Gastric Sleeve Surgery

It was first practiced in the early 2000s. There have been some changes in the technique over the years as the experience of surgeons has increased. In this process, the advancement in technology and the more reliable materials used in surgery have reduced the complication rates for such operations. The quality of life of patients has also improved with the new technique. After surgery, patients eat more comfortably, do not experience nausea and vomiting, and return to daily life much earlier.  Patients who previously suffered from vitamin deficiency, muscle loss, constant vomiting and decreased productivity during the day are no longer encountered.

Although Gastric Sleeve Surgery is in the restrictive surgery group, according to scientific studies it increases the small intestine-derived GLP-1 level. In this way, it reduces insulin resistance and increases muscle gain and burn of fat.

 In Gastric Sleeve Surgery Operation, 75-80% of the stomach is removed vertically. Patients do not feel hungry as there is decrease in ghrelin (hunger) hormone released in the removed part of the stomach.  Since 80% of the ghrelin peptide is synthesized from the gastric fundus, our patients can lose weight by adapting to the given nutrition program very easily, especially in the first 1-1.5 years, without feeling extremely hungry.

Surgical Technique

This operation is typically performed laparoscopically with cutting-edge and quality devices. Operation is carried out with 4 or 5 incisions and last about 30-45 min. In the first phase of the operation, stomach is released from surrounding tissues and spleen. Afterwards, a tube is placed in the stomach and stomach is cut at the edge of the tube with stapler. The cut stomach is strengthened by suturing it over the stapler and then sutured to the fat tissue to prevent the stomach from rotating and stenosis. Tube-shaped stomach is ¼ of the previous stomach capacity. Rest part of the stomach is removed and sent for pathology. This procedure lasts 2-2.5 hours including getting the patient into operating theater, preparations and waking the patient after the operation. Stomach is removed from the big incision. The big incision where the stomach is removed, at right side of the patient, is sutured. A drain can be placed just below the tube-shaped stomach for fluids that may accumulate in that area and to control the methylene blue given in the leak test.

Patients walk at the 3rd hour and drink water at the 8th hour after surgery.

The drain (if any) is removed after the leak test on the 1st day and the patient is discharged and placed in the hotel.

!!! We do not use urinary catheter or nasogastric tube.

After this operation, stomach keeps its sleeve shape. Stomach is about in size of tea glass. In the patient whose stomach shrinks after Gastric Sleeve Surgery, both the hunger hormone-ghrelin will decrease so that the patient will not feel hunger and insulin resistance will disappear. With these 2 effects, weight-loss will be observed in patients. Gastric Sleeve Surgery is still the most common (60-70%) obesity surgery in the world. Advantages;

It has been most preferred operation as it is safe, lasts short-term, patients are able to return their daily life quickly. In patients who gain weight after this operation, revision operations are carried out safely and easily.

How does the surgery work?

With Gastric Sleeve Surgery,

  1. the stomach capacity reduces,
  2. the level of hunger hormone (ghrelin) synthesized from the fundus decreases
  3. the level of GLP-1 increases, which is synthesized from the small intestine and accelerates the metabolism and decrease insulin levels.

With these 3 effects, our patients lose weight after surgery. In the first 2 years, gastric passage accelerates and absorption of food in the small intestine decreases. Due to the stomach and intestines adapting over time, ghrelin and GLP-1 hormone levels return to normal after the 2nd year. The first 2 years are the honeymoon period. In other words, the metabolic effect of the surgery decreases after 2 years. Patients who lose weight in this process need to adopt new habits. We definitely want patients to make the 7 golden rules a habit during this period.

7 golden rules

  • daily water consumption of at least 2-2.5 liters
  • taking multivitamins every day
  • at least 45 minutes of physical exercise for 4 days a week
  • protein-heavy diet
  • small-portion diet
  • no food rewards for the first 6 months. After the 6th month food reward can be enjoyed for 1 day a week. So balancing food rewards
  • strong communication and follow-up through WhatsApp group. Answering calls and messages.

After this operation, even in Type 2 diabetes patients, permanent success rate is between 70-80%. Hypertension can be controlled 60-70% permanently and patients quite their medications. Fatty liver decreases in a few months and insulin resistance disappears. We also observed that our patients who had sleep apnea, get rid of it. In scientific researches it is stated that sleep apnea disappears with 90%.

How much weight can I lose after bariatric surgery?

*Our patients can lose an average of 10% of their total weight in the 1st month, 20% of their total weight in the 3rd month and 27-30% of their total weight in the 6th month after surgery. In the 1st year, they lose 70-75% of their excess weight and reach their target weight in 1-1.5 years.

*The rate at which patients lose weight may be different from person to person. It depends on age, metabolic rate, muscle mass, and applying to diet and sport instructions after surgery. The area where weight is lost firstly also varies. While some patients lose belly fat firstly, some lose hip fat, and some lose cheek fat.

*The rate of weight loss after surgery decreases over time. Sometimes, it even stops for a few weeks. Our aim to provide our patients to have their target weight within 1-1.5 years.

*The parts where our patients primarily lose weight can sometimes be arms, legs, sometimes abdomen, waist or hips. It varies according to the patient.

What is the risk rate of bariatric surgery?

  • It should be highly noted that morbid obesity is a life-threatening fatal disease. Patient with this weight is at risk as in other operations. This risk is not more than risk of laparoscopic gallbladder removal. Risk of an obese patient is more than the risk of normal weight person in operations. However, the reason of increased risk is OBESITY. Already, we perform this operation to reduce these risks.

