Obesity Surgical Treatments

Obesity Surgical Treatments

WHAT IS SLEEVE GASTRECTOMY?

The sleeve gastrectomy procedure, colloquially referred to as the tube stomach is one of the most commonly used procedures in bariatric surgery. As this procedure is with the lowest complication risk and highest lifelong comfort compared to gastric bands or gastric bypass, most surgeons expert in bariatric surgery have preferred sleeve gastrectomy years ago and mainly perform this procedure worldwide.

During the laparoscopic sleeve gastrectomy procedures, access to intraabdominal cavity is gained through four small incisions and approximately 80% of the stomach is removed. As the section of the stomach which is removed is the gastric fundus where the hormone Ghrelin (the hunger hormone) is released, patients lose their appetite after this procedure. In addition, the significant reduction in the gastric volume mandates smaller meal portions. Thus, a rapid weight loss occurs following the procedure.

WHO IS ELIGIBLE FOR SLEEVE GASTRECTOMY?

People who are eligible for sleeve gastrectomy include those who are aged between 18 and 65 years and have a history of multiple failed attempts of losing weight with diet or exercise and have a body mass index of 40 kg/m² or higher.

People who have a body mass index of 35 to 40 kg/m² are also eligible if they have co-morbidities including diabetes, hypertension or sleep apnea. Non-surgical treatment modalities such as intragastric balloon or gastric botulinum toxin injections should be preferred in patients with a BMI less than 35 kg/m², however a sleeve gastrectomy procedure may be considered in patients with a BMI 30 to 35 kg/m² in the presence of very severe medical conditions.

WHAT ARE THE ADVANTAGES OF SLEEVE GASTRECTOMY?

Patients with obesity are at a significantly increased risk for heart diseases, diabetes and diabetic complications. Moreover, these patients have to cope with a number of comorbidities negatively impacting the quality of life such as hypercholesterolemia, hypertension or sleep apnea. A 90% improvement has been observed in obesity-associated co-morbidities in patients who have rapidly lost weight following sleeve gastrectomy procedures while potential co-morbidities are prevented from occurring.

In addition to physical challenges, there are also psychological challenges associated with obesity. Multiple attempts and multiple failures with diets may result in a sense of defeat, low self-esteem and depression in this population. Self-respect and self-esteem are increased and the sense of defeat disappears and social relationships become stronger in patients who have rapidly lost weight following sleeve gastrectomy.

Laparoscopic nature of the procedure reduces potential postoperative risks while represents a significant factor contributing to a comfortable recovery after surgery.

WHAT ARE THE RISKS OF SLEEVE GASTRECTOMY?

Benefits associated with bariatric surgery significantly outweigh the risks. However potential risks should never be ignored. Potential and life-threatening complications are more likely to occur during the first 15 days after the sleeve gastrectomy procedure and these complications may include staple line leakages, bleeding and embolism.
The first 2 weeks after the sleeve gastrectomy procedure is of paramount importance in terms of the surgery and patient’s mood. Both recovery from a major surgery and abrupt changes in eating routine may have a short–term negative impact on the patient. Please contact your doctor immediately after becoming aware of the first signs of such complications as early detection may decrease treatment duration and may have a positive impact on treatment outcomes.

Staple line leakages are the most serious complications of this procedure. It is of crucial importance to inform the surgeon about any adverse events experienced by the patient. Signs and symptoms of a leakage include elevated body temperature, severe abdominal pain, a high pulse rate, chills and fatigue. A timely and successful intervention of your doctor is the key to the treatment of a potential leakage. The detection and treatment of a leakage is quite easy for an experienced bariatric surgeon.

Any surgical procedure may be associated with a risk for embolism; however, the risk for embolism is higher in bariatric surgery procedures. Measures can be taken to minimize these risks and prevent them from occurring. An injectable blood thinner is started the day before or on the day of surgery and patients wear compression stockings (stockings for varicose veins) to reduce the risk for embolism. Patients have to wear compression stockings and receive blood thinner injections at home for an additional 10 days after their discharge from the hospital.
Bleeding is the most common complication of the procedure. All cases of bleeding occur in-hospital and drain monitoring facilitates the observation of a potential bleeding. The signs and symptoms of bleeding include fatigue, dizziness and low blood pressure. The treatment of bleeding consists of blood transfusions according to the amount of the bleeding and this complication can be easily overcome.

WHAT TO EAT AFTER A GASTRIC BYPASS PROCEDURE

During the first two days after the sleeve gastrectomy procedure, nutritional support is provided by parenteral nutrition. Patients undergo a leak test on the postoperative Day 3 and a 15-day liquid diet is started and this period is followed by a pureed food diet and solid food is added after then. The compliance with dietician’s recommendations is of paramount importance to prevent postoperative complications from occurring.
1.Liquid Diet Period

During the liquid diet period, liquids should be sipped slowly and in a small amount at a time to prevent complications associated with staple line leakages. During this period, liquids to be consumed should be tepid, sugar-free, clear and particle-free. Proteins are crucial to promote rapid healing. Necessary amount of protein is provided by milk, buttermilk, beef broths/chicken broths and protein powders. Doses and the use of protein powders will be determined by your dietician.
2.Pureed Food Period

During the pureed food period, all meals should be prepared using a blender and should be eaten with small morsels. During this period of time, patient’s diet should not include:
• Raw Vegetables
• Nuts and Appetizers
• Tomato paste
• Spices
• Oil
• Lemon juice
• Onion
• Garlic

3. Solid Food Period

Following the initiation of solid food period patients should eat slowly with small bites using a fork and knife. The most important point to be considered regarding food consumption, facilitation of digestion and prevention of gastric enlargement is making the distinction between solid food and liquids. Solid foods and liquids should not be consumed together and the interval between solid food and liquids should be at least 30 minutes during the postoperative period.

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