What is Gastric Sleeve Surgery (Stomach Reduction Surgery)?

What is Sleeve Gastrectomy?

Gastric sleeve surgery is a surgical procedure performed in the treatment of obesity, where approximately 80 percent of the stomach is removed, resulting in a smaller stomach and thus, loss of appetite and weight loss. It is one of the surgical methods and is performed by removing approximately 75-80% of the stomach. As a result of this process, the stomach takes the shape of a tube and the person feels full with less food. At the same time, ghrelin levels, also known as the hunger hormone, decrease, making appetite control easier.

Sleeve gastrectomy is performed to both achieve weight loss and help control obesity-related diseases (such as type 2 diabetes, hypertension, sleep apnea). It is a permanent procedure and is usually performed laparoscopically (closed).

In Which Diseases Is Sleeve Gastrectomy Surgery Used?

Gastric sleeve surgery is performed not only for weight loss but also to support the treatment of chronic diseases that develop due to obesity. In individuals with a high body mass index (BMI), some diseases may be difficult to control with diet and medication.

In this case, surgical intervention can alleviate or eliminate many health problems by both achieving weight loss and improving metabolic balance.

Gastric sleeve surgery may be preferred for the following diseases:

• Type 2 diabetes
• Hypertension
• Sleep apnea
• Polycystic ovary syndrome (PCOS)
• Gastroesophageal reflux disease (GERD)
• Fatty liver disease (NAFLD)
• Joint diseases (osteoarthritis)
• Metabolic syndrome

Type 2 Diabetes

Sleeve gastrectomy helps control blood sugar levels by reducing insulin resistance. Post-operative weight loss makes the pancreas produce insulin more efficiently. In some patients, complete remission of diabetes is possible.

Hypertension

Excess weight increases pressure on the veins, leading to high blood pressure. Post-operative weight loss lowers blood pressure and may reduce the need for medication, significantly reducing the risk of heart disease.

Sleep Apnea

Obesity causes narrowing of the airways, paving the way for sleep apnea. The weight loss associated with gastric sleeve surgery relaxes the airways and reduces breathing pauses during sleep.

Polycystic Ovary Syndrome (PCOS)

Excess weight can worsen PCOS symptoms by exacerbating hormonal imbalances. Healthy weight loss combined with sleeve gastrectomy can help regulate menstrual periods and have positive effects on fertility.

Gastroesophageal Reflux Disease (GERD)

Reflux occurs when stomach contents leak into the esophagus, and obesity can trigger this condition. Reflux complaints may be alleviated after gastric sleeve surgery as the stomach volume becomes smaller. However, careful evaluation is required as reflux complaints may increase in some patients.

Fatty Liver Disease (NAFLD)

Fatty liver disease due to obesity can lead to inflammation and liver damage over time. Weight loss can reverse this process by reducing the amount of fat in the liver.

Joint Diseases (Osteoarthritis)

Excess weight puts pressure on weight-bearing joints, especially the knees and hips. This situation increases joint pain. Weight loss after gastric sleeve surgery reduces this pressure, increases mobility, and relieves pain.

Metabolic Syndrome

Metabolic syndrome, a combination of factors such as insulin resistance, high blood pressure, and high triglycerides, increases the risk of cardiovascular disease. Sleeve gastrectomy improves overall metabolic health by lowering these risk factors.

Who Can Undergo Gastric Sleeve Surgery?

Gastric sleeve surgery is one of the surgical methods used in the treatment of obesity and is especially recommended for individuals who have not achieved successful results with diet, exercise and medical treatment. By reducing stomach volume, it helps the person feel full with less food and supports weight loss. However, this surgery is not suitable for everyone. Applicants must meet certain health criteria.

