What is Gastric Bypass Surgery?
Gastric bypass surgery refers to a surgical process in which the stomach is divided into a small upper pouch and a much larger lower "remnant" pouch and then the small intestine is rearranged to connect to both.
Sleeve Surgery can be applied to which patients?
It can be applied to patients with obesity who cannot lose weight, or who have complaints such as insulin resistance and joint discomfort due to excess weight. Until ten years ago, it was primarily applied as the first step surgery before gastric bypass surgery in very obese patients. In this way, the weight of the patients was reduced and then bypass surgery was performed. However, observations and studies made later show that most of the patients do not need a second operation, and thus sufficient and permanent weight loss is achieved. Similarly, when it was seen that diabetes was as effective as bypasses on errors such as blood pressure, the frequency of its application gradually increased. Nowadays, it has become the most common obesity surgery.
Do diseases such as diabetes, asthma, blood pressure prevent sleeve gastrectomy (sleeve gastrectomy) surgery?
On the contrary, these are the diseases caused and exacerbated by obesity. These diseases are not an obstacle for surgery but a reason.
How to prepare before Sleeve Gastrectomy? Which examinations are done?
First of all, the following tests and examinations are applied to each patient before surgery.
- Blood biochemistry tests
- Hormone tests
- Hepatitis tests
- Whole abdominal ultrasound
- Stomach endoscopy (with anesthesiologist)
- ECG (heart radiography)
- Lung X-ray
- Lung breathing test
- Effort test and echo (electrocardiography) if required
After all these tests, the necessary examinations and examinations are performed by anesthesiologists, internal medicine, cardiology, psychology, chest diseases and endocrine specialists. As a result of these examinations, it is first checked whether there is another underlying disease that may cause the patient to gain weight. If there is no such disease, the patient is examined in terms of anesthesia, like any patient who will undergo surgery, and it is checked whether there is an obstacle to the operation. Relevant experts will make recommendations about pre-operative treatments, if necessary. In this way, problems that may occur during and after surgery are minimized.
How is Gastric Bypass Surgery Performed?
The entire procedure is performed by laparoscopic (closed) surgery method. Laparoscopic surgery is performed by making 3 or 4 small incisions. The ports placed through these incisions are used for hand tools to reach the abdomen. One of them is a surgical telescope connected to a video camera and the others are for the introduction of specialized surgical instruments. The surgeon watches the operation on a video monitor.
Although the first gastric bypass surgery was performed in 1967, laparoscopic gastric bypass was performed for the first time in 1993 and is considered one of the most difficult operations to be performed with restricted access surgery. However, the use of this method has made this operation very popular thanks to the shortening of the hospitalization period, shorter recovery time, less scarring and the possibility of surgery site hernia. From the upper part of the entrance of the stomach where it joins with the swallow tube, a small stomach part (20-30% of the whole stomach) is left on the side of the swallowing tube and separated. Thus, a proximal gastric (at the entrance to the stomach) gastric pouch smaller than 30 mL is created. This new stomach pouch has a smaller volume than about 1 tea glass. In this surgery, any part of the stomach is not removed and left in place, unlike the "sleeve gastrectomy" surgery. By creating a stomach pouch, the existing stomach is deactivated and the food is brought here. It is taken from the part of the small intestine that goes towards the distal (large intestine) and cut approximately 50-75 cm and is connected to the new gastric pouch. The end of the small intestine, which is left behind with bile and pancreatic fluid, is connected to the intestine approaching 70-80 cm ahead. All these cutting, separating, joining and mouthing processes are carried out with special tools known as “staplers”, which are completely high-tech, disposable.
Is Leak Test Performed in Gastric Bypass Surgery?
A leak test is performed during gastric bypass surgery and on the 2nd day afterwards. The purpose of the leak test performed in surgery is to determine whether there is a problem with the staples and whether there is a leak in the suture line. If there is a leak, additional stitches are placed on the relevant part to prevent leakage. Again, before starting liquid foods after surgery, a leak test is performed and necessary precautions are taken and intervened in time.
Is There Any Pain After Gastric Bypass Surgery?
Since gastric bypass surgery is performed laparoscopically (closed), that is, by entering through millimetric holes, post-intervention pain is less than open surgery. Nevertheless, the phrase "He was operated, of course he will have pain" is extremely wrong. No patient should experience pain in the twenty-first century. Pain relief is completely prevented by applying postoperative painkillers to each patient. The important point here is this. Everyone's pain threshold is different. Again, drug tolerance and bioavailability from the drug are different. Therefore, treatment cannot be standard. Pain relief treatment should be arranged individually according to the needs of each patient.
Will there be any scars after Gastric Bypass Surgery?
Since the incisions are very small, the aesthetic results are also extremely good. After a few months, these lines will also become almost invisible. Once the wounds have healed, you will be recommended a cream to leave less scarring. If you use it for three months, you will get much better aesthetic results.
When Will Nutrition Begin After Gastric Bypass Surgery?
On the second day of the surgery, you will start taking liquid food after the leak test is done. After the first two weeks of liquid nutrition, you will be fed with soft (pureed food) food for two weeks. During this whole process, you will be in constant communication with our dieticians.
How Will Nutrition, Vitamin and Mineral Supplements Be After Gastric Bypass Surgery?
Protein supplements are given to patients during the first 15 days. Various vitamin and mineral supplements are given to patients especially in the first year. These are not standard for every patient, and after the examinations performed in routine controls, it is decided according to the condition of the patient, what and how much he needs.
How Long Is The Recovery Process After Gastric Bypass Surgery? Can I Get Back to Work Immediately?
Since the surgery is performed laparoscopically (closed), you can stand up and walk within an hour or two after surgery. Even during your stay in the hospital, you will not be a nursing patient and you will be able to do your own self-care. Patients working on a desk or in jobs that do not require heavy effort can return to work within a week. Patients who require heavy effort should take a break from work for at least a month.
Will There Be Weight Gain Again After Gastric Bypass Surgery?
The risk of regaining weight after Gastric Bypass is very low. In order to get maximum benefit from this physiology, the patient should only eat at meals, take 2-3 meals a day, and avoid snacks between meals. This surgery requires changing the eating habits acquired over a long period of time. In almost all cases where weight gain was observed again in the late stages of the surgery, there was no increase in meal capacity. The reason for regaining weight is especially high-calorie snacks between meals. There is no known operation to eliminate the side effects of this type of eating habit.