Sleeve Gastrectomy

Over the years, our bodies can experience overweight or obesity through a combination of many environmental and genetic factors. Although diet, exercise and lifestyle changes are among the first-line solutions for most people, in some cases, these methods may not give permanent results in the long term. Especially in weight problems called morbid obesity, which carry a high risk for health, surgical interventions can come into play. At this point, the operation called "Gastric Sleeve", popularly known as sleeve gastrectomy, appears.

What Exactly is Gastric Sleeve?

Gastric Sleeve is a type of bariatric surgery that aims to promote weight loss by reducing stomach volume. The word "sleeve" comes from the fact that the stomach takes the shape of a narrow and long tube as a result of the surgery. Technically, most of the stomach - usually 75 to 85 percent - is surgically removed. The remaining part can be likened to a narrow tube about the size of a banana.

The most important feature of this process is that it acts through two basic mechanisms:

Mechanical restriction (restriction): By shrinking the stomach, the amount of food taken at one time is automatically limited.

Hormonal change: The fundus part of the stomach, which produces the appetite hormone "ghrelin", is removed. In this way, appetite control may become a little easier after surgery.

This procedure, which we popularly hear as sleeve gastrectomy, has been used as a preparatory phase for other obesity surgeries for many years, but then it became widespread after it was seen to be very effective on its own.

Why Gastric Sleeve is Preferred?

Of course, there is no single answer to this question. It is necessary to determine the most appropriate treatment plan for each patient. However, there are several reasons why Gastric Sleeve is preferred:

Technical Relative Simplicity: This surgery is considered to be surgically simpler than some other bariatric surgery methods (e.g. gastric bypass). Of course, this does not mean that it is an "easy" operation. But the surgeon's learning and practice can be relatively less gradual compared to more complex methods.

Effective Weight Loss: It has been observed that most of the excess weight is lost within the first one to two years after Gastric Sleeve. This is one of the important factors that both patients and physicians favor this method.

Hormonal Advantage: Ghrelin is a hormone that increases appetite. Since the stomach area, which is responsible for most of the ghrelin production, is removed in the surgery, people may feel less hungry and can control their portions more easily.

Fewer Bowel Changes: Gastric Sleeve does not involve any additional changes to the intestines or a shortening of the absorption pathway of nutrients, so there is no different malabsorption profile than with, for example, Gastric Bypass. This may lead to a lower incidence of certain vitamin and mineral deficiencies in the long term compared to other methods.

Irreversibility is two-faced: On the one hand, permanent reduction of the stomach may contribute to the success of the procedure by reducing the risk of re-expansion. On the other hand, some patients or physicians may shy away from the responsibility of an irreversible procedure. Therefore, options should be evaluated well.

Who Is This Surgery Suitable For?

To put it briefly, there is no rule that anyone who needs to lose weight can have this surgery. On the contrary, there are certain criteria. Usually:

• Body Mass Index (BMI) of 40 kg/m² and above,
• BMI between 35-40 kg/m² and have severe obesity-related diseases (diabetes, hypertension, sleep apnea, etc.),
• Failed to lose weight permanently despite long-term attempts at diet, exercise and even medical treatment,

Gastric Sleeve may be considered as an option.

Certain psychological and social assessments should also be made. It is desirable that the person has sufficient motivation and understanding that he/she will be able to adapt to the diet and new lifestyle after surgery. Surgery is not a magic wand. The volume of the stomach can be reduced, but the person must adopt healthy living habits.

What kind of preparation is required before surgery?

Although Gastric Sleeve may seem simple, the preparation process is especially important. Both the surgeon and the patient have responsibilities. The following steps are usually followed:

Diet and Nutrition Counseling: Starting a few weeks in advance, the patient is asked to follow a specific diet program. This diet helps shrink the liver and improves the surgeon's visualization during surgery. In general, a high protein, low carbohydrate diet is recommended.

Psychological Assessment: The outcome of the surgery is directly related to the lifestyle of the person. Surgeons, through psychiatrists or psychologists, want to make sure that the patient has the mental strength, knowledge and support to manage the postoperative period.

Comprehensive Health Screening: Blood tests, endoscopy, heart examination, lung function tests, if necessary, are performed to assess whether there are any obstacles to surgery.

Medication Review: Some medications that have the potential to dilute blood or increase bleeding may be discontinued before surgery. If there are medications used continuously, these are regulated.

