Sleeve gastrectomy surgery, commonly known as sleeve gastrectomy, aims to reduce the stomach volume. That’s why its other name is stomach reduction. However, the known and most commonly thought to be this mechanism cannot alone explain weight loss and improved type 2 diabetes.
There must be other mechanisms. As a result of the studies, it has been revealed that decreased appetite, that is, eating less, is supported by the ghrelin hormone secreted from the entrance, that is, the fundus part of the stomach. In fact, when the stomach is empty, ghrelin secretion increases, which increases appetite, so the person feels hungry. Meanwhile, the secretion of hormones such as GLP-1 (glucagon like peptide 1), CCK (cholecystokinin), PYY (peptide YY), which gives a feeling of fullness, that is, stops the appetite, decreases. When the meal is eaten and the stomach is full, ghrelin secretion decreases, the secretion of hormones such as GLP-1, CCK, PPY increases, appetite decreases and the person feels full. In fact, with gastric sleeve surgery, the hormonal state of the stomach is achieved by rapid filling and stretching of the stomach, and the person’s desire to eat decreases.
How will I eat after surgery? Will I be able to eat and drink everything?
Candidates who decide to undergo gastric sleeve surgery often ask whether they will be able to eat the foods they used to eat and love after the surgery.
Patients who undergo gastric sleeve surgery are fed a special diet after the surgery. This diet consists of liquid foods for the first three weeks, pureed foods for the fourth week, and normal foods from the fifth week. There are two main rules in nutrition. The first is to avoid all carbonated drinks, the second is to distinguish between solid and liquid, that is, to stop drinking liquids 30 minutes before meals and start drinking liquids 30 minutes after meals. Another important point is adequate fluid intake. Daily water need should be calculated on the basis of 30-35 ml per kilo. For example, a 100 kg patient should consume at least 3 liters of fluid daily. We can understand insufficient fluid intake by dry mouth and small amounts of dark urine. Additionally, when we drink less water, we experience fatigue for no reason. In that case, if you cannot get enough water orally, you must have a serum placed in a hospital. When the fluid deficit is corrected, fatigue also improves. In addition, drinking water itself also consumes calories; approximately 30 calories are spent when a glass of water is excreted through the kidneys.
What can happen to us after the surgery?
The most fearful thing in the first 24 hours after the surgery is a clot from the calf veins to the lungs. We call this pulmonary embolism. To prevent this situation from occurring, we wear compression socks and give a small injection similar to blood thinner insulin before the surgery. Another complication most common between the second and seventh days is leakage. Leakage is the leakage of gastric juice into the abdomen from the newly created outer edge of the shrunken stomach. Since stomach fluid is very acidic, it has a burning effect. A miraculous secretion protects the stomach from dissolving its own inner wall. However, this acid has a burning effect in the abdomen. In addition, the infection caused by bacteria added to this environment worsens the patient’s condition. Fortunately, we don’t encounter leaks very often. A rate of 0-1% is given in various series.
How do I know if it’s illegal?
When there is a leak, fever due to infection and abdominal pain in the back occur, and in parallel with the infection and fever, the heart rate increases to over 100 beats per minute. This situation may happen to you at home within 1 month after being discharged on the 3rd or 4th day. In such a case, it is essential that you contact your own surgeon. It is not possible to miss this situation if patients are followed closely. For this reason, we attach great importance to the 7th day control and follow our patients closely via Whatsapp for 3 weeks until the 1st month, which is the first control day.
How is a leak treated?
It is dangerous not to miss the leak, but to miss the leak and fail to make a diagnosis, leaving the patient alone with his fate. Therefore, diagnosis constitutes 50% of the treatment. To make a diagnosis, we make our patients drink radiopaque liquid and have an abdominal tomography scan. After making the diagnosis, we stop oral feeding and place a pipe, that is, a drain, in the area where inflammation accumulates, under tomography or ultrasound guidance. We start broad-spectrum antibiotics simultaneously and provide intravenous feeding. Meanwhile, botox injection can be made into the pyloric muscles to reduce the pressure at the gastric outlet to facilitate closure. If it does not close within 30 days, we place plastic-coated metallic stents that extend from the esophagus to the duodenum and cut off the stomach’s contact with food.
If necessary, we take him to the intensive care unit. Our aim here is to prevent the infection from progressing and organs such as lungs, kidneys, liver and heart from failing. With such effective treatment, the leak is closed in 6-8 weeks and the stent is removed by endoscopic method. Methods such as endoscopically placing internal stitches or placing clips may be tried. Surgically repairing the area where the fistula occurs will not yield successful results. Therefore, the aim of surgical treatment is to reduce intragastric pressure and conversion to gastric bypass is performed with revision surgery.If it still does not close, the entire stomach can be surgically removed and replaced with a stomach from the small intestine. However, if we can create a controlled fistula in accordance with basic surgical principles, the leakage flow can decrease and close over time without the need for very complicated procedures.
Will sleeve gastrectomy surgery be good for my diabetes?
Apart from the beneficial effects of weight loss, we can say that type 2 diabetes is completely resolved by around 50%, with the removal of the fundus decreasing the ghrelin hormone and increasing the GLP-1 hormone, and the need for medication decreases in the remaining patients. However, in cases of type 2 diabetes combined with morbid obesity, over 85% successful results are achieved in the treatment of type 2 diabetes with gastric bypass and other metabolic surgical treatment techniques.
