Gastric Sleeve
Obesity is one of the most serious diseases of our time. Approximately one-third of people worldwide are classified as obese or overweight. If left untreated, it can cause permanent and more serious diseases. Gastric sleeve surgery (stomach reduction surgery) is the most commonly used surgical method in the treatment of obesity.
WHAT IS GASTRIC SLEEVE SURGERY?
Gastric sleeve surgery is a surgical procedure in which approximately 80% of the stomach is removed and 150-200 cc of stomach tissue is left behind. Sleeve Gastrectomy, which was performed in the 2000s as the first step of more complex multi-step laparoscopic bariatric surgeries (biliopancreatic diversion with duodenal switch BPD-DS, Roux-en-Y gastric bypass LRYGB), when the results obtained later are evaluated and the complication rates are very few compared to complex surgeries, it has been a separate surgery in the treatment of obesity and it constitutes approximately 60% of the current obesity surgeries.
In Gastric Sleeve surgery, the stomach is cut from the points where it meets the esophagus and duodenum and turned into a tube. Since the volume of the stomach is reduced and the dome-shaped “fundus” part, in which Ghrelin, known as the hunger hormone is secreted, is removed, patients lose weight easily in the postoperative period without feeling hungry.
The operation is performed with the laparoscopic method and the duration is approximately 1 – 1.5 hours.
Because of patients do not feel much pain after sleeve gastrectomy surgery, the process of rapid recovery and weight loss is easily started. There is a very rapid weight loss, especially in the first month, and then the process slows down a bit and continues for up to a year.
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WHAT ARE THE RISKS OF GASTRIC SLEEVE SURGERY?
The two most important complications are the leakage and bleeding from the cut line due to the openings in the suture line in the remaining stomach section.
In cases of bleeding, the condition usually resolves spontaneously with medical treatment and sometimes supplementation of blood products. In some cases, it may be necessary to intervene with endoscopic methods.
In case of leakage, it is important to detect it in the early period. For this purpose, a leak test is performed just before the end of the operation and the test is renewed on the first postoperative day. If leakage is detected, endoscopic sutures and stent application are usually performed.
The biggest reason for bleeding or leakage is the poor quality of the staplers used during the removal of the stomach section.
We use the Covidien Endo GIA TRI STAPLE™ product in our operations without sacrificing quality.
WHO IS ELIGIBLE FOR GASTRIC SLEEVE SURGERY?
Gastric sleeve surgery can be considered for people between the ages of 18-60, who do not have an obstacle to surgery, who have not benefited from the exercise and diet programs applied, and who meet the criteria.
In general, the group for which surgical treatment is prescribed;
Morbidly obese with a body mass index of 40 kg/m2 and above
Those who have a body mass index of 35 kg/m2 and above and have additional diseases (diabetes, hypertension, sleep apnea, high cholesterol, joint problems)
It is also very important that the patients who are planned for surgery do not have alcohol or substance addiction, are stable in terms of psychiatric conditions, and are stable in terms of long-term follow-up and lifestyle changes after the surgery.
If you are not suitable for gastric sleeve surgery, you can consider gastric balloon treatment, which is one of the treatment methods that do not require surgery in obesity treatments.
HOW IS THE SLEEVE GASTRECTOMY SURGERY PROCESS?
- After your doctor decides that the most suitable method for you to lose weight is gastric sleeve surgery, the preliminary preparation process for the surgery is started. Liquid or solid food intake must be stopped 12 hours before the operation. If food or fluid has been taken, it is important to report this. Blood thinners should not be used before surgery.
We recommend that smokers do not smoke heavily or even no at all before surgery.
Necessary controls are carried out to determine whether there is a situation that prevents you from having surgery or losing weight after surgery. The examinations performed before bariatric surgery are as follows:
Detailed blood tests, - EKG,
- Lung film,
- Covid test,
- Upper abdomen tomography,
- Internal medicine, cardiology physician controls,
- Detailed weight measurements.
In addition, the anesthetist evaluates whether if there is an restriction for the patient to receive anesthesia.
It is known that psychological disorders or past traumas are the causes of obesity. For this reason, the patient is also evaluated psychologically.
We naturally see stress and anxiety in our patients before surgery. First of all, it should be noted that gastric sleeve surgeries are performed laparoscopically. Therefore, postoperative pain is very less. Approximately 4-5 hours after the operation, you will recover and you can even walk. The fact that the surgery is performed by experienced surgeons using quality materials reduces the risk of complications significantly.
You will be sedated to reduce your fears and anxieties before the surgery. After the anesthesia is taken, your surgery is started by our expert team.