Smoking Cessation: Since smoking negatively affects wound healing and increases the risk of clots, it is strongly recommended to quit before surgery.

This preparation process is critical for a safer surgery and minimizing the complications that may occur afterwards.

How Does the Operation Proceed?

The surgery is usually performed under general anesthesia and laparoscopically. In the laparoscopic method, a camera and surgical instruments are inserted through several small incisions in the abdomen.This allows the surgeon to see the surgical field on a large screen and perform the procedures more precisely.

Anesthesia and Positioning: The patient is placed on the operating table in the supine position after receiving general anesthesia.

Trocar Placement: Usually 4-5 small incisions are made in the abdomen. Through these incisions, tubes called "trocars" are inserted to allow the instruments to enter.

Stomach Mobilization: Separation of the stomach from the surrounding tissues (especially the greater omentum and short gastric vessels) is achieved.

Size Determination (Use of Bougie): A "bougie" (measuring tube) is advanced through the mouth to determine how much stomach volume will remain. The bougie, which is usually 36-40 Fr thick, helps the surgeon maintain the cutting line by guiding the stapler line.

Cutting with Stapler: A cut is made from the lower end of the stomach (near the pyloric gate) to the upper part (up to the His angle) using a stapler. The cut tissue is removed and a thin long tube of stomach is left. At this stage, the edges of the cut tissue are stapled simultaneously to minimize the risk of bleeding and leakage.

Leak Test and Control: A leak test is usually performed to see if the integrity of the stomach is maintained. Blue dye (methylene blue) or air can be used for this test. If there is a possible leak or looseness, additional stitching or repair is done.

Final Controls and Closure: After the bleeding in the operation area is controlled, the instruments in the abdomen are removed and the small incisions are closed with aesthetic sutures.

Although the duration of the operation may vary from person to person, it usually takes between 1-2 hours.

What is the recovery period after surgery?

After Gastric Sleeve, patients usually have a hospitalization period of 2-3 days. It is normal to feel pain or discomfort in the first days and is managed with painkillers. The following steps are also important:

Transition to Liquid Diet and Nutrition: For the first few weeks, patients are fed liquid and pureed foods. Then they are gradually introduced to soft and then solid foods. It is useful to think of this phase as a long "getting acquainted period". The capacity of the new stomach and the amount of food it can tolerate are gradually discovered.

Vitamin and Mineral Supplements: As the stomach volume shrinks, the amount of food intake also decreases. Supplements such as iron, vitamin B12, vitamin D and calcium are recommended by the surgeon or dietitian to ensure adequate vitamin and mineral intake.

Movement and Exercise: Starting light walking as early as possible after surgery prevents clot formation and speeds up metabolism. As recovery progresses, a more regular exercise program can be planned.

Emotional Changes: Hormonal changes and rapid weight loss can cause emotional fluctuations. Getting expert support (psychologist, psychiatrist or support groups) helps to maintain motivation during this process.

What are the Benefits of Gastric Sleeve?

The biggest advantage of this surgery is that it promotes rapid and effective weight loss. In addition to this:

Improvement in Obesity Related Diseases: Problems such as type 2 diabetes, high blood pressure, sleep apnea can be greatly improved with weight loss.

Improvement in Quality of Life: Mobility increases, joint pain decreases, daily activities are more comfortable.

Appetite Control: Thanks to the decreased ghrelin hormone after surgery, the person may feel full faster and feel less hungry.

Technique and Long Term Process: It is a method that does not contain a foreign body (e.g. gastric band) or directly bypass the intestines and has a relatively low risk of complications.

Of course, everyone has a different rate and speed of weight loss. Many variables such as metabolic rate, age, gender and diet affect this result. However, the general opinion is that 50-70% of the excess weight can be lost within the first 1-2 years after surgery.

What are the Risks and Possible Complications?

Like any surgical intervention, Gastric Sleeve has some risks. The important thing is to understand these risks consciously and to make the right decision and take precautions together with the physician.

Bleeding Bleeding may occur during or after surgery. It can be managed with methods to stop bleeding called hemostasis and blood transfusion if necessary.

Leak (Staple Line Leak): Leakage in the stapled line of the stomach is a serious complication. It may manifest itself with symptoms such as fever, abdominal pain and palpitations. Early diagnosis and intervention are important.

