BODY MASS INDEX
Gastric sleeve surgery (sleeve gastrectomy) is a surgical method in which weight loss is achieved by removing most of the stomach in obese patients. Since the remaining stomach is in the form of a tube, it takes the name of tube stomach. The first Gastric sleeve surgery (sleeve gastrectomy) surgery was performed in 1988 as part of the duodenal switch operation with an open method. In 1999, it was applied closed for the first time. After 2001, the first step was surgically applied before gastric bypass surgery in overweight patients. After 2009, its popularity started to increase gradually and it was started to be applied as a stand-alone surgical method. Especially with the introduction of laparoscopic application, this operation has become very popular thanks to the shortening of hospitalization time, shorter recovery period, less scarring and reduction of the possibility of surgery site hernia.
It can be applied to patients with obesity who cannot lose weight or who have complaints such as insulin resistance and joint discomfort due to excess weight. Until ten years ago, it was primarily applied as the first step surgery before gastric bypass surgery in very obese patients. In this way, the weight of the patients was reduced and then bypass surgery was performed. However, subsequent observations and researches show that most patients do not need a second surgery, and thus sufficient and permanent weight loss is achieved. Similarly, when it was seen that diabetes was as effective as bypasses on errors such as blood pressure, the frequency of its application increased. Nowadays, it has become the most common obesity surgery.
On the contrary, these were diseases caused and exacerbated by obesity. These diseases are not an obstacle for surgery but a reason.
First of all, the following tests and examinations are applied to each patient before surgery.
After all these tests, necessary examinations and examinations are made by Anesthesiology, Internal Medicine, Cardiology, Chest diseases and Endocrine specialists. As a result of these examinations, it is first checked whether there is another underlying disease that may cause the patient to gain weight. If there is no such disease, the patient is examined in terms of anesthesia, like any patient who will undergo surgery, and whether there is an obstacle to the operation. Relevant specialists make recommendations about pre-operative treatments, if necessary. In this way, problems that may occur during and after surgery are minimized.
The entire procedure is performed by laparoscopic (closed) surgery method. Laparoscopic surgery is performed by making many small incisions. The ports placed through these incisions are used for hand tools to reach the abdomen. One of them is a surgical telescope connected to a video camera and the others are for the introduction of specialized surgical instruments. The surgeon watches the operation on a video monitor. With experience, an experienced laparoscopic surgeon can perform many procedures laparoscopically, just as in open surgery.
The first gastric sleeve surgery (sleeve gastrectomy) was performed in 1988 as part of the duodenal switch surgery with an open method. In 1999, it was applied closed for the first time. After 2001, the first step was surgically applied before gastric bypass surgery in overweight patients. After 2009, its popularity started to increase gradually and it was started to be applied as a stand-alone surgical method. Especially with the introduction of laparoscopic application, this operation has become very popular thanks to the shortening of hospitalization time, shorter recovery period, less scarring and reduction of the possibility of surgery site hernia.
The abdomen is inflated by injecting co2 gas into the abdomen. Then, the inside of the abdomen is reached through special tools called trocars. First, a guide silicone tube is placed from the mouth to the stomach exit to adjust the remaining stomach width. It is separated from the fat tissue surrounding the stomach, vessels and its immediate neighbor, the spleen. Then, the excess part of the stomach is cut and separated with special devices called staplers. About 80-150 ml of stomach volume remains. This separated part is taken out of the abdomen and sent to pathology. Then, bleeding is controlled in the cut and stapled part. Additional metal clips can be used for this, or additional stitches can be placed if needed. Also, if needed, some special drugs can be applied to the wound site in order to reduce bleeding. Then, a silicone drain is placed in the area of the surgery to remove the accumulated fluids. The wound areas are closed aesthetically and the surgery is terminated.
There are many different products on the market. The materials of the two leading American companies are the best quality products that are currently on the market and used all over the world. But their costs are much higher than Chinese products used for the same purpose. Moreover, safety is important, not cost, in health. Each product used has its own barcode containing its own serial number. The barcode of each material used is put in the patient file. Always ask for the material used.
A leak test is performed during sleeve gastrectomy (tube stomach) surgery and on the 2nd day afterwards. The purpose of the leak test performed in surgery is to determine whether there is a problem with the staples and whether there is a leak in the suture line. If there is a leak, additional stitches are placed on the relevant part to prevent leakage. Again, before starting liquid foods after surgery, a leak test is performed and necessary precautions are taken and intervened in time.
It is controversial to place additional stitches on special materials called staples in obesity surgeries. Some surgeons think that suturing reduces the possibility of bleeding and leakage and that every patient should be sutured. Some surgeons say that although suturing reduces the possibility of bleeding a little, it does not reduce the risk of leakage, on the contrary, it may cause more leakage and bleeding after vascular injury while suturing.
As a clinical approach, we are between these two. Although we do not put additional stitches in every patient, if the stapler line is not safe enough for us, we definitely put additional stitches. The fact that our results are much better than the world averages shows that the method we apply is more successful. The most important point here is that the surgeon performing the operation should have the ability and experience to intervene and correct all kinds of problems.
