Frequently Asked Questions

Sleeve Gastrectomy (Gastric Sleeve)

What is sleeve gastrectomy (gastric sleeve) surgery?

Sleeve gastrectomy (gastric sleeve) surgery is the surgical method in which weight loss is achieved by removing most of the stomach in obesity patients. The tube takes its name from the stomach because the remaining stomach is tube-shaped.This operation is specifically laparoscopically applied which reduces hospitalization time and recovery time, fewer leakages and reduces the likelihood of surgery hernia have made it very popular.

How much weight is lost after gastric sleeve surgery?

After the surgery, 65-80% weight loss can be achieved within 1 year of surgery in patients who have a health diet and perform regular exercises. However, patients who do not have nutritional habits may experience weight gain by approximately 5% in the future.

On the contrary, these are diseases caused and exacerbated by obesity. These diseases are not a reason not to have the surgery, but rather a reason for surgery.

First of all, the following tests and examinations are applied to each patient before the surgery:

    • Blood biochemistry tests
    • Hemogram
    • Hormone tests
    • Hepatitis tests
    • Ultrasound of the whole abdomen
    • Gastric endoscopy (with anesthesiologist)
    • EKG (Heart radiograph)
    • Chest x-ray
    • Lung respiratory test
    • Exertion test and ECO (Electrocardiography) if needed

After all these tests, necessary investigations and examinations are carried out by anesthesia, internal medicine, cardiology, chest diseases and endocrine specialists. As a result of these examinations, it is required to firstly ascertain whether there is another underlying disease that can cause the patient to gain weight. If there is no such disease, the patient will be examined in terms of anesthesia and looked at whether there is an obstacle to surgery, like any other patient who is to undergo anesthesia. The relevant experts make recommendations about treatments to be performed before surgery if necessary. In this way, the problems that may occur during and after the operation are minimized.

There are many different products on the market. The materials of two leading American companies are the best quality products currently available on the market and used all over the world. However, their costs are much higher than Chinese products used for the same purpose. Moreover, safety is the primary importance in health, not cost. Each product used has a barcode with its own specific serial number. The barcode of each material used is placed in the patient file. Make sure you ask for the material used.

Leakage testing is performed during sleeve gastrectomy (tube stomach) surgery and then on the second day. The purpose of the leakage test during the surgery is to determine whether there is a problem with the staples and if there is a leak in the suturing line. If there is a leak, the leak is prevented by putting additional stitches on the relevant part. Again, before starting liquid foods after surgery, leakage testing is carried out and necessary measures are taken and intervened in a timely manner.

In obesity surgeries, it is controversial to have additional stitches on special materials called staplers. Some surgeons think that suturing reduces the likelihood of bleeding and leakage and that stitches should be put on each patient. Some surgeons say that suturing can cause more leakage and bleeding after vascular injury, although it slightly reduces the risk of bleeding, but does not reduce the risk of leakage. We are between these two as a clinical approach. Although we do not put additional stitches on each patient, if the staple line does not seem safe enough for us, we always apply additional stitches. The fact that our results are much better than global averages suggests that the method we implement is more successful. The most important point here is that the surgeon who performs the surgery should have the ability and experience to intervene and correct any problems.

During each operation if there is a blood clot in the vein, there is a possibility of clogging up any vessels. This can lead to serious problems when there is a vein that feeds vital organs such as the heart, lungs and brain. The higher the weight of the patients, the greater the risk of embolism. For this purpose, these patients are given blood thinners no matter what surgery they have. Although it increases the risk of bleeding somewhat, the benefit is much higher. The use of blood thinners starts before surgery and continues for another two weeks. In patients with high risk, such as patients with cardiovascular disease or who have previously had embolism, their use may last even longer.

The biggest advantage of the surgery is that sleeve gastrectomy surgery (tube stomach) is laparoscopic (closed), i.e. by entering through millimetric holes, so pain after intervention is very small compared to open surgeries. Still, the idea that “a surgery has been performed, of course, will be in pain”, is extremely wrong. No patient should suffer in the twenty-first century. Pain is completely prevented by applying painkillers to each patient after surgery. Here is the important point; everyone’s pain threshold is different. Again, drug tolerance and bioavailability of the drug are different. Therefore, treatment cannot be standard. According to the needs of each patient, the treatment of painkillers should be arranged accordingly.

