Dr.Fatih YıldırımGeneral Surgery, Medical Aesthetics & Longevity
Bariatric & Metabolic

Surgery is part of a multidisciplinary journey.

Bariatric procedures such as sleeve gastrectomy and gastric bypass are planned together with nutrition, hormonal assessment and a long-term follow-up programme. Treatment success is assessed on an individual basis.

Conditions Treated

  • Morbid obesity (BMI ≥ 40)
  • BMI 35-40 with comorbidities (diabetes, hypertension, sleep apnoea)
  • Metabolic syndrome
  • Type 2 diabetes (metabolic surgery assessment at an appropriate BMI and in selected cases)
  • Obesity with fatty liver disease

Techniques

Laparoscopic Sleeve Gastrectomy (LSG)

A widely performed minimally invasive procedure in which part of the stomach is removed, leaving a tube-shaped stomach.

Roux-en-Y Gastric Bypass (RYGB)

A metabolic surgery technique in which a new connection is created between the stomach and the small intestine.

SADI-S (Single-Anastomosis Duodeno-Ileal Bypass)

An alternative metabolic procedure considered in selected cases.

Endoscopic Sleeve Gastroplasty (ESG) / Gastric balloon

Temporary endoscopic options that do not require surgery, assessed on an individual basis.

Pre-Treatment Protocol

Preparation and support program for your treatment.

Preparation, IV infusion and micronutrient support protocols planned after physician evaluation. All applications are personalized individually; effectiveness varies from person to person.

NAD+ IV support protocol

NAD+ infusion sessions (loading protocol) planned in the pre-operative period following physician assessment.

Why:

NAD+ is a coenzyme involved in cellular energy metabolism and DNA repair. Approaches aimed at raising NAD+ levels, which decline with age, have been reported to have favourable effects on biomarkers; their potential contribution to metabolic resilience before surgery is under investigation.

Glutathione + alpha-lipoic acid IV

Antioxidant infusion protocol planned with physician approval.

Why:

Antioxidant strategies for managing the oxidative stress that surgery can generate are discussed in the literature. Individual effectiveness varies from person to person.

Vitamin C and B complex

IV/oral micronutrient support in the pre-operative period, as recommended by the physician.

Why:

Vitamin C acts as a cofactor in collagen synthesis. Its role in the wound-healing process has been recognised for many years.

BPC-157 (within a research framework)

BPC-157 is not a licensed medicinal product under German or EU legislation; it is assessed within the framework of international research protocols.

Why:

Preclinical studies have reported effects on tissue healing and gastrointestinal protection; human clinical evidence is limited and regulatory approval processes are ongoing. Any use is planned solely under physician responsibility, with informed consent and within a framework that complies with applicable regulations.

Micronutrient assessment

Testing of B12, folate, iron, vitamin D and B1 (thiamine) levels, and correction of any deficiencies as recommended by the physician.

Why:

Micronutrient deficiencies are common among candidates for bariatric surgery; pre-operative assessment is important for a safe post-operative course.

Liver-shrinking programme

A low-calorie, high-protein nutrition protocol in the pre-operative period.

Why:

Reducing the size of the left lobe of the liver can facilitate access to the surgical field in laparoscopic bariatric surgery.

Multidisciplinary assessment

Consultations with endocrinology, psychiatry and a nutrition specialist.

Why:

The decision for bariatric surgery is not only a surgical one but a process requiring lifelong follow-up; multidisciplinary assessment is recommended.

Treatment Process

Treatment Steps

1

General anaesthesia + positioning

Reverse Trendelenburg position and laparoscopic trocar placement.

2

Gastric dissection

The greater curvature is mobilised and the short gastric vessels are ligated.

3

Stapler application (in LSG)

The stomach is shaped into a tube over a bougie.

4

Leak test and closure

Leak test with methylene blue or air, drainage.

Post-Treatment Protocol

Post-treatment support program.

