Sleeve gastrectomy (tube stomach surgery) is one of the most preferred methods in bariatric surgery. In this procedure, approximately 75-80% of the stomach is removed, and the remaining part is shaped into a tube-like form resembling a banana. Thus, by reducing the stomach volume, food portions are decreased, and appetite control is achieved since the section that secretes the hunger hormone (ghrelin) is also removed.
✓Advantages and Features of the Surgery
Laparoscopic (Closed) Method: It is performed through 4-5 small holes made in the abdomen, which allows for a fast recovery process and minimal pain.
Hormone Effect: Since the part of the stomach that produces ghrelin, which triggers the hunger sensation, is removed, appetite control becomes easier.
Rapid Weight Loss: Patients typically lose most of their excess weight within the first year
✓How is the Surgery Performed?
There are several basic procedures that need to be done before sleeve gastrectomy. During the few weeks before the surgery date, the patient needs to follow a physical exercise program. Also, if the person smokes, they should quit this habit before surgery.
Immediately before surgery, the patient's eating and drinking are restricted. This is a routine procedure done before all surgeries. Additionally, medications that the patient regularly uses can be stopped a few days before surgery under doctor's supervision. Sleeve gastrectomy is performed under general anesthesia. Therefore, during the surgery, the patient does not feel or hear anything. They are not aware of the procedures being performed on them.
Sleeve gastrectomy surgery is usually performed laparoscopically. In the laparoscopic method, a few incisions of approximately 1-2 cm length are made in the patient's abdomen. Through these holes, surgical instruments used to reduce stomach size and a thin tube with a camera at the end are inserted. The camera image is displayed on a screen. With the help of this image, the surgeon removes a portion of the stomach and closes the remaining stomach part with stitches. Laparoscopic surgery has advantages such as faster recovery time and fewer surgical scars. However, depending on the patient or surgeon, open surgery may be preferred for sleeve gastrectomy in some cases. In open surgery, a relatively large incision is made in the abdominal area and the stomach size reduction procedure is performed through this open area.
Sleeve gastrectomy surgery takes approximately 1-2 hours. After surgery, the patient is closely monitored for any potential complications. Sleeve gastrectomy surgery should be performed in a well-equipped hospital. After surgery, the patient is discharged within a few days, depending on their general condition.
✓Who Can Have Tube Stomach Surgery?
Those with Body Mass Index (BMI) above 35
Those with BMI between 30-35 who have diseases such as diabetes and hypertension
Those in the age range of 18-65
People who have failed with diet and exercise
Those without health problems that would prevent surgery
✓Why is Tube Stomach Surgery (Sleeve Gastrectomy) Performed?
Like all obesity surgeries, sleeve gastrectomy is performed not for aesthetic appearance but for the risk of health problems. If obesity is not treated, it causes serious health problems that can be life-threatening:
Heart disease
High blood pressure
High cholesterol
Obstructive sleep apnea
Type 2 diabetes
Stroke
Cancer
Infertility
✓What are the Risks of Sleeve Gastrectomy Surgery?
Like all surgeries, sleeve gastrectomy has short and long-term risks associated with surgery.
The effects that may be seen in the short term after sleeve gastrectomy are as follows:
Excessive bleeding
Infection
Anesthesia-related side effects
Blood clots
Breathing difficulties related to lungs or other organs
Leakage from the operated area of the stomach
Complications that may develop long-term due to sleeve gastrectomy are as follows:
Blockage in the stomach-intestine line (obstruction)
Hernia
Gastroesophageal reflux
Drop in blood sugar (hypoglycemia)
Malnutrition
Vomiting
Rarely, sleeve gastrectomy surgery can result in loss of life.
✓How Does Weight Loss Occur in Tube Stomach Surgery?
In Tube Stomach Surgery, weight loss occurs through 2 mechanisms:
Reduction of stomach volume results in decreased food intake due to decreased stomach capacity
Since the part of the stomach that produces the hormone known as ghrelin, which causes the hunger sensation, is removed, patients will experience reduced hunger sensation, resulting in weight loss.
Ghrelin is a hormone produced by certain cells in the fundus, the upper part of the stomach, and causes increased appetite. In every gram of stomach fundus, there is 10-20 times more ghrelin compared to the duodenum. In Tube Stomach Surgery, since the fundus region of the stomach that produces ghrelin is removed, appetite decreases and weight loss occurs.
