OBESITY (GASTRIC SLEEVE)

Obesity (Gastric Sleeve)

Gastric Sleeve
In addition to gastric bypass surgery, tubular stomach surgery is one of the standard procedures in obesity surgery in Turkey. The success of this surgical method, which is also often referred to as sleeve-gastrectomy (“sleeve” means “tube”), is essentially based on the restriction of the amount of food and the associated lower nutrient intake.

As a result of the stomach reducing operation, the stomach volume shrinks to about the size of a banana. This small stomach can only absorb small amounts of food. The stomach wall expands to a maximum after a very small portion of food, so that the patient feels full after only a few bites. In addition, the stomach reduction sets hormonal changes in motion. Since the operated, smaller stomach produces smaller amounts of the hormone ghrelin (hunger hormone), people with a tube stomach from Turkey have significantly less appetite than before.

Intact stomach function after Sleeve Gastrectomy
Gastric Sleeve

During a tubal stomach surgery, the surgeon separates about eighty to ninety percent of the intact stomach from the remaining stomach and removes it from the patient’s body. For this reason, this surgical procedure, which is generally performed laparoscopically and minimally invasive (keyhole technique), is one of the restrictive procedures in obesity surgery. In contrast to the gastric bypass, a tube stomach cannot be “rebuilt” to its original initial situation later.

The big advantage of a tube stomach compared to other surgical methods of obesity surgery is that the reduced stomach version retains all the functions of the original stomach. The stomach entrance and the closure of the stomach exit remain unaffected by the laparoscopic tube stomach surgery, so that the patient can eat, digest and excrete small amounts of food normally after the recovery phase with slow food build-up. With the appropriate indication, a sleeve gastrectomy is shorter and less stressful than, for example, a Roux-en-Y stomach bypass.

Efficiency of gastrointestinal tube surgery:
As the tubular stomach is internationally a comparatively new surgical method, there are currently no results available from long-term studies regarding guaranteed weight loss with this method. However, it is already clear today that the chances of success after a stomach reduction are very high. According to initial studies, patients lose between 40 and 80 percent of their excess weight in the first two years after gastrointestinal tube surgery, thereby improving their general state of health. The results of some studies also show that a change in eating habits and a post-operative movement-oriented lifestyle are indispensable for the lasting success of the surgical intervention.

The reduction in stomach size, changes in eating habits and weight loss are generally associated with the improvement of numerous important health parameters.

Gastric Sleeve : frequent and safe surgery:
Stomach reduction using minimally invasive surgery is a highly effective way of achieving sustainable weight reduction for patients with a BMI of 40 or more. For people suffering from a serious disease caused by obesity, such as type 2 diabetes, a tubular stomach is often indicated for a BMI of 30 or more. Extremely obese people sometimes benefit from weight loss due to a tubular stomach as a first step for further, more effective surgical interventions, such as gastric bypass or biliopancreatic division. The reason for this is the lower risk of surgery due to the already reduced body weight.

Gastric Sleeve: minimally invasive surgery under general anesthesia, the gastrointestinal surgery is always performed laparoscopically under general anesthesia. For this purpose, the surgeon makes a few small incisions in the abdominal wall through which he inserts the surgical instruments (keyhole technique). The operation under camera observation usually takes about two hours. After cutting off the lower part of the stomach, the surgeon closes the remaining stomach contour with a staple seam. Conventional sutures by hand no longer occur in modern  minimally invasive surgery.

Frequently Asked Questions

+ What does obesity mean in relation to a planned stomach reduction?
People with a body mass index of at least 40 are considered obese. People who have a BMI of at least 35 and who have been suffering from health problems due to their excess weight for years are also considered obese according to general medical definitions.

+ What is the average Gstric Sleeve recovery time??
Gastric sleeve recovery time depends on your condition and procedure. If you have gastric sleeve — also known as sleeve gastrectomy — you can usually return home the second day after surgery. Most people return to work or other daily routines in 5 to 10 days.

+ What should I know about Gastric Sleeve vs. Roux-En-Y Gastric Bypass?
Both procedures have a risk of leaks from stomach staples.
With any procedure, poor weight loss or weight regain can happen if there is a failure of behavioral modifications and dietary compliance.

Other considerations include:
Roux-en–Y gastric bypass is a more complex procedure that takes longer and has a higher risk of potential problems, including surgical risks such as infection, bleeding or stomach obstruction.
Gastric sleeve has a decreased chance of “dumping syndrome”, a gastric bypass side effect when undigested food spills from your stomach pouch into the small intestine causing various symptoms.
Roux-en–Y gastric bypass has a higher risk of potential problems, including surgical risks such as infection or bleeding.
For a higher BMI, some people need this second-stage procedure to lose excess weight.

+ What is the Gastric Sleeve Pre-op diet?
Two weeks before your surgery, you are required to follow a liquid meal replacement diet. The purpose of this diet is to reduce the size of the liver to make surgery safer. This diet includes protein shakes, several “approved” snacks (eg, sugar-free pudding, yogurt and sugar-free gelatin), and plenty of clear liquids (water, broth, sugar-free jello and popsicles). Your registered dietitian will go over the details of this diet once your surgery is scheduled.

*Note for patients with diabetes: You will be asked to talk to your primary care doctor or endocrinologist about adjusting your diabetes medications while following the pre-op liquid diet.

+ Why do I need to take vitamin/mineral supplements after surgery?
Research has shown that nutrient deficiencies are common after bariatric surgery. You may not be absorbing or utilizing nutrients in the same way and your food intake is restricted. Therefore, your requirements for vitamins and minerals are higher than they were before surgery. Once you have surgery you are committing to taking the necessary supplements permanently. If vitamin and mineral deficiencies become severe, you can have very serious and permanent complications.

Gastric Sleeve Surgery Aftercare:
After a gastric sleeve, patients need to work closely with our dieticians, following a recommended diet, slowly building up too bigger portions and less easily digested foods such as meat and fish. Good aftercare is needed, to ensure patients remain healthy. Patients need to take a multi-vitamin each day; most medication can be taken as normal although it is sometimes necessary to break tablets. As with the gastric bypass, annual blood monitoring is needed to avoid malnutrition.

Weight Loss After Gastric Sleeve Surgery:
Weight loss after sleeve gastrectomy, is affected by many patient factors including age, activity level and basal metabolic rate. But, on average, a typical lady who is 8 stone overweight will lose 5-6 stone.

The gastric sleeve is sometimes recommended as a safe alternative to the gastric band, the evidence does not support this recommendation. Currently the published data suggests that the risk of complications with the gastric sleeve is similar to that of the gastric bypass, with evidence that the long-term weight loss is less than that of the bypass.

Although we offer the laparoscopic sleeve gastrectomy, we remain cautious about recommending it over a gastric band or a gastric bypass. A consultation is needed to explain the pros and cons of sleeve gastrectomy for each individual patient.

The gastric sleeve is probably not a good operation for patients with long-standing gastro-oesophageal reflux or hiatus hernias. Gastric bypass is probably a better option in this group of patients.

 

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