In sleeve gastrectomy, the stomach is turned into a tube by surgical procedure. In the digestive system, almost all organs of this system are tubular.
The esophagus, intestines, all are organs in the form of thin long tubes. The stomach, which is an exception in this system, is shaped like a pouch so that it can take in more food and create storage. With surgery, a large part of the stomach is irreversibly removed and turned into a system that continues with the esophagus and intestines. No tube or other foreign body is inserted into the stomach.
Reducing the volume of the stomach is not the only result of sleeve gastrectomy. While the stomach is reduced and turned into a tube shape, it also has a serious effect on the hunger hormone secreted from the stomach. The desire for food decreases significantly, the brain feels less hunger, in other words, sleeve gastrectomy surgery creates not only a mechanical effect but also a hormonal effect.
How is Gastric Sleeve Gastrectomy Surgery Performed?
- Gastric sleeve gastrectomy is performed under general anesthesia.
- Gastric sleeve gastrectomy is usually performed with closed, laparoscopic methods. Depending on the doctor and the patient, it can be performed through a single hole or 4-5 holes. Since the holes are very small, it does not cause aesthetic problems in the future.
- In order not to make a mistake during the operation and make the stomach too small, a calibration tube is inserted into the stomach entrance up to the diameter of the esophagus. Thanks to this calibration tube, the stomach is reduced as if it were a continuation of the esophagus, while excessive stenosis and obstruction are prevented.
- After taking precautions against vascularization and bleeding, the stomach is cut with special cutting and closing tools (stapling).
- After the procedure is finished, the calibration tube placed at the beginning of the operation is removed.
- During the operation, it is tested for leakage with one or more different techniques. Similar tests can also be performed after surgery.
For Which Patients Is Gastric Sleeve Gastrectomy Suitable?
Sleeve gastrectomy is the most preferred method among the surgical techniques applied for morbidly obese patients. Gastric sleeve surgery is not recommended for obesity patients with uncontrolled diabetes or severe reflux problems. We can say that there are more effective methods if diabetes is the target rather than obesity. We can transform sleeve gastrectomy into other surgical techniques in the future. With a second surgery, it is a more comfortable and easier way to transform the sleeve gastrectomy into metabolic surgery techniques such as gastric bypass or duodenal switch.
What should be considered before gastric sleeve surgery?
Patients undergo major examinations before gastric sleeve surgery. It is checked whether there are problems such as stomach ulcers and heart disease that may prevent gastric sleeve surgery. First, the problems that prevent surgery are eliminated and the patient is made suitable for surgery. Sometimes these treatments applied before surgery can last for months. In addition, diet specialists, psychology and psychiatry specialists also check the patient and decide whether he/she is suitable for surgery. The important thing is that the patient undergoes obesity surgery without any problems.
The patient is usually hospitalized on the day of surgery. The patient is hospitalized for 2-3 days after the surgery.
In patients with very serious weight problems and especially in patients with fatty liver disease, a special diet program of 10-15 days can be applied before surgery. With this special diet program, it is aimed to make the surgery less risky by shrinking the liver.
Is There an Age Limit for Gastric Sleeve Gastrectomy?
In general, obesity surgery, including sleeve gastrectomy, is not preferred in individuals who have not completed their cerebral and personal development, that is, before the age of 18. However, in very rare cases, surgery may be considered in children who cannot lose enough weight despite being under the supervision of a child psychiatrist, nutritionist, endocrine and child development specialist for a long time, and who may experience serious metabolic problems in the early period due to this. However, this is a very small patient segment.
Apart from this exceptional case, gastric sleeve and other obesity surgeries are not performed before the age of 18.
Although the upper limit is accepted as 65 years of age according to classical knowledge, gastric sleeve surgery can be performed at older ages in patients with good general condition, who can tolerate the surgical procedure and have a long life expectancy.
What is the Appropriate Weight Range in Sleeve Gastrectomy Surgery?
When deciding on the surgical procedure in obesity surgeries, it is a more appropriate and better method to make calculations based on body mass index (BMI), not excess weight. Body mass index is the patient’s weight in kg divided by the square of his/her height in meters. If the number resulting from this calculation is between 18-25, the body mass index is normal. People with a BMI between 25-30 are not obese, this group is called overweight. However, people with a BMI of 30 and above are obese. Not all patients who are called obese are suitable patients for sleeve gastrectomy or other obesity surgeries. Patients with a BMI of 35 and above and who experience the discomforts and diseases caused by obesity are suitable for sleeve gastrectomy surgery. Patients with a body mass index of 40 and above can have gastric sleeve and other obesity surgeries even if they have no discomfort.
If the patient’s diabetes cannot be controlled despite all diet and medical treatment trials, the patient is suitable for metabolic surgery even if the patient’s body mass index is between 30-35.