Infection Infection may occur in the surgical wound or intra-abdominal area. It is treated with antibiotics and appropriate medical/sanitary methods.

Thromboembolism Conditions such as deep vein thrombosis (DVT) or pulmonary embolism are at risk of developing after surgery, especially in obese patients. Blood thinners and early mobilization help reduce this risk.

Gastroesophageal Reflux (GERD): Some patients may experience reflux complaints after Gastric Sleeve. It can be controlled with medication or lifestyle changes.

Nutritional Deficiencies: Especially protein, vitamin and mineral deficiencies can be seen. Regular consultation with a dietician and taking the necessary supplements reduces this risk.

What Should Be Considered After Surgery?

Gastric Sleeve is not a problem that is solved only on the operating table. This operation is the door to a new beginning and a lifestyle change. Some important points to consider afterwards:

Regular Check-ups: Regular follow-up appointments with the doctor and dietitian keep both the weight loss process and health status under observation.

Balanced Nutrition: Patients with a small stomach need to appreciate every bite. Conscious nutrition is essential for adequate protein, vitamin and mineral intake.

Eating slowly and chewing well: It is important to chew well and eat slowly to avoid overstretching the small stomach volume. This also ensures that the feeling of early satiety is used to advantage.

Fluid Intake: It is recommended to keep fluid intake separate, especially in the early stages. Drinking with meals causes the stomach to fill up quickly and can make it difficult to get enough nutrients.

Exercise and Active Life: Regular physical activity supports weight loss and helps shape the body. An exercise program can be planned according to doctor and physiotherapist recommendations.

Avoid Smoking and Alcohol: Smoking can delay the healing of wounds and alcohol is an empty calorie drink. It is important to avoid both of these habits for a healthy lifestyle.

What are the Long Term Results of Gastric Sleeve?

The first year of the weight loss process is usually the period of fastest weight loss. By the end of the second year, the target goal is largely reached. But this is sometimes where the real challenge begins: Weight maintenance. The body can be prone to weight regain after a certain point. Therefore in the long run:

Regular Check-ups and Willpower: It is important for the patient to stay motivated. In order to prevent weight regain, it is necessary to change eating habits permanently.

Psychological Support: Rapid weight loss can have a positive impact on sense of identity, social relationships and self-confidence. However, some people may need additional counseling to adapt to the new body shape.

Vitamin and Mineral Monitoring: Especially in women, iron deficiency anemia or B12 deficiency can be seen. Having regular blood tests to detect deficiencies and not neglecting supplements is the key to long-term health.

Continue Physical Activity: Sagging skin or loss of tonus in the belly, arms and legs can occur. Continuous exercise is very beneficial to maintain muscle mass and improve body shape.

It is important to remember that Gastric Sleeve is a tool. Lasting success in the treatment of obesity is ensured by the patient's self-determined goals and the patient's continuous efforts to achieve these goals.

Gastric Sleeve is a Journey

Gastric Sleeve may be an effective method in the fight against obesity, but it is not a "miraculous" or "one-step" solution. In fact, this surgery is the key to a new lifestyle. The most important factor on this path is that the patient is conscious, willing and ready to take responsibility.

In summary, the volume of the stomach is reduced with surgery; however, it is essential that the person adopts healthy living habits and makes them sustainable. When a good team (surgeon, dietician, psychologist) and the patient's determination come together, the results of Gastric Sleeve can be very satisfying. Balanced nutrition, regular exercise, adequate rest and stress management will be indispensable parts of the new road map.

If you are someone who struggles with obesity and has a weight problem that puts your health at risk, it is important to consult a specialist for more detailed information about Gastric Sleeve. After the evaluation and examinations to be performed under the control of a doctor, it is possible to decide together which method is more suitable for you.

If you are looking for a solution that improves your quality of life, reduces your health problems and makes you feel happier, bariatric surgery methods such as Gastric Sleeve can be an important step on this path. As with any surgery, keeping in mind that there are certain risks and responsibilities helps to manage the process more planned and consciously. In short, this surgery can be a strong companion as long as you do your part. Remember, the best results are achieved with long-term efforts and determination.

While Gastric Sleeve brings you to your ideal weight, it also invites you to a completely different lifestyle. It is your choice whether or not to participate in this invitation; however, it is very important to think about what this step towards a healthy and balanced life will bring you in the future and to make the necessary preparations. Listening to your body and following the guidance of experts will be the best approach.