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Sleeve Gastrectomy

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Gastric Sleeve Surgery

Overview

Recently, gastric Sleeve or sleeve gastrectomy is one of the most common surgical weight loss methods.

Obesity is characterized with highest increase in prevalence around the world. Even though there are tens of medical etiologies of obesity, the most important ones are abnormal weight gain and sedentary lifestyle. Life time of obese patients is approximately 15 years shorter than other people due to diseases caused by obesity, including but not limited to hypertension, type 2 diabetes, hyperlipidemia, ischemic heart disease etc. Obesity is a risk factor for cancers such as colorectal cancers, breast cancer and prostate cancer.

In gastric sleeve surgery, approximately 70 to 80 % of the stomach is surgically removed and the stomach is given a tube shape; thus, the amount of food which can pass through the stomach is restricted.  You will feel full sooner, as the volume of the stomach is reduced. ‘Ghrelin’ hormone, which is released from fundus of the stomach, is thought to be responsible from overweight and obesity. This hormone regulates the hunger. In this surgical method, fundus of stomach is totally excised and this helps diminishing appetite and losing weight.

Why is this procedure done?

This is one of the most common methods used for obesity surgery in our hospitals, since it is easy to practice and leads to less complications although it is as effective as other complicated surgical methods. In this method, 80 to 90% of stomach is removed and transformed into a form of tube. This surgery takes about one to two hours and is performed with closed (laparoscopic) method. Hospital stay is two to three days. Patients can start consuming normal foods after they eat liquid foods for two weeks and soft foods for the subsequent two weeks after the surgery. Vitamin supplements may be required. ‘Ghrelin’ hormone, which is released from fundus of the stomach, is thought to be responsible from overweight and obesity. This hormone regulates the hunger. In this surgical method, fundus of stomach is totally excised and this helps diminishing appetite and losing weight. Gastric sleeve surgery utilizes both mechanical effects (reducing the volume of the stomach) and hormonal effects to help losing the excess weight. Thus, both volume of the stomach is reduced and the appetite is controlled. No problem is faced in digestion of food, since small intestines are left untouched.  

Thanks to sleeve gastrectomy, patient loses excess weight and therefore, the health risks arising out of the obesity are eliminated.

There are some criteria for sleeve gastrectomy to be performed.  First of all, the patient should fail optimal or target body weight despite diet and exercise. Just as the case for all health issues, surgery should be considered as the last option.  The commonly accepted two criteria are high BMI (>40) or lower BMI (35-39) accompanied by coexisting obesity-induced serious health conditions.

Gastric sleeve surgery can either be used as a primary surgical treatment method for weight loss or can be performed as the first stage of a gastric bypass surgery.

Therefore, it will be the most suitable approach for you to ask all your questions to your surgeon before deciding on a gastric sleeve surgery to manage the post operative period.

Risks

As the case for all surgeries, gastric sleeve surgery involves some risks.

Although all possible measures that modern medicine allows are taken to prevent occurrence of risks, it is no means possible to warrant that the risks will be completely eliminated.

The potential risks that can be faced in a gastric sleeve surgery are listed below:

  • Bleeding
  • Infection
  • Thrombosis (blood clot)
  • Leakage from anostomosis line
  • Damage to other organs
  • Transition to open surgery
  • Anesthesia-related complications

Risk of major complications in gastric sleeve surgery is very low.

Your surgeon will explain in detail whether those risks apply to you or if so, the rate of occurrence.

Preparation

The first phase of preoperative preparation is same in all Medicana Hospitals. Decision of gastric sleeve surgery is made following a series of medical tests and examinations.  Your doctor will make a comprehensive assessment to determine whether this surgery helps your complaints or not.

In the preoperative period, all of your prescription and over-the-counter medications, your comorbidities such as obesity-induced hypertension, diabetes mellitus and cardiovascular diseases, and your overall health will be assessed.  All these assessments will both help you be ready for the surgery and minimize the problems that can be encountered during or after the surgery.

  • Review of health history
  • A detailed physical examination
  • Necessary laboratory tests and radiology studies
  • Assessment by anesthesiologist and other laboratory tests and radiology studies to minimize anesthesia-related complications

After it is verified that the surgery does not pose risk, you will be asked to quit smoking, if you are a smoker, and to stop taking certain medications that increase risk of bleeding. All other prescribed and over-the-counter medications, herbal products and supplements will also be questioned and you will be informed to continue or stop taking them.

A preoperative discussion with your surgeon about gastric sleeve surgery is very important. All details of the procedure, potential risks and healing period are explained.  

Moreover, it is reasonable to plan discharge, post-discharge accommodation and travel at this phase in order to manage postoperative period better.

Surgery and early postoperative period

Gastric sleeve surgeries are performed under anesthesia with laparoscopic approach to a great extent.

However, open surgery can be performed subject to your surgeon’s decision, in case that your condition requires so or any problem is faced during the surgery.

Your surgeon makes small incisions.  First, your abdominal cavity is inflated by CO2 gas through one of those incisions. Then, a camera is inserted into your abdominal cavity. Other incisions are used for surgical instruments to be inserted into your abdominal cavity.

Next, after 75 to 80 % of your stomach is removed by your surgeon, your stomach is given a tube shape. Following all necessary controls in the surgery site, incisions are stitched and the procedure is ended.

After you recover from anesthesia and you are ready to walk, you will be mobilized by or under supervision of our healthcare professionals.

You will be given pain killer(s) after the surgery in order to manage the postoperative pain.

Treatments will be started and measures will be taken to eliminate risks arising out of clot formation.

You may also need to use antibiotics to prevent a possible infection.

It is very important that you follow all instructions of your doctor after the surgery to protect and support the outcome of the surgery.

You should see your surgeon for follow-up visits that are scheduled before you are discharged.

If you experience warmth and redness in your incision line, or if you have a fever or any symptoms that you think are due to surgery after you are discharged, contact your surgeon immediately.

Results

A very different life, in many aspects, is waiting for you after gastric sleeve surgery. Primarily, you need to follow the instructions of your physician and your dietitian to the letter.

While you start to get used to live with your new stomach, you will be asked to take liquid food for the first a couple of days.  Next, you will start to eat soft foods at first and then you will gradually start your routine diet that you must follow for the rest of your life.

You will lose most of your excess weight over time in the post operative period. However, you must see your physician and your dietitian in follow-up visits that are pre-scheduled by them.

Another benefit of the gastric sleeve surgery is recovery or regression of comorbidities caused by obesity, such as diabetes mellitus, hypertension, abnormal blood lipid counts, sleep apnea, heart diseases etc.

As you will be free of your excess weight, you will be more active in your daily activities and you will need to preserve that level of activity.  Lifestyle changes are an important of postoperative care after gastric sleeve surgery.

Patients should chew well and eat foods in small amounts after the surgery. Exercise should not be ignored. High-calorie liquid foods should not be eaten in high amounts to avoid rebound weight gain.