Gastric Sleeve Surgery

Obesity to a degree that impairs one's health is called morbid obesity. The word morbid here is used in the sense of disease. Although it is not clear which type and degree of obesity impairs our health, a number called body mass index (BMI) has been defined in order to make this subject easy to understand. If this number is over 40 or if it is over 35 in the presence of a disease such as diabetes or high blood pressure, the person is considered to be morbidly obese, that is, overweight at the disease level. Recently, the view that BMI alone is not sufficient to describe unhealthy obesity has become widespread. Although your body mass index is below 40, we can talk about unhealthy obesity, especially in people with abdominal fat, that is, in people whose waist circumference is above normal. In this kind of people, the liver is much more likely to be larger than normal and fatty.

Is it not possible for morbidly obese people to lose weight with diet and sports?

The most effective treatment for obesity we know is diet without dispute. When you add healthy lifestyle and sports to this, the best results are undoubtedly obtained. At the same time, we know very well that the feeling of hunger is one of the strongest impulses in the structure of the living. None of us can accept to leave a meal before we fill our stomach. Imagine doing this for the rest of your life. It is a very heavy price. What can we promise to do in life, even if we don't want to! Think of someone with severe obesity. The body weight this person needs to lose to reach his/her ideal weight may be as much as 60 or even 90 kg. And that is the second problem. The goal you need to achieve is far away. No matter how difficult it is, a more important problem waiting for those of us who have lost that much weight and achieved their goal is to maintain this weight for life. I'm not sure how realistic our demand for a lifetime diet and exercise from someone with a problem of morbid obesity. Morbid obesity is a very difficult situation to eliminate with diet, exercise and psychological help. 

Can anyone have surgery? Who are suitable candidates for this surgery?

In numerical terms, people with a body mass index of 40 or over 35 in the presence of co-morbidities may consider surgery when other methods are not successful in losing weight. Of course, we would like to consult with a psychiatrist or psychologist before deciding on this surgery. Because there are some eating urge disorders that can cause problems even after surgery. I think it may not always give a healthy result to chart out with only numbers while making the decision of surgery for a morbidly obese person. For example, shouldn't someone who has a body mass index of 38, who has been dieting and exercising for a long time, losing weight and regaining it, not have surgery just because their body mass index is not over 40? Or should someone who has diabetes requiring insulin use and a body mass index of 34 not have surgery? It is difficult to answer these questions with the current criterion that we have. The American Society for Metabolic and Bariatric Surgery needed to make an additional statement on its website in recent months, as such people are frequently encountered in practice. In this statement, in terms of the results of a total of 57 studies based at Oxford University, which included 900,000 people, the risk of death increased by 30 percent for every 5 points in people with a BMI over 25. It has been observed that the risk here is related to stroke, heart attack and sugar, regardless of age. As a result, it is thought that life expectancy is shortened by 3 years, even in those with first degree obesity, that is, BMI between 30-35. The American Society for Metabolic and Bariatric Surgery says, “In such a situation, we should not deprive people of these methods, who are below the classical BMI figures, but who can benefit from surgery due to their special conditions and whose life span can be extended.” 

How is sleeve gastrectomy performed?

Under auspices of developing technology, it is performed with laparoscopic, that is, closed method, with special instruments through a few small holes opened in the abdominal wall. One of the most frequently applied techniques today is sleeve gastrectomy. The favorite aspect of this surgery is that the food goes naturally in our digestive system and no foreign body is attached to the body. In addition, since the intestines are not included in the surgery, absorption disorders, which require lifelong medication, are less observed. 

When is the patient discharged after sleeve gastrectomy?

After the surgery, 48-hour hospital accompaniment is considered sufficient. 

When does the patient return to his/her normal life after sleeve gastrectomy?

The patient can return to his/her daily life on the third day, and return to his/her daily life on the seventh day if he/she does not use heavy physical force. 

When does the patient start to lose weight after sleeve gastrectomy?

Patients usually share with us that they have lost 4-5 kilos excitedly when they are discharged. The first month is the period when they lose the weight fastest. They lose about 50-60 percent of their excess weight during this period. The weight loss process continues slowly until 18 months. At the end of 18 months, they lose about 70 percent of their excess weight. Afterwards, if the person supports this process with diet and sports, he/she can even reach his/her ideal weight.

Is 100 percent success achieved after surgery after sleeve gastrectomy?

With the sleeve gastrectomy method, effective weight loss is achieved at rates of up to 90-95% in the first 1-2 years. If a successful psychiatric evaluation is not made, a small number of patients may make up this failing group. Of course, there is the problem of regaining weight over the years. Even if you do not return to your old weight, you can go up to 10 kilos sometimes 20 kilos above the lowest weight you have gone down. 

Why is the sleeve gastrectomy method used most often?