Care, micronutrient and support protocols applied in line with physician recommendations. Individual recovery times may vary.

Multimodal support protocol

IV hydration, micronutrient support and a controlled mobilisation programme in the post-operative period.

Why:

Contemporary ERAS (Enhanced Recovery After Surgery) approaches report that multimodal protocols support the recovery process.

Anti-inflammatory micronutrient support

Minerals such as magnesium, zinc and selenium, together with antioxidant IV support as recommended by the physician.

Why:

The perioperative role of micronutrients that act as cofactors in immune modulation and tissue repair has been reported.

Collagen, glycine and protein support

Oral collagen and a balanced protein/amino-acid nutrition plan (8-12 weeks).

Why:

The role of collagen substrate support in the regeneration of wound tissue and connective tissue has long been discussed in the literature.

Peptide support assessment (within a research framework)

Peptides such as BPC-157 are assessed within the framework of German/EU legislation and physician responsibility.

Why:

Although preclinical evidence exists, the level of clinical evidence is still limited. Use requires informed consent and physician follow-up.

GLP-1 bridging assessment (selected cases)

GLP-1 receptor agonist treatment planning, with physician approval, in cases where it is considered necessary.

Why:

GLP-1 therapy may be considered as an option during weight plateau phases or periods of metabolic adaptation.

Lifelong micronutrient monitoring

B12, iron, calcium, vitamin D, folate: checked at regular intervals.

Why:

Long-term micronutrient monitoring after bariatric surgery is part of standard care.

Metabolic biomarker assessment (in suitable cases)

Monitoring of inflammatory and metabolic biomarkers according to individual need.

Why:

Monitoring systemic metabolic changes after metabolic surgery can contribute to personalised care planning.

Treatment Journey

Day-by-Day Recovery

−6 weeks

Multidisciplinary assessment

Consultations with endocrinology, psychiatry, a nutrition specialist and cardiology.

−4 weeks

Pre-operative preparation

Micronutrient assessment, nutrition plan, IV support where required.

−2 weeks

Liver-shrinking diet

Low-calorie, high-protein nutrition programme.

Day 0

Operation

Procedure duration varies by case.

Days 1-2

Early mobilisation + liquid diet

Gradual initiation of walking and fluid intake.

Days 2-3

Discharge

Discharge timing varies by case.

Weeks 2-4

Puréed/soft diet phase

Gradual transition to normal eating under dietitian supervision.

Months 1-6

Monthly check-ups

Micronutrient panel, dietary adherence, lifestyle follow-up.

Year 1+

Lifelong follow-up

Annual full panel, nutrition and activity assessment.

FAQ

Frequently Asked Questions

Scientific Sources

The references below are the literature sources for information on this page. For informational purposes only; treatment decisions are made through face-to-face physician evaluation.

  1. 1.Cao Y, Lu Y, Chen P, et al. ERAS guidelines and hospital length of stay, readmission, complications, and mortality: a meta-analysis of randomized clinical trials — JAMA Network Open, 2024. Source
  2. 2.Vinten H, Petersen K, et al. NAD+ precursor supplementation in human ageing: clinical evidence and challenges — Nature Aging, 2025. Source
  3. 3.Vasireddi N, Hahamyan H, Salata MJ, et al. Emerging Use of BPC-157 in Orthopaedic Sports Medicine: A Systematic Review — HSS Journal, 2025. Source
  4. 4.Mechanick JI, Apovian C, et al. Clinical practice guidelines for the perioperative nutrition, metabolic, and nonsurgical support of patients undergoing bariatric procedures, 2019 update — Surgery for Obesity and Related Diseases, 2020. Source

Information: The information on this page is provided for medical information purposes and does not replace a consultation with a physician. The perioperative approaches described are based on current data in the literature; individual results vary from person to person and may not be suitable for every patient. Treatment decisions are made after an in-person consultation.

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