Gastric Sleeve surgery is technically the procedure to remove the large part of the stomach that functions as storage. Thus, normally a stomach with a volume of 1.5-2 litres turns into a thin tube, roughly 50-100 ml (approximately a large banana). In other words, it is the process of removing a large part of the stomach by preserving a tube-shaped part of it. That will ensure the continuity of the stomach with the oesophagus and intestine through a laparoscopic operation.
The surgery aims to reduce the amount of food that you can eat at once. However, the procedure does not intervene with the natural flow of the digestive system. Consequently, it leads to less vitamin and mineral deficiencies, absence of dumping syndrome, less reflux.
If the patient’s compliance with the nutritional rules is right after the surgery, complaints such as nausea, vomiting and pain are extremely rare.
Gastric Sleeve operation is the most preferred operation type among obesity surgeries, which provides sufficient weight loss. In operation, the adipose tissues, which are primarily adherent to the stomach, are separated by the latest technological devices that perform the sealing and cutting process together. Moreover, the duration of the operation and technical requirement are less than other types of surgery.
After this stage, a tube is inserted into the patient. Then the 80 per cent of the stomach is separated from the tube stomach with 3 rows of staples. Finally, the excess stomach tissue is taken out of the stomach. Operation is terminated after leak tests of the punch lines.
Gastric Sleeve operation is performed laparoscopically through 5 holes approximately one centimetre in size. With closed surgery, patients experience no pain and return to their social life earlier.
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Due to the shrinking stomach volume after the operation, the patients do not feel hunger as the hormones that cause the feeling of hunger disappear.
It is also a beneficial surgery on appetite control and a feeling of satiety. Since the healthy intestinal tract is preserved, it is a more physiological method, and complications related to food absorption disorder do not occur. This method has been accepted as effective obesity surgery and has been used in recent years.
Difference between Gastric Sleeve and Gastric Bypass
Even in the USA, where Gastric Bypass surgery was once considered the gold standard, the rate of Gastric Sleeve has now exceeded 60%. In this process, the Gastric Bypass decreased from 62% to 37%.
The effectiveness of Gastric Sleeve in the recovery of type 2 diabetes is close to or equal to the Gastric Bypass. Gastric Sleeve is much more advantageous than bypass in terms of operation time. Moreover, the feeling of hunger is lower than the Gastric Band and Gastric Bypass surgery. In terms of quality of life, both operations have similar effects. Other advantages of Gastric Sleeve compared to other weight loss methods are;
- It requires less lifelong vitamin-mineral supplements and follow-up.
- The options for intervention that can be made in weight gain again are extremely wide.
- When there is a problem, there is a chance of intervention in the bile ducts and pancreatic duct with endoscopy. Moreover, procedures such as ERCP and biopsy can be done easily.
- Since no stomach tissue is closed and left, there is always a chance to check with endoscopy.
- Since the fundus part of the stomach secreting Gharlin (appetite hormone) is taken, appetite reduction is higher.
History of Gastric Sleeve
The first operation was performed in 1988 as part of the duodenal switch surgery. It was applied closed for the first time in 1999. After 2001, first step surgery was started before gastric bypass surgery in overweight patients. Then in 2009, its popularity began to increase gradually, and the procedure started to be used as a surgical method alone. Especially the laparoscopic application has made this operation very popular thanks to the shortened hospitalization time and recovery time.
How Does Gastric Sleeve Surgery Work?
Gastric Sleeve surgery is performed by laparoscopic method, that is, by making 4 or 5 small incisions in the abdomen. The operation takes about 20-30 minutes. Of course, this is also related to previous surgeries or anatomy. Generally, the length of hospital stay is one or two days.
During the procedure, approximately 85% of the stomach is removed. Then only a thin tube in the thickness of your thumb is left in the form of a stomach. Thus, the amount of food that can be eaten is significantly reduced, and the feeling of saturation is provided.
On the other hand, Gastric Sleeve surgery is not only a restrictive surgery but also a hormonal and metabolically effective surgery. The extracted part of the stomach is the part that produces the Ghrelin hormone that triggers hunger. Removal of this section reduces the amount of the hormone that stimulates appetite in the blood and often causes the appetite to be suppressed.
Since the natural flow of the digestive system stays intact, digestion and absorption continue healthily after the surgery. Therefore, there is a much lower risk of vitamin and mineral deficiency compared to operations that interfere with absorption.
Gastric Sleeve operations usually take 60 to 75 minutes, excluding preparation. It takes 20-25 minutes for the patient to prepare for surgery and sleep, and it takes about 20-25 minutes for the patient to wake up after surgery.
The abdomen is reached through special tools called trocar. First, a guide silicone tube is placed from the mouth to the stomach outlet to adjust the remaining stomach width. The fat that surrounds the stomach is separated from the tissue and veins. Then, with the particular devices called staples, the excess part of the stomach is cut off. About 80-150 ml of stomach volume remains. Finally, this separated part is taken out of the abdomen and sent to pathology.
