Laparoscopic Sleeve Gastrectomy

LAPAROSCOPIC SLEEVE GASTRECTOMY

Sleeve Gastrectomy

What is the Sleeve Gastrectomy?

It is a weight loss procedure that aims to reduce the amount of food eaten by converting the stomach into a tube 1.5 cm from the junction point of the stomach and esophagus to the exit of the stomach. As with other metabolic surgeries, it provides hormonal changes at the stomach, brain, intestines, and liver, thereby providing weight loss.

How Does Sleeve Gastrectomy Cause Weight Loss?

Most of the stomach is removed so that a tube-shaped stomach remains. A 60 100 cc volume of the stomach remains. Patients eat less amount of food they can consume at a meal, they get fewer calories. The appetite is reduced by removing the part of the ghrelin hormone secreted part of the stomach that causes the starvation signal in the brain.

Transit time in the small intestine increases three times. Foods cannot spend enough time for digestion in the intestine. Thus, digestion does not occur sufficiently and caloric intake is restricted.

The intestinal hormones begin to be secreted again because the undigested food is now more to the end of the intestines. Re-secreted hormones include GLP-1, PYY, TGR5, PTP1B, FXR, FGFR4, FXR. Also, some hormones from the liver and pancreas begin to be re-secreted.

What are the Health Benefits of Sleeve Gastrectomy?

1-Clinically it has been shown that patients provide many postoperative benefits.

2- On average, 66-80% of excess weight is lost.

3-More than 70% of patients with type 2 diabetes have improved or fully recovered.

4-Hypertension, hyperlipidemia, sleep apnea, liver fatty diseases, such as serious improvements are seen.

5-Increase in physical activity, productivity, well-being, economic opportunities, and self-confidence

6- As it is a simpler procedure, there is a shorter hospital stay and recovery time.

In many diseases after sleeve gastrectomy, recovery or remission is seen.

Type 2 Diabetes (55-80%)
Hypertension (>50-80%)
Hyperlipidemia (>90%)
Sleep Apnea (>70%)
Fatty liver disease (90%)

Advantages and Disadvantages of Sleeve Gastrectomy

Advantages:

Causes significant weight loss (EWL 60 to 80%)
Improvement in obesity-related comorbidities (80 to 90% depending on the type, duration, and damage to the organ of concomitant disease)
As in the gastric band, a foreign body is not used and the path of the digestive system is not changed as in the operations like a bypass.
It is a simpler procedure, there are a shorter hospital stay and a faster recovery time.
Hormonal changes lead to a decrease in hunger and an increase in metabolism.
No dumping syndrome with surgeries that change the digestive tract
Due to the reduced stomach volume, there is a feeling of early saturation.
In the case of weight gain, revision surgery is a simple surgery.

Disadvantages:

A proper nutrition program and routine exercise program should be continued throughout life. It is an irreversible surgery.
May cause vitamin deficiencies (usually occurs within the first year, so routine vitamin supplementation is initiated after surgery)
Consumption of high-calorie liquid food can lead to inadequate weight loss or weight regain.
Excess weight loss rates are 5-10% better in bypass surgery.

Possible complications:

Those associated with obesity (possible complications when performing any operation in each obese patient, regardless of the operation performed)

Deep vein thrombosis (Clot in leg veins)
Pulmonary embolism (Thrombosis of the lungs)
Wound site infection Lung infection Anesthesia complications
İncisional hernia
• Surgery related (complications specific to this surgery)
Bleeding (occurs in 3-5%. It may be caused by blood-thinning drugs, cuts of the stomach, or other organs in the abdomen. No further intervention is required by treating with more than 95% blood and blood products)
Leakage (3-5% in old technology stapler group, 0.1% in new technology stapler group. More than 90% of patients can be treated with endoscopic stent implantation and feeding tube insertion)
Reflux

Risks

Obesity and metabolic surgery is a safe surgery. It is as safe as other surgical procedures, such as gall bladder surgery. Inexperienced obesity and metabolic surgery specialists, the life-risk associated with obesity surgery is about 0.13%, while the life-risk of gall bladder surgery in an obese individual is 0.4%.

All surgical methods include risks. These risks vary according to weight, age, and comorbidities. Each patient should have a specific risk assessment. A clearer interpretation cannot be made until the patient and the physician come together and make a preliminary assessment interview and conduct an examination evaluation.

But safe surgery is based on three main points.

1. Preoperative Evaluation: This includes routine blood tests, ultrasonography, endoscopic examination, chest disease evaluation, and cardiology evaluation. The patient should not be operated on unless the deficiencies (diabetes control, iron deficiency, vitamin B12 deficiency, vitamin D deficiency) that affect wound healing are eliminated. Smoking should be discontinued. A preoperative diet should be applied.

2. Surgery: The appropriate surgical procedure should be selected for the patient. Surgical experience is required. The most current stapler technology should be used during surgery. Preventing clotting in the operating room measures should be taken.

3. Postoperative: A good follow-up after surgery is very important for complication management.

Before - After Photos