Since the incisions are very small, the aesthetic results are also extremely good. In a few months, these lines will become almost invisible. Once the wounds are healed, you will be offered a cream to allow for fewer marks. If you use it for three months, you will get much better aesthetic results.

After the second day of surgery, following the leak test, you will begin liquid food. After the first two weeks of liquid nutrition, you will also be fed with soft (mashed style) food for two weeks. Throughout this whole process, you will be in constant communication with our dietitians.

Protein supplementation is performed for patients for the first 15 days. Especially in the first year, various vitamin and mineral supplements are applied to patients. These are not standard for each patient, but after routine check-ups, it is decided depending on the condition of the patient, and depending on how much is needed.

Since the surgery is laparoscopic (closed), you can stand up and walk after an hour or two after the surgery. Even during your stay in the hospital, you will not be a care patient; you will be able to take care of yourself. Patients who work at desks or engage in work that does not require heavy effort can start work back within a week. Patients employed in jobs with heavy lifting should take a break from work for at least a month. After surgery, patients are given a sufficient medical rest report.

Since sutures are often self-absorbed, there is no need to remove stitches. If the suture is not absorbed for a different reason, when you come for a check-up on the tenth day, the stitches are checked and removed if appropriate.

You can take a bath when you leave the hospital. There is no problem of sutured regions remaining open and becoming wet. Dry with a clean towel after the shower, rub the Batticon on them and allow it to dry. Batticon does not leave permanent stains on your laundry. After the tenth day, there is no longer the need to use a Batticon.

For the first month, do not take any medication except what we suggest. When a drug is recommended by another physician, be sure to consult us. After the first month, you can use all kinds of medications. Still, try not to use too much painkillers and take plenty of fluids after taking the drug.

Sleeve gastrectomy (tube stomach) surgery does not work by simply restricting food intake, contrary to what is thought. At the same time, the surgery has very important hormonal and metabolic effects. First of all, less food is taken because the stomach’s volume decreases. However, it is not like a diet. You do not starve, but rather you are full. Even a small amount of food is enough to be saturated. Commonly known as the hunger hormone of the gastrointestinal part of the stomach, the ghrelin hormone is secreted. With the removal of this part of the stomach, appetite is also significantly reduced. There are also different hormonal effects that are secreted from the stomach and affect the intestines and the mechanism still continues to be investigated. Although the exact form of this effect is not known, problems such as diabetes and blood pressure are seen, even before weight loss begins after surgery. Unless it pushes the stomach seriously, there is no significant increase in the volume of pouch in the long term. The first response when the patient receives a small amount of food is that the wall of the stomach is stretched and the nerves warn the brain that the stomach is full. The patient feels saturation as if he had eaten a big meal, but he actually ate a few spoons.

The risk of reweight gain after sleeve gastrectomy (tube stomach) surgery is quite low. In order to achieve maximum benefit from this physiology, the patient should eat only at meals times, taking 2-3 meals per day, and avoid snacks between meals. This surgery requires a change in eating habits acquired over a long period of time. In the late stages after surgery, almost all cases of regaining weight have not increased meal capacity. The reason for gaining weight again are high calorie snacks, especially between meals. There is no known operation to eliminate the side effects of such eating habits.

  • It causes less vitamin and mineral deficiencies (especially vitamin B12, iron, calcium and folate deficiency).
  • It requires less lifelong vitamin-mineral supplementation and follow-up.
  • Intervention options that can be made again in weight gain are extremely wide.
  • When there is a problem, there is a chance to interfere with the bile ducts and pancreatic ducts with an endoscopy. ERCP and biopsy can be done easily.
  • Since there is no closed stomach tissue, there is always a chance to check with endoscopy.
  • Since the fundus part of the stomach secreting ghrelin (the appetite hormone) is removed, appetite decrease is higher.

NON-SURGICAL SLIMMING

Can it be applied in pregnant women and while breastfeeding??

There have been not enough studies on the use of Non-Surgical Slimming in pregnant women and breastfeeding.

Patients are expected to lose 10-15% of their total weight within a period of 3-6 months. The amount of weight loss depends on age, metabolic rate and the frequency of exercise which may vary from person to person.

