Gastric Sleeve Surgery (Weight Loss Surgery)

What is Gastric Sleeve Surgery?

The Gastric Sleeve, also called Sleeve Gastrectomy, is a Bariatric Surgery, and like every other Bariatric Surgery, aims to make patients lose weight through making modifications to the digestive system. Gastric Sleeve is recommended to patients that are obese and can not lose weight with diet and exercise. The Gastric Sleeve involves reducing the stomach size by approximately 80%, leaving behind a tubular sleeve in the shape of a banana, lowering the calorie intake and inducing weight loss as a result. Majority of the Fundus region of the stomach is removed during Gastric Sleeve, which is responsible for the secretion of the hunger hormone, Ghrelin, therefore reducing the appetite of the patient.

Why is Gastric Sleeve Surgery Performed?

Gastric Sleeve is used to treat obesity and obesity-related detrimental health conditions. Obesity has become more prevalent over the last few decades and substantially lowers the life expectancy of individuals. Surgical methods, like Gastric Sleeve, are often recommended if the patient is morbidly obese to such a degree that even dieting and exercises are not enough to help the patient lose weight. Gastric Sleeve is one of the, if not the most, popular Bariatric Surgery as it allows patients to lose weight comfortably and quickly while allowing them to go back to their daily lives shortly after the surgery. Gastric Sleeve is performed laparoscopically, i.e. using small keyholes instead of opening up the abdomen, therefore has a very low rate of complication, and is considered even safer than Gallbladder removal.

Gastric Sleeve helps alleviate obesity related medical conditions such as type 2 diabetes, hypertension, high cholesterol, joint pain, and sleep apnea. Gastric Sleeve has also been shown to help with Polycystic Ovary Syndrome (PCOS) and is a recommended treatment option, even increasing pregnancy outcomes1.

What are The Conditions Of Sleeve Gastrectomy Surgery?

The final decision on if a patient qualifies for Gastric Sleeve or if Gastric Sleeve is recommended is made by our Bariatric Team, here are some of the qualifying criteria that our Bariatric Team uses for Gastric Sleeve:

• A Body Mass Index, BMI, of at least 30 is required, or having an obesity related condition.
• Must not have tested positive for Covid within the month before surgery.
• Must not have an active infection at the time of the surgery.
• Must not have Acid Reflux caused by a hiatal hernia.
• Chronic diseases, such as thyroid diseases, Crohn's disease, diabetes, etc, might require additional testing before arriving in Turkey.
• History of other surgeries can be disqualifying.
• Currently having or having a history of a disease might require a letter of eligibility from the patient’s doctor or require additional consultations after arriving in Turkey.

For any additional information or to learn if you qualify for the Gastric Sleeve, contact a Patient Coordinator.

What Are The Things To Be Considered Before Gastric Sleeve Surgery?

After a patient qualifies for Gastric Sleeve, their Patient Coordinator, along with a treatment schedule, will provide the patient with a Liver Fat Reducing Diet that has to be followed before arriving at the hospital. The patient should not consume any food or liquid 12 hours before the surgery in order to make sure the stomach is empty before surgery. The following dietary and medicinal restrictions have to be followed before the surgery as well:

• Usage of vitamin K should be stopped 30 days before surgery as it is an anticoagulant, i.e. blood thinner, and increases the rate of complications associated with internal bleeding.
• Oral contraceptives and any other contraceptives that have estrogen or progesterone, like coils, HRT patches, or birth control implants, must be stopped or taken off 30 days before the surgery as they increase the rate of complications arising from blood clots. Hormonal and oral contraceptives can be used 30 days after surgery. Non-hormonal implants are safe and recommended if considering a Gastric Sleeve.
• Smoking should be avoided starting a week before surgery until three weeks after surgery. Smoking causes the veins to constrict and limits blood circulation, potentially causing complications such as leakage.
• Alcohol consumption should preferably be avoided in the last 3 months leading up to the surgery. Alcohol consumption a week before surgery should especially be avoided as it will increase the burden on the liver and cause complications with anesthesia.

What Are The Things To Be Considered During Gastric Sleeve Surgery?

Laparoscopic Gastric sleeve surgery is performed under general anesthesia, so the patient will be asleep during the surgery. Laparoscopy is a minimally invasive surgical technique, which involves 4 - 5 keyhole incisions on the abdomen and the healing is faster than a regular open surgery. The surgeon will make a half an inch long cut on the patient's abdomen and insert a port from where carbon dioxide gas will be pumped to expand the abdomen.

The surgeon will enter the abdomen with a thin and long telescope with a tiny camera at the end which will act as the surgeon’s eyes by projecting the insides of the patient onto a screen. The surgeon will make one to three additional incisions, again half an inch in size, and will insert additional ports to complete the procedure using long and narrow surgical instruments. The surgeon will remove 80% of the stomach including the fundus region. The Fundus region, as mentioned before, contains most of the area of the stomach where the Ghrelin hormone is secreted, thus taking out this part of the stomach will decrease appetite and cravings. The new stomach will be much smaller and will have the shape of a banana. The gastric sleeve will be measured, divided and separated by using surgical stapler. The resected sections of the stomach will be placed in a specimen bag and then will be extracted through the trocar site. The port sites will then be closed with non-absorbable sutures, non-absorbable sutures are used as they prevent port site hernia.

What Are The Things To Be Considered After Gastric Sleeve Surgery?

