What is Sleeve Gastrectomy?
Sleeve gastrectomy is among the most preferred and proven operations of obesity surgery. It is an important application that provides very high weight loss during the first 3 months and shows its effect up to 18-24 months as a result of the surgery being performed with a specialist team and equipment. It has benefits not only for obesity, but also for many obesity-related diseases. Sleeve gastrectomy goes back a long way. In the light of the data accumulated over the years, its effect has been proven and it has been determined that its side effects are limited.
How is Sleeve Gastrectomy Surgery Performed?
With the sleeve gastrectomy, approximately 80% of the stomach is removed with the closed surgery method. Regardless of the surgery size, every surgery carries the risk of complications. Sleeve gastrectomy surgery has a low risk compared to many surgeries. It provides very fast recovery, especially as it is performed as a closed surgery.
During sleeve gastrectomy surgery, 4-6 holes with a diameter of approximately 1 centimeter are opened on the abdomen. Through these holes, both the surgical equipment and the camera are transmitted to the bottom of the stomach. A large part of the stomach is cut and taken out. With the volume reduction experienced in the stomach, the patient reaches high fullness with much smaller portions.
Sleeve gastrectomy surgery takes about 60-90 minutes. Considering the features of the surgery, there is no change in both entry and exit connection of the stomach. The stomach is cut vertically and has very low risk thanks to this approach. Adaptation is achieved within a few days after surgery.
Frequently Asked Questions About Sleeve Gastrectomy Surgery
Can Sleeve Gastrectomy Surgery Be Applied To Everyone With Weight Problems?
Those who want to have sleeve gastrectomy surgery are expected to meet certain conditions. These conditions are listed as follows;
- Body mass index should be over 40. It is the class known as the morbid obese. In order to calculate the body mass index, the current formula of weight/square of the height in meters can be used.
- The body mass index should be in the range of 35 to 40, but also have Type 2 diabetes, sleep apnea, hypertension and comorbidities.
Those who do not meet the above conditions should try to lose weight with regular diet and exercise. Sleeve gastrectomy surgery is performed only in cases where the current situation of the person is more than the risk of surgery. Especially those with Type 2 diabetes pose a great risk when their disease cannot be controlled. With this method, Type 2 diabetes is largely no longer a problem and the patient recovers.
Until What Age Is Sleeve Gastrectomy Surgery Performed?
There are some criteria determined for sleeve gastrectomy surgery. Another of these is the age criterion. The patient must be between the ages of 18 and 65. Patients who are in this age range and have a body mass index over 35 can recover from both obesity and Type 2 diabetes.
People who are under the age of 18 but have a very risky condition can undergo physician examinations with the approval of the family. If appropriate, it is possible for them to have surgery. However, all other ways (such as weight loss with diet and exercise) must be tried.
People over the age of 65, their current health status and the risks that may be experienced in the surgery should be examined very carefully. If there is no risky situation, they can have sleeve gastrectomy surgery.
How Much Weight Can Be Lost With Sleeve Gastrectomy Surgery?
The first process after sleeve gastrectomy is known as the rapid weight loss process. Especially up to 6 months, the weight loss process occurs very quickly. The body wants to adapt to the sudden decrease in stomach volume. The result is much less eating and rapid weight loss.
There are differences in the amount of weight to be lost according to the initial weight of the person. In this respect, the average weight loss process in sleeve gastrectomy surgery is expressed as a percentage. A person who has sleeve gastrectomy shows weight loss in the following percentiles;
- 10% weight loss is experienced within 1 month.
- At the end of 3 months, 20% of the initial weight is lost.
- At the end of 6 months, 30% of the initial weight is lost.
- At the end of the 18th month, 40% of the initial weight will be lost.
Above is the average weight loss process of an 18-month period. Considering the average values, it is expected that a person who has undergone surgery with 150 kilos will decrease to 90 kilos within 18 months.
The person’s age, gender, compliance with the diet program, regular exercise and other factors are effective factors in the weight loss process. During the weight loss process, attention should be paid to protein intake. When you start to consume less portions, especially protein intake is seen to be deficient. As a result, there may be deterioration in the health of the musculoskeletal system and loss of muscle mass. In this respect, it is very important to take protein supplements for the first month. Protein supplement products can be used during the first 1 year.