✓What Should Be Done If Weight is Regained After Tube Stomach Surgery?
Removing excess stomach that expands through repeat laparoscopic tube stomach surgery.
Gastric bypass surgery can be performed.
Laparoscopic duodenal switch surgery can be performed.
✓Nutrition After Tube Stomach Surgeries
Tube stomach surgeries involve removing 2/3 of the stomach to narrow the stomach volume. Your remaining stomach capacity will be approximately 90-100 ml (1 teacup) and your newly formed stomach will be roughly tube-shaped. This is why this surgery is called tube stomach. This surgery primarily reduces your stomach volume, thereby creating a feeling of fullness with small portions. Additionally, it is an effective surgery for appetite control because it stops the activation of the ghrelin hormone secreted from the removed part of the stomach. The success after tube stomach surgery is directly related to how well you adhere to the nutrition plan recommended to you. Changing your eating habits will enable you to lose weight successfully and healthily, while also allowing your body to repair itself and recover without complications. The special nutrition plan to be followed for approximately six weeks after surgery covers the person's digestive activation, tolerance, and the time it takes for the stomach and intestinal system functions to return to normal. During this process, being under dietitian supervision and maintaining continuous communication will help you complete the process more smoothly. In tube stomach surgeries, the nutrition plan is completed successively with liquid, puree, soft solid, and optimal nutrition.
There are rules that must be followed in nutrition after gastric bypass surgery.
Carbonated and fizzy drinks are prohibited for life.
For the first 10-14 days following gastric bypass surgery, liquid nutrition is required.
In the diet plan, liquids and solid foods should not be consumed at the same time.
In general, since the patient can eat only very small amounts and feel full after gastric bypass surgery, these small amounts must consist of high-quality foods. Foods high in animal or plant protein are recommended. Protein-rich foods such as chicken, fish, turkey, eggs, cheese, and yogurt should be prioritized.
Salads consisting of vegetables and greens, fruits, and nuts should not be neglected in the diet plan.
A specialist dietitian and, if necessary, an endocrinologist must definitely monitor the nutrition plan.
If there is any incompatibility with the nutritional function, psychological support can be obtained if needed. When the patient dislikes certain foods, rather than forcing them, the professional team should determine the correct foods that the patient can consume.
When nutrition is insufficient, there may be a need to take supplementary foods such as minerals, protein, and vitamins.
After gastric bypass operations, B-12 vitamin in pill form may not be absorbed adequately when swallowed. This problem can also occur with B-12 vitamin obtained from foods. In this case, B-12 supplementation can be used as sublingual tablets and sprays, or as injections.
How Weight Loss is Achieved in Tube Stomach Surgery (Sleeve Gastrectomy)
In tube stomach surgery, the stomach is shaped like a tube, similar to the continuation of the food pipe, thereby reducing its volume. In addition to the reduction in stomach volume, the secretion of Ghrelin, known as the hunger hormone, also decreases significantly. Both the reduction in stomach volume and the decreased secretion of the hunger hormone affect appetite. Patients whose appetite decreases, who feel full very quickly, and who feel less need for nutrition should be provided with information about proper nutrition before and after surgery. Since patients become full with very little food, this food must be of high quality, meaning it should be rich in protein, minerals, and vitamins.
What are the Signs of Leak After Tube Stomach Surgery?
The signs of leak in tube stomach surgery are generally abdominal pain and fever.
What is the Treatment for Leak After Tube Stomach (Sleeve Gastrectomy) Surgery?
In cases where a leak occurs after tube stomach surgery, treatment is not always surgical. In some cases, endoscopic methods can be extremely successful. Sometimes radiological methods can also resolve the leak problem.
How Long Does Tube Stomach Surgery Take?
The duration of tube stomach surgery generally varies between 30-90 minutes (averaging one hour). This time can vary depending on the patient's anatomy and the surgeon. In obesity surgeries, there is no race against time. What is important is to perform the surgery in the most ideal way.
When Can a Person Who Has Had Tube Stomach Surgery Return to Social Life?
The hospital stay after surgery is between 2-3 days. Patients who have successfully undergone surgery and feel well can return to their work life 5 days after surgery, according to their preference. In fact, if the patient wishes, they can spend time with friends going out at night to the cinema or similar places. However, it is very important to follow post-operative nutrition rules during this period.