During every surgery, there is a possibility that there is a blood clot in the vein and any vein occlusion. This can cause serious problems when it’s a vessel that feeds vital organs such as the heart, lungs, and brain. As the weight of the patients increases, the risk of embolism increases. For this purpose, these patients are given blood thinners regardless of the surgery. Although it increases the risk of bleeding slightly, the benefit is much higher. The use of blood thinners starts before the surgery and continues for another two weeks. The duration of use may be prolonged in patients with high risk, such as patients with cardiovascular disease or previous embolism.
The biggest advantage of the surgery is that gastric sleeve surgery is performed laparoscopically (closed), that is, by entering through millimetric holes, postoperative pain is less than open surgery. Nevertheless, the phrase “he has surgery, of course he will have pain” is extremely wrong. No patient should experience pain in the twenty-first century. Pain relief is completely prevented by applying postoperative painkillers to each patient. The important point here is this. Everyone’s pain threshold is different. Again, drug tolerance and bioavailability from the drug are different. Therefore, treatment cannot be standard. Pain relief treatment should be arranged individually according to the needs of each patient.
Since the incisions are very small, the aesthetic results are also extremely good. After a few months, these lines will also become almost invisible. Once the wounds have healed, you will be recommended a cream to leave less scarring. If you use it for three months, you will get much better aesthetic results.
On the 2nd day of the surgery, you will start taking liquid food after the leak test is done. After the first two weeks of liquid nutrition, you will be fed with soft (puree style) food for two weeks. During this whole process, you will be in constant communication with our dieticians.
Protein supplements are given to patients during the first 15 days. Especially in the first year, patients are given various vitamin and mineral supplements. These are not standard for every patient, and after the examinations performed in routine controls, it is decided according to the condition of the patient, what and how much he needs.
The surgery is laparoscopically (because it is performed closed, you can stand up and walk within an hour or two after the surgery. Even during the period you stay in the hospital, you will not be a nursing patient, you will be able to do your own self-care. Patients working at a desk or working in jobs that do not require heavy effort can start back to work within a week. Patients who require it are required to take a break from work for at least one month.After the operation, patients are given a resting report for a sufficient amount of time.
Since self-absorbing stitches are often used, there is no need to take stitches. If non-absorbable stitches are used for a different reason, the stitch is checked on the tenth day when you come to the control and taken if appropriate..
You can take a bath when you leave the hospital. There is no problem if the seams are open and wet. After showering, dry with a clean towel, apply baticon on them and wait for it to dry. Baticon does not stain your clothes permanently. There is no need to use baticon after the tenth day.
Do not use any medication other than what we recommend for the first month. When a medication is recommended by another physician, you should definitely consult us. You can use any kind of medication after the first month. Still, try not to use too much painkillers and drink plenty of fluids after taking medication.
Gastric sleeve surgery does not work by restricting food intake only, contrary to popular belief. At the same time, surgery has very important hormonal and metabolic effects. First of all, less food is taken because the stomach volume decreases. But this is not like diet. You will not be hungry, you will be completely full. Even a small amount of food is enough for you to feel full.
A hormone called Gharelin, also known as appetite hormone, is secreted from the fundus part of the stomach. With the removal of this part of the stomach, appetite decreases significantly. There are also different hormonal effects that are secreted from the stomach and affect the intestines, and the mechanism of action is still being investigated. Although the exact form of this effect is not known, the final effect is serious, even before the weight loss begins after the surgery, serious improvement is seen in problems such as diabetes. There will be no significant increase in the volume of the pouch in the long term unless it is seriously straining the stomach.
When the patient takes a small amount of food, the first response is to stretch the wall of the stomach pouch and stimulate the nerves that inform the brain that the stomach is full. The patient feels satiated as if he has eaten a large meal, but in fact he has eaten a few spoons.
Will there be weight gain again after gastric sleeve surgery? The risk of weight gain after gastric sleeve surgery (tube stomach) is very low. In order to get maximum benefit from this physiology, the patient should only eat at meals, take 2-3 meals a day, and avoid snacking between meals.
This surgery also requires changing the eating habits acquired over a long period of time. In almost all cases where weight gain was observed again in the late stages of the surgery, the meal capacity did not increase. The reason for regaining weight is especially high-calorie snacks between meals. There is no known operation to eliminate the side effects of this type of eating habit.
What Are The Advantages of Gastric Sleeve Surgery (sleeve gastrectomy) over Gastric Bypass Surgery?
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The prices of obesity surgeries are slightly higher than other surgeries. But here a few topics are extremely important.
The materials used are an important cost item. There are many different products on the market. The materials of the two leading American companies are the best quality products that are currently on the market and used all over the world. But their costs are much higher than Chinese products used for the same purpose. Moreover, safety is important, not cost, in health.
The operating room and hospital where the surgery is performed must have certain equipment and standards. Sufficient number of intensive care beds and full time physicians in all branches are required. All equipment from the operating table to the patient bed should be suitable for obese patients. Therefore, it is not appropriate to perform the procedure in every hospital.
Obesity surgery does not end with surgery only, there should be a support team that you can reach 24/7, including expert dieticians.
Meeting all these requirements increases the cost of the surgery slightly more than other surgical procedures. Even if you put the quality of life aside, obesity is the main cost in the long term. The money to be spent for the treatment of health problems such as joint wear caused by obesity, diabetes, asthma, sleep apnea and blood pressure is many times higher.
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