What is sleeve gastrectomy (stomach tube) surgery?
Sleeve gastrectomy (stomach tube) surgery is a surgical method in which weight loss is achieved by removing most of the stomach in obesity patients. Since the remaining stomach is tube-shaped, it is called tube stomach. The first sleeve gastrectomy (stomach tube) surgery was performed by open method in 1988 as part of duodenal switch surgery. In 1999, it was implemented closed for the first time. After 2001, it began to be performed as a first-line surgery before gastric bypass surgery in overweight patients. After 2009, its popularity began to increase and it began to be applied as a stand-alone surgical method. Especially with the introduction of laparoscopic surgery, this operation has become very popular thanks to the shorter hospital stay, shorter recovery time, less scarring and reduced possibility of surgical site hernia. To Which Patients Is Gastric Bypass Surgery Applied? It can be applied to patients who are obese and cannot lose weight or who have complaints such as overweight and weight-related insulin resistance and joint disorders. Until ten years ago, it was primarily performed as a first-line surgery in very obese patients before gastric bypass surgery. In this way, the weight of the patients was reduced and then bypass surgery was performed. However, later observations and research showed that most patients did not need a second surgery, and thus sufficient and permanent weight loss was achieved. Similarly, when it was seen that it was at least as effective as bypass on diseases such as diabetes and blood pressure, the frequency of its application gradually increased. It has now become the most commonly performed obesity surgery today. Do diseases such as diabetes, asthma, blood pressure prevent Sleeve gastrectomy (stomach tube) surgery? On the contrary, these were diseases caused and exacerbated by obesity. These diseases are not an obstacle but a reason for surgery. How to prepare before sleeve gastrectomy (sleeve gastrectomy) surgery? What tests are performed? First of all, the following tests and examinations are applied to each patient before the surgery. Blood Biochemistry tests Hemogram Hormone tests Hepatitis tests Whole abdominal ultrasound Stomach endoscopy (with the anesthesiologist) ECG (Heart Radiograph) A Lung X-ray Lung breathing test If necessary, stress test and ECHO (Electrocardiography). After all these tests, necessary examinations and examinations are performed by Anesthesiology, Internal Medicine, Cardiology, Chest Diseases and Endocrine specialists. As a result of these examinations, it is first checked whether there is any other underlying disease that may cause the patient to gain weight. If there is no such disease, the patient is examined for anesthesia like any patient who will undergo surgery, and it is checked whether there is any obstacle to the surgery. Relevant experts make recommendations about preoperative treatments, if necessary. In this way, problems that may occur during and after the surgery are minimized. How is sleeve gastrectomy surgery performed? The entire procedure is performed by laparoscopic (closed) surgery method. Laparoscopic surgery is performed by making many small incisions. Ports placed through these incisions are used to allow hand tools to reach the abdomen. One of these is a surgical telescope connected to a video camera, and the others are for insertion 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 like open surgery. The first sleeve gastrectomy (stomach tube) surgery was performed by open method in 1988 as part of duodenal switch surgery. In 1999, it was implemented closed for the first time. After 2001, it began to be performed as a first-line surgery before gastric bypass surgery in overweight patients. After 2009, its popularity began to increase and it began to be applied as a stand-alone surgical method. Especially with the introduction of laparoscopic surgery, this operation has become very popular thanks to the shorter hospital stay, shorter recovery time, less scarring and reduced possibility of surgical site hernia. The abdomen is inflated by injecting CO2 gas into the abdomen. Then, special tools called trocars are used to reach the abdomen. First of all, a guide silicone tube is placed from the mouth to the stomach exit to adjust the remaining stomach width. The stomach is separated from the fatty tissue surrounding it, the vessels and the adjacent spleen. Then, the excess part of the stomach is cut and separated with special devices called staplers. �r. Approximately 80-150 ml of stomach volume remains. This separated part is removed from the abdomen and sent to pathology. Bleeding is then controlled in the section that is cut and stitched with a stapler. Additional metal clips can be used for this or additional stitches can be applied if necessary. Again, if necessary, some special medications can be applied to the wound site to reduce bleeding. Then, a silicone drain is placed at the surgery site to remove the fluids accumulated inside. The surgery is completed by closing the wound areas aesthetically. Does it matter which brand of materials used during sleeve gastrectomy surgery? There are many different products on the market. The materials of the two leading American companies are the highest quality products currently on the market and used all over the world. However, their costs are much higher than Chinese products used for the same purpose. Moreover, in health, safety, not cost, is important first. Each product used has its own barcode with a serial number. The barcode of each material used is placed in the patient file. Be sure to ask about the materials used. Is a leak test performed in sleeve gastrectomy surgery? A leak test is performed during sleeve gastrectomy (sleeve gastrectomy) surgery and on the second day thereafter. The purpose