Gastric sleeve gastrectomy, also known as sleeve gastrectomy, is one of the most popular methods of bariatric surgery. When performed according to the standards, sleeve gastrectomy surgery can provide highly effective and permanent weight loss. The most important feature of sleeve gastrectomy is that although changes are made in the digestive system, the food progresses naturally. In this way, vitamin and mineral deficiencies after gastric sleeve surgery are less common and easier to correct compared to other methods. In a way, sleeve gastrectomy can be considered as a more organic method.

How Many Years Has Gastric Sleeve Gastrectomy Been Performed?

Before the sleeve gastrectomy surgery, in the 1950s, American surgeons first tried to shorten the path of food in the intestines for extremely obese people and this surgery was called 'jejuno-ileal bypass'.

As can be seen in the drawing below, this surgery consisted of cutting the small intestine near the exit of the stomach, dragging the upper end to the lower part of the intestine and adding it to a point near the end of the intestine. The food would pass through 2 meters of intestine instead of 4-6 meters of small intestine and reach the large intestine in a shortcut.

After jejunoileal bypass, which was performed when sleeve gastrectomy was not yet invented, undesirable side effects such as excessive diarrhea, osteoporosis, night blindness and liver failure were observed in patients and this method was abandoned after a while.

In the 1960s, gastric bypass was introduced. In this surgery, the upper part of the stomach was separated from the other part and a small pouch was created. Then the small intestine was cut at about 60 cm from the exit of the stomach and the lower end was connected to this small gastric pouch. The open end of the small intestine was also connected to the thin glass 1 meter below. this method was called RNY Gastric bypass. RNY Gastric Bypass, which was performed openly in the 1960s, was first performed laparoscopically in the United States in 1994. RNY gastric bypass was the most common obesity surgery in the United States until 2010.

In the 90s, when sleeve gastrectomy was not yet in use, the risk of complications in gastric bypass surgeries increased in people with a body mass index of 50 and above, that is, super obese people. Especially surgeries such as Duodenal Switch and Gastric Bypass, which have been practiced since 1995, took 2 - 4 hours and technical difficulties were experienced in these overweight people. In addition, staying under anesthesia for so long increased other risks. Therefore, surgeons Hes and Marceau started to divide duodenal switch surgery in overweight people into two stages (1998). In the first stage, they reduced the stomach in the form of a tube (sleeve gastrectomy) and told the patients to come back after one year. In this way, patients would lose some weight with the sleeve gastrectomy and in the second stage, a part of the intestine would be deactivated in order to reduce calorie intake. In those years, gastric sleeve surgery was not yet approved to be performed alone, but of course, American surgeons were coding the first-stage stomach reduction surgery (sleeve gastrectomy) as 'the first half of duodenal switch surgery' and receiving insurance payments.

But something happened that no one expected! Patients who underwent gastric reduction did not come for the second stage bypass surgery after one year. They had all lost weight and were happy. This is how it became clear that gastric sleeve surgery alone was sufficient. In 2010, the insurance system accepted gastric sleeve surgery alone and included it in the payment list.

Medical studies showed that gastric sleeve surgery was at least as effective and safe as gastric bypass surgery. Moreover, patients had less vitamin and mineral deficiencies after gastric sleeve surgery compared to gastric bypass surgery. Surgeons also liked the sleeve gastrectomy because it was shorter and less complicated.

Patients also liked this gastric sleeve surgery. In the first months after gastric sleeve surgery, most of the patients realized that they did not feel excessive hunger as before. Some patients even had to remind themselves to eat. Later medical research showed that the hunger-producing hormone ghrelin was significantly reduced in patients who underwent gastric sleeve surgery. It was found that the upper part of the stomach removed during sleeve gastrectomy produces most of the ghrelin hormone. Since this part of the stomach remained in the body in gastric bypass patients, the ghrelin hormone level did not decrease, and therefore this decrease in hunger sensation seen in sleeve gastrectomy patients was not seen with the same frequency in bypass patients.

In summary, sleeve gastrectomy has been performed laparoscopically since 1998.

How Much Weight Should I Be To Have Gastric Sleeve Gastrectomy?

In order to answer the question of how much weight is required for gastric sleeve surgery, not only the weight but also the height of the person is taken into account. Body Mass Index (BMI) is calculated by dividing your weight by the square of your height. Click here if you want to calculate your BMI

It is suitable for people who are severely obese (morbidly obese) (i.e. those with a BMI above 40 kg/m²), those with a BMI between 35-40 who suffer from hypertension, sleep apnea, type 2 diabetes due to obesity, and diabetic patients with a BMI between 30-35.