Gastric sleeve surgery can be performed on the following individuals:

• Individuals with a body mass index (BMI) of 40 and above: This level indicates morbid obesity and surgical intervention is usually recommended.
• Those with a BMI between 35-39.9 and who have health problems related to obesity: Surgery may be considered in individuals with diseases such as type 2 diabetes, hypertension, sleep apnea, and joint diseases.
• Those who cannot lose weight permanently with diet and exercise: People who cannot successfully lose weight with medical methods are evaluated for surgical options.
• Those who are psychologically ready for surgery: People who can adapt to lifestyle changes after surgery are preferred.
• Those between the ages of 18-65: This age group is generally considered suitable; However, in some special cases, younger or older individuals may also be evaluated.
• Those with a general health condition that can carry the risks of surgery: Individuals whose heart, liver or other systemic diseases are under control may be suitable candidates.

How is Gastric Sleeve Surgery Performed?

Gastric sleeve surgery is a bariatric surgery method that involves surgically removing approximately 80% of the stomach. During this procedure, the stomach is turned into a long, thin tube, reducing both the stomach volume and the areas where appetite-controlling hormones are secreted.

Laparoscopic surgery, which is a closed procedure, is performed using special instruments through small incisions in the abdominal area and is usually performed under general anesthesia.

Robotic Gastric Sleeve Surgery

If a general surgeon recommends weight management surgery, this indicates that the individual may be a suitable candidate for robotic bariatric surgery. This procedure, performed with the "da Vinci" robot, is defined as robot-assisted laparoscopy surgery.

With the da Vinci robot, the surgeon can perform highly precise procedures on the patient through small incisions. Various operations can be performed successfully for morbidly obese individuals with robotic surgery, which is used in many areas of medicine, from urology to cardiac surgery, from gynecology to general surgery.

How Long Does Gastric Reduction Surgery Take?

Gastric sleeve surgery takes approximately 1.5 hours to complete. Since the exit and entrance sections of the stomach are preserved and continuity in the digestive system is maintained, the risks after sleeve gastrectomy surgery are low and some undesirable side effects are reported to be very few.

Can Gastric Sleeve Surgery Be Applied to Anyone With Weight Problems?

Gastric sleeve surgery is a surgical procedure performed on individuals who have difficulty controlling their weight and for whom obesity has serious effects on their health. This surgery is performed not only for aesthetic reasons but also to improve the quality of life and eliminate health problems related to obesity.

Eligibility criteria are determined by taking into consideration the patient's body mass index (BMI) and comorbid health problems.

In order to undergo gastric sleeve surgery, the following criteria must be met:

• Individuals with a body mass index above 40 kg/m² (morbid obesity) are considered candidates for this surgery.
• People with a BMI between 35-40 kg/m² and serious health problems such as type 2 diabetes, hypertension, and sleep apnea due to excess weight are also suitable for surgery.
• For individuals with a BMI between 30-35 kg/m² and newly developed type 2 diabetes or metabolic disorders due to obesity, surgery can be performed with the decision of an obesity specialist.

Bariatric surgery is performed not only to lose weight or look thinner, but also to treat health problems caused by obesity.

At what age can gastric sleeve surgery be performed?

Gastric sleeve surgery, or stomach reduction surgery, is performed on people between the ages of 18 and 65. To be a suitable candidate for gastric surgery, a person must have a Body Mass Index (BMI) of 35 or higher, as determined by the World Health Organization.

For people under the age of 18, the degree of obesity and the presence of the diseases listed above are important, and parental approval is required as well as a physician's decision. For people over 65 years of age, the health status and the necessity of surgery (the person's weight-related problems and problems they experience) are evaluated.

What are Revision Surgeries After Bariatric Surgery?

Revision surgeries are surgeries performed due to various problems such as weight regain, stenosis or leakage after obesity surgery. The most important reason for revision surgery is usually weight regain.

The main reasons why patients regain weight are that patients are not followed up adequately, patients are not informed enough, or they do not comply with the process even if they are conscious. For these reasons, patients may experience 20-30% weight regain.

It is very important to carefully select the revision surgeries performed on patients. These surgeries are technically more difficult and must be performed by experienced surgeons. Nowadays, as the number of obesity surgeries increases, the number of revision surgeries also increases.

There are types of surgery recommended for patients who have relapsed comorbidities such as diabetes and high blood pressure, or who have regained weight. The most appropriate type of surgery should be decided after discussing it with the patient and making an evaluation.

