What is Gastric Sleeve Surgery? How is it performed?

Gastric sleeve surgery, also known as stomach reduction surgery, is one of the most common procedures among obesity surgeries today. During this surgery, approximately 80% of the stomach is removed, leaving behind a much smaller stomach volume. As a result, food and calorie intake are significantly reduced after the procedure. Furthermore, by removing the fundus region of the stomach, which secretes appetite hormones, patients experience a sense of satiety, facilitating weight loss.

The surgery is typically performed laparoscopically, using a minimally invasive approach. Three or four incisions are made in the abdominal skin, through which instruments called trocars are inserted into the abdominal cavity. CO2 gas is then used to inflate the abdomen, and an optical camera is employed to project the inside of the abdomen onto a screen. The stomach is then separated from any adhesions with other organs and completely freed. Subsequently, approximately 80% of the stomach is removed vertically using surgical staplers. Finally, the remaining stomach is sutured along the stapler line to complete the procedure.

Who can undergo Gastric Sleeve Surgery?

Gastric sleeve surgery can be performed on individuals between the ages of 18 and 65. It is typically recommended for individuals with a body mass index (BMI) of 35 or higher who have been unable to lose weight despite prolonged diet and exercise, and who have accompanying conditions such as diabetes, hypertension, or sleep apnea. Additionally, individuals with a BMI of 40 or higher may also be eligible for stomach reduction surgery.

How Safe is Gastric Sleeve Surgery?

Gastric sleeve surgery is commonly performed today, and hospitals and surgeons have become quite experienced in this regard. The complication rate of stomach reduction surgery is around 8%, with a mortality risk of 1 in 1000 cases. Gastric sleeve surgery is a relatively safe method for obese patients. However, several factors need to be considered to ensure the surgery’s safety. Patients should undergo thorough evaluation before the operation, and all relevant factors should be identified. When the surgery is performed and monitored by a professional team, it is a very safe procedure.

What is the Success Rate of Gastric Sleeve Surgery?

After gastric sleeve surgery, the majority of patients either reach their ideal weight or come close to it. Following stomach reduction surgery, patients typically lose 30-35% of their weight by the 6th month post-operation. Additionally, individuals may experience a reduction in the severity or complete resolution of accompanying conditions after gastric sleeve surgery. Therefore, gastric sleeve surgeries have a high success rate.

What to Expect from Gastric Sleeve Surgery?

Gastric sleeve surgery typically lasts 1-2 hours and is performed under general anesthesia. Following the operation, intense incision site pain may be experienced during the first four hours, but this discomfort is managed with morphine or similar pain relievers. It is normal to experience nausea, belching, and a desire to vomit in the first two days after surgery, but these symptoms typically subside as time progresses. You will be encouraged to walk a lot after gastric sleeve surgery because expelling gas from your abdomen through digestion will provide relief. You may be discharged on the second day after surgery without experiencing pain or nausea.

What to Expect After Gastric Sleeve Surgery?

After gastric sleeve surgery, it is generally expected that you will reach your ideal weight by the end of the first year. With this surgery, it’s possible to lose approximately 30-35% of your current weight. Having a smaller stomach volume and the removal of the fundus region, which constitutes the appetite center of the stomach, will make you feel full with smaller portions. Following gastric sleeve surgery, your accompanying health issues will either significantly improve or completely disappear. It particularly has a positive impact on metabolic diseases like diabetes and hypertension, contributing to the overall improvement of your health.

Precautions Before Gastric Sleeve Surgery

Gastric sleeve surgery is a serious procedure and a significant decision. Therefore, before undergoing gastric sleeve surgery, it is important to have a preliminary consultation with the surgeon who will perform the operation. During this consultation, the surgeon will evaluate you for the surgery and determine if you are a suitable candidate for obesity surgery. They will also determine the most appropriate treatment method for you. If you live outside the city or abroad, it is advisable to arrange an online consultation with the surgeon. During these consultations, the surgeon will explain the changes that gastric sleeve surgery will bring to your life, as well as the advantages, disadvantages, and risks of the operation.

After deciding to undergo stomach reduction surgery, you will undergo a series of tests at the hospital. If the anesthesiologist approves the surgery, there will be no problem proceeding with the operation.

Preparations before Gastric Sleeve Surgery

Gastric sleeve surgery is a serious procedure. It is performed under general anesthesia and carries risks related to both surgery and anesthesia. Therefore, numerous tests and doctor consultations should be conducted before the surgery. Firstly, several blood tests should be conducted at the hospital. Among these blood tests, a complete blood count (CBC) should be performed to check for anemia. Additionally, liver function tests, thyroid function tests, coagulation tests, iron parameters, and C-reactive protein (CRP) tests indicating inflammation should also be examined. Apart from blood tests, a chest X-ray and pulmonary function tests measuring your respiratory reserve should be conducted. Your abdominal organs should be evaluated before the surgery, and an abdominal ultrasound (USG) should be performed, especially to determine if there are any gallstones in your gallbladder. After these tests, specialists in chest diseases, cardiology, and anesthesia should assess whether the patient is suitable for surgery and determine the risks involved. Before the surgery, an endoscopy should be performed to evaluate the stomach and check for any conditions that may hinder the surgery.