In practice, those who are 25 kilos or more above their ideal weight may consider sleeve gastrectomy if they cannot maintain their normal weight with diet and exercise.

How is Gastric Sleeve Gastrectomy Surgery Performed?

How is sleeve gastrectomy surgery performed? It is performed with laparoscopic (closed) method. The patient is given sedative medication before the sleeve gastrectomy and taken to the operating room in his/her own bed. The anesthesia team welcomes the patient and puts them to sleep with general anesthesia after taking them to the operating table. Sleeve gastrectomy surgery takes about 1 hour. Small millimeter holes are made in the abdominal wall and the stomach is accessed. We see all the benefits of laparoscopic surgery such as low postoperative pain, a good cosmetic result and early mobilization in obesity surgery. In sleeve gastrectomy, the stomach is cut with special disposable instruments (stapler) and a special reinforcing suture is placed on it at the same time. After the cutting process, approximately 80% of the stomach is removed. Since the stomach remaining in the body resembles a banana-shaped tube, this technique is called sleeve gastrectomy. In order to detect a possible leakage from the suture line, the stomach is inflated with a special dye and the suture line is checked.

What are the Risks of Gastric Sleeve Gastrectomy?

What are the risks of gastric sleeve surgery?

The risks of sleeve gastrectomy surgery can be divided into two groups, early and late. All precautions will be taken to ensure that your hospital stay is problem-free for 2 or 3 days. The most serious risk seen in the early period is bleeding. Especially in sleeve gastrectomy surgery, bleeding may occur from the stapler line. The incidence is around 1 in every 100 surgeries. There may also be bleeding into the abdomen or into the muscle through the holes opened in the abdominal wall during sleeve gastrectomy. Bleeding after sleeve gastrectomy surgery usually occurs within the first 24 hours. Depending on the severity of bleeding, sometimes it is just monitored and stops spontaneously, sometimes it may be necessary to give blood, sometimes the abdomen is entered again with laparoscopy and the bleeding focus is found and controlled with stitches.

In order to minimize bleeding after sleeve gastrectomy surgery, we have been re-closing the entire staple line with a special stitch for the last 6 years. Thanks to this stitch, the bleeding rate has decreased from 1 in 100 to 1 in 1000. Thanks to this suture method we apply in sleeve gastrectomy surgery, we no longer use postoperative drains.

Among the risks of sleeve gastrectomy surgery, it is necessary to mention the problem of persistent vomiting that may occur after surgery. Again, due to the lack of training of the surgeon performing the surgery, stenosis occurs due to the stomach tube that cannot be shaped properly. If the stenosis is serious, vomiting occurs even with liquids. This mechanical stenosis, which is the most serious cause of vomiting after sleeve gastrectomy, develops mostly in the middle part of the stomach tube. These strictures are tried to be opened with an application called balloon dilatation. If gastric sleeve balloon dilatation is not successful, gastric bypass surgery may be revised.

Another risk seen in the early period after sleeve gastrectomy surgery is wound infection. Since the wounds are quite small, the risk of infection is not as high as in open surgeries. Especially the brocar site where the stomach exits can be infected. Redness, swelling and fever are the first symptoms. The incidence is 1 in 200 surgeries. Most of the time it is treated with antibiotics and heals spontaneously. Rarely, it may be necessary to open the suture and drain the inflammation. Incision site inflammation after sleeve gastrectomy surgery usually gives symptoms on days 3-5.

One of the most serious risks that can be seen from the 2nd week to the 3rd month after sleeve gastrectomy surgery is embolism. It is called “embolism” when a blood clot, which may form especially in the leg veins during or early after surgery, breaks off from here and goes to vital organs and prevents blood flow here. Depending on the location and size of the blockage, it can pose a serious danger. Prevention is the most important form of treatment. For this purpose, a blood thinning injection “Clexane” is administered at 23:00 the night before the operation. Embolism stockings are worn in your room before the operation and your blood circulation is supported with a pneumatic compression device during the operation. We want you to walk in the 2-3rd hour after the surgery, this reduces your risk of developing embolism by regulating your blood circulation in a similar way.

