Obesity, which has become a major problem today, is extremely dangerous in terms of health, in addition to being an aesthetic concern. Sleeve gastrectomy is recommended as a solution for obesity, which brings many different diseases with it.

Sleeve gastrectomy, recommended to patients who struggle with weight loss, cannot adhere to prescribed diets, or whose weight loss rate is not at the expected level even if they do, is performed very quickly and smoothly with the development of technology and medical techniques.

What is Sleeve Gastrectomy?

Sleeve Gastrectomy is an effective method used for the treatment of obesity. With this procedure, patients' stomachs can be permanently reduced in size, allowing them to consume less food. This also means the prevention of many diseases associated with obesity, such as diabetes and heart disease.

The primary goal of the sleeve gastrectomy operation is to permanently reduce the volume of the stomach, enabling the patient to feel full with less food consumption. In this surgery, approximately 75% to 80% of the stomach’s large, balloon-shaped section (the greater curvature) is removed. The remaining portion of the stomach takes the shape of a banana or a narrow tube (sleeve).

The removed part of the stomach is where a large portion of the Ghrelin hormone, which controls appetite and stimulates the feeling of hunger, is produced. When this section is removed, the Ghrelin level in the body decreases.

Who is Suitable for Sleeve Gastrectomy?

Sleeve gastrectomy may not be suitable for everyone. Therefore, it is not possible to apply it to every obese patient. Primarily, this surgery is performed on individuals who have reached a certain weight range. A multidisciplinary team decides whether the patient can undergo surgery. This team includes an obesity doctor, a dietitian, a psychiatrist, and an internal medicine specialist.

The patients who are suitable for sleeve gastrectomy can be listed as follows:

• The Body Mass Index (BMI) must be $40 \text{ kg/m}^2$ or higher. In patients below this, if there is a co-existing illness, sleeve gastrectomy can be performed with the doctor's decision.

• Generally, individuals between 18 and 65 years old are considered suitable. However, for adolescents (13-17 years old) and patients over 65, the surgical decision is made after a much more detailed evaluation and risk-benefit analysis.

• The patient is expected to have repeatedly attempted and failed non-surgical methods (monitored diet and exercise programs). Therefore, surgery is expected to be the last option.

Pre-Operative Preparation Process

Although sleeve gastrectomy can be performed easily thanks to developing technology and techniques, it is an operation that cannot be decided upon and performed instantly. The patient's body values must be checked before the surgery. The tests requested by the obesity doctor include:

• Blood tests: Complete blood count, liver, kidney functions, thyroid tests, control of vitamin (especially D and B12) and mineral levels.

• Cardiological evaluation: ECG (Electrocardiography) and, if deemed necessary, Echocardiography (ECHO) to check heart health.

• Pulmonary Function Tests: Assessment of lung capacity and respiratory health.

• Endoscopy: To determine if there are conditions such as ulcers, reflux, or hiatal hernia in the stomach that could affect surgical planning.

How is Sleeve Gastrectomy Performed?

In sleeve gastrectomy, as in many surgeries today, the laparoscopic, or minimally invasive, method is used. In this case, the patient enters a rapid recovery process and can quickly return to their social life.

The stages of the surgery are as follows:

• General Anesthesia: It is appropriate for the patient to be asleep throughout the operation so that they feel nothing during the surgery. For this reason, gastric reduction is performed under general anesthesia.

• Entering the Stomach: The obesity doctor makes 4 or 5 incisions of 1 to $1.5 \text{ cm}$ in length on the abdominal area. A tube called a trokar is placed into these incisions like an entry gate.

• Separating the Organs: The surgeon first carefully separates the stomach from the surrounding fat and connective tissues (especially from the Greater Omentum region, where the stomach's largest vessels are located).

• Cutting and Stapling: Guided by a bougie (a calibration tube), the large section on the left side of the stomach is cut longitudinally and simultaneously sealed using automated surgical stapling and cutting devices (linear staplers). This process separates the 75% to 80% large portion of the stomach from the remaining narrow, tube-shaped portion.