How is Gastric Sleeve Surgery Performed?

Gastric sleeve surgery is performed using laparoscopic techniques under general anesthesia. The surgery typically lasts between 1 to 2 hours. During the procedure, small incisions are made in the abdominal wall, and instruments called trocars are inserted through these incisions to access the abdominal cavity. After inflating the abdomen, surgical instruments and an optical camera are inserted through the trocars. The internal organs are visualized on a screen, allowing the surgeon to perform the operation while watching the screen. The stomach is not a freely mobile organ within the abdomen; it is attached to various structures such as the omentum and spleen. Initially, these attachments are dissected using special energy devices called Ligasure, and the stomach is completely freed. Subsequently, a tube is inserted into the stomach orally. The excess stomach tissue around this tube is removed using staplers. These staplers perform both cutting and suturing functions in three rows. Then, eighty percent of the stomach is removed through a hole made by the trocars and brought out of the body. The remaining stomach’s stapler line is sutured as a fourth layer to reinforce it. In the final stages of the surgery, bleeding control and leakage tests are conducted. In the leakage test, the stomach is inflated with methylene blue, and any leakage is observed. The surgery is then concluded, and the patient is awakened.

Complications of Gastric Sleeve Surgery

Gastric sleeve surgery is an effective method used in the treatment of obesity. However, like any surgery, this operation carries its own risks of complications. These complications can range from simple conditions such as wound infections and incisional dehiscence to more serious problems such as pulmonary embolism, bleeding, gastrointestinal stricture, and gastrointestinal leakage.

Pulmonary embolism is a serious side effect, and anticoagulant therapy is administered during the preoperative and postoperative periods to prevent this condition. The risk of bleeding can arise from bleeding along the stapler line or in the omentum, or from vascular injuries during surgery.

Stricture occurs when the sleeve is excessively narrowed, leading to persistent vomiting and feeding difficulties. Leakage or fistula is one of the most serious complications, involving leakage from the stapler line of the stomach and the emptying of stomach contents into the abdominal cavity. This is a complication that requires immediate intervention and can be life-threatening.

The Process After Gastric Sleeve Surgery

The follow-up and process after gastric sleeve surgery are crucial. Following stomach reduction surgery, clear fluids such as water and apple juice are started to be consumed sip by sip on the first day. On the second day after surgery, blood tests are conducted, and the patient is discharged. After discharge, prescriptions for stomach protectors, pain relievers, and anticoagulant injections are provided. A doctor’s visit is scheduled for the first week. Professional dietary support is provided for one year. During the first week, a clear fluid diet is followed, and efforts are made to consume at least 1.5 liters of fluid per day. From the fifth day onwards, pureed chicken broth or meat broth soups are added to the diet. The diet is gradually increased after the first week. Blood tests for vitamin, mineral, and liver function are conducted at one month, three months, and six months after surgery. Weight tracking is done biweekly. Vitamin and mineral supplements are provided throughout the process.

After Gastric Sleeve Surgery, How Should Nutrition Be?

After gastric sleeve surgery, having a smaller stomach volume requires a special diet program. It’s crucial to avoid solid foods and stick to a liquid-based diet for the first two weeks to avoid straining the sutures during the early stages of surgery. By the end of the first year, you should have implemented post-gastric sleeve surgery diet and behavior changes.

During the first two weeks after gastric sleeve surgery, when the risk of leakage is highest, you should strictly avoid solid foods. Refrain from consuming high-volume and hard-to-digest solid foods during this period, as they may strain the stomach surgical site. While your stomach stapler line is healing, aim to consume at least 70 grams of protein daily. However, due to your smaller stomach capacity, you should meet this requirement with lactose-free milk and protein-containing enteral products recommended by your dietitian and doctor.

Your fluid intake and drinking habits will also change. You should now sip your water slowly, aiming to consume at least 8-9 glasses of water per day in small sips. Failure to consume this amount of fluid may result in reduced body resistance and constipation.

After gastric sleeve surgery, establish a nutrition regimen, avoid skipping meals, and ensure you do not have a calorie deficit. Your goal should be to consume low-calorie, high-protein foods, but without skipping meals or being undernourished. Your dietitian should recommend transitioning gradually from soft pureed foods to solid foods after the second week. Avoid carbonated drinks and do not consume solid and liquid foods together.