After Gastric Sleeve Surgery

The post-gastric sleeve surgery period is a critical period that encompasses both physical recovery and the restructuring of dietary habits. After surgery, patients must follow certain rules to ensure healthy weight loss and minimize the risk of complications.

During this period, nutrition, follow-up appointments, exercise planning and psychological support are of great importance.

Will There Be Pain After Gastric Sleeve Surgery?

Nowadays, gastric sleeve surgery is performed laparoscopically, that is, with very small incisions through the abdomen. These incisions are millimetric. This method, called closed surgery, can also be performed using a "da Vinci robot, " or robotic surgery. In robotic surgery, the doctor controlling the robot's arms and accompanying specialists perform the surgery.

What is the Process of Returning to Normal After Gastric Reduction Surgery?

Since the abdominal muscles and membranes are not cut in laparoscopy surgeries, there is no serious pain after the surgery. After the surgery, the patient is given painkillers.

People with gastric sleeve surgery start walking the evening of the day of surgery and generally do not experience any serious pain on the second day. The patient may feel tension and pressure on the first day, which can be relieved with painkillers.

Can I Gain Weight Again After Surgery?

The rate of regaining weight after gastric sleeve surgery is around 15 percent. Even after surgery, there is a 5-10% chance of becoming morbidly obese again. For this reason, it is very important for the patient's relatives to be followed up by specialists to prevent those who have had gastric sleeve surgery from gaining weight again.

Those who have gastric sleeve surgery are closely monitored by an obesity team that includes a dietitian and psychologist. With this approach, which aims to monitor the patient throughout his/her life, support is provided against situations that may cause weight gain or affect his/her health.

Post-Gastric Surgery Nutrition

The success of gastric surgery is directly related to the patient's ability to embrace their new lifestyle. It is of great importance to follow the nutrition program created under the supervision of metabolism and endocrinology specialists and to use nutritional, vitamin and mineral supplements regularly if necessary.

Although a personalized plan is prepared for each patient, some basic principles apply to nutrition after gastric sleeve surgery.

Nutrition after gastric sleeve surgery should be as follows:

• Protein intake is the most important nutritional criterion in the post-operative period. It is recommended to consume an average of 60 grams of protein per day. This amount should be provided by sources such as 1 serving of chicken, turkey, fish or low-fat cheese.
• Meals should not be skipped. Consuming at least 3 main meals and 2 snacks a day prevents exceeding the stomach capacity and contributes to the regular functioning of the metabolism.
• Each meal should be consumed carefully at the table. Setting aside at least half an hour for main meals helps keep eating habits under control. Eating should not be done while standing or in front of the television or computer.
• Portions should be kept small. Meals should be served on small plates and with small cutlery. Foods should be prepared by cutting them into small pieces and consumed slowly and thoroughly by chewing. Serving plates and pots should not be left on the table, and second portions should never be taken.
• Fluid intake should be adequate. At least 6-8 glasses of caffeine-free, calorie-free and non-carbonated beverages should be consumed daily. Liquids should not be consumed half an hour before meals, this will help prevent nausea.
• Vitamin and mineral supplements should be used regularly. The supplements recommended by the doctor after surgery should not be neglected. It is not recommended to use any other medications or supplements without physician approval.

Gastric surgery is not a temporary diet or weight loss cure. This process aims to make healthy eating a way of life. The support of the same approach by the patient's social environment has a positive effect on the treatment process.

Exercise After Gastric Surgery

An exercise program is crucial for a healthy recovery and permanent weight control after gastric surgery. A regular physical activity plan initiated under specialist supervision increases the success of obesity surgery and contributes to the patient's physical and psychological strength.

Difficulty may be experienced initially, especially in individuals who have not had any sports habits before; However, as weight loss increases and a person discovers the types of exercise they enjoy, this process becomes more sustainable.

