Tube Gastric Surgery

Definition and Purpose

Tube stomach surgery (sleeve gastrectomy) is a surgical method used in the treatment of obesity, which involves the tube narrowing of the stomach by removing a large part of the stomach. As a result of this operation, the volume of the stomach is reduced by about 80%, leaving only a thin gastric tube in the shape of a banana. Thanks to this, the person feels satiety with much less food and begins to lose weight. Shrinking stomach, in addition to satiating with less food, known as hunger hormone Ghrelin due to the removal of the secretory part, it also leads to a pronounced decrease in appetite. The main goal of tube stomach surgery is to get rid of the excess weight of patients, to improve the health problems such as obesity-related diabetes (diabetes), high blood pressure, sleep apnea, joint problems, and improve the quality of life. This surgery is not a slimming aesthetic, but a metabolic treatment method with medical necessity.

How Is It Done?

Tubular stomach surgery is almost always today laparoscopic (closed) method is carried out with. In surgery under general anesthesia, long surgical instruments and a camera are inserted through 4-5 small incisions that open into the abdominal wall. The surgeon sutures approximately 75-80% of the stomach using special stapler (stapler) devices along the large edge of the stomach. The cut stomach section is removed outside the abdomen, leaving behind the stomach in the form of a thin tube. This tube ensures the continuity of the digestive system from the stomach, esophagus to the small intestine, but food intake is severely restricted because its capacity is too small. During surgery, a calibration tube is placed inside the stomach to determine the size of the stomach volume, so that the width of the new stomach is ideally maintained.

The operation is usually 1-2 hours lasts. Because laparoscopically, there are no large incisions in the abdomen, which means less surgery pain and faster healing. At the end of the operation, a tightness check is performed (in most centers, a leak test is performed on the sutured line of the stomach). If everything is in order, the incisions are sutured and closed. After waking up from anesthesia, the patient is taken to his room and is encouraged to get up and walk at an early stage. The length of hospitalization after tubal gastric surgery is usually 2 to 4 days. During this period, the patient is given liquid foods and it is monitored whether his new stomach tolerates these fluids. Before discharge, the patient is given dietary training; it is explained in detail which foods for how long and how to consume.

Who is it suitable for?

Tube gastric surgery is considered for obese patients with a very high body mass index and who cannot succeed with other methods of losing weight. The following are the situations that can be candidates:

• Body Mass Index (BMI) that is too high: People with a BMI of 40 and above (morbid obesity) or those who have a BMI above 35 and have serious health problems such as obesity-related diabetes, hypertension, sleep apnea are suitable candidates for this surgery. (For example, a 1.60 tall person is 102 kg and above, or 1.75 is 122 kg and above mean a BMI of ~40.)
  
  
• People Who Can't Lose Weight With Diet and Exercise: People who, despite repeatedly trying methods such as diet, exercise, drug therapy, cannot lose weight meaningfully and permanently, lose weight and gain it again. The tube stomach can offer a permanent solution to these people.
  
  
• Sufferers of Obesity-Related Diseases: Patients who, due to severe obesity, have problems such as Type 2 diabetes, cardiovascular diseases, fatty liver, excessive load on the knee joints and will progress these diseases if they do not lose weight.
  
  
• Psychologically and Physically Prepared for Surgery: People who have undergone the necessary evaluations (dietitian, psychologist, endocrinologist, etc.) in the preoperative period are convinced that they can adapt to the changes they will experience after surgery. The patient should be willing to radically change his diet and lifestyle after surgery.
  
  
• Obese Individuals Aged 18-65 Years: It is usually administered in adults over 18 years of age and those who do not have serious risk factors in old age. However, in special cases it can also be done to younger (very severely obese adolescents) or older (over 65 years of age, with additional risks considered) patients with a specialist's decision.
  
  

Each patient should be evaluated individually in the decision to undergo tubal gastric surgery and be approved by a team of specialists in obesity surgery. Before surgery, a detailed medical screening (blood tests, endoscopy, cardiology evaluation, etc.) is confirmed by the patient's suitability for surgery.

