Gastric sleeve surgery has become a popular treatment among obese patients seeking weight loss. In this method, with the help of a simple surgery, the ideal conditions for losing weight are achieved, which, of course, has the least possible long-term complications. Gastric sleeve is a surgical procedure that results in weight loss by restricting food intake. In this procedure, which is usually performed laparoscopically, the surgeon removes about 75% of the stomach. Eventually, a sleeve-shaped tubular stomach remains that can hold much less food. This method is more recommended in people with a body mass index above 40 and with pear-shaped obesity.
Extremely obese people (people with a body mass index greater than 45) should be exposed to potential risks of prolonged anesthesia during any surgery, such as gastric bypass surgery, which can take more than 2 hours, as well as duodenal surgery, which often It takes more than 4 hours. So the surgeons came up with another way to divide the surgeries into two stages. In the first stage, they reduce the volume of the stomach, and in the second stage, which will be done after a year, they decide to bypass a part of the intestine according to the amount of weight loss. In cases where the patient has lost enough weight after one year, no further surgery will be needed. Studies have shown that the production of the hormone ghrelin, which is effective in causing the feeling of hunger, significantly in patients with gastric sleeveIs reduced. An area of the stomach that is removed during gastric sleeve surgery is believed to produce a large portion of the hormone ghrelin. Although gastric bypass patients also experience less hunger, this seems to be more pronounced in patients with gastric sleeve.
Benefits of gastric sleeve surgery
Gastric sleeve surgery has benefits including:
Reduce the feeling of hunger and cause anorexia in many patients.
Shorter surgery than gastric bypass.
Preservation of the intestine in the gastrointestinal tract.
No gastrointestinal problems due to the absence of part of the intestine.
Preservation of gastric pylorus.
No need for special settings.
Weight loss over 18 months after surgery.
Failure to lose weight with gastric bypass surgery or gastric sleeve surgery is significantly less than other methods. However, this procedure, like many major gastric bypass surgeries, is irreversible and puts patients at risk for long-term nutrient deficiencies.
Preparation before gastric sleeve surgery
Surgery is likely to be scheduled for early morning. However, this depends in part on the surgeon’s and the hospital’s schedule. From two weeks before gastric sleeve surgery, you should pay attention to your pre-surgery diet. It is important to follow a preoperative diet, as it helps reduce potential risks during surgery by reducing the size of the liver and making it easier to access the stomach. You should fast and avoid eating and drinking the night before the operation. If you eat anything, the surgery will be canceled due to the possibility of vomiting and the return of stomach contents into the lungs and airway obstruction, as this can be fatal or lead to pneumonia. Even chewing gum, drinking water, chewing tobacco, or taking medication that has not been approved by a surgeon may cancel the surgery.
The medical record is completed according to the preoperative control tests and the patient’s consent to accept the risks and possible complications. The patient wears an operating room suit and removes jewelry and belongings. An open vein is taken for emergency drug or serum injections and then transferred to the operating room.
How to do gastric sleeve surgery
After entering the operating room and connecting the pulse and heart rate monitors by putting on an oxygen mask and injecting anesthetic, the person is ready for surgery in a few seconds. This surgery can be performed by making a large incision in the abdomen (open method) or by making several small incisions with the help of small instruments and a camera to guide the surgery (laparoscopic method). In this method, more than half of the stomach is removed and only one vertical tube stomach the size of a banana remains. The stomach and abdomen are then sutured and closed.
Necessary care after gastric sleeve surgery
Typically, in the first 5 hours after gastric sleeve surgery, the person is asked to take a few steps next to the bed to help reduce the risk of blood clots in the legs. The pain of gastric sleeve surgery can be very painful for some and more tolerable for others. Each person experiences a different degree of pain intensity and different analgesics are used for different people.
Some outpatient gastric sleeve procedures (you can be discharged the same day) and many require a 1 or 2 day hospital stay to recover. Some surgeons prefer the patient to spend 3 days in the hospital, while others will easily allow discharge. It is important to follow the surgeon. Finally, the patient is discharged from the hospital with a post-operative instruction manual and a prescription. Notes in the booklet include:
Do not forget to drink plenty of fluids regularly throughout the day to prevent dehydration.
Difficult or painful bowel movements and constipation in the first week after surgery are normal and are aggravated by taking painkillers. However, do not hesitate to seek the help of your surgeon to solve this problem.
Take painkillers only when necessary.
Medications prescribed to reduce stomach acid to relieve heartburn regularly.
Walking and daily exercise help the healing process.
Avoid lifting heavy objects, as they can put pressure on the surgical sutures and cause severe pain.
It is normal to feel extremely tired due to reduced calorie intake up to one month after surgery.
