Gastric Sleeve Surgery

What is Gastric Sleeve Surgery?

Gastric Sleeve Surgery: Gastric sleeve surgery (sleeve gastrectomy) is a surgical procedure to reduce the volume of the stomach by 70% to help obese people lose weight. The procedure is performed laparoscopically (closed surgery).

How can I lose weight with Gastric Sleeve Surgery (Sleeve Gastrectomy)?

This surgery reduces the volume of the stomach by 70%. Therefore, those who have undergone surgery cannot eat much even if they want to. The reduced amount of food eaten leads to weight loss. Besides, the surgical procedure also removes the part of the stomach called the “fundus”. The fundus secretes a hunger-inducing hormone called “ghrelin”. By removing the fundus, one of the mechanisms that trigger hunger is also eliminated.

How is Gastric Sleeve Surgery (Sleeve Gastrectomy) performed?

This method involves creating canals between the inside and outside of the abdomen through 5 very small skin incisions (about 5-15 mm in size) made in the anterior abdominal wall, using apparatus called trocars, which allow access to the abdomen. The procedure first involves inflating the abdomen by introducing CO2 (carbon dioxide) gas into the abdomen through the first inserted trocar, thereby creating a suitable field of view to perform the procedure. The procedure is performed using specially designed laparoscopic materials for grasping and pulling, opening, cutting, controlling bleeding, sealing the vessels, suturing, and excision, which are inserted into the abdomen through these canals. The lower left outer axis of the stomach, the part called “curvatura majus”, which has abundant vascular structure, is freed from the structure called “gastrocolic ligament”, which has abundant vascular structure, by both sealing and cutting the vascular structures using the instrument known as “LigaSure”, provided that it proceeds from the stomach border. Then, a titanium stapling procedure is performed in three rows, side by side, on each of the parts of the stomach that will be removed and left, starting from the lower left outer part of the stomach, leaving about the thickness of the esophagus between the esophagus and duodenum, and it is divided by cutting it in the middle with the blade on the stapler. Each stapler stroke staples a 5 cm area, followed by an incision. In about 4 to 5 strokes, about 70% of the stomach is removed, starting from the bottom of the stomach and moving upwards, leaving a tube-shaped stomach. To ensure that the part of the stomach that will not be removed is the size we want, a hose-like instrument called “calibration tube”, which is inserted through the mouth into the stomach, is used to define the required diameter.

The part of the stomach that is removed by the procedure is taken out of the abdomen through a 15 mm abdominal opening using grasping and pulling instruments.

Then the procedure site is checked for any bleeding. If any, the bleeding is stopped.

The remaining stomach is tested for leaks by administering pressurized blue serum through an oral gastric catheter. If any, the leak is sealed.

Upon completion of the whole procedure, an intra-abdominal cleansing is performed. Over the line where the stomach is stapled, a silicone tube called “drain” is placed, and the tip of this tube is taken out of the abdomen through one of the openings we make in the abdominal wall for insertion of the trocar. This drain serves to drain out any post-procedure bleeding or leaking fluids, if any, and also gives us an idea about whether we need to perform an additional procedure due to leaks and bleeding. This drain is also used on the 2nd day after surgery to test for leaks by making the patient drink blue colored water through the mouth.

Finally, two of these 15 mm trocars are sutured using special instruments both for the possibility of hernia and for bleeding control. With the trocar valves opened, the CO2 (carbon dioxide) gas in the abdomen is completely evacuated. All trocars are pulled out and removed out of the abdominal wall. The minor incisions are sutured, and the surgical procedure is thus finalized.

Why is Gastric Sleeve Surgery (Sleeve Gastrectomy) performed?

Obesity reduces life expectancy by around 10-15%. For those who cannot lose weight on their own efforts, by dieting, exercising, using medication, or endoscopic obesity methods, surgical treatment remains the only option to increase the remaining life span and quality of life.

This surgical procedure is performed to eliminate or minimize cardiovascular diseases, joint diseases, fertility problems, sexual dysfunction, psychological disorders, respiratory system diseases, hormonal diseases, cancer, impaired quality of life and social problems caused by obesity.

What are the criteria for Gastric Sleeve Surgery and who can have it?

• Those with a BMI above 35 kg/m2 (1)
• Those with a BMI above 30 kg/m2 accompanied by comorbidities
• Diabetes, COPD, Cardiovascular Disease etc. (1)
• Those who cannot lose weight by dieting and exercising
• Those who cannot lose weight with other methods
• Those suffering from sexual dysfunction, fertility problems and psychological and social disorders due to overweight
• Those under 65 years of age
• Those over 18 years of age
• Those over 12 years of age, on whom a medical board decision has been issued

Who cannot have Gastric Sleeve Surgery (Sleeve Gastrectomy)?

• Uncontrolled schizophrenics
• Pregnant women
• Those who want to conceive in the next year
• Those with stomach tumors
• Those who receive ongoing treatment for cancer
• Those under 18 years of age
• Those over 65 years of age
• Those with comorbid health problems who cannot tolerate a surgical operation
• Alcohol and drug addicts
• Those who merely rely on the surgery without changing their lifestyle and dietary habits at all

When is Gastric Sleeve Surgery (Sleeve Gastrectomy) performed?