Is It Necessary to Diet Before Sleeve Gastrectomy Surgery?
Before undergoing sleeve gastrectomy surgery, certain examinations must be performed by the physician. In particular, the body mass index of some patients may be above the limit set for surgery. Special diet plans are applied for people who are known as super obese and whose body mass index is over 50. The aim here is to shrink the liver as much as possible. The risk for a person with a very enlarged liver will increase during surgery. With the reduction of the body mass index to the 35-40 range until the surgery, the surgery becomes much less risky.
If the body mass index is not at the level of 50 and there is no special situation that will prevent the surgery, a customized surgery diet is not prepared for the person. The operation process is started directly and it is made plans about the diet that should be applied after the operation. The person can continue to follow their own diet while preparing themselves for surgery. It is important that this diet is prepared by a professional dietitian. A successful post-operative weight loss process only depends on following the diet and exercise plan. It should not be forgotten that people who do not follow the diet and exercise plan correctly after the surgery may experience the process of gaining weight again.
Pain After Sleeve Gastrectomy Surgery
Sleeve gastrectomy surgery is performed with the laparoscopic method, which is a closed surgery method. There are no large skin incisions because it is not an open surgery. As a result, there is a much more painless and faster healing process. In order for the operation to be carried out smoothly, the stomach is inflated with carbon dioxide gas during the operation. At the end of the operation, this gas is discharged. However, as the carbon dioxide in the stomach cannot be completely discharged, the remaining gas may cause pain after the surgery. It is a very short term pain. Walking is very important after surgery for both excess gas removal and rapid adaptation. After the operation, it is necessary to rest in the next 3 hours. With the completion of 3 hours, the patient can start short walks if there is no adverse event.
Although the operation is a closed operation, it requires 1 centimeter holes. This situation includes the incision, albeit small. For a period of several days, the person may feel very minor pain in these incision areas when sitting and getting up. These pains are both very short-term pains and do not greatly affect the comfort of the person.
Alcohol Consumption After Sleeve Gastrectomy Surgery
It is one of the issues that people who drink alcohol in their social life are curious about after the surgery. Alcohol is strictly not recommended, especially during the first 6 months. Although alcohol consumption is not recommended for health reasons, it can be consumed carefully, taking into account the social life of the person. There are 3 important factors that require alcohol not to be consumed. These;
- Alcohol, together with its high calories, is one of the biggest enemies of the person in the weight loss process. In this respect, alcohol should not be consumed in order to benefit effectively from sleeve gastrectomy surgery.
- A much lower alcohol intake, along with a large reduction in stomach volume, can lead to toxic levels in the blood. Due to the large volume of the stomach before the operation, the rate of alcohol mixed into the blood is much more limited. However, this process takes place very quickly after the surgery. A person will be much more affected by a much smaller portion of the amount of alcohol they used to consume before.
- Most of the alcoholic beverages cause bloatedness and indigestion. Considering the shrinkage of the stomach volume, the person will be very uncomfortable in the face of the large bloatedness that occurs. In this respect, it is necessary to avoid alcohol as well as foods that will increase stomach acid.
Nutrition After Sleeve Gastrectomy Surgery
The purpose of sleeve gastrectomy surgery is to both lose weight and eliminate diseases such as Type 2 diabetes. Surgery allows the person to receive support in this process. However, it will not ensure to lose weight on its own. The patient must follow the given diet and exercise plan very carefully.
In the post-operative period, the large reduction of portions poses a risk, especially in terms of adequate protein intake. When a person is not sure that he is getting enough protein, he has problems in the musculoskeletal system. He/she cannot maintain muscle mass. This situation is absolutely undesirable.
It is necessary to pay attention to the following key parts after the operation;
- During the first week, clear liquid foods should be consumed. The main goal here is to readapt the digestive system to food.
- With the 2nd week, dark liquid foods can be started to be consumed. While much more liquid foods are consumed in the first week, thick textured liquids should be consumed with the second week.
- In the following 3rd week, puree of foods can be consumed. In this process, which is between dark liquid and solid food, the body gets adapted to solid food.
- Soft solid foods can be consumed at the beginning of the 4th week. Solid foods should be chopped, ground, crushed and pureed as much as possible. Great emphasis should be placed on protein consumption. Afterwards, the consumption of vegetables and fruits is important.
