FAQ

In the field of medicine, every surgical intervention naturally carries some risk. However, contrary to popular belief, the risks of obesity surgery are not very different from other abdominal surgeries. The risk of mortality associated with obesity surgeries is 0.1%. Other procedure-specific complications include bleeding (2%), leakage from the line where the stomach is cut (1–2%), and blood clot formation in the leg veins (0.1%). The most important parameter in minimizing these complication rates is the experience of the surgical team. It should be remembered that the risk of obesity surgery is much lower compared to the risks posed by being morbidly obese.

Today, obesity surgeries are performed using video-laparoscopic technology, commonly known as keyhole or laparoscopic surgery. This means the procedure is carried out using special instruments through 5–6 small incisions of just a few millimeters. Therefore, postoperative pain is significantly less compared to surgeries with large abdominal incisions. Pain typically lasts only the first night after surgery and can be easily controlled with IV medication. Most of our patients do not need painkillers after the second day.

Postoperative nutrition follows a staged approach that transitions from clear liquids to solid foods. Roughly speaking: for the first week, you may consume clear liquids in which you can see the bottom of the glass (water, fruit juice, herbal teas, broth-based soups, diluted ayran, etc.). In the second week, you can have thicker soups and drinks. In the third week, you can consume puréed foods (vegetable purées, fish, soft cheese, etc.), and in the fourth week, you move on to solid foods. After the first month, in our clinic, we provide each patient with customized dietary programs under the supervision of our dietitians, taking into account the patient’s taste preferences and eating habits.

None of these conditions pose an obstacle for surgery. On the contrary, it should be understood that after surgery, one can almost completely be freed from these diseases. Depending on the duration and severity of type 2 diabetes, it can improve by 70–95%. Hypertension improves by 50–90%, and sleep apnea by 90–99%.

In our facility, we routinely perform comprehensive blood tests, cardiology, pulmonary medicine, and anesthesia examinations, along with a pulmonary function test and an echocardiogram, evaluated by specialists. Where necessary, our specialist psychologist evaluates patients for surgical preparation. This is carried out meticulously to ensure the patient can safely undergo general anesthesia.

For patients planning pregnancy after surgery, this period is at least 12 months.

After surgery, we place a drain to check for bleeding, and you can shower at least one hour after this drain is removed. Before showering, a waterproof bandage is applied over your stitches. The water you use shouldn’t be very hot; it should be lukewarm. After you are discharged, for your first bath at home, you should again use a waterproof bandage to cover your stitches. For subsequent showers, there is no need to cover the stitches.

With the minimally invasive laparoscopic approach, recovery is quite fast. When you are discharged from the hospital, you can easily return to your normal life, but you must pay attention to certain points related to the surgical procedure. First, once discharged, you can handle your basic personal needs on your own and continue most of your daily activities. However, we advise against overexerting yourself in the first 10 days. For example, do not lift heavy objects during this period. If you have a child, do not lift them for about 15 days. Generally, we advise not lifting anything heavier than 4 kg in those 10 days. For homemakers, you may perform your usual daily household tasks. For those with desk jobs or roles that do not require significant physical effort, you can typically return to work starting from day 7, which is when you have adapted to your liquid diet. In some cases, our patients returned to work on days 4 or 5, depending on how they felt. If your job involves physical exertion, we recommend 10 days of rest. Sexual activity is permitted after day 15.

Your first check-up will be in the first month after surgery. During that check-up, you should bring the results of the blood tests we requested. We will maintain regular telephone communication with you during this first month, and you’ll be contacted by our dietitian and nurse. Because this type of surgery is not doctor-dependent, we do not make a one-month follow-up visit mandatory for patients coming from out of town; instead, we ask you to send us your lab test results. After that, you should have check-ups every three months. At months 1, 3, 6, 9, and 12, you will have blood tests and come in for follow-up. After the first year, you should repeat these blood tests once a year.

After discharge, we recommend daily walks for at least 20 minutes. You can begin swimming on day 15, although we suggest waiting until day 45 for more active or normal swimming. Swimming on your back is particularly beneficial for maintaining good posture during weight loss. You can start gym exercises like fitness, cardio, or Pilates after day 45.