Although a personalized plan is prepared for each patient, some basic principles apply to post-gastric surgery exercise practices:

• Before starting exercise, a doctor's approval must be obtained. All types of exercise to be performed should be shared with the doctor and action should be taken in accordance with approval.
• Physical activity should generally be started 3 months after surgery. During this period, exercises should be at a light level and should not exceed the recommended time for rapid weight loss.
• Walking is the safest and most effective exercise option for early childhood. Duration and tempo must be adjusted according to the guidance of the physician or exercise consultant.
• Abdominal exercises and weight lifting should not be done without doctor's approval. Usually, such exercises are allowed to start after 6 weeks.
• The exercise program should be tailored to personal preferences. Activities that strengthen both muscle and bone structure and increase cardiovascular endurance should be preferred.
• Swimming and fitness are among the effective exercises recommended in the post-operative period. Individuals who have these opportunities should contact their exercise consultant and request that a program be created specifically for them.

Exercise after gastric surgery is important not only for weight loss but also for maintaining healthy lifestyle habits. Making exercise a natural part of life supports long-term success.

Exercise After Gastric Sleeve Surgery

Exercises are recommended by experts for the first three months after gastric sleeve surgery. As patients lose weight after the surgery, they move more easily, their lungs relax and allow the person to exert themselves better, their condition increases, and the risk of injury decreases as the weight is lost.

After the first three months after gastric sleeve surgery, sports, especially fitness and swimming, are recommended for the development of striated muscles.

Are Vitamin and Mineral Supplements Required After Gastric Sleeve Surgery?

Vitamin and mineral supplements are crucial after gastric sleeve surgery. Since stomach volume shrinks and food intake decreases after surgery, the risk of missing some nutrients increases. Therefore, vitamin and mineral supplementation is necessary to prevent deficiencies and maintain metabolic balance.

Vitamin and mineral supplements should be taken after gastric sleeve surgery as follows:

• Multivitamin use is initiated in the first month after surgery in dissolve-in-the-mouth forms.
• For the first year, it is recommended to take two multivitamins daily.
• After the first year, one multivitamin supplement per day is considered sufficient.

After obesity surgeries such as gastric sleeve and gastric bypass, patients' blood values should be monitored at regular intervals. These follow-ups are carried out by physicians and relevant branch specialists working in the healthcare institutions that performed the surgery.

The nutrition process should be carried out under the supervision of a dietitian. Individuals who have gastric sleeve surgery can transition to solid foods after approximately 1 month. During this period, a protein-based nutrition plan should be implemented, as satiety is achieved with small amounts of food.

Additionally, the following guidelines should be followed:

• Foods high in carbohydrates (bread, pasta, rice, etc.) should be avoided.
• Caloried liquids (sugared drinks, fruit juices, etc.) should be avoided.
• Meals should be planned in small portions and at frequent intervals.
• Regular physical activity is an important factor in increasing the success of the process.

If dietary guidelines are not followed, the expected success of gastric sleeve surgery cannot be achieved. Therefore, dietary and lifestyle changes play a decisive role in ensuring the surgery provides a permanent solution.

How Much Weight Do People Who Have Gastric Sleeve Surgery Lose?

Those who undergo gastric sleeve surgery can generally lose 60-70% of their body weight. This percentage occurs within the first 12-18 months after surgery. Weight loss varies depending on the person's age, metabolic rate, pre-surgery weight, and lifestyle changes.

The weight loss process after surgery may progress as follows:

• First month: Average 8-12 kilos
• First 3 months: Total 15-25 kilos
• 6 months: 25-35 kilos
• 1 year: 30-50 kilos or more

However, these values may vary depending on individual differences. Compliance with diet, exercise, and medical follow-up is crucial for long-term success.

What are the risks of gastric sleeve surgery?

Gastric sleeve surgery is a major surgical procedure that provides effective and permanent results in the treatment of obesity. However, as with any major surgical procedure, it carries certain risks. The risks of gastric sleeve surgery may vary depending on factors such as the patient's age, body mass index, comorbidities, and surgical experience.