Since gastric sleeve surgery is performed by removing a part of the stomach, patients can easily lose weight without feeling hungry, as there is a decrease in the appetite hormone secreted by the stomach.
What is Stapler? What is Endo GIA™ with Covidien Tri-Staple™ Technology?
Staplers are surgical equipment that are generally used in many surgical procedures, like a paper stapler, which closes the tissue while cutting it at the same time. It has been used for many years during surgical procedures that must be performed quickly, or in areas of the body that are difficult to stitch.
In sleeve gastrectomy surgery, an average of 6 staplers are used to cut and stapling at the same time while cutting 80% of the stomach. You can watch the video on how the stapler is used in a sleeve gastrectomy surgery here.
Over the years, the first surgical staplers were developed and became what they are today. One of these is Endo Gia staplers with Tri-Staple technology developed by Medtronic. There are three rows of staple lines at different heights on both sides of the cutting line of the staples. It is a specially designed stapler used for Sleeve Gastrectomy surgery to work in harmony with the stomach tissue during and after stapling.
It has high strength and impermeability as a result of its design and the technology behind it.
Approximately 6 staplers are required for a sleeve gastrectomy surgery, depending on the size of the stomach.
The stapler is placed laparoscopically in the stomach on a loading unit and stapled from the outside with the stapler unit (staple gun).
Stapler punches are made of titanium. There are three rows of titanium staples on each side. There will be 3 rows of staples left in your tube-shaped stomach. During gastric sleeve surgery, approximately 300 of these tiny staples remain in your stomach. The remaining 300 are removed with the cut stomach section.
Why is Stapler Material Very Important?
Many metal and alloys such as steel, magnesium and platinum are used in the medical industry. However, according to research, the best medical material is titanium due to its strength and resistance to rust. Medical grade titanium does not cause any allergic reactions or infections.
It also has very little magnetic response, so it won’t cause any problems with MRI scans.
Endo GIA™ high performance staplers with Covidien Tri-Staple™ Technology are made of medical grade titanium, making them safe to use.
We have previously mentioned in the risks section of gastric sleeve surgery that one of the biggest risks will be leakage from the stapler line. Staplers can be manufactured from materials other than titanium. However, none of them are as healthy as titanium.
Poor stapler material and technology increases the risk of this leakage. Poor quality of the material leads to situations such as bleeding, leakage, infection and non-healing of the wound.
Unfortunately, due to commercial concerns and attractive prices, costs can be reduced by using Chinese origin or poor quality staplers in sleeve gastrectomy surgeries. It is important for patients to be careful in this regard, so as not to risk their health and life.
The Covidien brand staplers we use in our surgeries are made of titanium and are at the latest in terms of production technology.
FDA, CE, FSC, ISO, GPC approved Endo GIA™ staplers with Covidien Tri-Staple™ Technology provide the highest material quality, best design features and modeling type, triple staple technology that prevents postoperative bleeding and leakage, allowing surgeons to perform the procedure more steadily and smoothly. It provides a safe surgery with minimum risk with its features such as a special system that provides better hemostatic and airtight effects, a design that enables smooth entry into the tissue and reduces damage, and a new key design that allows easy replacement of components.
Frequently Asked Questions About Staplers
We know that our patients have questions about the staplers that have been used in Gastric Sleeve Surgeries since the 1960s. In this section, we will try to clarify these questions in general.
Do staplers dissolves or always stay there ?
No. After the stomach tissue heals and fuses together, the staplers no longer have any function. It remains in the stomach for the rest of your life, embedded in the tissue. For this reason, it is very important to use approved and high quality staplers.
Can staplers cause any reactions in the body?
Staples made of quality titanium do not cause any allergies or inflammation.
Still, is there any risk?
Yes, there is always a risk of leakage. All improvements are made to minimize the risk of leakage. After surgery, surgeons perform a leak test. Even if no leakage is detected, there will be a risk of leakage if the tissues do not heal well in the future. There may be several reasons for this. Particular attention should be paid to nutritional balance.
Do staplers produce signals in detectors during security checks?
No. The metals inside are not numerous enough to produce a signal.
Does it cause problems in MRI?
Titanium does not affect MRI signals. It does not cause any problems.
WHERE DO WE DO GASTRIC SLEEVE SURGERY?
The satisfaction of our patients before and after the operation is very important to us. For this reason, we perform Gastric Sleeve and other obesity surgeries with the top quality hospitals and therefore with the best equipments.
