SLEEVE GASTRECTOMY (STOMACH REDUCTION)
In this method, 2/3 of the stomach is removed laparoscopically.
Normally, the volume of the stomach is 800-1000 ml. After sleeve
gastrectomy, the stomach volume is reduced by 250-300 ml. This means
that the patient can only eat 1/4 of what he or she could eat before the
surgery. Another effect of sleeve gastrectomy is the decrease in the
feeling of hunger after the operation. The hormone (Ghrelin), which
gives the feeling of hunger, is largely secreted from the removed part
of the stomach. Therefore, the level of Ghrelin hormone decreases after
the surgery and thus the appetite.
What is sleeve gastrectomy?
Vertical
sleeve gastrectomy or longitudinal "vertical gastrectomy" is the
vertical removal of 75% of the stomach and turning the stomach into a
banana or tube shape. The procedure is performed laparoscopically with a
stapler. Laparoscopic Sleeve Gastrectomy (LSG) is a safe and effective
surgical method for weight loss for patients with high body mass index
(BMI) and high risk. Sleeve gastrectomy is a new bariatric surgery
technique that can be performed laparoscopically and reduces the volume
of the stomach. The stomach takes the form of a tube like the
continuation of the esophagus. Since the stomach volume decreases to
25%, patients feel full when they eat 1/4 of what they ate before. In
this method, since a bypass application is not implemented on
intestines, there will be no absorption disorder, less food causes
weight loss. Sleeve gastrectomy has emerged as a method which restricts
food. However, it has been understood that it also has metabolic effects
through hormonal changes.
Insertion sites for laparoscopic sleeve gastrectomy
Features of sleeve gastrectomy
Sleeve gastrectomy is performed under general anesthesia using laparoscopic method using 4 insertions.
Laparoscopic sleeve gastrectomy surgery is performed with a stapler.
The stomach part separated by stapling is taken out of the abdomen through the 12 mm trocar insertion.
After laparoscopic sleeve gastrectomy surgery, the stomach volume is reduced by 75%.
It is a method with lower risk compared to other methods.
Sleeve gastrectomy is an excellent surgical procedure for morbid obesity. Generally, 50% of the excess weight is lost in the first 6 months after surgery and 75% is lost within 12 months.
Features of sleeve gastrectomy
Sleeve gastrectomy is performed under general anesthesia using laparoscopic method using 4 insertions.
Laparoscopic sleeve gastrectomy surgery is performed with a stapler.
The stomach part separated by stapling is taken out of the abdomen through the 12 mm trocar insertion.
After laparoscopic sleeve gastrectomy surgery, the stomach volume is reduced by 75%.
It is a method with lower risk compared to other methods.
Sleeve gastrectomy is an excellent surgical procedure for morbid obesity. Generally, 50% of the excess weight is lost in the first 6 months after surgery and 75% is lost within 12 months.
Schematic view of laparoscopic sleeve gastrectomy
Advantages of sleeve gastrectomy
It is a surgical technique with very good results in moderately and severely obese patients.
Obesity-related co-morbidities such as hypertension, sleep apnea and diabetes improve by 70-80% after surgery.
This technique does not require enterotomy and religation.
There will be no change in stomach functions, only the volume of the stomach will decrease. Therefore, any type of food can be consumed normally, though in small amounts.
The majority of patients lose 50% of their excess weight in the first 6 months after surgery.
As a result of the removal of 75% of the stomach wall, the production of Ghrelin hormone, which gives the feeling of hunger, is mostly eliminated and therefore the feeling of hunger decreases.
Sleeve gastrectomy is a simpler operation than gastric bypass.
As with procedures bypassing the small intestine, no malabsorption occurs in minerals and vitamins, which may be important in elderly patients.
Dumping syndrome does not occur and sugar and sugary foods can be tolerated better.
As with the gastric band (stomach staple), there is no foreign device in the body.
It can be converted to other bariatric surgical operations when necessary.
Postoperative late complications are rare. However, late complications can be seen at a rate of 25% in gastric band and 10% in gastric bypass.
Advantages of sleeve gastrectomy
It is a surgical technique with very good results in moderately and severely obese patients.
Obesity-related co-morbidities such as hypertension, sleep apnea and diabetes improve by 70-80% after surgery.
This technique does not require enterotomy and religation.
There will be no change in stomach functions, only the volume of the stomach will decrease. Therefore, any type of food can be consumed normally, though in small amounts.
The majority of patients lose 50% of their excess weight in the first 6 months after surgery.