During Ramadan, fasting can be challenging, especially during the first year post-bariatric surgery, and it can be even more difficult in hot, long summer days. Many bariatric procedures greatly reduce the amount of food and fluids that can be consumed at one time, meaning patients are advised to drink small amounts of fluid throughout the day. During long summer days, fasting exposes patients to the risk of dehydration. At the time of breaking the fast (iftar), the heightened appetite after a long period of hunger can prompt attempting to consume as much food and fluid as possible in a short time, potentially causing vomiting, worsening dehydration, and leading to inadequate nutrition. A study conducted in Kuwait, involving telephone follow-ups between July 20 and August 19, 2012, compared the amount of food and fluid intake during Ramadan among 230 patients (207 sleeve, 13 gastric bypass, 7 gastric band) with a normal four-week, non-fasting period after Ramadan. Interestingly, there was no difference in total fluid intake between the two periods, but during Ramadan they consumed 18% fewer calories and 41% less protein. The group that published this study stressed that one should be especially cautious with patients who have diabetes or who have undergone a malabsorptive procedure such as a duodenal switch, particularly during the long summer days. In conclusion, although there is no definitive evidence-based study in this area, clinical experience suggests that especially during the first few months following obesity surgery, patients should avoid fasting. For patients with diabetes or who have had malabsorptive procedures like duodenal switch, it is recommended they do not fast for at least 12–18 months.

After surgery, you will be prescribed a medication to suppress stomach acid, which should be used for 3 months. After a sleeve gastrectomy, your blood tests will be monitored at regular intervals for 1 year, and additional support will be provided if needed. Following malabsorptive surgeries such as gastric bypass and duodenal switch, lifelong vitamin-mineral supplementation is required.

The patient’s age, the rate of weight loss, and engaging in regular exercise can influence whether or not there will be excess skin after bariatric surgery. Exercising regularly post-surgery is the most crucial factor in preventing possible skin sagging during the weight loss process. We recommend that our patients practice gym workouts or swimming for at least 45 minutes, 4–5 days a week (see “Post-Surgery Exercise”). In our experience, those under 45 years old who regularly exercise during their weight loss process rarely experience skin sagging severe enough to necessitate plastic surgery.

Between the 6th and 9th months after surgery, some degree of hair loss may occur. It is generally believed to be related to trace element and vitamin deficiencies. Studies show that the hair root portion remains intact, with the hair breaking off closer to the base. The body interprets weight loss as a period of energy conservation, reducing the distribution of minerals and vitamins to hair. Because the hair roots remain healthy, this hair loss is 100% temporary and usually subsides after the 9th month.

The decision depends entirely on the experience of the surgical team and certain patient characteristics. Therefore, while a sleeve gastrectomy may be the preferred procedure for some patients, gastric bypass may be the first option for others. In some very obese patients (BMI over 50, or “super-obese”), a gastric balloon or short-term diets may be recommended prior to laparoscopic bariatric intervention. Does the patient have diabetes, and if so, how severe is it? Are there complications due to diabetes? Are there any psychological eating disorders, and to what extent? How is the abdomen observed on examination? Does the fat distribution shift and flatten when the patient lies down, or does the abdomen remain distended? Experienced bariatric teams take all these factors into account, provide thorough information to the patient, and select the type of surgery through active communication with the patient.

About 20–25% of our patients come from outside the city or from abroad. The pre-surgery examinations (see “Before Surgery”) can be completed in about 2–3 hours with the assistance of a nurse from our team. Consequently, arriving one day early is sufficient. Two hours of flight is possible on the 5th day post-surgery. For patients coming from abroad, we recommend waiting until day 7 to return.

The weight loss process following bariatric surgery takes about 12–18 months, with the fastest progress occurring in the first 6 months. Depending on the type of surgery, an average of 60–80% of excess weight is lost. For example, if someone should ideally weigh 70 kg but weighs 170, that person has 100 kg of excess weight. Within 12–18 months after the operation, around 70 kg of weight loss is anticipated. If less than 50% of excess weight is lost, this is considered a surgical failure, and a revision surgery may be planned.

My journey in obesity surgery began in 2009 upon a recommendation by Prof. Dr. Mehmet Ali Yerdel for me to visit Prof. Dr. Koray Tekin at Denizli Pamukkale University. At that time, I was working in a center heavily involved in laparoscopic upper GI surgeries (reflux, achalasia, endoscopic GI procedures), and my interest in obesity surgery grew significantly. Together with Prof. Dr. Koray Tekin, we performed about 600 bariatric surgeries. Later, in the United States, I worked on revision bariatric surgery and duodenal switch operations with Dr. Mitchell Roslin, a global expert in obesity surgery. Since 2013, I have been practicing independently in Istanbul. My friendship with Dr. Koray Tekin continues in Istanbul, where we still perform all our operations together.