The surgery should be performed at the best possible time for those who cannot lose weight despite following a diet, exercising and undergoing endoscopic obesity methods or those who cannot use diet, exercise and endoscopic obesity methods or those who cannot do so, those with a BMI over 35 kg/m2 or BMI over 30 kg/m2 and who suffer from comorbidities (Diabetes, COPD, Cardiovascular Disease, etc.) and those who cannot stop weight gain.

What are the risks involved in Gastric Sleeve Surgery?

The most important criteria determining the risk is the level of experience of the team performing the surgery. The most significant factors posing risks include poor experience, lack of diligent work, inappropriate physical conditions due to budgetary concerns, use of low-cost materials, and inexperienced auxiliary medical personnel.

Possible risks involve:

• Leaks from the stomach sutured with stapler (2%) (If waited, most of the cases stop spontaneously, 10-15% of those with leaks are endoscopically repaired with a stent, 5% are re-operated and repaired with sutures).
• Postoperative bleeding (2-3%) (Most of these cases stop without intervention)
• Embolism in the lung and brain (0.05%)
• Intra-abdominal organ injury during the procedure (0.03%)
• Infection (0.5-1%)
• Risk of death (0.01%) (This is the same rate as in any medium-sized surgery)

How much weight loss can be achieved with Gastric Sleeve Surgery (Sleeve Gastrectomy)?

Gastric sleeve surgery provides weight loss for two years, if considered in periods of three months each. However, the weight loss decreases with each trimester from the beginning. The most weight loss is observed in the first three months after the procedure. The patient loses 20-25% of his/her excess weight in the first trimester, 15-20% in the second trimester, 10-15% in the third trimester, 5-10% in the fourth trimester and 5% or less in the following trimesters.

But these rates may vary depending on the patient’s diet and exercise. It is usually expected that the patient will reach his/her ideal weight in the second year.

How long does a Gastric Sleeve Surgery (Sleeve Gastrectomy) take?

The sleeve gastrectomy takes an average of 60-90 minutes.

How long is the hospital stay before and after Gastric Sleeve Surgery (Sleeve Gastrectomy)?

The patient is preferably hospitalized the day before the procedure to complete the necessary tests and examinations, or the pre-procedure tests and examinations are performed on an outpatient basis and the patient is hospitalized on the day of surgery. The patient is hospitalized on the day of surgery and for two days afterwards.

How soon can I start eating after Gastric Sleeve Surgery (Sleeve Gastrectomy)?

The patient is tested for leaks by drinking blue water two days after the surgery. Unless the blue water is flowing through the drain inserted in the abdomen, nutrition is started by switching to liquid diet, starting with water. During this period, you should eat small portions at frequent intervals and chew and swallow the food thoroughly. You should avoid carbohydrate foods and carbonated drinks.

How soon can I walk after Gastric Sleeve Surgery (Sleeve Gastrectomy)?

Four hours after the surgery, the patient is allowed to stand up and start walking. The patient can also relieve himself/herself.

How soon can I be discharged after Gastric Sleeve Surgery (Sleeve Gastrectomy)?

On the third day after surgery, provided that there is no flow from the drain inserted into the abdomen and the patient’s nutrition and vital signs are normal, the drain is removed, and the patient is discharged with a prescribed diet and medication.

Should I visit the Clinic for follow-up after Gastric Sleeve Surgery (Sleeve Gastrectomy)?

The last follow-up examination is performed three days after discharge. The patient is then invited for a follow-up visit if he/she lives in the city where the clinic is located. If the patient lives in another city or country, he/she is given a calendar of check-up periods. If necessary, he/she is followed up at 3 and 6 months after surgery at his/her place of residence. However, for monitoring the rate of weight loss, our dietitian contacts the patient once a month for the first six months and once every 3 months for the next 18 months.

What are the instructions I should follow after Gastric Sleeve Surgery (Sleeve Gastrectomy)?

• The patient should change his/her eating habits and follow the recommendations
• Eating a large meal quickly at once leads to a feeling of fullness and vomiting
• The foods in the carbohydrate group (flour, sugar, fruit, rice, etc.) and sugary, carbonated drinks should be avoided
• It is recommended to swim or walk briskly for at least 30 minutes a day
• Heavy sports should be avoided in the early period
• Sedentary life should be avoided

Please contact us for further information about endoscopic treatments for obesity and gastric sleeve surgery prices.

 

References:

1. Eisenberg, D., Shikora, S.A., Aarts, E. et al. 2022 American Society of Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) Indications for Metabolic and Bariatric Surgery. OBES SURG 33, 3–14 (2023). https://doi.org/10.1007/s11695-022-06332-1

Please contact us to get more detailed information about endoscopic treatments and flora transplantation for obesity. You can reach us via E-mail or Whatsapp.