Sleeve Gastrectomy

Gastric sleeve gastrectomy (gastric bypass surgery) is one of the most effective operations in the fight against obesity. In the intervention applied with laparoscopy (closed system), the stomach is accessed through small incisions and part of the stomach is cut out. Stomach reduction surgery prepares the ground for the patient to have a healthier life in the long term.

Many people who cannot lose weight with diets and exercises, who gain back more than the weight they lost in the long term even if they lose weight in the short term, who cannot prevent weight gain after some medications or some treatments they use, who are faced with excessive weight gain due to some diseases they have, struggle with obesity. In Turkey, sleeve gastrectomy is the most frequently assisted operation in this sense.

What does gastric sleeve surgery do?

Obesity, which is a global problem, ranks among the first among the health problems that are becoming more and more common every day. Improper eating habits, inactivity, excessive consumption of ready-to-eat foods, excessive weight gained due to genetic background and excessive adiposity bring other disorders with them. Gastric sleeve gastrectomy is an operation that restricts food consumption as a result of reducing the volume of the stomach, allowing the patient to drop to the weight the patient needs. The operation, which eliminates the feeling of hunger to a great extent, ensures that the level of nutrition remains within normal limits. With the type of stomach surgery, the volume of the stomach is reduced, but no changes are made in the intestinal structure or the functions of the stomach. Although the stomach capacity is reduced after the operation, many food groups can be consumed in small amounts.

The main purpose of stomach reduction operations, which is one of the most applied methods within the scope of bariatric surgery in Turkey, is to prevent health problems such as diabetes, hypertension, rheumatism, cardiovascular diseases that the patient may encounter in the long term. In people who have reached their ideal weight with obesity surgery; while the quality of life increases, the foundations of a healthier life are laid.

Body mass index and obesity grades

The level of obesity is one of the factors that help to decide whether a surgical intervention is necessary. The degree of obesity is determined according to body mass index values. Body mass index is calculated by dividing the body weight (in kilograms) by the square of the height (in meters). For example; The calculation of a person who is 1.70 meters tall and weighs 70 kg is as follows;

• 1.7×1.7=2.89 (height squared in meters) 70/2.89=25 (body mass index)

The obesity level table according to body mass index is as follows;

• 20-25 kg/m2 Normal
• 25-30 kg/m2 Overweight
• 30-35 kg/m2 Mild Obesity
• 35-40 kg/m2 Advanced Obesity
• 40-50 kg/m2 Morbid Obesity
• 50 kg/m2 and above Super Obesity

Who can have gastric sleeve surgery?

One of the factors that determine whether sleeve gastrectomy, known as sleeve gastrectomy in medicine, can be performed is the health problems brought by obesity. Gastric reduction surgery can be applied to patients with a body mass index above 36, patients with obesity as well as diabetes, hypertension, cholesterol, sleep apnea health problems, patients with morbid obesity, patients who have applied diet and exercise programs for a long time but have not been able to lose weight, and patients with exogenous (not caused by systemic and internal factors within the body, but caused by external factors) overweight problems.

Gastric reduction surgery should not be performed in cases of obesity caused by hormonal disorders and in cases where the body mass index is 35 and below.

How is sleeve gastrectomy surgery performed?

Gastric sleeve gastrectomy operations are performed by closed method. While the patient is under general anesthesia, the “ghrelin” producing part of the stomach is removed laparoscopically (without cutting the abdominal wall) through 6 small holes. Ghrelin is a 28 amino acid peptide protein produced by cells in the upper part of the stomach called the fundus. Ghrelin has a strong orexigenic (appetite-enhancing) effect. It can therefore simply be said to control the feeling of hunger.

After about 80% of the stomach has been removed using special equipment, the remaining part is shaped like a banana with a volume of 150-200 cc. During suturing, the stomach is inflated with a special liquid to check for leakage.

Sleeve Gastrectomy in Turkey can be performed on patients between the ages of 15-65.

Is gastric sleeve surgery risky?

