What is Sleeve Gastrectomy?
Sleeve gastrectomy is a surgical method in which weight loss is achieved by removing most of the stomach in obese patients. Since the remaining stomach is in the form of a tube, it takes the name of tube stomach. Especially with the introduction of laparoscopic (closed) application, this operation has become very popular thanks to the shortening of hospitalization time, shorter recovery period, less scarring and reduction of the possibility of surgery site hernia.
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 Sleeve Gastrectomy performed?
The entire procedure is performed by laparoscopic (closed) surgery method. Laparoscopic surgery is performed by making many 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. With experience, an experienced laparoscopic surgeon can perform many procedures laparoscopically, just as in open surgery.
The abdomen is inflated by injecting co2 gas into the abdomen. Then, the inside of the abdomen is reached through special tools called trocars. First, a guide silicone tube is placed from the mouth to the stomach exit to adjust the remaining stomach width. It is separated from the adipose tissue surrounding the stomach, veins and its immediate neighbor, the spleen. Then, the excess part of the stomach is cut and separated with special devices called staples. About 80-150 ml of stomach volume remains. This separated part is taken out of the abdomen and sent to pathology. Then, bleeding is controlled in the cut and stapled part. Additional metal clips can be used for this, or additional stitches can be placed if needed. Also, if needed, some special drugs can be applied to the wound site in order to reduce bleeding. Then, a silicone drain is placed in the area of the surgery in order to remove the accumulated fluids. The wound areas are closed aesthetically and the surgery is terminated.
Is leak test done in Sleeve Gastrectomy surgery?
A leak test is performed during sleeve gastrectomy (tube stomach) 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 made to prevent leakage. Again, before starting liquid foods after surgery, a leak test is performed and necessary measures are taken and intervened in time.
Will there be pain after Sleeve Gastrectomy?
The biggest advantage of the surgery is that sleeve gastrectomy surgery is performed laparoscopically (closed), that is, by entering through millimetric holes, postoperative pain is less than open surgery. Nevertheless, the phrase "he had surgery, of course he will have pain" is extremely wrong. No patient should experience pain in the twenty-first century. Pain 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 Sleeve Gastrectomy?
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 and how to start feeding after Sleeve Gastrectomy?
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 (puree style) 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 done after Sleeve Gastrectomy?
Protein supplements are given to patients during the first 15 days. Especially in the first year, various vitamin and mineral supplements are given to patients. These are not standard for every patient, and after the examinations performed in routine controls, it is decided according to the patient's condition, what and how much he needs.
Is it possible to stand up immediately after Sleeve Gastrectomy and return to work immediately?
Since the surgery is performed laparoscopically (closed), you can stand up and walk one or two hours after the operation. 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. After the operation, patients are given a sufficient resting report.
Will there be weight gain again after Sleeve Gastrectomy?
The risk of regaining weight after sleeve gastrectomy 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 also 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, the meal capacity did not increase. The reason for regaining weight is especially high-calorie snacks between meals.
What are the advantages of Sleeve Gastrectomy compared to Gastric Bypass surgery?
- It causes less vitamin and mineral deficiencies (especially deficiencies in vitamin B12, iron, calcium and folate).
- Requires less lifelong vitamin-mineral supplements and follow-up.
- The intervention options that can be made for weight gain again are extremely wide.
- When there is a problem, there is a chance to intervene in the bile ducts and pancreatic duct with endoscopy. Procedures such as ercp and biopsy can be performed easily.
- Since there is no stomach tissue that has been closed and left, there is always a chance to control it with endoscopy.
- Since the fundus part of the stomach secreting gharlin (appetite hormone) is removed, the appetite is more decreased