Effects and Advantages of Sleeve Gastrectomy on the Body

We can say that sleeve gastrectomy has multifaceted effects. First, its physiological effects should be mentioned. Studies have shown that patients typically lose 60% to 80% of their excess weight within the first 12 to 18 months after surgery. Therefore, the operation is highly successful in this sense.

The Ghrelin hormone (the hunger hormone) constitutes a large part of the removed stomach. This means a reduction in the hunger hormone and a significant drop in appetite.

Many obesity-related diseases such as hypertension, sleep apnea, high cholesterol, and joint problems can also be reduced or resolved with gastric reduction surgery.

Possible Risks and Complications

As with any operation, there are some complications and risks associated with gastric reduction. The risks that may occur in this surgery are divided into early-term and late-term. Early-term risks include issues such as leakage, bleeding, embolism (blood clot), and infection.

Late-term risks include conditions such as stomach stricture (narrowing), nutritional deficiencies, reflux, and hair loss.

First Days Post-Surgery and Hospital Recovery

The patient's discharge after gastric reduction is quick due to the minimally invasive (laparoscopic) operation. The first 48 to 72 hours post-surgery is a critical period where the transition to the new lifestyle and the risk of surgical complications are closely monitored.

The first 24 hours after surgery are very important for follow-up. During this process, pain management and potential complications are closely monitored. No food is given by mouth during the first 24 hours. Fluids and nutrients are given to the patient intravenously.

The patient is given detailed instructions on what to look out for at home, wound care, the medications to use (vitamins, stomach protectors, and blood thinner injections), and the rules of the liquid diet.

Nutrition and Diet Process After Sleeve Gastrectomy

Great care must be taken regarding nutrition and diet after sleeve gastrectomy. In the first days, plenty of fluids should be consumed to ensure body hydration and allow the stomach to rest without straining the staple line. Sugar-free, calorie-free, clear liquids can be preferred during this period.

In the following weeks, pureed foods can be chosen for lighter nourishment. Mashed vegetables, yogurt, soft cheeses, lean ground meat purees, and cooked fish purees can be consumed at this stage.

Drinking fluids while eating or immediately after a meal (usually 30 minutes) increases the risk of stretching the stomach by causing it to fill quickly and resulting in hunger shortly after. Therefore, performing this action may not be correct. To aid body recovery, preserve muscle mass, and prolong the feeling of fullness, high-protein foods should be consumed first at every meal.

Which Doctor Should I See for Sleeve Gastrectomy?

Since sleeve gastrectomy falls under the field of metabolic surgery and these surgeries are performed by a general surgery specialist, you should apply to the General Surgery department for the operation. A general surgeon specialized in the field will perform the necessary tests and evaluations before the surgery to decide whether the patient is suitable for the operation.

Patient Comments on Sleeve Gastrectomy

You can visit Google Maps and DoktorTakvimi to read the reviews of Op. Dr. Serkan Tüğen, founder of Healthylife Clinics and specialist in obesity and metabolic surgery.

Lifestyle Changes and Exercise After Sleeve Gastrectomy

Sleeve gastrectomy offers you a very powerful tool on your weight loss journey. However, utilizing the full potential of this tool and maintaining the lost weight permanently is possible not only by adhering to diet rules but also by adopting an active lifestyle. The post-operative period is a time for dropping old habits and transitioning to a new and healthy routine.

Frequently Asked Questions About Sleeve Gastrectomy

Will I have a scar after Sleeve Gastrectomy?

Since sleeve gastrectomy is performed using the minimally invasive (laparoscopic) surgical method, scars the size of a lentil grain remain after the surgery. However, regular use of the medication prescribed by your doctor can completely eliminate these scars.

How many days after Sleeve Gastrectomy can I have sexual intercourse?

You can return to sexual life 7-10 days after the surgery.

How long does Sleeve Gastrectomy take?

Every patient is unique. Therefore, there is no fixed duration for the surgery. However, it typically takes an average of 70-100 minutes.

How many days after Sleeve Gastrectomy can I return to work?

Recovery begins 7-10 days after the surgery. However, you can fully return to your work and social life after 15 days.

When can I drink coffee after Sleeve Gastrectomy?

Drinking coffee poses no harm 40 days after the surgery. However, during this process, you should definitely consult your specialist dietitian and doctor about your eating and drinking habits.