First of all, you should not expect miracles from any treatment. After the medicine application, nutrition should be paid attention. Following Non-Surgical Slimming, it is especially necessary not to eat fast food style food with high fat and carbohydrate content. Maximum benefit can be provided from medicine application by staying as healthy as possible.

Fast-consumed foods such as fast-food and acidic beverages are harmful to consume. Patients with medicine are hungry later, saturated with fewer portions, and feel full earlier.

There is no guarantee of any available weight-loss method. Non-Surgical Slimming is an application aimed at reducing one’s appetite. If a regular diet program is not followed after the application, the person cannot be expected to lose weight.

Non-Surgical Slimming and gastric balloon applications both aim to prolong the time of fullness, making it easier for the patient to diet and lose weight.A stomach balloon is a slightly different method than Non-Surgical Slimming due to sometimes casing nausea, volume adjustment and need to endoscopy again when the balloon needs to be removed.

There is no specific age limitation in the Non-Surgical Slimming application. However, patients over the age of 18 are preferred.

Patients do not feel soreness or pain because anesthesia is applied during Non-Surgical Slimming. There may only be a slight feeling of discomfort in the throat after the procedure, but this is not permanent.

Gastric Bypass

Do diseases such as diabetes, asthma, blood pressure prevent gastric bypass surgery?

On the contrary, these are diseases caused and exacerbated by obesity. These diseases are not a reason not to have surgery, but are in fact a reason to have surgery.

First of all, the following tests and examinations are applied to each patient before the surgery:

  • Blood Biochemistry tests
  • Hemogram
  • Hormone tests
  • Hepatitis tests
  • Ultrasound of the whole abdomen
  • Gastric endoscopy (with anesthesiologist)
  • EKG (Heart radiography)
  • Chest x-ray
  • Lung respiratory test
  • Exertion test and ECO (Electrocardiography) if needed.

After all these tests, necessary investigations and examinations are carried out by anesthesia, internal medicine, cardiology, chest diseases and endocrine specialists. As a result of these examinations, it is required to firstly ascertain whether there is another underlying disease that can cause the patient to gain weight. If there is no such disease, the patient will be examined in terms of anesthesia and looked at whether there is an obstacle to surgery, like any other patient who is to undergo anesthesia. The relevant experts make recommendations about treatments to be performed before surgery if necessary. In this way, the problems that may occur during and after the operation are minimized.

There are many different products on the market. The materials of two leading American companies are the best quality products currently available on the market and used all over the world. However, their costs are much higher than Chinese products used for the same purpose. Moreover, safety is the primary importance in health, not cost. Each product used has a barcode with its own specific serial number. The barcode of each material used is placed in the patient file. Make sure you ask for the material used.

Leakage testing is performed during gastric bypass surgery and then on the second day following surgery. The purpose of the leakage test during the surgery is to determine whether there is a problem with the staples and if there is a leak in the suturing line. If there is a leak, the leak is prevented by putting additional stitches on the relevant part. Again, before starting liquid foods after surgery, leakage testing is carried out and necessary measures are taken and intervened in a timely manner.

In obesity surgeries, it is controversial to have additional stitches on special materials called staplers. Some surgeons think that suturing reduces the likelihood of bleeding and leakage and that stitches should be put on each patient. Some surgeons say that suturing can cause more leakage and bleeding after vascular injury, although it slightly reduces the risk of bleeding, but does not reduce the risk of leakage. We are between these two as a clinical approach. Although we do not put additional stitches on each patient, if the staple line does not seem safe enough for us, we always apply additional stitches. The fact that our results are much better than global averages suggests that the method we implement is more successful. The most important point here is that the surgeon who performs the surgery should have the ability and experience to intervene and correct any problems.

During each operation if there is a blood clot in the vein, there is a possibility of clogging up any vessels. This can lead to serious problems when there is a vein that feeds vital organs such as the heart, lungs and brain. The higher the weight of the patients, the greater the risk of embolism. For this purpose, these patients are given blood thinners no matter what surgery they have. Although it increases the risk of bleeding somewhat, the benefit is much higher. The use of blood thinners starts before surgery and continues for another two weeks. In patients with high risk, such as patients with cardiovascular disease or who have previously had embolism, their use may last even longer.

