Sleeve Gastrectomy

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Sleeve gastrectomy, also called a vertical sleeve gastrectomy, is a well known and most popular surgical weight-loss procedure. This procedure is typically performed laparoscopically using surgical devices called “staplers”.Laparoscopy is a minimal invasive surgery using an endoscope pass through the abdomen. Minimal invasive surgery means less risk to the patient.

Sleeve gastrectomy, also called a vertical sleeve gastrectomy, is a surgical weight-loss procedure. This procedure as mentioned above is performed laparoscopically through several small abdominal incisions.

Vertical sleeve gastrectomy is a procedure thet reduces stomach size via partial gastrectomy that preserves the lesser curve and pylorus. The patient’s stomach is removed about 75-80 percent of its original size resulting in a sleeve or a tube-like structure like a banana reducing the volume of the stomach to 150-200 ml, consequently limiting food intake. Although sleeve gastrectomy appears to be a purely restrictive procedure, its mechanism of action is more complex. As a result small size of stomach after the surgery causes patients to feel satiated sooner and reduces the secretion of ghrelin also called hunger inducing(orexigenic) hormone. Thus, the patient does not feel hungry, and he/she gets full so quickly because of the reduced size of stomach.

The patients lose about 80 % of the excess body weight in the first year after sleeve gastrectomy. However, the stomach volume may increase in the following years.

There is the risk of not being able to lose adequate amount of weight and even regain weight when diet and exercise rules and bariatric eating habits are broken and former bad habits such as sweet tooth and binge eating are resumed because of the interruption of psychiatric treatment. That’s why the patients undergoing sleeve gastrectomy should be followed-up closely as recommended by bariatric team

Diet after sleeve gastrectomy:

Patients will have a special diet after gastric sleeve operation. This type of diet will be prepared and followed up by our dietitians and the patient will has to obey the rules for 3 weeks. Then, it is followed by mash food period, allowing the patient to eat pureed meals after 3rd week and then to start eating solid foods after 4th week. Patients can have their normal dieting after 4th week but have to eat small amounts of food because of the reduced size of stomach.

Some advantages of sleeve gastrectomy are listed below:

Less postoperative pain
Less blood loss and scarring
Reduce patient risks and accelerates recovery
Not change the natural anatomy of the digestive system, thus does not lead to mineral or vitamin deficiencies,digestion and absorption functions continue normally after sleeve gastrectomy.
Not cause Dumping syndrome
No foreign body in the abdominal cavity such as adjustable gastric band

Some disadvantages of sleeve gastrectomy are listed below:

Risk of bleeding (0,1%) and leakage (0,1%) according to relatively longer staple line and high intraluminal pressure due to lack of anastomosis between the stomach and small bowel.

Frequently Asked Questions

Here are some frequently asked questions about sleeve gastrectomy:

What is sleeve gastrectomy?

Sleeve gastrectomy, also known as gastric sleeve surgery, is a laparoscopic surgical procedure. It involves removing a large portion around 75-80% of the stomach involves the removal of a portion of the stomach to create a smaller, sleeve-shaped stomach pouch. Aim of the procedure is to reduce the amount of food a person can eat. Thus, since the person can eat limited amount, weight loss occurs.

How does sleeve gastrectomy help with weight loss?

Sleeve gastrectomy limits the amount of food because of reducing the size of the stomach. The patient feels of fullness with smaller portions. Eating less leads to weight loss. Additionally, the portion of the stomach that produces ghrelin is typically removed or significantly reduced, further lowering ghrelin levels. The decrease in ghrelin levels has several effects on the body.These important effects are reduced appetite and increased satiety. The combination of reduced appetite and increased satiety results in a lower overall caloric intake. This caloric deficit is one of the most important mechanisms by which gastric sleeve surgery implements weight loss.

Who is a suitable candidate for sleeve gastrectomy?

Candidates for sleeve gastrectomy are usually individuals with a body mass index (BMI) of 40 or higher, or those with a BMI of 35 or higher with obesity-related conditions such as type 2 diabetes, hypertension, high concentration of fats in the blood, onstructive sleep apnea, joint disorders, reflux esophigitis, depression, nonalcohlic steatohepatitis and cancers. Candidates for surgery usually have unsuccessfully tried other weight loss methods such as diet and exercise.

What are the advantages of sleeve gastrectomy?

It is a less complex surgery than some other weight loss procedures like gastric bypass or duodenal switch, transit bipatition etc. It doesn’t involve rerouting or shortcut connection between the stomach and small intestines. Therefore duration of surgery is short and postoperative course is more comfortable.

What are the benefits of sleeve gastrectomy?

Sleeve gastrectomy offers several benefits, including significant weight loss, improvement in obesity-related health conditions type 2 diabetes, hypertension, high concentration of fats in the blood, sleep apnea, joint disorders, reflux esophigitis, depression and sleep apnea and an enhanced quality of life. It can also help with long-term weight management if the patient obeys all of the postoperative recommendations.

How is sleeve gastrectomy performed?