EQUIPMENT USED IN GASTRIC SLEEVE SURGERY
Gastric sleeve surgery is a serious surgical procedure. The equipment used during the operation, the hospital where the operation is performed, the experience of the doctor and the postoperative follow-up have a very important place. We use the Covidien series Tri-Staple equipment of Medtronics, one of the safest companies in the world, in medical equipment, without compromising on quality in our surgeries.
AFTER THE GASTRIC SLEEVE SURGERY
You will be taken to your room after the surgery and kept under constant observation by the expert team. After about 5 hours, you can get up and walk. In fact, walking is very important during the recovery phase to prevent blood clots and to alleviate the effects of gases remaining in the abdomen during surgery.
Is There Any Pain After Gastric Sleeve Surgery?
After the surgery, the pain is normally very little, but since the pain varies from person to person, it can be alleviated with medications.
Is There a Risk of Leakage After Gastric Sleeve Surgery?
During the surgery, just before finishing a leakage test is performed. After 1 day, a radiological liquid is drunk and an x-ray of the abdomen is taken to see if there is any leakage.
The risk of leakage in gastric sleeve surgery depends on the experience of the surgeon, the quality of the material used in the surgery and the anatomical structure of the patient. In gastric sleeve surgeries, where a part of the stomach is cut and removed, there are risks, as like any complex surgical intervention.
If no problems are detected, you can start drinking water.
How Many Days Will You Stay in the Hospital After Surgery?
You stay in the hospital for a total of 3 days. During this period, the body is fed with serum. It is important for patients to be able to take fluids on their own. Because serum cannot be used in the home environment. Dehydration after surgery is a possible condition. Therefore, it is necessary to pay attention to fluid intake after surgery.
Before discharge, you will be given information about the post-operative process, you will be discharged after information about the rules you need to follow, the nutrition program, and the drugs to be used.
What to Eat After Gastric Sleeve Surgery?
Liquid foods must be consumed in the first stage after the surgery. There may be liquid foods specially prepared for this. Your dietitian and doctor will give you detailed information about this. Your stomach size has only been reduced, it is still digesting the foods you take, since the absorption does not change in sleeve gastrectomy surgery, these foods should not contain high fat and calorie. For example, you can drink low-fat milk. Low-fat milk rich in both protein and calcium.
The first 2 months can be seen as a transition period from liquid food to normal solid food. In the first 2 weeks, liquid foods and protein and vitamin supplements such as B12 should be taken. In the second stage, after 2 weeks, pureed foods should be taken. Fruits and vegetables can be crushed and pureed and consumed. These foods should be high in protein and low in calories.
After the 5th week, solid foods can be consumed. However, bites should be chewed slowly and portion control should be ensured. Drinks should be drunk sparingly. When you feel you are full, the meal should be finished. Carbonated drinks should be avoided.
Drinks should not be consumed with meals after sleeve gastrectomy surgery. High-calorie, sugary drinks should be avoided.
Exercise After Gastric Sleeve Surgery
After surgery, sports and excercises can be done with the advice of a doctor and an expert sports consultant. You can start with light-paced walks 1 month after the surgery.
HOW LONG DOES IT TAKE FOR STOMACH TO HEAL AFTER GASTRIC SLEEVE SURGERY?
Gastric sleeve surgery is performed using advanced techniques and equipment. This shortens the recovery time after surgery. Although the recovery process varies from person to person, patients can usually return to their homes after 3 days and continue their work that does not require heavy working conditions at the end of 15 days. Healing of the wounds (laparoscopy wounds) formed during the surgery heals in approximately 4-6 weeks. The healing of the stapler line, which is used to cut the stomach and keeps the remaining part of the stomach in place may take 6-8 weeks. In this process, it is very important for the patient to abide by the given rules and prohibitions and to follow the nutrition method stricly.
WHEN AND HOW MUCH WEIGHT LOSE?
After the gastric sleeve surgery, the patient starts to lose weight. In sleeve gastrectomy surgeries, an average of 60% of excess weight is lost in general. This is more in some patients.
While the results can be much higher than this rate with eating habits and exercise after gastric sleeve surgery, lower rates are observed in patients who return to their old habits. Therefore, surgery is a start. The next process should be followed with precision.
Weight loss may stop over a period of time. This can be defined as the self-balancing process of metabolism (homeostasis) against changing external influences. Since weight is lost rapidly in the post-operative period, the metabolism enters the adaptation process. This can usually be seen at 6 months. This situation is called a weight loss plateau. In fact, this situation is also observed in the case of losing weight with normal diet and exercise. The easiest way to overcome such a situation can be by changing the external factors.