As a result of the removal of 75% of the stomach wall, the production of Ghrelin hormone, which gives the feeling of hunger, is mostly eliminated and therefore the feeling of hunger decreases.
Sleeve gastrectomy is a simpler operation than gastric bypass.
As with procedures bypassing the small intestine, no malabsorption occurs in minerals and vitamins, which may be important in elderly patients.
Dumping syndrome does not occur and sugar and sugary foods can be tolerated better.
As with the gastric band (stomach staple), there is no foreign device in the body.
It can be converted to other bariatric surgical operations when necessary.
Postoperative late complications are rare. However, late complications can be seen at a rate of 25% in gastric band and 10% in gastric bypass.
Disadvantages of sleeve gastrectomy :
This is an irreversible process.
Leakage (1%) and bleeding (2%) may occur in the stapler line due to stapling.
Preoperative preparations:
As with other surgical operations, there are pre-operative preparations that must be carried out carefully. Recommendations to you by your doctor are usually as follows.
Advantages of sleeve gastrectomy
It is recommended to follow a diet for a week before surgery to reduce the fat around the liver.
Watery food intake for 48 hours before surgery.
In patients with constipation, it is necessary to clean the colon by taking magnesium citrate or Colyte before surgery.
Stop all medications you are taking unless your doctor has advised you to.
If you are using any herbal medicine for headache or allergy or blood thinner, it should be known before the operation. Especially 30% of obese people have reflux disease. If so, surgical intervention for reflux during the operation is performed in combination.
Stomach endoscopy is usually required before surgery. Gastric hernia, reflux disease, ulcer and tumor should be investigated. The stomach is resected with a stapler. The operation takes 1-1.5 hours. Postoperatively, patients are kept in the intensive care unit for 1-2 days. On the 3rd day of the operation, if there is no suspicion of leakage, liquid food can be consumed orally. Patients are discharged on the 4th or 5th day.
Laparoscopic Sleeve Gastrectomy complication rates are the same as gastric band (stomach staple), but significantly lower than Gastric Bypass. In general, sleeve gastrectomy has two important complications as staple line leak (1%) and bleeding (2%), apart from surgery and anesthesia complications. Leakage is usually treated endoscopically with a stent placed in the leak area. Any intervention for bleeding is rarely required, it usually stops on its own. A blood transfusion may be required.
“As of 2014, we have performed 176 laparoscopic sleeve gastrectomy operations. Leakage occurred in one of our patients (0.5%) and bleeding in 3 patients (1.7%). Leakage was treated with endoscopic stenting. It was sufficient to give blood to 2 of 3 patients with bleeding. In one patient, the bleeding was stopped by surgery. We did not lose any patients"
Lifestyle and diet changes after surgery
Diet and eating habits will change after surgery. You will need to drink water more often (about 8 glasses of water per day), increasing by 10-20% if you exercise. Do not drink water or liquids with solid food. With regard to food, the first two months will be the most difficult period for you to adapt to your new stomach size. Due to the fact that 75% of the stomach is removed, patients can eat 1/4 of what they ate before. During longer meal times (30-45 minutes for each meal), less amount of food should be chewed more. When satiety is felt, it is necessary to stop eating. Since you will eat very little at the beginning, the meal should be 5 meals every day. The important thing is to reduce the fat and carbohydrate ratio in the diet and to get enough protein (1 g/kg) as an essential nutrients.
Vitamin deficiencies are rarely seen after sleeve gastrectomy, unlike gastric bypass. Iron deficiency anemia can be seen in 5% of cases, especially in women. Female patients can become pregnant one year after surgery.
The benefits of stomach reduction surgery
The majority of patients lose 50-70% of their pre-operative weight within the first year. 75% of obesity-related problems such as hypertension, diabetes, joint problems, high cholesterol and sleep apnea improve or completely disappear after surgery. It is a great chance to get rid of this disease or problem. Patients often feel that they have come back to life. In addition, patients who have been disconnected or distanced from social life due to obesity return to social life.
Diseases that occur due to obesity and disappear completely or improve considerably with the loss of excess weight.
OBESITY-RELATED DISEASES RECOVERY RATE (%)
Asthma 72
Gastroesophageal reflux disease (GERD) 60
Hypertension 50
High cholesterol level 77
Obstructive sleep apnea 60
Osteoarthritis of the knee and foot joints 75
Type 2 diabetes 50-64
Depression 75
There are 5-6 surgical options in the treatment of morbid obesity. Sleeve gastrectomy is one of the most commonly used methods. Your doctor will recommend the most suitable surgical options for you after evaluating your weight, comorbidities and surgical risks. Your life will change in a few months. Do not miss the chance given to you to return to life and live a life free from obesity.
