00f6l\u00fcm\u00fc , on iki parmak ba\u011f\u0131rsa\u011f\u0131 ve ince ba\u011f\u0131rsa\u011f\u0131n ilk 1 metrelik \u00fcst k\u0131sm\u0131 devre d\u0131\u015f\u0131 b\u0131rak\u0131lm\u0131\u015f yani t\u0131bbi anlamda \u201cby-pass\u201d \u2018lanm\u0131\u015f olur. Bu ameliyat\u0131 olan biri yemek yedi\u011fi zaman g\u0131dalar yutma borusu i\u00e7inden midenin ufac\u0131k kalm\u0131\u015f k\u0131sm\u0131na ge\u00e7tiklerinde \u00e7ok k\u0131sa s\u00fcre i\u00e7inde, hatta derhal doygunluk hissi olu\u015fur. \u00c7\u00fcnk\u00fc a\u00e7l\u0131k hissi olu\u015fumu ve yemek yeme arzusu ile ilgili en \u00f6nemli uyaranlar\u0131n ba\u015f\u0131nda midenin bo\u015f ve gerilimsiz olmas\u0131 gelmektedir. Ufac\u0131k kalan mide gelen g\u0131dalarla birdenbire dolup derhal gerilim ve bas\u0131n\u00e7 art\u0131\u015f\u0131 olunca; baz\u0131 hormonlar\u0131n da etkisi ile ki\u015fide yemek yeme arzusu daha ilk lokmadan sonra ciddi bi\u00e7imde frenlenir. Mide by-pass\u2019\u0131 ameliyat\u0131n\u0131n \u201crestriktif\u201d yani g\u0131da al\u0131n\u0131m\u0131n\u0131 k\u0131s\u0131tlay\u0131c\u0131 etkisi bu anlatt\u0131klar\u0131m\u0131zdan kaynaklanmaktad\u0131r.<\/p>

Dahas\u0131, mide by-pass\u2019\u0131 ad\u0131ndan da anla\u015f\u0131labilece\u011fi gibi; al\u0131nan g\u0131dalar\u0131n ufac\u0131k kalm\u0131\u015f mideye ula\u015ft\u0131ktan hemen sonra sindirim sistemin \u00fcst b\u00f6l\u00fcm\u00fcne hi\u00e7 u\u011framadan (yani bu b\u00f6l\u00fcm\u00fc by-pass\u2019layarak), bir anda sindirim sisteminin daha alt b\u00f6l\u00fcmlerine ge\u00e7mesini sa\u011flad\u0131\u011f\u0131ndan ayn\u0131 zamanda \u201cmalabsorbtif\u201d yani g\u0131dalar\u0131n emilimini de azalt\u0131c\u0131 bir y\u00f6ntemdir. Bu da mide by-pass\u2019\u0131n\u0131n zay\u0131flama ad\u0131na ikinci ve ba\u011f\u0131ms\u0131z bir etkisidir.<\/p>

Konuya \u00f6zelle\u015fmi\u015f merkezlerde mide by-pass\u2019\u0131ndan 5 y\u0131l sonra ki\u015filer fazla kilolar\u0131n\u0131n % 65 \u2013 80 \u2019ini halen kaybetmi\u015f olabilirler. Bu ameliyattan 20 y\u0131l sonra yeniden kilo alma oran\u0131 ise % 15\u2019ler d\u00fczeyinde olabilir. Mide by-pass\u2019\u0131 sonras\u0131 uzun d\u00f6nemde ameliyat\u0131n etkisini tamamen kaydedip yeniden morbid obez olabilme olas\u0131l\u0131\u011f\u0131 ise % 1-2 aras\u0131ndad\u0131r. Cerrahi \u00f6l\u00fcmc\u00fcl risk ise % 0.1 \u2013 0.2 civar\u0131nda olabilir.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t

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Mide By-Pass\u2019\u0131n Dezavantajlar\u0131 Var M\u0131?<\/h4>\t\t\t\t<\/div>\n\t\t\t\t
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Bu y\u00f6ntemin en \u00f6nemli dezavantaj\u0131; az bir olas\u0131l\u0131k da olsa y\u0131llar sonra yeniden ciddi kilo al\u0131nmas\u0131 durumunda tekrar yeni bir \u015fi\u015fmanl\u0131k ameliyat\u0131n\u0131n yap\u0131lmas\u0131n\u0131n teknik a\u00e7\u0131dan neredeyse imkans\u0131z olmas\u0131d\u0131r. Ayr\u0131ca; by-pass\u2019lanan ve yerinde b\u0131rak\u0131lan mideye standart endoskopi yap\u0131lmas\u0131n\u0131 olanaks\u0131z k\u0131lmas\u0131, emilim bozuklu\u011fu nedeni ile daha yak\u0131n takip ve birtak\u0131m ek mineral ve vitaminlerin \u00f6m\u00fcr boyu al\u0131nmas\u0131n\u0131 gerektirmesi gibi de dezavantajlar\u0131 vard\u0131r.<\/p>

T\u00fcm bu dezavantajlar\u0131 neticesinde birincil morbid obezite olgular\u0131nda taht\u0131n\u0131 giderek \u201ct\u00fcp mide\u201d ameliyat\u0131na b\u0131rakan \u201cRoux-en-Y gastrik by-pass\u201d ; baz\u0131 komplike olgular\u0131n tedavisinde ve \u00f6zellikle re-do yani tekrar (ikinci) ameliyat durumlar\u0131nda halen ge\u00e7erlili\u011fini korumakt\u0131r.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t

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Mini Gastrik By-Pass.<\/h4>\t\t\t\t<\/div>\n\t\t\t\t
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Son y\u0131llarda pop\u00fcler olan daha basit bir gastrik by-pass giri\u015fimidir. Teknik olarak Roux-en-Y gastrik by-pass \u2018dan daha kolayd\u0131r ancak bire bir ayn\u0131 dezavantajlara sahiptir. Dolay\u0131s\u0131 ile ancak ve ancak tekrar ameliyat durumlar\u0131nda, ya da tip II \u015fekerin \u00e7ok \u00f6n planda oldu\u011fu veya s\u00fcper-s\u00fcper obezite durumlar\u0131nda tercih edilebilmektedir.<\/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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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":"

Mide By-Pass Ameliyat\u0131 Bu tarz \u201cprimer\u201d morbid obezlerin tedavisinde ilk ameliyat se\u00e7ene\u011fi olarak mide by-pass\u2019\u0131 y\u00f6ntemleri sadece ileri derecede \u015fi\u015fmanl\u0131k durumlar\u0131nda (VK\u0130>60 \u2013 \u201csuper super obezite\u201d) [\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-507","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/mehmetaliyerdel.com\/index.php?rest_route=\/wp\/v2\/pages\/507","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=507"}],"version-history":[{"count":0,"href":"https:\/\/mehmetaliyerdel.com\/index.php?rest_route=\/wp\/v2\/pages\/507\/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=507"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}