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 Surgery
Laparoscopic (Closed) Method: Performed through 4-5 small holes made in the abdomen, allowing for a faster recovery process and minimal pain.
Hormone Effect: Since the part of the stomach that produces ghrelin, which triggers the feeling of hunger, 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 preparations that need to be done before sleeve gastrectomy. During the weeks before the surgery date, the patient needs to follow a physical exercise program. Additionally, 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 performed before all surgeries. Also, medications regularly used by the patient may be stopped before surgery under physician supervision. Sleeve gastrectomy is performed under general anesthesia. Therefore, during the surgery the patient does not feel or hear anything and is unaware of the procedures being performed.
Sleeve gastrectomy surgery is typically performed laparoscopically. In the laparoscopic method, several incisions approximately 1-2 cm long are made in the patient's abdomen. Through these openings, surgical instruments used to reduce stomach size and a thin tube with a camera at its tip are inserted. The camera's image is displayed on a screen. With the help of this image, the surgeon removes a portion of the stomach and closes the remaining part with stitches. The laparoscopic procedure 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 opening.
Sleeve gastrectomy surgery takes approximately 1-2 hours. After surgery, the patient is closely monitored to prevent any potential complications. Sleeve gastrectomy surgery should be performed in a well-equipped hospital. After surgery, the patient is typically discharged within a few days, depending on their general condition.
✓# Who Can Have Gastric Sleeve Surgery?
Those with Body Mass Index (BMI) over 35
Those with BMI between 30-35 who have diseases such as diabetes and hypertension
Those between the ages of 18-65
People who have failed with diet and exercise
Those without health problems that contraindicate surgery
✓# Why is Gastric Sleeve Surgery (Sleeve Gastrectomy) Performed?
Like all obesity surgeries, sleeve gastrectomy is performed not for aesthetic appearance but due to the risk of health problems. If obesity is left untreated, it causes the following 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 both short-term and long-term risks associated with surgery.
Short-term effects that may be seen after sleeve gastrectomy are as follows:
Excessive bleeding
Infection
Side effects related to anesthesia
Blood clots
Breathing difficulties related to lungs or other organs
Leak from the surgical area of the stomach
Long-term complications that may develop due to sleeve gastrectomy are as follows:
Blockage in the stomach-intestine line (obstruction)
Hernia
Gastroesophageal reflux
Low blood sugar (hypoglycemia)
Insufficient nutrition (malnutrition)
Vomiting
Sleeve gastrectomy surgery, though rarely, may result in loss of life.
✓# How is Weight Loss Achieved in Gastric Sleeve Surgery?
Weight loss in Gastric Sleeve Surgery occurs through 2 mechanisms:
Reduction in the amount of food that can be consumed as a result of decreased stomach volume due to stomach size reduction
Since the part of the stomach where the hormone known as ghrelin, which causes the feeling of hunger, is produced 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 the stomach fundus, there is 10-20 times more ghrelin compared to the duodenum. In Gastric Sleeve Surgery, since the fundus region of the stomach that produces ghrelin is removed, appetite is reduced and weight loss occurs.
✓# What Should Be Done If Weight is Gained After Gastric Sleeve Surgery?
Removal of excess expanded stomach volume through repeated laparoscopic gastric sleeve surgery.
Gastric bypass surgery can be performed.
Laparoscopic duodenal switch surgery can be performed.
✓# Nutrition After Gastric Sleeve Surgery
Gastric sleeve surgeries involve removing 2/3 of the stomach to narrow the stomach volume. Your remaining stomach volume is approximately 90-100 ml (1 teacup) and your newly formed stomach is roughly tube-shaped. For this reason, this surgery is named gastric sleeve surgery. This surgery primarily reduces your stomach volume, thus creating a feeling of fullness with small portions. Additionally, since it also stops the activation of the ghrelin hormone secreted from the removed part of the stomach, it is an effective surgery in appetite control. The success after gastric sleeve surgery is directly related to how well you adhere to the recommended nutrition plan. Changing your eating habits will enable you to lose weight in a successful and healthy manner while allowing your body to repair itself and ensure trouble-free recovery. The special nutrition plan to be followed for approximately six weeks after surgery covers the person's digestive activation, tolerance, and the time until the stomach and intestinal system's functions return to normal. During this period, being under dietitian supervision and maintaining continuous communication will make the process easier to complete. In gastric sleeve surgery, the nutrition plan is completed sequentially 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 is weight loss achieved in tube stomach surgery (sleeve gastrectomy)?