Gastric Sleeve prescriptions given to the patients after the operation will include blood thinner injections and stomach protectors. The medicine provided will include antibiotics and painkillers that should be used if needed. Booking Surgery dieticians will provide a diet list for each patient and will provide additional support if needed. The initial dietary restrictions post surgery will be as follows:

• The patients will only consume liquids for the first 3 weeks following surgery. Also called the liquid stage, patients are advised to consume protein shakes, soups, herbal tea, etc.
• The patients are advised to consume puree and liquid foods for the following 3 weeks. Also called the puree stage, patients are recommended to increase their diet by eating mash and blended foods.
• After 6 weeks of liquid and puree stage, the patients can start consuming solid foods. After Gastric Sleeve surgery, patients should never eat solid and liquid foods at the same time.
• Additionally, patients should avoid caffeinated or carbonated drinks for 2 months following surgery, but decaffeinated coffee can be safely consumed 10 days after surgery.
• Patients should also avoid smoking, alcohol, and any recreational drugs for at least 3 weeks following surgery.

Post surgery, some physical activities should be avoided as well:

• Patients can go back to work 2 weeks after getting home if it's not a physically strenuous job.
• Patients should avoid strenuous activity and sexual intercourse for the first month following surgery.
• Patients should walk a lot and should not carry things that weigh more than 6.6 pounds (3 kilograms) for the first few weeks following surgery.
• Patients can start exercising to help the weight loss process 2 months after the surgery.

Additionally, the surgical stitches will dissolve on their own, but if they do not, patients should take an appointment from their GP’s to get them removed.

What are the Risks of Gastric Sleeve Surgery?

Gastric Sleeve Surgery, while considered relatively safe mainly due to it being done Laporoscipally, has some risks associated with it like any major surgery. These risk include:

• Infection
• Leaks and bleeding
• Negative reaction to anesthesia
• Lung or breathing problems
• Blood clots

These risks most likely show up within the first month after surgery. The long term side effects of Gastric Sleeve Surgery, as a result of the modifications to the digestive system and due to the rapid weight loss, include:

• Vomiting
• Pain
• Fatigue
• Dry Skin
• Mood Changes
• Hair Loss
• Hernias
• Gastroesophageal reflux
• Hypoglycemia
• Malnutrition

Booking Surgery has a complication rate of 2%, and consists mainly of bleeding complications, which is easy to treat and most of the time does not require a prolonged stay. Out of 16000 patients over a span of 11 years, none of the complications with Booking Surgery has resulted in a fatality.

What To Do When Gastric Sleeve Surgery Doesn't Work?

A correctly performed Gastric Sleeve Surgery by a certified General Surgeon will always result in substantial weight loss. Gastric Sleeve has a very low chance of failure and the result is considered a failure if the patient regains the weight. Going back to old eating habits by forcing the body or commonly drinking carbonated drinks may cause the stomach to enlarge, therefore allowing weight regain.

In such a case, the patient will be advised to go through a revisional Bariatric Surgery. Depending on the patient, they will be recommended to revise into Roux En Y Bypass, Mini Gastric Bypass or into Gastric Sleeve. Gastric Sleeve surgery can be revised into another Gastric Sleeve surgery, this is also called re-sleeving.

What Are the Advantages Of Gastric Sleeve Surgery?

Even compared to other Bariatric Surgeries, Gastric Sleeve Surgery is simpler, quicker and safer. The biggest advantage of gastric sleeve surgery is that it has a relatively comfortable healing process. People with health conditions that might make longer procedures unavailable can often undergo a Sleeve Gastrectomy as it only lasts up to 1 hour. It's also much less likely to cause long-term complications like malnutrition and dumping syndrome. This is because Gastric Sleeve Surgery only modifies the volume of the stomach and leaves the rest of the digestive system intact. Gastric Sleeve surgery only requires 6 months usage of Bariatric vitamins, unlike Roux En Y Bypass and Mini Gastric Bypass which require lifelong usage of Bariatric vitamins.

Some obesity related chronic diseases like high blood pressure, hypothyroidism, and sleep apnea are treated with Gastric Sleeve as well.

Gastric sleeve surgery is also the cheapest surgical Bariatric treatment.

Booking Surgery offers a streamlined process to have a Gastric Sleeve in Turkey. The professional service starts when the patient arrives in Turkey, and includes airport transfers, more than 30 pre-op tests, state-of-the-art equipment, qualified bariatric surgeons, full hospital stay, 24-hour observation by nurses and Booking Surgery translators, and Dietician support for up to a year after the surgery.

What Are the Disadvantages of Gastric Sleeve Surgery?

While Gastric Sleeve surgery has many advantages, it does possess some disadvantages that have to be considered before going through with the surgery. Some of the disadvantages include:

• Gastric Sleeve surgery is not reversible,
• Acid reflux caused by a hiatal hernia will be exacerbated by Gastric Sleeve surgery. In rare cases might even require a revision into Roux En Y Bypass. ,
• Losing weight might cause sagging skin.
• Risks associated with Gastric Sleeve.

1 Malik SM, Traub ML. Defining the role of bariatric surgery in polycystic ovarian syndrome patients. World J Diabetes. 2012 Apr 15;3(4):71-9. doi: 10.4239/wjd.v3.i4.71. PMID: 22532886; PMCID: PMC3334389.