    Some possible risks are blood clot embolism, formed in legs, in lungs, brain and heart, hemorrhage in stomach incision, and leak. All of these risks are below 0.1%.

What is mortality risk?

Mortality risk of sleeve gastrectomy bariatric surgery is below 0.1%. With increasing experience and changing surgical technique, complications have decreased significantly. With the advancing technology, the increase in the quality of the devices we use in surgeries has led to a further decrease in such rates. A body mass index of 50 and above, age over 60, smoking, chronic obstructive pulmonary disease and diabetes mellitus increase the risk.

What are adverse effects and complications of obesity/bariatric surgery?

  • With these operations performed laparoscopically, complications of laparoscopic method, an anesthesia and surgical technique, are not different from complications of gallbladder removal procedures and are seen very rarely.

    Complications associated with sleeve gastrectomy are divided into two as early and late surgical complications.

Early Complications Following the Operation

Embolism: Coagulation in legs and blood clot embolism in lung, heart and brain: this is a process which leads respiratory/heart arrest, and even stroke. These are most feared complications. Measures that we take against these complications are stated above.

Leak: There is a leak risk on stomach incision. This risk is controlled with a leak test performed during operation. It is occurred rarely and when it is detected, it can be treated with follow-up-re-operation or by placing a stent inside stomach.

Hemorrhage: Hemorrhage occurring on surgical incision. This complication is also observed rarely. It can occur in every operation. In case of this complication, follow-up or re-operation may be required.

Why have complication rates decreased substantially?

  • With these operations performed laparoscopically, complications of laparoscopic method, an anesthesia and surgical technique, are not different from complications of gallbladder removal procedures and are seen very rarely.

    Complications associated with sleeve gastrectomy are divided into two as early and late surgical complications.

Late complications

* Gallstone formation: Gallstone may reform in 30% of the patient. In this case, gallbladder removal surgery may be required.

* Stenosis & upside-down stomach: Even though it is seen very rarely, stomach may get narrow or turn around its own axle. It can be diagnosed with an endoscopy procedure again. These patients frequently experience vomiting. This problem is treated by placing a stent.

* Vitamin- mineral deficiency: iron-B12-D vit., calcium-zinc, magnesium deficiencies may be observed in patients. It should be controlled during follow-ups and in case of deficiency, medicine should be administered as supportive.

* Hair loss: It is observed especially in first 6 months. It may be depending on vitamin and mineral deficiency stated above. Lost hair will be grown up again after 6 months.

* Weight regaining. It is the most important point to be taken into account after operation. 1 out of 6 patients gains weight and 1 out of 8 patients undergo reoperation.

Do I regain weight after bariatric surgery?

  • First of all, we should note that the most successful treatment of obesity is surgery. It has a higher success rate when compared to other methods. It is possible to obtain 80-85% permanent success. Regaining weight rate to the extent of morbid obesity is 15-20%. There is a risk for the patients who do not change their lifestyle and do not adopt exercise to their lives to regain weights. Weight regaining is observed in patients especially who have a high glycemic index, bad carbs consumption habit and who do not quit alcohol consumption. Bad carbs are desert, pastry, cake and foods containing white flour, which rise insulin level in blood. This possibility is 15-20%. These patients should be re-operated. These operations called revision surgery are performed with various techniques.

How is the process after operation?

After the operation at 3rd hour, our patients can walk and perform regular breath exercise. At the 8th hour, patient starts drinking water.  On the 1st day after operation, gastric leak test is performed. Accompanied by a device called fluoroscopy, a special liquid that can be detected with this device is administered. Our patients are discharged on the 1st day. Patients check into the hotel.

What To Do After Being Discharged from the Hospital?

  • Patients are discharged the day after the surgery and placed in a hotel. Patients staying 2 days at the hotel are transferred to Cukurova International Airport before the flight time. Patients should take at least 500 steps and consume at least 2000 cc of water for the first 1 month after surgery.

    When you return to your country, you can do daily household chores, you can drive a car, you can go back to your desk jobs.

    You are not allowed to exercise for the first month as we do not want you to sweat.

What kind of diet should I follow after operation?

There is a dedicated section in our website about diet after operation. A detailed information is given about what should be taken into account in this process.

When should I start to exercise after operation?

  • After the surgery, 5-10,000 steps per day, light sports, brisk short walks can be started in the 1st month. After the second month, more brisk walking-running and Pilates without using the abdominal muscles are recommended. Pilates helps you to lose weight and firm your body. In the 3rd month after the operation, you should add weight exercise to your program. Especially leg – thigh muscle groups exercises, which are big muscle groups, will help you to lose weight. When you start to exercise, you should consult to a professional. You should increase exercise intense gradually. A Misinformed exercise may injure your health.

What is our Aim with this treatment?

Our aim is to provide:

*Our patients lose 10% of the total weight in the 1st month after surgery, 20% of the total weight in 3 months, 27-30% of the total weight in the 6th month, and 70-75% of the excess weight in the 1st year.

*They should change their lifestyle, learn to eat right and make exercising a part of their lives within a 2-year period.

The most effective treatment, proved with scientific researches, is bariatric surgery.

It should be emphasized that the most ideal treatment of obesity is diet and exercise. Surgery should not be the first option.

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