Leakage after sleeve gastrectomy is a serious complication. The line where the stomach is cut is automatically closed by staples. Although the stapler technology is very advanced, the wall thickness of the stomach close to the esophagus can thin up to 1mm. This point is the weakest place in terms of rupture after sleeve gastrectomy. 90% of the leaks occur from this point. The incidence of leaks in this part of the stomach is 1 in every 100 surgeries. Leakage occurs mostly between the 4th and 10th days. Symptoms of leakage after sleeve gastrectomy surgery may be in the form of pain, fever and weakness. If not treated correctly, it can be life-threatening. The most important issue is of course to minimize this complication. In order to reduce the rate of leakage after sleeve gastrectomy surgery to 1 in 1000 surgeries, Prof. Dr. Koray TEKİN has been using a special suturing technique for the last 6 years. This technique is described in detail in the videos above. Leaks can often be treated without surgery. However, this treatment may take 3 weeks or more. Early diagnosis and correct intervention are life-saving. Therefore, it is very important to choose surgeons experienced in bariatric surgery.

How long does gastric sleeve surgery take to heal?

After sleeve gastrectomy, the stomach stapler line generally heals within 12 days. Gastric sleeve surgery has been one of the most ideal solutions for many people with obesity problems. It is very important that this surgery is performed meticulously and by experienced people.

Recovery after sleeve gastrectomy is fast. Since closed (laparoscopic) surgery is applied, you can get up and walk 2 hours after surgery. If there is no feeling of nausea, the liquid can be taken in the form of ice melting in the mouth after 3 hours. The next day after sleeve gastrectomy surgery, stomach healing is checked by X-ray (Scopy) in the morning and clear liquids are started to be drunk.

Skin stitches heal in 10 days after sleeve gastrectomy. Since intradermal hidden sutures are used, there is no need to take stitches. The stitches applied to the skin in sleeve gastrectomy surgery dissolve spontaneously. You should not get the stitches wet for the first five days you go home. To ensure this, your stitches should be covered with waterproof bandages during showering.

Nutrition after sleeve gastrectomy

After spending the first night after sleeve gastrectomy surgery, your scopy examination, i.e. leakage test, will be performed in the morning, and if there is no problem, you will be informed about fluid intake by our nurse. On the first day, you will start with clear liquids such as apple juice and water. When taking fluids, you should not exceed 30 ml per hour. Again, if you feel bloating or pain while taking fluids, you should stop fluid intake. The liquids you can take in the first days after sleeve gastrectomy surgery should be acid-free, alcohol-free and low-calorie. You can click to review the detailed nutrition plan.

Clear liquids are taken in the first week after sleeve gastrectomy surgery. In the second week, more viscous liquids and purees are consumed. In the third week, semi-solids such as fish, and in the 4th week, solids are consumed in a way that a new one is tried every day.

After the first 3 weeks of liquids, purees and semi-solids, you can gradually move on to solids. But how...

The new stomach should be introduced to solids gradually. For example, after the 28th day (5th week) the red meat group can be consumed, but in the first attempt, you should start with easy-to-consume and easy-to-digest meats such as vegetable dishes with minced meat, minced meat with tomato sauce or meatballs. In week 6, you can try well-cooked, soft red meats that are easy to chew. If there are no problems with consumption and digestion, red meat varieties can be consumed easily.

Chicken meat is the most difficult meat to digest and should therefore be tried last. At week 6, chicken meat can be tried. The point to be considered here is to prefer the softer parts of the chicken (thighs and hips). Since chicken breast is hard and difficult to digest, it is better to try it after the 8th week.

Legumes are our vegetable protein source. It is very useful to consume 1-2 times a week. However, it is necessary to start consuming them after the 45th day because they can cause gas and bloating.

One of the other foods that are inconvenient to consume is corn. In addition to being difficult to digest, it should not be consumed for at least 3 months because it causes blockages in the stomach.

The consumption of raw vegetables, which is forbidden in the first month, can now be started. If we talk about the bread group, there is no harm in consuming 1 slice of bread a day. The much-missed coffee can be drunk 1-2 cups a day without cream, milk powder and added sugar. However, if coffee is not accompanied by plenty of water, it causes edema. For this reason, people who have difficulty in water consumption should not prefer too much. Alcohol is very high in calories and sugar. When consumed in excess, it causes weight loss to slow down and even stop. People who prefer it should pay attention to its frequency. Excessive consumption of sweets also negatively affects weight loss. It should be preferred once a week and preferences should be used mainly for milk desserts.

The surgery restricts the volume of the stomach, but it is still up to the individual to decide which foods to fill that stomach with. The most important food group for our health is proteins. In order to maintain a good weight loss, to prevent muscle loss, to maintain our vitamin-mineral and blood values in the best way, the most important thing to do is to eat a protein-based diet.