In line with the perception created in the public opinion, the risks of leakage and death in sleeve gastrectomy surgery are mentioned among the public. The risk rates found in international data on the operation are between 0.2% – 0.4%. In other words, it is at the same rate with the risk factors that are likely to be encountered in every surgery.

At this point, eliminating the risks depends on factors such as the experience of the doctor, the expertise and success of the team, the quality of the equipment used, and the correct use of the equipment during the operation. For this reason, the choice of doctor is very important in bariatric surgery as in every surgical operation.

In order to prevent some risks that may develop due to anesthesia and operation, patients are recommended to quit alcohol consumption 15 days before the operation and smoking at least 1 week before the operation. Food and liquid consumption should be completely stopped by 12 o’clock the night before the operation. If the patient is taking regular medications for chronic conditions such as blood pressure, he/she can drink a few sips of water while taking his/her medication on the day of the operation.

Nutrition after sleeve gastrectomy

Clear fluid period for the first month: For the first month after the operation, fluid intake should be between 2.5-3.5 liters per day, of which at least 1.5 liters should be water. Water, milk, homemade buttermilk, filtered meat or chicken broth or fruit juice without additives can be consumed. Fluid consumption should be adjusted for a total of 5 meals during the day, with each meal consisting of approximately 150 ml of fluid intake.

Second and third month puree period: This is the period when pureed foods are started to be consumed in addition to liquid consumption. In this period, Brussels sprouts, broccoli, carrots, celery, artichokes and spinach boiled in water and pureed can be consumed. Potatoes are not recommended as they are high in carbohydrates. To increase the amount of protein, lean minced meat or chicken meat can be added to vegetable purees. The point to be considered in consumption, which can increase to 7 meals in total during this period, is to consume purees only at main meals. Apple, pear or quince compotes can also be added to the liquid consumption in the remaining snacks, but without sugar.

Transition to normal food between 4-6 months: During this period, all types of flour-free soups, boiled lean red or white meat or grilled fish can be consumed. Raw vegetables and fruits can be consumed as long as they are chewed thoroughly. During the transition period to normal food, the main thing is to readjust to normal food consumption. In case of possible sweet cravings, it is recommended to consume dried fruit or 1 scoop of light ice cream once a week.

After the transition to normal food is completed, all types of food can be consumed. However, there are some points to be considered at this stage.

Dietary considerations after the operation

• Solid foods and liquids should not be consumed at the same time. There should be at least 30 minutes between liquid and solid consumption. (This rule, called the half-hour rule, should be applied from the puree period).
• Spend 25-30 minutes for main meals and 15 minutes for snacks.
• Solid foods should be chewed at least 25-30 times before swallowing.
• Continue to consume 1.5 liters of water per day.
• After completing the 4th week of the normal food period, no more than 4 meals per day should be consumed (3 main meals + 1 protein-rich meal). Priority should always be given to low-calorie, high-protein foods at meals.
• If vomiting occurs when solid foods are introduced, only liquids should be consumed for 12-24 hours.
• Alcohol should not be consumed for 6 months after the operation, and doctor’s approval should be obtained after the 6th month.
• It is recommended not to consume carbonated and acidic drinks as they may cause pain and bloating in the stomach.
• Grains (pasta, rice, biscuits) and legumes, spices and acidic foods (lemon, orange) should not be consumed for 3 months after the operation.
• Consumption of hard red meat should be avoided for 1 year after the operation.

Physical activity after sleeve gastrectomy

• Heavy and strenuous physical activities should be avoided for 2 months.
• There is no harm in walking and climbing stairs after surgery.
• It is recommended not to drive for 2 weeks.
• If you have a job that requires heavy, strenuous and physical activity, you should wait at least 2 weeks after the operation before returning to work.
• It is recommended not to have sexual intercourse for 2 weeks after the operation.
• It is not recommended for women to get pregnant for 2 years following the operation. (Although there is no health problem in getting pregnant before 2 years; vitamin and mineral deficiency is common during pregnancy).