Then, bleeding is checked in the section cut and stitched with staples. Additional metal clips can be used for this, or extra stitches can be placed if needed. Some particular medicines can also be applied to the wound to reduce the complications. A silicone drain is then placed in the place of the surgery to remove fluids that accumulate inside. Finally, the wound is closed aesthetically, and the operation is terminated.
The whole procedure is performed by laparoscopic (closed) surgery method by making many small incisions. The surgeon watches the operation on a video monitor. An experienced laparoscopic surgeon can perform the procedure smoothly.
There are many different products for the procedure. The materials of the two leading companies are the highest quality products available on the market. However, their prices are much higher than Chinese products for the same purpose. Besides, in this type of operations, safety is more important than cost. Each product has a barcode with its own serial number. The barcode of each material used is put in the patient file. Always ask for the material used before the operation.
After the operation
Obesity is not just an imbalance between calories and calories consumed, as initially thought. Many hormonal mechanisms underlie the fact that people who come to the obesity stage cannot lose weight only by decreasing calories.
Gastric Sleeve surgery, when supported by a healthy diet and exercise, can provide you with 60-80% of your excess weight within one year after surgery. Of course, there is a risk of not losing enough weight or even gaining weight again if you do not follow the rules and return to old bad eating habits.
As with all other methods of obesity surgery, success in Gastric Sleeve surgeries increases directly with strict follow-up control and follow-up. For this reason, first evaluation is made on average 7-10 days after surgery. In this initial evaluation, the clues of the early complications of the operation are investigated, and it is determined whether the postoperative nutrition and other life functions are normal.
Routine checks include the controls of sugar, insulin, liver enzymes, kidney function tests, vitamin and mineral levels with blood tests. If any deficiency is detected in these, special supportive treatments are determined.
Although different surgeons have different approaches to the liquid food start time after the operation after leakage is not observed in an abdominal x-ray, the period of drinking with liquid foods begins. Then, under the control of dietitians, patients gradually switch to solid foods after three months.
One of the most significant advantages of Gastric Sleeve operation is that there is no problem in the intake of vitamins and minerals since it does not affect the absorption process. Patients only receive temporary supports such as iron in specific periods (first liquid feeding period).
Adaptation disorders in dietary patterns are the most significant factor in patients after Gastric Sleeve operation. Consequently, around 20% of back weight gain may occur.
Those who have desk work can return to work within 7-10 days after surgery. In those with heavy work, the restriction lasts until the 3rd week after the operation. Moreover, those who return to work after the 7th day should also avoid movements that will force the abdominal wall.
During the first 15 days, patients are given protein supplements. Especially in the first year, patients are given various vitamin and mineral supplements. These are not standard for every patient. After the routine controls, the decision is made according to the patient’s condition.
You can take a bath when you leave the hospital. After the shower, dry with a clean towel, apply for a recommended medicine on you. It is no longer necessary to use anything after the tenth day.
Do not use any medication other than the ones we recommend during the first month. When another doctor suggests medicine, be sure to consult us. You can use any kind of medication after the first month. However, try not to use too many painkillers and take plenty of fluids after taking medication.
In the success of obesity surgery, it is vital for the patient to adopt the new lifestyle, follow the diet program created in collaboration with metabolism and endocrinology specialists, and if necessary, use food, vitamin and mineral supplements regularly.
Eating habits after the surgery
Although a specific program is created for each patient, the following principles are essential in eating after Gastric Sleeve:
- Protein will be a vital nutrient for your diet from now on. You will need to take about 60 g of protein sources per day (1 serving of chicken, turkey, fish, or 1 serving of low-fat cheese).
- Take great care not to skip meals. Eat at least 3 main meals a day. In addition, it will be appropriate to consume 2 snacks. So you don't overfill your stomach and help your metabolism work faster.
- Always eat your meals at the table after Gastric Sleeve surgery. Spend at least half an hour on main courses. Never eat on the kitchen benches, in front of the TV or computer.
- Prepare your meals both in small portions and divided into small pieces. To prevent overeating, use small plates and small cutlery. Eat your food very slowly and chew thoroughly. Do not keep serving plates and saucepans on the table and never take the second portion.
- Drink at least 6-8 glasses of caffeine-free, calorie-free, and still beverages a day. Do not drink anything half an hour before meals. Thus, you will prevent your stomach from getting sick.
- Regularly take the vitamins and minerals recommended by the doctor following you after the surgery. Do not use any other medicines or supplements without asking him.
- Do not view obesity surgery as a cure or diet. These healthy eating habits you will acquire will be your new lifestyle. Ensure that your family and friends also adopt this view.
Blood values of patients with the surgery and gastric bypass surgery are monitored periodically by doctors in hospitals performing obesity surgery.