How Much Should One Weigh for Stomach Reduction Surgery?
For this operation, rather than weight alone, the Body Mass Index (BMI) value is considered. According to generally accepted criteria, people with a BMI value above 40, or between 35-40 who have comorbid diseases related to obesity, are considered suitable candidates for this surgery.
Can Heart Patients Have Stomach Surgery?
Heart patients can have stomach surgery; however, this process requires a comprehensive cardiac evaluation. After the patient's heart function and anesthesia risk are analyzed in detail by specialist physicians, the surgical decision is made taking into account the risk-benefit balance of the operation.
What Should People Who Have Had Stomach Reduction Surgery Pay Attention To?
The primary focus after surgery is a complete change in eating habits. Patients should not consume liquids with meals, should choose portions focused on protein, and should chew each bite for a very long time to help the stomach adapt to its new volume.
Which Medical Specialty Performs Stomach Reduction Surgery?
These operations are performed by General Surgery physicians who specialize in obesity and metabolic surgery. For the success and safety of the operation, the surgeon's experience in this specific field and the hospital's technological equipment are the most determining factors.
Does the Stomach Enlarge After Tube Stomach Surgery (Sleeve Gastrectomy)?
Some enlargement of the stomach after tube stomach surgery is a natural process. However, excessive enlargement of the stomach's volume can cause the lost weight to be regained. For the patient to return to their original weight, the stomach does not need to return to its original volume. Failure to follow proper nutrition rules after tube stomach surgery and not organizing lifestyle create conditions for stomach enlargement. The most important nutrition mistake is the consumption of carbonated beverages and simultaneous intake of solid and liquid foods.
When Can One Start Exercising After Tube Stomach Surgery?
Depending on the patient's body structure, comorbid diseases, age, and sports habits, they can return to active sports life approximately 1-1.5 months after surgery. There are no lifetime restrictions on sports. It is only recommended not to do heavy exercise in the early period after surgery. Frequently, help is sought from physical therapy specialists on this matter. If sports are to be done after tube stomach surgery, certain rules can be set based on recommendations from a sports coach and physical therapy specialist.
What is the Difference Between Tube Stomach Surgery and Gastric Bypass?
In gastric bypass surgery, just like in tube stomach surgery, stomach volume is reduced. However, in gastric bypass surgery, the stomach is divided into two parts, and one divided portion is connected to the middle of the intestine. With this surgical procedure, food does not pass through the twelve-finger intestine. In tube stomach, there is no change in how food progresses through the digestive system. Successful results are achieved in weight loss in both tube stomach surgery and gastric bypass surgery. However, gastric bypass surgery is more effective for Type 2 diabetes. In patients with stomach reflux problems, gastric bypass operations produce more satisfactory results.
Does Scarring Remain After Tube Stomach Surgery?
Tube stomach surgeries generally use a closed method, that is, the laparoscopic method. The number of holes used in laparoscopic surgery can vary depending on the patient's condition. Each hole is approximately 1-1.5 cm, and the holes are closed using aesthetic methods. A very small scar may remain after tube stomach surgery, but these scars do not cause aesthetic problems.
Is Weight Regained After Tube Stomach Surgery?
Weight regain after tube stomach surgery is possible. Moreover, weight gain is reported very frequently among patients who neglect their post-operative follow-ups and do not accept their new lifestyle. The human body wants to protect itself. One of the things it wants to protect itself from is death from starvation. It is actually due to this natural reflex that obesity disease develops. Our brain wants our body reserves to be full. These reserves are generally fat. When excessive amounts of energy are provided to the body, that is, when fed with too many calories, weight gain occurs. Nutrition after tube stomach surgery is very important in this regard. By avoiding foods like chocolate, ice cream, and rice pudding that are liquid, occupy little space, and contain a lot of energy, and by following nutrition rules, weight regain does not occur.
How Many Kilos Per Month are Expected to be Lost After Tube Stomach Surgery (Sleeve Gastrectomy)?
The weight lost after tube stomach surgery varies from patient to patient. There is no target in the form of kilos per month. A female patient who is 1.45 meters tall and weighs 90 kg will lose a different amount in the same time period as a male patient who is 1.95 meters tall and weighs 220 kg.