The biggest advantage of the surgery is that gastric bypass is laparoscopic (closed), i.e. by entering through millimetric holes, so pain after intervention is very small compared to open surgeries. Still, the idea that “a surgery has been performed, of course, will be in pain”, is extremely wrong. No patient should suffer in the twenty-first century. Pain is completely prevented by applying painkillers to each patient after surgery. Here is the important point; everyone’s pain threshold is different. Again, drug tolerance and bioavailability of the drug are different. Therefore, treatment cannot be standard. According to the needs of each patient, the treatment of painkillers should be arranged accordingly.

Since the incisions are very small, the aesthetic results are also extremely good. In a few months, these lines will become almost invisible. Once the wounds are healed, you will be offered a cream to allow for fewer marks. If you use it for three months, you will get much better aesthetic results.

After the second day of surgery, following the leak test, you will begin liquid food. After the first two weeks of liquid nutrition, you will also be fed with soft (mashed style) food for two weeks. Throughout this whole process, you will be in constant communication with our dietitians.

Protein supplementation is performed for patients for the first 15 days. Especially in the first year, various vitamin and mineral supplements are applied to patients. These are not standard for each patient, but after routine check-ups, it is decided depending on the condition of the patient, and depending on how much is needed.

Since the surgery is laparoscopic (closed), you can stand up and walk after an hour or two after the surgery. Even during your stay in the hospital, you will not be a care patient; you will be able to take care of yourself. Patients who work at desks or engage in work that does not require heavy effort can start work back within a week. Patients employed in jobs with heavy lifting should take a break from work for at least a month. After surgery, patients are given a sufficient medical rest report.

Since sutures are often self-absorbed, there is no need to remove stitches. If the suture is not absorbed for a different reason, when you come for a check-up on the tenth day, the stitches are checked and removed if appropriate.

You can take a bath when you leave the hospital. There is no problem of sutured regions remaining open and becoming wet. Dry with a clean towel after the shower, rub the Batticon on them and allow it to dry. Batticon does not leave permanent stains on your laundry. After the tenth day, there is no longer the need to use a Batticon.

For the first month, do not take any medication except what we suggest. When a drug is recommended by another physician, be sure to consult us. After the first month, you can use all kinds of medications. Still, try not to use too much painkillers and take plenty of fluids after taking the drug.

The risk of re-weight gain after gastric bypass surgery is quite low. In order to achieve maximum benefit from this physiology, the patient should eat only at meals times, taking 2-3 meals per day, and avoid snacks between meals. This surgery requires a change in eating habits acquired over a long period of time. In the late stages after surgery, almost all cases of regaining weight have not increased meal capacity. The reason for gaining weight again are high calorie snacks, especially between meals. There is no known operation to eliminate the side effects of such eating habits.

Longer-term vitamins and mineral deficiencies (especially vitamin B12, iron, calcium and folate deficiency) can be caused. Dietary recommendations require lifetime vitamin-mineral supplementation and follow-up. Intervention options that can be made again in weight gain are more limited. When there is a problem, there is no chance of interfering with the bile ducts and pancreatic ducts with an endoscopy. ERCP, biopsy and similar operations cannot be performed. There is no chance to control the check the stomach tissue with an endoscopy. As the fundus part secreting Ghrelin (the appetite hormone) of the stomach is not removed, there is a lower reduction in appetite compared with tube gastrectomy.

Our clinic attempts to provide services to be as affordable as possible. Detailed information can be obtained from our contact numbers. The prices of obesity surgeries are somewhat higher than other surgeries. However, the few points below are extremely important.

  • The materials used are an important cost item. There are many different products on the market. The materials of two leading American companies are the best quality products currently available on the market and used all over the world. However, their costs are much higher than Chinese products used for the same purpose. Moreover, safety is the primary importance in health, not cost.
  • The operating room and hospital where the operation is performed must have certain equipment and standards. There needs to be sufficient intensive care beds, and full-time physicians in all branches. All equipment from the operating table to the patient’s bed should be suitable for obese patients. Therefore, it is not appropriate to do the procedure in every hospital.

Obesity surgery should be a support team that can only be reached 24/7 within surgery, including dietitians who are experts in this field. Meeting all these requirements increases the cost of the surgery somewhat more than other surgical procedures. Even if you put the quality of life to one side, obesity is the main cost when viewed in the long-term. The money to be spent is multiple times higher for the treatment of health problems such as joint wear, diabetes, asthma, sleep apnea blood pressure caused by obesity.