Exercise After Stomach Surgery
Adopting a regular sports program under the supervision of a specialist plays a role in the success of obesity surgeries and accelerates recovery. However, it may not be easy to adopt such a program for people who have not used to exercise before. As overweight is lost and the person does the exercises he likes, it can be easier to gain the habit of doing sports.
- Although a special program is created for each patient, the following principles are essential for doing sports after stomach surgery;
- Never start doing sports without your doctor’s approval. And tell him about all the exercises you plan to do.
- Exercise 3 months after surgery, start doing it slowly and never worry about losing weight faster than doing it for longer or recommended exercises.
- In the early period, the ideal exercise type for you will be walking. Take care to walk at the time and pace recommended by your doctor and exercise counsellor.
- After surgery, if your doctor approves – usually within 6 weeks – avoid abdominal movements and weight lifting.
- Prefer the exercises you love. Try to combine exercise types that will improve both your muscle and bone structure, as well as increase your fitness.
- Swimming and fitness are ideal exercises. If you have the opportunity to do this, tell your exercise counsellor and ask them to create a program that includes them for you.
- All patients are followed by nutrition and diet specialists in feeding after the operation.
- Those who have the procedure should do sports regularly should eat foods frequently and with little meals, and avoid calorie liquid foods.
If the nutrition rules are violated after Gastric Sleeve surgery, the desired success cannot be obtained from the operation.
Is Gastric Sleeve Surgery Suitable For Me?
Gastric Sleeve will definitely be the first option for you if you;
- have a weight problem entering the surgery limit according to the World Obesity and Metabolic Surgery Association (IFSO) criteria
- have vitamin-mineral deficiencies that may cause problems in bypass and other methods
- have conditions that may cause issues in bypass surgeries that require the use of prednisolone or anti-inflammatory drugs,
- have a history of heavy abdominal surgery,
- have heart or lung problems where a long surgery will cause problems,
- are at the super morbid obese border,
- Age ranges in which Gastric Sleeve can be applied are 12-79 years.
On the other hand, it can be applied to patients who are unable to lose weight or who have weight-related insulin resistance and joint discomfort with weight. Until ten years ago, it was primarily performed as a first-line surgery before gastric bypass surgery in very obese patients.
However, subsequent observations and researches show that most patients do not need a second operation, thus ensuring sufficient and permanent weight loss. Similarly, the frequency of its application increased gradually when it was seen that it was at least as effective as bypasses on errors such as diabetes blood pressure. It is now the most common obesity surgery today.
What are the Advantages of Gastric Sleeve Surgery?
There are some main advantages of Gastric Sleeve surgery compared to other weight-loss operations. You can find these above.
- It can be performed laparoscopically (closed), so wound healing is faster, pain is less, the hospital stay is shortened.
- The capacity of the stomach is reduced. However as its functions are not changed, it allows many foods to be consumed less.
- As a result of removing 75% of the stomach wall, Ghrelin hormone production, which gives a feeling of hunger, is mostly eliminated. Therefore, the sense of longing for food is reduced.
- In those with chronic bowel disease, such as Crohn’s disease, intestinal bypass carries a high risk. Gastric Sleeve surgery can be performed easily in these patients.
- Since it is a surgery that can be performed laparoscopically in high-weight patients, it provides fewer wounds, fewer lung problems, less pain and faster recovery.
- It is a surgical technique with outstanding results in moderate and advanced obese.
- Comorbid diseases associated with obesity such as hypertension, sleep apnea and diabetes recover 70-80% after surgery.
- As with processes that bypass the small intestine, no absorption disorder occurs in minerals and vitamins, which may be necessary for elderly patients.
- Dumping syndrome does not happen, and sugary foods can be better tolerated.
- If necessary, it can be converted to other obesity surgery surgeries.
It is the most popular obesity surgery performed in the world. Gastric Sleeve, which is performed closed, takes 30-90 minutes. Approximately 80% of the stomach staples in operation.
In Which Conditions Gastric Sleeve Surgery May Not Be Suitable For Me?
Bypass may be a more suitable option for you if you have type 2 diabetes, especially if you have enough weight to require insulin if you have a BMI of 50 and above if you have severe reflux. In other words, patients with Barrett’s oesophagus should definitely not undergo surgery and bypass should be preferred.
Am I suitable for this surgery?
Like other obesity surgeries, International Obesity and Metabolic Surgery Association standards are valid in this case. Patients who has a body mass index above 40 or between 35-40 and having a problem related to obesity (diabetes, hypertension, joint problems, sleep apnea, etc.) are suitable for this surgery.
Will there be a scar after Gastric Sleeve gastrectomy Surgery?
Aesthetic results are also perfect because the incisions are tiny. After a couple of months, these lines will become almost invisible.
Do I feel pain after the operation?
Gastric Sleeve surgery is performed laparoscopically (closed), that is, through the millimetre holes, the pain after the operation is very low compared to open surgery. In case of any problem, relief treatment should be arranged separately according to the needs of each patient.