- Transition to solid food is achieved with the 5th week. The diet plan differs from person to person. In this respect, a diet plan is prepared in the post-operative period, accompanied by a specialist dietitian.
Stenosis After Sleeve Gastrectomy Surgery
Large volume reduction experienced in sleeve gastrectomy surgery may pose a risk in terms of stenosis. Thanks to a mold placed through the mouth during the surgery, it is aimed that the stomach is not narrow and that there is no problem during the passage of food. In this respect, it is very important to perform the surgery together with the expert team and equipment. If attention is paid to this issue, the problem of stenosis will not be encountered after the operation.
After the surgery, there is a great decrease in stomach volume. In cases where food is consumed rapidly, there is a risk of stomach turning. During the postoperative period, food consumption should be carried out in small portions and slowly. If the stomach turns, it causes symptoms such as nausea and vomiting. During the surgery, while the new state of the stomach wall is created, the surrounding fat tissues are stitched. The aim here is to prevent the possible risk of stomach turning after surgery.
How is the Stenosis Detected? What are the Symptoms?
Situations such as nausea and vomiting are considered as natural after sleeve gastrectomy surgery, especially within the 48-hour period. In addition, in the first 3 months, some food sensitivity and occasional vomiting may occur. However, by the end of the 6th month, full adaptation should be achieved. After this period, complaints such as congestion, food sitting in the chest, vomiting, etc. will not be normal any more. If these and similar complaints continue, it is necessary to apply to the clinic.
How is the Stenosis Detected?
Stenosis, which is a complication seen in the range of 2% to 3% after sleeve gastrectomy surgery, can be detected upon evaluation of patient complaints. In particular, it is very important when the stenosis occurs. It should be followed by the patient whether it occurs while eating fast or eating without chewing. If it is seen after such activities, it will be necessary to make changes in habits. If the stenosis persists, further examinations with endoscopy should be performed.
How Is Stenosis After Sleeve Gastrectomy Surgery Treated?
The most basic method used in the treatment of stenosis is endoscopic balloon dilatations. In this way, the narrowed part is widened and the problem is eliminated. If any resistance is encountered in this regard, revision surgeries are performed. Gastric bypass surgery can be performed together with revision surgery, mostly for a person who has sleeve gastrectomy surgery.
What is Leakage After Sleeve Gastrectomy Surgery?
Leakage is one of the most feared complications in obesity surgery. It is possible to be seen both after sleeve gastrectomy surgery and after gastric bypass surgery. Particular attention should be paid to the risk of leakage in sleeve gastrectomy surgeries. Because of the high pressure in the stomach, treatment is more difficult.
Leak refers to the leakage that occurs at very small openings that occur if there is insufficient healing in the reduced stomach or intestinal connection. It is an extremely risky situation for the fluids in the stomach and intestines to flow into the abdomen after leakage. In particular, it is one of the main reasons for the formation of infection. There is a risk of leakage in all surgeries targeting the digestive system. The probability of being seen in sleeve gastrectomy, gastric bypass and other obesity surgeries is between 1-2%. Leakage treatment can be done easily and quickly.
How to Detect Leakage?
There are various symptoms of this undesirable condition. Among these, high fever, abdominal pain and palpitations are prominent. People who have undergone obesity surgery should pay attention to these symptoms in the first 2 weeks. If similar symptoms are seen, it should be consulted to a physician quickly and the problems should be explained clearly. After various examinations and imaging by the physician, the leakage is detected and the treatment process begins. After the first 2 weeks, the risk of leakage disappears.
How to Treat Leakage?
If a leakage is detected, the first thing to do is to determine the size of the leakage and the amount of fluid. If too much leakage fluid is detected in the abdomen, the patient can be operated again. If a small amount of fluid is seen, the discharge of the leakage is performed along with the imaging. Afterwards, endoscopic stent is applied. It is a non-operative treatment. Leakage treatment lasts a period of 2-8 weeks in total. If any infection is observed, hospitalization is performed.
Can Any Precautions Be Taken for Leakage?
There are various factors that can be done to prevent leakage in obesity surgery. The most important factor is that the surgeon is experienced and performs the surgery meticulously. In addition, the equipment used and the double suture technique used in the surgery are important issues that prevent leakage.