Recovery After Gastric Sleeve Surgery

Recovery after gastric sleeve surgery is quite rapid, thanks to the minimally invasive laparoscopic method used. The surgery typically lasts about 1-2 hours, and the average hospital stay is around 2 days. After being taken to your room post-surgery, blood tests are conducted at the 2nd and 4th hours. If there are no signs of bleeding and your vital signs such as blood pressure and pulse are normal, you can start with short walks. On the first day after surgery, fluid supplementation is provided intravenously to prevent dehydration. Additionally, you receive medication intravenously for pain and nausea post-surgery. On the first day after surgery, you begin consuming fluids slowly by mouth. On the second day after surgery, your tests are evaluated by your doctor, and after a general examination, you are discharged. Upon discharge, you will receive diet education from your doctor and dietitian. It is important to pay attention to adequate fluid and protein intake during the first two weeks to maintain your body’s resistance. After discharge, pain relievers and stomach protectors that can be taken orally will be prescribed. If you work in an office, you can return to work in the first week; if you do heavy work, you can return to work in the second week. You can start driving at the end of the first week. After gastric sleeve surgery, incisions on the abdomen usually heal completely within 2 weeks, while the stomach stapler line heals completely within 4-6 weeks. You can engage in walking during the first two weeks post-surgery, start exercising without abdominal exercises at the end of the first month, and begin abdominal exercises at the end of the second month.

How to Eat in the Third Week After Gastric Sleeve Surgery?

After gastric sleeve surgery, around the 14th day, the liquid diet phase ends, and patients transition to pureed foods. During this period, you can add vegetable purees such as low-fat yogurt, omelets, cottage cheese, and carrots to your diet. Additionally, puddings with low sugar content can also be included in your meal plan. This transition period is important for adapting to the needs of your new stomach and easing the digestive system. Shaping your post-surgery eating habits according to the recommendations of your doctor and dietitian plays a critical role in achieving successful results from gastric sleeve surgery.

How Painful is Gastric Sleeve Surgery?

Gastric sleeve surgery is a minimally invasive surgical procedure performed laparoscopically. Since there are no large incisions or muscle cuts involved in gastric sleeve surgery, it is far from being a highly painful process. Typically, any pain experienced after the surgery can be easily managed with pain medication. If abnormal pain occurs, it should be thoroughly investigated. The recovery process after gastric sleeve surgery generally proceeds comfortably for patients.

Can Alcohol be Consumed After Gastric Sleeve Surgery?

After gastric sleeve surgery, alcohol consumption should be strictly avoided for the first six months. After six months, very small amounts of alcohol intake may be possible. Due to the reduced stomach capacity as a result of this surgery and the rapid passage of alcohol into the small intestines, even the amounts of alcohol you were previously accustomed to can have a quicker and more intense effect on you. Therefore, it is crucial for patients who have undergone gastric sleeve surgery to be extremely cautious about alcohol consumption and to follow the advice of their doctors. Adapting to lifestyle changes after gastric sleeve surgery supports the success of the operation.

Can Coffee be Consumed After Gastric Sleeve Surgery?

It is recommended to avoid consuming coffee during the first month after gastric sleeve surgery. Since coffee has properties that can lead to dehydration, it should be avoided during this period. After completing the first month post-surgery, you may start consuming a small amount of coffee under the recommendation of your doctor. However, during this period, it is important to be cautious about the amount and frequency of coffee consumption. Adapting to dietary and lifestyle changes after gastric sleeve surgery is critical for achieving successful outcomes.

How Long Does it Take to Get Approval for Gastric Sleeve Surgery?

If you choose to undergo gastric sleeve surgery within the coverage of public hospitals under insurance, the time between getting approval for surgery and actually undergoing the procedure can range from 6 months to 2 years, depending on the hospital’s workload and capacity. However, in private clinics, this waiting period is generally much shorter. In private clinics, the decision made by the surgeon to proceed with your surgery constitutes a sufficient step to initiate the process. The planning process for gastric sleeve surgery may vary depending on the healthcare institution preferred by the patient.

Can I Have Gastric Sleeve Surgery Again?

After gastric sleeve surgery, some patients may experience weight regain. If your body mass index returns to a level suitable for obesity surgery and your stomach has expanded, it may be possible to undergo surgery again after necessary evaluations. A second obesity surgery performed in such cases is called “revision surgery.” “Re-sleeve” or repeat gastric sleeve surgery are among the options for revision surgery. This option should be evaluated based on the patient’s condition and needs. Weight control and healthy eating habits after gastric sleeve surgery are important to prevent such situations.

