Laparoscopic Sleeve Gastrectomy

What is Laparoscopic Sleeve Gastrectomy?

Sleeve Gastrectomy is a simpler, more effective surgical weight-loss procedure, used in obesity treatment. During sleeve gastrectomy, about 80% of the stomach is removed, leaving a tube-shaped stomach, about the size and shape of a banana. This surgery is typically performed laparoscopically (closed) and it takes about 1-2 hours. Depending on your recovery, your hospital stay may last one to two nights. You may also need to prepare planning ahead for your recovery after surgery. People who have a sleeve gastrectromy are typically off work for four weeks.

Limiting the size of your stomach restricts the amount of food you are able to consume. Losing excess weight, will considerably reduce the potentially life-threatening weight related health problems such as high blood pressure, heart diseases , high cholesterol, Type 2 diabetes, stroke, sleep apnea, gastroesophageal reflux disease, infertility.

Following the operation, patients’ diet begins with sugar-free, non-carbonated liquids for 2 weeks and soft pureed foods for the following weeks. Later on, they can switch to normal type of nutrition. Vitamin supplements may be necessary. Finally, the passing to regular foods will be done in approximately four weeks after surgery. The patients lose about 80% of their excess weight in the post operative process. They also get rid of their problems related to being overweight such as sleeping apnea and diabetes. Following the operation, the patient needs to chew tiny bits and consume food in small ratios. Having exercises should not be avoided.

Who is eligible for Laparoscopic Sleeve Gastrectomy?

The following criterias have to be met by the prospective patient.

Patients who have tried supervised dieting programs and dietary education without success.
Patient’s BMI has to be above 40 kg/m2 meaning he / she is a morbid obese.
Patients with BMI of 35 and above, with or without associated obesity related illness such as back pain, diabetes, sleep apnea, knee and joint problems.
Presence of disease besides the obesity level is essential regarding the patients who are between 18 and 65 . (In addition to doctor’s decision, parental consent is necessary)

For patients above 65, medical condition and the necessity of surgery depending on the problems arising from the excess weight is taken into consideration.

How much weight can I lose after Laparoscopic Sleeve Gastrectomy?

A patient who is meticulous about his / her nutrition routines and engages in regular exercise following the operation can experience about 65 – 80 % weight loss in 1 year after the surgery. However, in case patients can not regulate nutrition patterns, there is a 5 % chance weight gain can recur.

What are the risks of Laparoscopic Sleeve Gastrectomy?

Obesity surgeries can be extremely successful in helping patients suffering from obesity lose weight. The mortality rate among patients undergoing bariatric operations is generally quoted as between 0,001-0.05 % Therefore, bariatric surgery is medically considered a safer approach since the risk is significantly low given the potential risks the morbid obese patient faces in daily life.

The most serious complication that may arise out of Bariatric Surgery can be regarded as leakage running down from the remaining stomach into abdominal cavity. Even though Stenosis in stomach is rarely seen after the operation, it can be easily treated by performing endoscopic expansion. It is possible to reduce the risks to minimum in bariatric surgery under supervision of a specialist at a fully fledged hospital.

Pre Operation

Pre-op Investigations

A date is set for patients who opt for an operation and preliminary tests are performed.

Those tests are as follows :

Blood Test
Gastrointestinal Endoscopy
Whole Abdomen Ultrasound
Lung X-ray
Cardiology Consultation and Echocardiogram
Psychiatry Consultation
Internal Medicine and Endocrinology Consultation
Dietician Consultation
Gastrointestinal Passage Simulation (in case of a revision surgery)
Anesthesiology Consultation

Evaluation of Pre-op Results

Pre-op tests are evaluated within a week and in the event of a diagnosis that needs to be treated, personalized treatment (mostly medication) is recommended and prescribed.

Diet Prior to Operation

A protein based vegetarian diet is recommended prior to operation. Having undergone the short term diet, the weight loss at a certain rate is targeted prior to operation. The amount of weight loss is determined according to weight and overall condition of the patient.

The typical pre-op diet is high in protein and low in fat and carbonhydrates. This will reduce the size of liver, excess fat in the abdominal cavity, helping to reduce the risk of complications associated with the surgery.

Besides, possible weight loss relieve both the cardiovascular and respiratory system.

Therefore, operation gets easier for surgeon and the patient as well, reducing the risks related to surgery to minimum. Moreover, possiblity of a diet enables a quicker operation and more importantly a faster recovery.

Duration of Hospitalization

Following the operation, patients are hospitalized in our private rooms where comfort and other needs of our patients are met accordingly and closely monitored by nurses. Thus, a patient is not required to be monitored in Intensive Care Unit under normal circumstances.

The patient is admitted to hospital the day before operation.

Total hospitalization time for the operation is roughly 3 or 4 days, considering the patients’ healing and progess. Our patients can be mobilized and get back home right after the discharge date. Prior to discharge, patient will be given specific dietary and activity instructions, along with information about certain precautions and when to notify the surgeon

Return to Work

Return to work of our patients varies depending on the profession of the patient.

The patient can get back to work between 7 and 10 days unless he / she works in an environment that requires heavy physical activity.

Post Operation Process

Post Surgery Diet

After surgery, the patient must follow a strict diet that enables the body to recover and adjust to a smaller size. All of our patients that underwent Laparoscopic Sleeve Gastrectomy are regularly monitored by the dieticians. The gastric sleeve diet follows 3-4 distinct phases for getting back to a healthful eating pattern. (Low carb & High protein diet) If the patient manages to adopt any eating pattern and keeps his / her portions at a normal size it is unlikely the patient will experience discomfort. Patient can usually start eating regular foods about 3 months after surgery. During the first 2 weeks after the surgery, patient should consume only liquids. Protein intake is highly recommended during full liquid diet. Remaining well hydrated following surgery can speed the healing process.

Patients have to exercise a full liquid diet for the first two weeks after surgery. Protein intake is highly recommended during full liquid diet.

Guidelines for the Post Bariatric Surgery

Number of courses have to increase and the patient needs to prefer small portions. The meals have to be chewed up multiple times.

Protein rich diet must be applied following the operation.
Regular exercise can support weight loss, but patient should talk with the surgeon about when is safe to resume exercise after surgery.
Liquids should not be taken 10-15 minutes before and 20-30 minutes after meals. Liquid and solid food should not be consumed together.
The amount of liters of water consumed is important. Patient needs to use straw if possible, drinking 1 liter a day and gradually increase daily intake for a total 1,5 to 2 liters per day.
Routine checks should not be missed out.

Exercise following the Bariatric Surgery

It is recommended that patients engage in sports activities 2 months after the Sleeve Gastrectomy. Taking short walks is an ideal option during the first month of surgery. Fitness and swimming are particularly recommended in terms of improving striped muscles 2 months after the surgery.

Bariatric Surgery produces significant weight loss, drastic improvements in metabolic health, changing the capacity to mobilize of patients following surgery, improving quality of life.

Exercise following bariatric surgery improves muscle function, lung capacity , reduces osteoarthritis, knee pain and injury risks