Sleeve gastrectomy is usually performed laparoscopically, which involves making small incisions in the abdomen and using specialized surgical instruments to remove a large portion of the stomach. The remaining portion is stapled together to form a smaller stomach sleeve.

Sleeve gastrectomy, also known as gastric sleeve surgery, is typically performed laparoscopically. Here’s a step-by-step overview of how the procedure is performed:

Anesthesia: The patient is placed under general anesthesia to ensure they are unconscious and pain-free throughout the surgery.
Incisions: Several small incisions, usually about 5 to 6, are made in the abdomen. These incisions serve as entry points for the laparoscopic instruments and a camera called a laparoscope.
Trocar placement: Trocars, which are long, thin tubes, are inserted through the incisions. The laparoscope and surgical instruments are then inserted through these trocars.
Stomach exposure: The surgeon carefully moves the liver and other organs to gain access to the stomach.
Stomach division: Using surgical staplers or a cutting device, a large portion of the stomach along the greater curvature is removed. The remaining stomach is reshaped into a long, narrow tube or sleeve-like structure. The stapling and cutting instruments are used to create a seal along the staple line to prevent leaks.
Stomach closure: The newly formed sleeve-shaped stomach is reinforced with additional staples or sutures to ensure the integrity of the closure.
Inspection and leak testing with blue dye: The surgeon inspects the surgical site, checks for any leaks with blue dye, and ensures proper blood supply to the remaining stomach.
Closure: The laparoscopic tracers are removed, and the incisions are closed with sutures or surgical tape.
Recovery: The patient is taken to the recovery area to wake up from anesthesia under close monitoring. They are typically advised to stay in the hospital for 2 to 3 days for observation and postoperative care.

What are the potential risks and complications of sleeve gastrectomy?

Sleeve gastrectomy carries risks, such as bleeding, infection, and complication of anesthesia as with any surgery. Other potential complications include leaks or fistulas from the staple line, blood clots in the vessels of lower limb, or strictures-narrowing of the sleeve, acid reflux, vitamin and mineral deficiencies. However, serious complications are relatively rare. It’s important to discuss these risks with your bariatric surgeon before making a decision.

How long is the recovery period after sleeve gastrectomy?

The recovery period varies from person to person, but most individuals can expect to stay in the hospital for 1 to 3 days after surgery. It may take 1 to 2 weeks to return to normal activities, and a long-term commitment to lifestyle changes is crucial for successful weight loss. The recovery process involves a gradual transition from a liquid diet to a pureed diet and then to a regular diet in 4 to 5 weeks. Physical activity is gradually increased as tolerated day by day. At least 10.000 steps walking daily is highly recommended. Regular follow-up visits with the bariatric team are important to follow up progress and make any necessary adjustments.

Will I be able to eat normally after sleeve gastrectomy?

Of course you can eat whatever you need but after sleeve gastrectomy, your stomach will have a smaller capacity, so you feel full very quickly and that’s why you will need to adjust the food portions according to your new stomach volume. Your bariatric team will provide guidance about your modified diet.

How much weight can be expected to be lost after sleeve gastrectomy?

Weight loss results can vary, but on average, patients can expect to lose about 50-70% of their excess body weight within the first two years following sleeve gastrectomy. The actual amount of weight lost will depend on various factors, including individual adherence to dietary and lifestyle changes.

Does sleeve gastrectomy have long-term effects on weight loss?

Sleeve gastrectomy has been shown to provide long-term weight loss maintenance for many patients. But, individual results may vary, and it is important to remember that maintaining weight loss requires lifelong commitment to a healthy diet, regular physical activity, and ongoing medical follow-up.

Can sleeve gastrectomy be reversed?

Sleeve gastrectomy is an irreversible bariatric procedure because approximately 80% of the stomach is permanently removed. However, in some rare cases, a second surgery may be performed to convert the sleeve gastrectomy into a different weight loss procedure, such as a gastric bypass, if there are specific medical reasons such as weight regain or some complications of gastric sleeve surgery.

Some details about the procedure:

Lenght of operation is about 1 hour.
Postoperative length of hospital stay is around 2-3 days after being follow-up. The length of hospital stay varies from one patient to the other.
Recovery time: 1-2 weeks.
Leak test during the procedure: Yes

When sleeve gastrectomy is unsuitable for me?

Uncontrolled Type 2 Diabetes esp requires insulin use;
Crohn disease;
Barret’s esophagus according to the reflux disease;
below 12 and above 75 years of age.

How Is The Follow-Up Process After Sleeve Gastrectomy?

The success rate after gastric sleeve surgery increases depending on strict postoperative controls and observations. Therefore, your first visit will be done 7 days after surgery for early complications.

Your routine controls will be done in the 1st-3rd-6th-12th-18th-24th-36th-48th-60th
postoperative months. Fasting blood sugar and insulin levels, liver enzymes, vitamins and mineral levels as well as renal functions will be checked through blood tests. Supportive treatments will be started if any deficiencies found. Our dietitian will also follow up your body composition.

If you have severe metabolic conditions such as uncontrolled diabetes, your follow up will be done by our endocrinologist. You can send your test results if you are living abroad via whatsapp and face-to-face communication with our team with video conferences.