Gastric Sleeve Surgery and Pregnancy Process

After gastric sleeve surgery, pregnancy is not recommended for the first 12-18 months. Many comorbidities, especially infertility, improve or completely disappear due to weight loss after this surgery. Therefore, infertile women may find it easier to conceive after gastric sleeve surgery, and it is important for them to be cautious about contraception during the first year. However, due to potential vitamin and mineral deficiencies in the mother after gastric sleeve surgery, an early pregnancy could pose risks to both the child and the mother. Therefore, before planning a pregnancy, the mother’s vitamin and mineral levels should be checked. The prospective mother should plan pregnancy based on her health status at the end of the first year.

Can Gastric Bypass Surgery Be Performed After Sleeve Gastrectomy?

If a patient experiences weight regain or insufficient weight loss after sleeve gastrectomy, gastric bypass surgery may be preferred as a revision surgery. This surgery is also performed laparoscopically. In this procedure, the stomach is horizontally divided, and a new connection pathway is created between the stomach and the small intestine. While sleeve gastrectomy primarily provides restriction in volume, gastric bypass creates both volume restriction and malabsorption. After sleeve gastrectomy, gastric bypass can be a successful revision surgery option.

Can Sleeve Gastrectomy Be Performed After Gastric Bypass?

In gastric bypass surgery, the stomach is divided horizontally, and a new pathway is created between the upper part of the stomach pouch and the small intestine. This procedure is performed to reduce stomach volume and to allow some of the food to pass through the small intestine without being absorbed. After gastric bypass surgery, it is not technically feasible to perform a sleeve gastrectomy again, and such a surgical procedure is not practiced. Gastric bypass is particularly chosen when the desired outcome is not achieved with previous obesity surgery procedures.

How do individuals who have undergone gastric sleeve surgery feel?

Individuals who undergo gastric sleeve surgery acquire a new and smaller stomach. This situation enables them to feel full with smaller portions and experience easier satiety. Since the fundus part of the stomach is removed during the surgery, the secretion of the appetite-stimulating ghrelin hormone decreases. This helps patients feel less hungry. These changes are among the main reasons why gastric sleeve surgery is effective in the weight loss process. In the post-gastric sleeve surgery period, patients need to develop dietary habits suitable for their new stomachs.

Can Gastric Sleeve Surgery Be Reversed?

During gastric sleeve surgery, approximately 80% of the stomach is removed, leaving behind a significantly smaller stomach portion. As a result of this procedure, reverting the stomach to its previous size is technically impossible. Therefore, gastric sleeve surgery is considered an irreversible procedure. This permanent change requires patients to alter their dietary habits and lifestyle in the long term. While gastric sleeve surgery provides an effective solution for combating obesity, it is important for patients to take the post-operative process seriously and adapt to necessary dietary and lifestyle changes.

Why Does Gas Pain Occur After Gastric Sleeve Surgery?

Gas pain can occur after gastric sleeve surgery and typically lasts for up to one week. Since gastric sleeve surgery is performed laparoscopically, similar to other laparoscopic procedures, the abdomen is inflated with CO2 gas. This gas can put pressure on the diaphragm inside the abdomen, causing irritation and leading to shoulder and back pain. To alleviate this gas pain, it is beneficial to engage in plenty of walking and perform breathing exercises. These activities help facilitate the expulsion of gas from the abdomen, thereby reducing pain. Managing such side effects after gastric sleeve surgery is important for a comfortable and speedy recovery process.

Can Individuals with Type 2 Diabetes Undergo Gastric Sleeve Surgery?

Type 2 diabetes often occurs due to insulin resistance and is frequently associated with obesity. After reaching the ideal weight following gastric sleeve surgery, it is possible for Type 2 diabetes, especially non-severe and late-onset cases, to improve. This surgery can improve insulin resistance by reducing body weight, thus helping to control diabetes. Weight loss after gastric sleeve surgery is a significant step in diabetes management and can contribute to the overall improvement of patients’ health.

Post-Gastric Sleeve Surgery Leakage Symptoms

Leakage after gastric sleeve surgery is most commonly observed between the 5th and 7th days post-surgery and typically continues to pose a risk for the first month. Symptoms of leakage can vary significantly. While abdominal pain may be present, it is not always apparent. Patients may exhibit a tendency towards drowsiness or anxiety. Typically, patients may experience an increased heart rate and low blood pressure. General symptoms such as fever may also accompany the condition. Blood tests may reveal leukocytosis and elevated CRP levels. In such cases, vigilance is necessary, and appropriate tests should be conducted. Typically, leakage can be identified through tomography, and the leaking area can be observed through endoscopy. Leak management is crucial; the earlier it is detected, the more favorable the outcomes. Options for managing leakage post-gastric sleeve surgery include endoscopic stenting, revision surgery, intra-abdominal washing, and conversion to bypass surgery.