Possible Risks and Complications

As with any surgery, tubal gastric surgery has some risks, but when performed by experienced surgeons under appropriate conditions, these risks are quite low. The main risks that patients should be informed about are:

• Risk of Leakage (Leak): One of the most important risks of tubal gastric surgery is that leakage occurs at any point in the line where the stomach is cut and sutured with a stapler. This condition requires immediate intervention, as infiltration of gastric contents into the abdomen can cause serious infection (peritonitis). The risk of leakage is a low probability (generally reported around 1-2%), but if it occurs, intensive care and a second surgical intervention may be required. Leakage tests and proper technique applied during surgery are aimed at minimizing this risk.
  
  
• Bleeding: There may be bleeding from the stapler line, through which the stomach is cut, or from the surrounding vessels. Often small leaks stop on their own or are controlled during surgery. Rarely, if bleeding develops after surgery that does not stop, it may be necessary to stop the bleeding again with surgical intervention. The risk of severe bleeding is less than 1% in tubal gastric surgeries.
  
  
• Vascular Obstruction (Clot Thrush): In patients with obesity, there is a risk of developing an intravascular clot due to immobility in the postoperative period. The ejection of this clot into the lung (Pulmonary embolism) is a serious complication. To prevent this, in the period before and after surgery, blood-thinning needles are made, the patient is put on a varicose sock and allowed to walk as soon as possible. Thanks to these measures, the risk of clots is quite low (a probability of several thousand).
  
  
• Infection: There is a possibility of developing infection in the abdominal cavity or in places of incisions. Since the laparoscopic method is used, the risk of infection is low compared to open surgeries. Superficial infections that may occur can be treated with antibiotics. A serious intra-abdominal infection (eg abscess) occurs very rarely.
  
  
• Constriction (Stenosis): In some patients, the newly formed gastric tube may become too hard or narrow as it heals. This creates difficulties in passing solid foods. With endoscopic dilation methods (such as balloon dilatation), this problem can usually be solved; very rarely, it may require re-surgery.
  
  
• Reflux and Heartburn: After tube gastric surgery, some patients may experience complaints of stomach acid escaping into the esophagus (reflux) or existing reflux complaints may increase. Reflux is managed by dietary adjustments, hospitalization and, if necessary, drug therapy. In the case of severe and non-passing reflux, it may be necessary to switch to a different surgical method (for example, gastric bypass), albeit rarely.
  
  
• Nutritional Deficiencies: Because the volume of the stomach becomes smaller, especially in the first months, patients may find it difficult to get enough nutrients. Dietitian follow-up is important so that there are no protein, vitamin and mineral deficiencies. Supplemental vitamin supplements (such as B12, vitamin D, folic acid, etc.) and mineral (such as iron, calcium) should be used when deemed necessary.
  
  
• Other Possible Problems: Due to rapid weight loss, conditions such as temporary hair loss, the formation of stones in the gallbladder, the development of hernias on the abdominal wall (especially with large weight losses, surgical incisions or places of old incisions) can be observed. Many of these risks are problems that can be prevented or treated.
  
  

In general, tubal gastric surgery is a safe method in experienced hands and the incidence of serious complications is low. According to international statistics, the risk of death due to this operation is less than one thousand, that is, even less than the risk of getting into a serious car accident. The patient should be informed about the possible risks of surgery and should not interrupt postoperative follow-up.

Healing Process

The recovery process after tubal gastric surgery involves both the healing of surgical incisions and the adaptation of the body to the new, small stomach. In the first days after surgery, patients are usually initiated into feeding with water and clear liquids. Since the volume of the new stomach is very small, even a few sips of water at the beginning can create a feeling of satiety. During your hospital stay, our team will carefully monitor the amount of fluid you receive and your tolerance. In the first days, nausea or vomiting is minimal, but if it happens, you can be relieved by giving the necessary medications.

Nutrition after discharge proceeds through certain stages:

• First 2 Weeks (Fluid Period): Only liquid foods are taken, such as water, grain-free soup, sugar-free compote juice, herbal tea, milk, protein-supplemented drinks. Meals are arranged in such a way that they are in very small volumes and at frequent intervals. During this period, it is very important to drink sips and consume slowly.
  
  
• 2-4 Weeks (Puree Period): Under the control of the dietitian, it is switched to foods with a liquid-puree consistency. Foods such as soups passed through a blender, yogurt, mashed vegetables and fruits, eggs with a soft consistency can be consumed. Again, the portions are small and should be eaten slowly. The patient should take care of taking foods with a nutritious content, as he will still get full quickly.
  