In tube stomach surgery, the stomach is reduced in volume by being shaped like a tube, similar to the continuation of the food pipe. In addition to reducing the stomach's 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 with reduced appetite who feel full very quickly and need less nutrition should be provided with information about proper nutrition before and after surgery. Since patients feel full with very little food, these foods must be of high quality, meaning they should be nutrient-rich foods containing protein, minerals, and vitamins.
What are the signs of leakage after tube stomach surgery?
The signs of leakage in tube stomach surgery are generally abdominal pain and fever.
What is the treatment for leakage after tube stomach (sleeve gastrectomy) surgery?
In cases where leakage 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 leakage problem.
How long does tube stomach surgery take?
Tube stomach surgery duration generally varies between 30-90 minutes (averaging about one hour). This duration can vary depending on the patient's anatomy and the surgeon. There is no time pressure in obesity surgeries. It is important to perform the surgery in the most ideal way.
When can a person who has had tube stomach surgery return to their social life?
The hospital stay after surgery is between 2-3 days. Patients who undergo successful surgery and feel well can return to work within 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, during this process, it is very important to follow post-operative nutrition rules.
How much should you weigh to have stomach reduction surgery?
For this operation, rather than the amount of 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?
It is possible for heart patients to have stomach surgery, but this process requires a comprehensive cardiological evaluation. After the patient's heart function and anesthesia risk are analyzed in detail by specialist physicians, the surgical decision is made considering the risk-benefit balance of the operation.
What should people who have had stomach reduction surgery pay attention to?
The main focus after surgery is completely changing 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 specialty performs stomach reduction surgery?
These operations are performed by General Surgery physicians who specialize in obesity and metabolic surgery. The surgeon's experience in this specific field and the hospital's technological equipment are the most determining factors for the success and safety of the operation.
Does the stomach grow after tube stomach surgery (sleeve gastrectomy)?
Some stomach enlargement after tube stomach surgery is a natural process. However, excessive stomach enlargement can cause the lost weight to be regained. The stomach does not need to return to its original size for the patient to maintain the lost weight. Failure to follow correct nutrition rules after tube stomach surgery and not organizing lifestyle creates conditions for stomach enlargement. The most important nutrition mistake is the consumption of carbonated beverages and taking solid and liquid foods at the same time.
When can you start exercising after tube stomach surgery?
Depending on body composition, comorbid diseases, age, and sports habits, the patient can return to active sports life approximately 1-1.5 months later. There is no lifelong restriction in sports. Only in the early period after surgery, heavy exercise is not recommended. Physical therapy specialists are frequently consulted on this matter. If sports are to be done after tube stomach surgery, it can be done following certain rules recommended by 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, the stomach volume is reduced. However, in gastric bypass surgery, the stomach is divided into two parts and one part is connected to the middle of the intestines. With this surgical procedure, food does not pass through the duodenum. In tube stomach surgery, there is no change in how food progresses through the digestive system. Both tube stomach surgery and gastric bypass surgery produce successful results in weight loss. However, gastric bypass surgery is more effective for Type 2 diabetes. In patients with stomach reflux problems, gastric bypass operations produce more favorable results.
Does a scar remain after tube stomach surgery?
Tube stomach surgeries generally use closed, that is, laparoscopic methods. Depending on the patient's condition, the number of holes used in laparoscopic surgery may vary. 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?
It is possible to regain weight after tube stomach surgery. Moreover, weight gain is frequently reported 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's stores to be full. These stores are usually fat. When the body is given excessive amounts of energy it can store, that is, when fed with too many calories, weight gain occurs. Nutrition after tube stomach surgery is very important in this regard. If foods such as chocolate, ice cream, and rice pudding that are liquid, occupy little space, and contain a lot of energy are avoided and nutrition rules are followed, weight regain will not occur.
How much weight is expected to be lost per month after tube stomach surgery (sleeve gastrectomy)?
The amount of weight lost after tube stomach surgery varies from patient to patient. There is no target in terms of weight loss per month. A female patient who is 1.45 meters tall and weighs 90 kg and a male patient who is 1.95 meters tall and weighs 220 kg will lose different amounts of weight within the same period.