The absence of leakage does not depend only on the operation process. There are also important issues that the patient must comply with after the surgery. At the beginning of these is the strict fulfillment of the diet given to the patient. Especially during the first 14 days, acid-free and liquid foods should be consumed in order not to put pressure on the stitches.
Solid-Liquid Separation After Sleeve Gastrectomy Surgery
With sleeve gastrectomy surgery, there is a significant decrease in the volume of the stomach. In this respect, the post-operative nutrition process is very important. Due to the decrease in volume, if not taken care of, it can cause discomfort that will affect the comfort of life. As the volume of the stomach does not have the capacity to take both solid and liquid foods at the same time, this separation must be made. In addition, the simultaneous intake of solid and liquid foods can cause rapid growth of stomach volume and weight gain again. Those who have sleeve gastrectomy and those who struggle with obesity should pay attention to their lifelong avoidance of solid and liquid foods. While consuming solid foods, liquid foods can be taken to make it easier to pass. However, this should not be enough to quench thirst.
A patient who is both thirsty and hungry should choose one of the two options. It is necessary to put 30 minutes before and after water intake. Before starting to eat, it is necessary to create a 30-minute fluid intake gap. Likewise, it is extremely important to avoid liquid drinks after meals and to consume after a 30-minute period.
Does the Stomach Enlarge After Sleeve Gastrectomy Surgery?
After sleeve gastrectomy surgery, there is a significant decrease in stomach volume. This rate is approximately 80%. The stomach, which has a volume of 1000-1500 ml, decreases to the level of 100-150 ml with the surgery. This volume corresponds to approximately one tea glass. With the passage of 12 months after the operation, the stomach volume can rise to the level of 200-250 ml. The stomach, which rises from the tea glass to the water glass level, does not grow to the level it was before. The important issue to be considered here is the possibility of experiencing discomfort due to the small size of the stomach. If the patient begins to eat large portions without taking into account the volume of the stomach, complaints of bloatedness will arise. This can cause major problems in quality of life.
Weight loss is rapid after sleeve gastrectomy surgery. One of the biggest fears is regaining the lost weight. The reason behind this is not the enlargement of the stomach; It is the person’s consumption of frequent and high-calorie foods. Even if the stomach does not reach its previous volume, if the patient does not follow his diet and consumes high-calorie foods, he will start to gain weight again.
Is It Possible To Fast After Sleeve Gastrectomy Surgery?
Many issues need to be considered in the post-operative period. Successfully losing weight also requires meeting the body’s needs. Unhealthy weight loss should definitely be avoided. Especially in the first months, it is necessary to pay attention to nutrition. With the large decrease in the volume of the stomach, the patient has to eat frequent and small portions. Not only solid foods, but also liquid foods and water should be consumed very often and in small sips. In this respect, prolonged hunger and thirst is strongly discouraged. If these issues are not taken care of, many diseases may occur. Many diseases such as digestive problems, weakness, dizziness, low blood pressure begin to be seen. It is definitely not recommended to stay hungry and thirsty for a long time in the 12-month period after the surgery.
Active weight loss process takes 18-24 months after sleeve gastrectomy. During this period, great attention should be paid to the nutrients taken and the needs of the body should be met. In this respect, it is necessary to be careful about fasting. Long-term starvation will not only negatively affect the weight loss process, but also other health issues.
Is Weight Gained After Sleeve Gastrectomy Surgery?
There are restrictive measures at the target of sleeve gastrectomy surgery. Thanks to the 80% volume decrease experienced in the patient’s stomach, the patient reaches satiety by consuming much lower portions. Sleeve gastrectomy surgery does not affect the absorption process like gastric bypass surgery. In this respect, there will be no difference in absorption obtained from meals, and therefore in calories. If the diet and exercise plan is followed after sleeve gastrectomy, the lost weight cannot be regained. However, if frequent and high-calorie foods are consumed, the lost weight begins to be regained.
Following the 24-month period after sleeve gastrectomy, some patients experience weight gain. However, this weight gain remains limited. It should be noted that weight gain is limited, given the large decrease in stomach volume and the volume that the stomach can expand. If the patient avoids high-calorie foods, weight gain is not observed.
In the first 2 years of sleeve gastrectomy surgery, approximately 40% of the initial weight is given. After this period, After this process, if the diet and exercise plan are followed, the weight loss process can continue slowly.