Possible risks of gastric sleeve surgery include:

• Leak (leakage from the stomach suture): It is one of the most important complications. Its incidence is approximately 1% and can be life-threatening if not detected early.
• Bleeding: Internal bleeding from the stomach area may occur during or after surgery.
• Infection: Infection may occur at the surgical site or within the abdomen.
• Pulmonary embolism: It occurs when a clot in the leg veins is carried to the lungs and carries a serious risk.
• Blood clot formation (deep vein thrombosis): It is especially seen in patients who remain immobile.
• Stomach stenosis: Difficulty in passing food may occur over time as a result of the narrowing of the stomach tube.
• Nausea and vomiting: Might be encountered frequently and temporarily in the postoperative period.
• Vitamin and mineral deficiencies: Vitamin B12, iron and folic acid deficiencies may develop due to malabsorption.

The risk of death in gastric sleeve surgery is quite low compared to general surgical procedures. This rate is:

• While it is around 2% in heart surgeries,
• it is 1 in 1, 000 in sleeve gastrectomy surgeries.

These surgeries are not for aesthetic purposes, but are life-saving interventions. In morbidly obese individuals, health risks caused by obesity (fatty liver, type 2 diabetes, hypertension, kidney diseases) may be significantly reduced or completely eliminated after surgery.

Post-Gastric Sleeve Leak Risk and Symptoms

Post-Gastric Sleeve Leak occurs when stomach contents leak into the abdominal cavity through the stitches left after the stomach is cut and formed into a tube. Although this condition is rare, it is a serious complication and requires early intervention.

In the first days after surgery, patients are given radiopaque fluid to check for leaks through imaging. Additionally, patients are closely monitored in the hospital for the first three days.

The main symptoms to be aware of against the risk of leakage are:

• Unexplained fever
• New onset abdominal pain
• Palpitations, weakness, shortness of breath
• Nausea, vomiting, or loss of appetite
• Pain radiating to the left shoulder (due to intra-abdominal irritation)

Frequently Asked Questions About Sleeve Gastrectomy Surgery

What is sleeve gastrectomy surgery?

Gastric sleeve is a weight loss surgery that involves removing a large portion of the stomach and reducing it to a tube shape. After this procedure, the stomach volume decreases and the person feels full with less food.

How is gastric sleeve surgery performed?

In this laparoscopic surgery, the stomach is cut lengthwise and approximately 80% of it is removed, leaving behind a long, thin tube of stomach.

How many kilos does it take to undergo gastric sleeve surgery?

Generally, those with a body mass index (BMI) of 40 and above, or those with obesity-related diseases and a BMI of over 35, are suitable for surgery. This mostly includes individuals weighing over 100 kilograms.

Is it healthy to have gastric sleeve surgery?

When performed on people who meet medical criteria, gastric sleeve surgery reduces the risk of many diseases by helping to get rid of excess weight. However, since it is a surgical procedure, it must be evaluated by expert teams.

How much weight do I need to weigh for gastric sleeve surgery?

The determining factor for surgery is not weight, but body mass index. If the BMI is over 35 and there are additional diseases, surgery is considered.

Does the stomach shrink in 1 week?

The stomach volume does not physically shrink in the short term with a diet, but the stomach may feel temporarily smaller as eating habits change. Permanent reduction is only possible with surgery.

What should I do to shrink my stomach?

Portion control, eating slowly, and choosing fiber-rich foods can naturally limit stomach volume. However, if there is a serious weight problem, surgical options should be considered.

How many kilos should be lost to reduce stomach size?

For stomach reduction surgery, a weight of 90-120 kilos is generally required, but the most accurate measurement is made by body mass index. Health problems are also important factors affecting the decision.

When can you eat lahmacun after gastric sleeve surgery?

Fatty and spicy foods such as Lahmacun can generally be consumed 2-3 months after surgery, under the supervision of a doctor. In the early stages, such foods can cause digestive problems.

When can you eat nuts after gastric sleeve surgery?

Nut consumption is usually started gradually after the second month. However, it is necessary to chew well and pay attention to the amount.

How many hours does gastric sleeve surgery take?

The average duration of surgery is between 1 and 2 hours. The healing process is faster when performed with the laparoscopic (closed) technique.