  
• Weeks 4-8 (Soft Foods Period): Solid foods that can be crushed are added. For example, well-boiled vegetables, meat with a very soft consistency or soft fruits such as chicken (stewed), cheese, bananas can be consumed. When switching to solid foods, each new food should be tried individually and the reaction of the body should be observed.
  
  
• Week 8 and After (Normal Feeding Period): After approval from your doctor and dietitian, switch to normal foods, provided that they are healthy and balanced. During this period, portion control should also be a permanent habit. It is aimed to avoid high-calorie, sugary and fatty foods, to eat a protein-heavy diet. At meals, it is recommended to consume protein-source foods (meat, chicken, fish, legumes, dairy products) first, and then switch to vegetables and fruits. Carbohydrates such as bread, rice, pasta are kept to a minimum.
  
  

Patients are usually the first after surgery 1-2 weeks They will be able to do their daily work, but it may take a few weeks for them to regain their full energy. Heavy exercise should be avoided in the first month, but physical activities such as light walking should be encouraged. Activities such as swimming can also be allowed, as the seam sites will have healed after about a month. 6-8 weeks After that, the patient can gradually begin more intense exercises, such as weight lifting, with the approval of the doctor.

The process of losing weight after tubal gastric surgery is rapid: in the first 3 months a noticeable part of the excess weight is given, by the end of 6 months, patients drop significantly below their initial weight. Usually following surgery 12-18 months in it it is possible to get rid of 50-70% of excess weight. In this process, regular doctor and dietitian checks are carried out; the patient's nutritional status, vitamin-mineral levels and general health picture are monitored. If necessary, supplements are arranged or changes are made to the nutritional plan.

With rapid weight loss, there are various changes in the body: mobility increases, in diseases such as obesity, diabetes, hypertension, often dramatic improvements are observed. Patients get rid of many drugs that they had to use before. However, temporary side effects such as heavy hair loss can occur in the first 6 months, which stops when the body regains its new balance and the hair begins to grow again.

The important thing in the recovery process is that patients strictly adhere to the recommended diet and lifestyle and do not neglect their control. Surgery is a tool; the main success comes with the correct use of this tool. Just as psychological support may be required on the weight loss journey, the support of the patient's relatives is also valuable for motivation.

Tubular Gastric Surgery at Central Hospital Istanbul

Central Hospital Isztambul, Obesity Surgery It has high success rates in tube stomach surgeries with experienced general surgeons specializing in and multidisciplinary treatment approach. Patients contemplating a tubal gastric operation in our hospital first undergo a comprehensive evaluation. In this process, our endocrinology, cardiology, pulmonology and psychiatry specialists examine the patient to rule out situations that may interfere with surgery and determine whether the patient is ready for the surgical procedure. In addition, our dietitians analyze the patient's eating habits and plan a preliminary diet, if necessary, in the preoperative period.

Surgeries are performed in our state-of-the-art operating rooms, fully equipped equipment and experienced surgeons in the field of obesity surgery by closed method is carried out. Our anesthesiology team is well versed in the specific requirements of anesthesia management of obese patients and ensures patient safety throughout the operation. After tubal gastric surgery, we welcome our patients in their comfortable rooms, ensuring their mobilization (walking, moving) from the first day. Our nursing team provides continuous support to the patient in pain control, wound care and nutrition.

At Central Hospital Istanbul, postoperative care is just as important as the surgery itself. Our dietitians equip our patients with a detailed nutrition program upon discharge and inform them about any conditions they may encounter in the time leading up to subsequent check-ups. Our patients are called for check-ups at periodic intervals such as the first week after discharge, the first month, the third month, the sixth month and the first year after discharge, and their general health status are closely monitored. At each control, blood tests are performed and vitamin and mineral levels are evaluated and supplementation is recommended if needed.

In addition, our hospital has a support program for people who have undergone obesity surgery. As part of this program, we help our patients adapt to their new lifestyles by offering patient education seminars, exercise recommendations, and psychological counseling services. As Central Hospital Istanbul, our goal is that every patient who has undergone tubal gastric surgery can lose weight safely, regain their health and make this healthy condition permanent. In this journey, we support our patients every step of the way.