Although gastric reduction operations have been performed since the 1990s, this technique was last performed in 2001 by the American surgeon. Reported by Gagner. Dr. Gagner considered this technique as the first-step surgery for overweight patients who gain weight and cannot undergo conventional gastric bypass and biliopancreatic bypass operations. However, when it was observed that patients who underwent a sleeve gastrectomy had lost more weight than expected and, more importantly, this technique was introduced in the medical literature as an obesity surgery that can be performed alone.
How is Sleeve Gastrectomy Done ?
As with other methods of obesity surgery, it is done with the closed method called laparoscopy. It is made of 6 small holes (approximately 2 inches). All the benefits of laparoscopic surgery, such as extremely low postoperative pain, good cosmetic outcome and early mobilization, are also seen in obesity surgery.The stomach is cut with special disposable instruments and sutured at the same time. The thinness of the stomach remaining during the procedure is provided by a tube placed inside the stomach. After cutting, approximately 80% of the stomach is removed. Since the remaining stomach resembles a banana-shaped tube after the procedure, the technique is often called a stomach tube. To detect a possible leakage of the suture line, the stomach is inflated with a special dye and the suture line is checked.
How does Sleeve Gastrectomy work?
The primary effect is to achieve early satisfaction by eating less food with a small stomach volume. In normal metabolism, the feeling of saturation occurs when the stomach wall is stretched. Then, after the stomach is filled with enough food, the saturation signal goes to the brain with the wall tension and the feeding is finished. Since a thin stomach remains after a stomach tube surgery, a small amount of food causes tension in the stomach wall and a feeling of saturation occurs. Another effect is the change in the level of ghrelin, also known as the fasting hormone, which has been emphasized in recent years. Ghrelin is the hormone secreted by the part of the stomach dome known as the background and sends the signal to the brain when the stomach is empty. Since the gastric fundus is almost completely removed after sleeve gastrectomy, the glycerin level decreases and the feeling of hunger is suppressed. This is the most surprising effect for patients after surgery. Many patients say that I eat very shortly after surgery, but I'm not hungry.
Advantages and disadvantages of Sleeve Gastrectomy
The main advantage of this method is that no changes are made in the natural route of the digestive tract. Postoperative vitamin and mineral deficiency is much lower than other obesity operations. It is a relatively technically simpler procedure, which usually lasts between 40 and 90 minutes. As the canceled stomach is removed, there is no gastric portion that cannot be shown. Another advantage is that sleeve gastrectomy can be checked if you gain weight again after obesity surgery. The results of the transaction, which has a history of 10 years, are not known for 20-30 years.
After Sleeve Gastrectomy
Oral ingestion begins after the radiograph of gastric passage taken the next day. Fluid intake increases on day 3 and the patient is usually discharged on day 3. The first week is fed with liquid food for 14 days, including clear liquids. Subsequently, the transition to soft foods occurs gradually and at the end of the fourth week, all foods can be eaten. During this period, most teams prefer to be under the control of a dietitian. The expected weight loss after surgery is 70% of excess weight. So, if a person must weigh 70 kg, it is 170 kg; After a year and a half after surgery, it is reduced to about 100 kg. Weight gain is faster in the first 6 months and then continues more slowly. Permanent weight gain after sleeve gastrectomy is around 75-80%. Although weight gain can be seen in 15-20% of patients, the probability of returning to the same weight is about 1%.
What are the risks of Sleeve Gastrectomy ?
During the surgery, a long suture line is formed in the stomach. Some patients may have small leaks from this long suture line. This rate is less than 2%. In case of leakage, there may be small abscesses around the suture line. In this case, the radiological deposits are drained and leaks are expected to close. A cover device called a stent can be placed at the vanishing point, possibly by surgery or endoscopically. Thanks to advances in medical technology (especially stapling technology that cuts and closes the stomach), this surgery can be performed with the utmost confidence and complications related to the procedure are very rare. The risk of death from sleeve gastrectomy is 0.3-0.5%.