Alternative Names
Bariatric Surgery – obesity surgery – laparoscopic sleeve gastrectomy – sleeve gastrectomy – tube stomach – stomach reduction
This is an irreversible process.
Leakage (1%) and bleeding (2%) may occur in the stapler line due to stapling.
Preoperative preparations:
As with other surgical operations, there are pre-operative preparations that must be carried out carefully. Recommendations to you by your doctor are usually as follows.
Advantages of sleeve gastrectomy
It is recommended to follow a diet for a week before surgery to reduce the fat around the liver.
Watery food intake for 48 hours before surgery.
In patients with constipation, it is necessary to clean the colon by taking magnesium citrate or Colyte before surgery.
Stop all medications you are taking unless your doctor has advised you to.
If you are using any herbal medicine for headache or allergy or blood thinner, it should be known before the operation. Especially 30% of obese people have reflux disease. If so, surgical intervention for reflux during the operation is performed in combination.
Stomach endoscopy is usually required before surgery. Gastric hernia, reflux disease, ulcer and tumor should be investigated. The stomach is resected with a stapler. The operation takes 1-1.5 hours. Postoperatively, patients are kept in the intensive care unit for 1-2 days. On the 3rd day of the operation, if there is no suspicion of leakage, liquid food can be consumed orally. Patients are discharged on the 4th or 5th day.
Laparoscopic Sleeve Gastrectomy complication rates are the same as gastric band (stomach staple), but significantly lower than Gastric Bypass. In general, sleeve gastrectomy has two important complications as staple line leak (1%) and bleeding (2%), apart from surgery and anesthesia complications. Leakage is usually treated endoscopically with a stent placed in the leak area. Any intervention for bleeding is rarely required, it usually stops on its own. A blood transfusion may be required.
“As of 2014, we have performed 176 laparoscopic sleeve gastrectomy operations. Leakage occurred in one of our patients (0.5%) and bleeding in 3 patients (1.7%). Leakage was treated with endoscopic stenting. It was sufficient to give blood to 2 of 3 patients with bleeding. In one patient, the bleeding was stopped by surgery. We did not lose any patients"
Lifestyle and diet changes after surgery
Diet and eating habits will change after surgery. You will need to drink water more often (about 8 glasses of water per day), increasing by 10-20% if you exercise. Do not drink water or liquids with solid food. With regard to food, the first two months will be the most difficult period for you to adapt to your new stomach size. Due to the fact that 75% of the stomach is removed, patients can eat 1/4 of what they ate before. During longer meal times (30-45 minutes for each meal), less amount of food should be chewed more. When satiety is felt, it is necessary to stop eating. Since you will eat very little at the beginning, the meal should be 5 meals every day. The important thing is to reduce the fat and carbohydrate ratio in the diet and to get enough protein (1 g/kg) as an essential nutrients.
Vitamin deficiencies are rarely seen after sleeve gastrectomy, unlike gastric bypass. Iron deficiency anemia can be seen in 5% of cases, especially in women. Female patients can become pregnant one year after surgery.
The benefits of stomach reduction surgery
The majority of patients lose 50-70% of their pre-operative weight within the first year. 75% of obesity-related problems such as hypertension, diabetes, joint problems, high cholesterol and sleep apnea improve or completely disappear after surgery. It is a great chance to get rid of this disease or problem. Patients often feel that they have come back to life. In addition, patients who have been disconnected or distanced from social life due to obesity return to social life.
Diseases that occur due to obesity and disappear completely or improve considerably with the loss of excess weight.
OBESITY-RELATED DISEASES RECOVERY RATE (%)
Asthma 72
Gastroesophageal reflux disease (GERD) 60
Hypertension 50
High cholesterol level 77
Obstructive sleep apnea 60
Osteoarthritis of the knee and foot joints 75
Type 2 diabetes 50-64
Depression 75
There are 5-6 surgical options in the treatment of morbid obesity. Sleeve gastrectomy is one of the most commonly used methods. Your doctor will recommend the most suitable surgical options for you after evaluating your weight, comorbidities and surgical risks. Your life will change in a few months. Do not miss the chance given to you to return to life and live a life free from obesity.
Alternative Names
Bariatric Surgery – obesity surgery – laparoscopic sleeve gastrectomy – sleeve gastrectomy – tube stomach – stomach reduction