Bathing or sitting in a hot tub is delayed for the first 3 weeks after surgery.
Returning to work is possible within 2 to 4 weeks after the operation, depending on the type of job. Most people regain full strength and ability after 4 to 6 weeks.
Be sure to see your doctor if you notice these symptoms. Warning signs after gastric sleeve surgery include.
Severe fever and chills.
Increasing pain.
Redness, warmth or discharge of pus from the sutures.
Persistent nausea.
Inability to swallow fluids.
Diet after gastric sleeve surgery as the stomach
shrinks, it is important to follow a nutrient-dense diet. In other words, vegetables, sources of lean protein and whole grains should be included in a person’s daily diet. Most doctors recommend that these people get a large portion of the calories they need from lean meat. However, it should be noted that some vegetarians have also had successful gastric sleeve surgery. The recommended diet after gastric sleeve surgery is:
A complete fluid and protein diet begins in the second week after surgery.
Soft and pureed foods from the third week that include soup, scrambled eggs and cheese.
Soft foods are recommended from the fourth week with boiled chicken, fish, cereals and mashed potatoes.
It is time to start introducing real foods, but in small quantities and quantities, with an interval of one day.
Other important points about eating and drinking after surgery include:
It is necessary to chew well and eat slowly.
It is necessary to eat 3 small meals a day.
It is recommended to eat dense foods containing small nutrients as a snack if needed.
Adequate protein intake with vegetables and fruits should not be forgotten.
Vitamins and supplements daily after gastric sleeve surgery
As there is a possibility of vitamin and mineral deficiency after gastric sleeve surgery, it is necessary to prevent this nutritional deficiency by taking prescribed supplements and vitamins. Sometimes it is necessary to take these supplements twice a day. The list of these vitamins and minerals includes:
Iron, the onset of which is determined by your doctor.
Calcium citrate is taken 3 times a day and started 1 month after surgery, which should be chewed or liquid two hours after iron supplementation.
Vitamin B12, which is prescribed by a doctor as a daily or weekly sublingual injection.
Protein supplements are sometimes prescribed by a doctor to provide at least 60 grams of protein daily.
Risks and complications of gastric sleeve surgery
Gastric sleeve surgery is a very simple surgical procedure with few complications. Most complications usually occur in the first few days after surgery. However, before undergoing this surgery, one must understand the risks and possible complications during and after surgery. The risk of death after gastric sleeve surgery is low. The most worrying complication of gastric sleeve surgery is leakage from the suture site, which can occur during or after surgery. It is usually identified during surgery and corrected before the operation is completed. However, the complication of leakage usually occurs during the first month after surgery, which can cause damage to the stomach tissue and lack of proper repair due to eating improper foods. Leakage will lead to major infection and the entry of gastric contents into the abdominal cavity. Symptoms include increased heart rate, fever, chest pain, and abdominal pain.
Gastroesophageal reflux may occur in up to 10% of cases, and its symptoms may persist for only a few months after surgery and are usually less persistent. Taking prescription drugs in the first few months after surgery can be effective.
There is a possibility of creating tension in the stomach and enlarging it, which can be prevented by re-stretching the folds in the stomach, including:
Drink water one hour before and one hour after eating.
Do not consume soft drinks and carbonated beverages.
Eat healthy, small snacks when you feel hungry.
Consumption of nutritious foods in main meals.
Other complications that can occur include internal injuries, bleeding, blood clots in the veins of the legs and lungs or abdomen, infections in the abdomen and chest or ulcers, and allergic reactions to the anesthetic that may occur after any surgery. But precautions in all patients minimize these risks.
It should be noted that overeating will put the stomach on the path to obesity. On average, patients who have had gastric sleeve surgery lose about 60 percent of their excess weight. Many people who have also exercised daily have lost more than 60 percent of their weight. Of course, some people who have returned to their bad eating habits have also lost less than 60% of their weight.
Weight loss will be followed by changes in the emotional state of the body as a result of hormonal changes in the body. Severe weight loss will lead to changes in the production of estrogen and testosterone, resulting in mood swings, especially in the first 2 months after surgery. If you do not tolerate the psychological changes, you can seek help from a psychologist.
To maintain an ideal weight after gastric sleeve surgery, It is necessary to make permanent changes in a person’s lifestyle. A healthy and nutritious diet in the right volume, quitting overeating and exercising daily or at least three times a week for 30 minutes can help balance calorie intake and consumption and weight stability. If you have a habit of eating indiscriminately to drain your psyche when you are upset or angry, you should quit with the help of a psychologist. Patients usually need to be examined and followed up 3 weeks after discharge from the hospital and once every three months in the first year after surgery.