The reason why this method is highly preferred is that it provides less food and satiety, as well as the fact that the food proceeds naturally within the digestive system. Since this does not cause too many problems in the absorption of beneficial vitamins and minerals, the need for lifelong medication use is less.  

Do patients have a hard time after surgery?

Under auspices of developing technology, the surgery is performed with laparoscopic, that is, closed method. This provides them to heal quickly. So that they can stand up and walk 6 hours after the surgery. Contrary to ordinary, they no longer wake up with an unattractive tube in their nose after surgery. The next day they are able to drink drink water and apple juice. On the third day, they can leave the hospital and return to their normal lives. 

Is there a risk of not losing weight or regaining weight after the surgery?

We explain that the type of food preferred by the patients after the surgery is also effective in the success of the surgery. You can fill your reducted stomach capacity with protein and carbohydrates. We rarely encounter problems of not losing enough weight, especially in people who have a carbohydrate-heavy diet and are not compatible with us after surgery. In this case, we can add the second by-pass surgery After this surgery called “duodenal switch”, there is almost no problem such as gaining weight again or not being able to lose weight. 

Suitable for whom?

This surgery is suitable for anyone who has a problem of morbid obesity, that is, who is overweight and who cannot get rid of this problem permanently through diet and sports methods. If we need to set bounds to this, these surgeries should be performed between the ages of 17 and 65. Also, it may not be suitable for those with advanced health problems who cannot receive anesthesia. Finally, it may not be suitable for people with alcohol or drug addiction or psychiatric problems. 

How is surgery decided?

An experienced dietitian and psychologist also participate in the interview with the patient. The most important criterion for me, which I also tell my patients when deciding on surgery, is that they demand this from me. In other words, it is very important how important it is for them to be underweight or how much of a problem being overweight is in their lives. 

What do you check before performing the surgery?

After deciding on surgery, general blood tests of the heart and circulatory system, lungs and some hormone measurements are performed. Some patients are brought into the sleep laboratory to detect sleep apnea syndrome, a very common problem. Those with advanced sleep apnea complaints are prepared for surgery at home with an assisted respiratory support device for one or two months before the surgery. Psychological evaluation is also an application that we do all the time. We make patients who we think cannot evaluate this surgery and the life after it very well or do not fully understand us, meet with our psychologist. Sometimes we may encounter an eating urge disorder. In this case, we recommend that they go on a diet with our psychologist before the surgery. 

Do morbidly obese people diet or exercise after surgery?

Diet is the most effective way to lose weight. We are already performing the surgery so that they can diet. Of course, they can easily make their diets as their stomach gets full easily after the surgery. Since their stomach volumes have decreased, we want them to be fed with higher quality food, that is, protein-based. We recommend walking for the first 2 months, gymnastics such as fitness and pilates from the third month. This both facilitates weight loss and reduces sagging that may occur in the body. Swimming is the type of sport we recommend the most. 

What are the things that the patient should do after the surgery?

The patient should learn the feeling of satiety very well after the surgery and should pay attention to it. Must be very careful about chewing. And should turn to foods richer in protein. In the future, should also determine the foods that keep himself/herself full for a longer time. In the first and third months, the patient should have some blood tests checked to see if there is any vitamin or mineral deficiency. Doing regular sports, especially swimming, will minimize the sagging of the body due to excessive weight loss, while the body will also provide a balanced weight loss. After the surgery, it is necessary to avoid excessive alcohol consumption. 

What improves after the surgery? 

The person who gets rid of most of his excess weight in the first six months after the surgery makes great gains both in social and physical health, condition and general health. Many people who suffer from sleep apnea at night recover from it. Women, who have been afraid to enter the stores because they could not find suitable size clothes for years, happily return to the shopping environment.  Before everything, the patient's mood changes. Fat people usually pretend to be happy. They live in great sadness. They are expelled from society. They are the subjects to social pressure. Your self-confidence comes first. You keep your feet on the ground. Your work life is improving. You come back to life again. Your health is improving; the risk of diabesetes and cancer decrease. You get rid of movement limitations. You can easily go up and down stairs. You can run. You can take a walk with your child. You enjoy being born again. 

What is Body Mass Index?

It is very easy to calculate the body mass index used to define obesity. You will divide your weight by the square of your height. Let's say you weigh 80 kilos and are 1.60 meters tall. the square of 1.60 (1.60X1.60)  is 2.56. It represents a body mass index of 31.25 kilograms/square meter, which comes out when you divide 80 by 2.56. 
Underweight………..18.5 kg/m²
Normal weight……….18.5-24.9 kg/m²
Overweight……………25-29.9 kg/m²
Obese (Mild)……….30-34.9 kg/m²
Obese (Medium)………..35-39.9 kg/m²
Obese (Morbid)………..40 kg/m²

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