THE COSTS OF GASTRIC SLEEVE SURGERY
The costs of the surgery are not fixed, due to some equipment costs are depend on the exchange rate, the hospital prices where the surgery is performed, and other diseases of the patient. If you want to get successful and quality service to get rid of obesity disease, you can contact us.
IF YOU HAVE GASTRIC SLEEVE CAN YOU HAVE GASTRIC BALLOON LATER?
Unfortunately, after gastric sleeve surgery, some patients are able to gain weight again because they return to their old habits over the years, and they cannot maintain their weight loss in the first period, which is the success of the surgery. For this reason, patients are turning to obesity treatments such as non-invasive gastric balloon or allurion swallowable gastric balloon (allurion balloon) instead of serious revision surgery.
However, gastric balloon application cannot be performed because there is not enough space for the balloon in the stomach due to the shrinking stomach volume after sleeve gastrectomy surgery.
Gastric Sleeve Surgery FAQ (FREQUENTLY ASKED QUESTIONS)
Gastric Sleeve Surgery is the removal of a large part of the stomach by laparoscopic method. The remaining stomach volume is about 100-150cc and is left in the form of a tube similar to a banana. The word tube comes from here. Stomach volume is reduced from 1.5-2lt to 100-150cc. The surgery is performed using laparoscopy through 4 holes opened in the abdominal area. For this reason, the healing process is minimized. Appetite decreases as the stomach shrinks. The amount of food taken at each meal decreases.
Gastric sleeve surgery is a stomach reduction surgery. Since the stomach is reduced by 80%, the amount of food intake is severely restricted after the surgery. However, since the stomach section removed after gastric reduction surgery plays a role in the secretion of the appetite hormone GH, hormone secretion is minimized. Thus, it causes appetite suppression.
Stomach reduction surgery is not an absorption-restricting surgery. The small intestine is not shortened like Gastric Bypass. Since absorption does not change, vitamin and mineral deficiencies are very rare. Effects such as dumping syndrome are not observed.
The average duration of surgery is 60-90 minutes. However, this time may vary depending on the patient’s anatomy, the surgeon’s experience and the quality of the equipment used.
Although the age range for stomach reduction surgery is generally 18-65, in some cases the surgery criterion is not just age. For this reason, it would be appropriate for patients to meet with the doctor regardless of their age range.
Gastric sleeve surgery can be performed on obese or morbidly obese patients between the ages of 18-65. It can be applied to individuals with a body mass index of 35 and above and comorbid diseases such as type 2 diabetes sleep apnea caused by obesity, and to morbidly obese individuals with a body mass index of 40 and above. Patients over the age of 65 should be re-evaluated, and if they are under the age of 18, parental consent should be obtained. In super obese patients with a BMI of 50 and above, sleeve gastrectomy surgery can be performed as the first stage before gastric bypass.
Obesity surgery is not performed on people who cannot receive anesthesia, patients with serious psychological disorders, alcohol and drug addicts, and patients with serious heart diseases such as advanced heart failure.
Stomach Reduction surgery is performed using the laparoscopic surgery method using 4 holes opened in the abdominal area. Depending on the patient’s weight, body structure and previous surgeries, the surgery duration is 1-2 hours in total.
Since sleeve gastrectomy surgery is performed laparoscopically, its risks are less than open surgeries. However, as with any surgery performed under anesthesia, there are risks associated with anesthesia. In addition, there are risks such as leakage, bleeding and embolism from the cut section, although they are small. These risks are related to the quality of the devices and tools used and the experience of the team.
Immediately after the surgery, our patients can stand up and walk for 4 hours, which is a desired condition for the healing process. They can meet their own needs under hospital conditions. At the end of the 3rd day, they are discharged after the necessary checks are made. Patients working in light desk jobs can return to work after an average of 1 week.
A 4-week recovery period is required for our patients who work in heavy labor.
Heavy physical activities should be avoided for 4 weeks after surgery. We recommend light-paced walking during the 4-week period, brisk walking after 4 weeks, and sports such as swimming, in which the whole body works. After the 6th month, depending on the person’s wishes, they can start heavy sports under supervision.
As with every surgical operation, there may be a certain amount of pain in stomach reduction surgery. Since it is performed laparoscopically, this pain is minimal. Painkillers are routinely given to the patient after the surgery. In general, our patients state that they feel little or no pain.
Remember that it is wrong to evaluate obesity treatment methods alone. The factors that cause obesity also need to be eliminated. In addition to the mandatory diets that must be followed after the surgery, the implementation of appropriate nutrition and exercise habits as a lifestyle are the most effective methods for the success of the surgery.