of the leak test performed during surgery is to determine whether there is a problem with the staples or whether there is a leak in the suture line. If there is a leak, additional stitching is placed on the relevant part to prevent leakage. Again, before starting liquid foods after the surgery, a leak test is performed to ensure that the necessary precautions are taken and intervened in a timely manner. Are there any stitches required in sleeve gastrectomy surgery? It is controversial to place additional stitches on special materials called staplers in obesity surgeries. Some surgeons think that stitching reduces the possibility of bleeding and leakage and that stitches should be placed on every patient. Some surgeons say that although placing stitches reduces the possibility of bleeding somewhat, it does not reduce the risk of leakage, on the contrary, it may cause more leakage and bleeding after vascular injury while placing stitches. Our clinical approach is between these two. Although we do not place additional stitches on every patient, the stapler line is sufficient for us. If it does not feel safe, 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 surgery must have the ability and experience to intervene and correct all kinds of problems. Why are blood thinners used in sleeve gastrectomy surgery? During any surgery, there is a possibility of a blood clot in the vein and blocking any vein. This can cause serious problems when it is a blood vessel that feeds vital organs such as the heart, lungs and brain. As the weight of patients increases, the risk of embolism also increases. For this purpose, these patients are given blood thinners regardless of the surgery they undergo. Although it slightly increases the risk of bleeding, its benefit is much higher. The use of blood thinners begins before surgery and continues for two more weeks. The duration of use may be longer in patients at high risk, such as patients with cardiovascular disease or those who have had an embolism before. Is there pain after sleeve gastrectomy surgery? The biggest advantage of the surgery is that since Sleeve gastrectomy surgery is performed laparoscopically (closed), that is, by entering through millimetric holes, the pain after the procedure is very less compared to open surgeries. However, the statement "There was surgery, of course there will be pain" is extremely wrong. No patient should suffer from pain in the twenty-first century. Pain is completely prevented by administering painkillers to each patient after surgery. The important point here is this. Everyone's pain threshold is different. Again, drug tolerance and drug bioavailability are different. Therefore, treatment cannot be standard. Pain relief treatment should be arranged individually according to the needs of each patient. Will there be any scars after sleeve gastrectomy surgery? Since the incisions are very small, the aesthetic results are also extremely good. After a few months, these lines will become almost invisible. After the wounds heal, you will be recommended a cream to leave fewer scars. If you use it for three months, you will get much better aesthetic results. When and how to start nutrition after sleeve gastrectomy (stomach tube) surgery? You will start taking liquid food after the leak test is performed on the 2nd day of the surgery. fluid intake for the first two weeks After feeding, you will be fed with soft (mashed) food for two weeks. You will be in constant communication with our dietitians throughout this entire process. What will nutrition, vitamin and mineral supplements be like after sleeve gastrectomy (sleeve gastrectomy) surgery? Patients are given protein supplements for the first 15 days. Various vitamin and mineral supplements are given to patients, especially in the first year. These are not standard for every patient, and decisions are made according to the patient's condition and what and how much he needs after the examinations performed during routine checks. Can I stand up and return to work immediately after sleeve gastrectomy surgery? Since the surgery is performed laparoscopically (closed), you can stand up and walk an hour or two after the surgery. Even during your stay in the hospital, you will not be a care patient and you will be able to do your own self-care. Patients who work at a desk or work in jobs that do not require heavy effort can start back to work within a week. Patients who require it must take a break from work for at least a month. Patients are given a rest certificate for a sufficient period of time after the surgery. When will stitches be removed after sleeve gastrectomy (sleeve gastrectomy) surgery? There is no need to remove stitches, as self-absorbing stitches are often used. A different procedure If non-absorbable stitches are used for this reason, when you come for a follow-up on the tenth day, the stitches are checked and removed if appropriate. When can you take a bath after sleeve gastrectomy (sleeve gastrectomy) surgery? You can take a bath when you leave the hospital. There is no problem for the stitches to remain open and get wet. After the shower, dry them with a clean towel and apply baticon on them. Apply and wait for it to dry. Baticon does not leave permanent stains on your laundry. After the tenth day, there is no need to use baticon anymore. Can I use medication after sleeve gastrectomy surgery? Do not use any medications other than those we recommend for the first month. If a medicine is recommended by another physician, be sure to consult us. You can use any kind of medication after the first month. However, try not to use too much painkillers and drink plenty of fluids after taking the medication. How does sleeve gastrectomy surgery work? Contrary to popular belief, sleeve gastrectomy (stomach tube) surgery is not only
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