How much weight will I lose after surgery is one of the questions our patients ask most? This entirely depends on the person. Such as pre-operative weight, body mass index, motivation, and implementation of the given diets. Generally speaking, it has been observed that they lose up to 20% of their weight in the first 3 months after surgery, and this increases to 40% in the 6th month. In the later period, they can reach their ideal weight. However, weight loss may stop for a while. This is the situation that worries our patients the most. This condition, called Weight-Loss Plateau, is the metabolism’s habit of losing sudden and excessive weight. A person can easily overcome this situation by changing external factors, namely eating habits and exercise status.
In gastric sleeve surgery, a large part of the stomach is cut out. The remaining stomach is closed with tools called staplers and left as a tube. In order for the stapler part to heal, the patient is allowed to consume only liquid foods for at least 1 week immediately after the surgery. By liquid food, we mean clear water, fruit tea, or watery soup. Carbonated drinks should not be consumed.
In the 2nd week, liquid food intake should be continued. During this period, protein drinks and low-calorie and fatty soups can be consumed. Our dietitian will help you with your options. During this period, we recommend nutritional support products such as Barifit, which are already produced for this purpose, to our patients.
In the 3rd or 4th week, the transition to pureed foods is made. Fat-free and low-calorie food should be consumed by pureeing it.
Soft foods can be started after the 6th week. Protein foods should be consumed and each meal should be chewed slowly and long. Meals should be planned 6 hours apart. You should not continue eating as soon as you feel full.
Approximately 4 months after stomach reduction surgery, normal food consumption can be resumed. However, meals should be planned and each bite should be chewed for a long time before swallowing. In general, high-calorie and fatty foods should be avoided. Carbonated sugary drinks should not be consumed and alcohol intake should be controlled.
You can take a bath even after 1 day, provided that the laparoscopy trocar incisions are covered so that they do not get wet.
Before the end of the surgery, the cut part of the stomach is removed and blue dye is administered through the tube inside the stomach to test whether there is a leak in the cut area and the surgery is completed. In case of any leakage, immediate action is taken. One day after the surgery, a tomography is performed with contrast water and a re-check is performed.
This is completely dependent on the person’s anatomy. The skin becomes thinner with age. The person’s weight before surgery is also important. In overweight patients, skin sagging may occur after losing too much weight because the skin is overstretched. How the person proceeds after surgery is also a factor. Proper nutrition, balanced protein and exercise minimize this situation. However, if there is still sagging skin after a long period of time, plastic surgery procedures may be used.
You can review our article about skin sagging after stomach reduction surgery.
Gastric sleeve surgery is performed using advanced techniques and equipment today. This shortens the recovery time after surgery. Although the recovery process varies from person to person, patients can generally return home after 3 days and continue their jobs that do not require heavy working conditions after 15 days. Healing of the wounds caused by the surgery takes approximately 4-6 weeks. The staple line used to cut the stomach and holds the remaining part of the stomach in place during healing may take 6-8 weeks to heal. In this process, it is very important for the patient to comply with the given rules and prohibitions and to follow the nutrition method determinedly.
Today, sleeve gastrectomy surgery is performed using advanced techniques and equipment. This shortens post-operative recovery time and hospital stay. Although the recovery process varies from person to person, patients can usually return home after 3 days. If complications develop, the doctor decides this period.
Although gastric sleeve surgery is not a bariatric surgery that reduces absorption, the mineral and vitamin intake that the person needs may decrease in the first period because the stomach volume becomes very small. Although vitamin and mineral intake is generally recommended, this should be decided by the doctor and dietitian, and random vitamin and mineral supplements should not be made.
During the first month of recovery, no exercise other than light walking can be done, and after that, sports can be done by avoiding sports movements that are particularly challenging to the abdominal area. During this period, it is recommended to do sports under the advice of a doctor and under the supervision of a specialist who is knowledgeable about the surgery.
Although gastric sleeve surgery is performed in public hospitals within the scope of SSI, this is subject to some conditions. It is performed in obese patients with a body mass index of 40 and above, when excess weight is life-threatening.
After stomach reduction surgery, if the patient does not follow the nutrition and lifestyle change recommendations given by the doctor and dietitian and returns to his old habits, he may gain weight again. However, patients who change their lifestyle with gastric sleeve surgery can maintain their ideal weight for life.
In addition to the term Gastric Sleeve Surgery, Gastric Reduction Surgery is also used because the stomach is reduced in size by removing a large part of the stomach. Both surgeries describe the same operation.