Before surgery
Examinations:
Blood count, liver and kidney function tests, blood lipids, blood sugar, insulin, cortisol, thyroid hormone levels,
respiratory function tests, an x-ray of the lungs, cardiological examinations (ECG, Echo, Effort), abdominal ultrasonography and gastric endoscopy
Consultation:
Endocrinologist, dietitian, psychologist, gastroenterologist, radiologist, cardiologist (if necessary), pneumologist, and anesthetist.
Smoking:
The patient should quit smoking to minimize the risk of thrombosis after surgery.
Diet Before Surgery:
The patient should follow a low-calorie diet under the supervision of a specialist before surgery, if necessary. This diet contains the needed proteins and minerals. With the diet,
the body fat percentage decreases.
The dimensions of the liver decrease and the surgical intervention becomes easier.
Certain surgery-related risks decrease.
The physical functions and mobility improves.
The patient is prepared to adopt the new diet program after surgery.
Surgery
Regarding surgery:
You should fast for 8 hours before surgery, do not intake any food including water until surgery. Bring all your drugs with you. Do not discontinue your drugs or start to take a new drug without informing your physician and anesthetist.
During the operation
Before surgery, cables will be attached to your body and arms to monitor your heart beat and oxygen level. Drugs will be added to the intravenous solution and you will be requested to breathe through a mask and you will fall asleep. After you have felt asleep, a urinary catheter will be placed before the surgical intervention is started.
Sleeve gastrectomy will be performed with the laparoscopic (closed) technique. During this procedure, 4-5 incisions with a size of 1-2cm each or only one incision will be done. First, the intraabdominal cavity will be filled with a harmless gas.
A rod-shaped camera will be inserted into the abdominal cavity and the images will be transferred to a monitor. The surgeon will carry out the surgical procedure with surgical instruments while watching the operation site on the monitor.
During the sleeve gastrectomy, %80iof the stomach will be removed. First, the broad left margin of the stomach will be detached from the surrounding tissues and organs using an electrical cutting and sealing device (LigaSure).
A calibration tube with a diameter of 12-13mm (39F) will be inserted through the mouth into the stomach and leaned on the right margin of the stomach. The stomach will be divided vertically into two parts, while a tube (diameter 2-3cm) will be created along the right margin of the stomach. The balloon-shaped bigger left part of the stomach will be removed and thus the stomach will be scaled down. The total duration of the surgery will be approximately 1.5 hours, including surgical intervention (30 minutes) and waking up (30 minutes) periods.
After surgery
Do the following
In the hospital
On the day of surgery
After the leak test (blue water) done on the first day, you can drink water in small portions.
Mobility and deep breathing are critical for a rapid and trouble-free recovery.
The anti-embolism stockings and frequent walking are necessary to minimize the development of clots in the legs. Deep breathing and breathing exercises with recommended devices will help to maintain the lung functions.
First day
A blood test will be performed. We recommend drinking a tea glass of water hourly during the time you are awake. You should drink at least 1.5-liter water daily. Continue with walking and breathing exercises.
Second day
A liquid diet will be initiated. The amount and variety of liquid diet can be increased according to the recommendation of the dietitian.
Keep walking and wearing anti-embolism stockings. You can take your pills.
Third day
Blood tests and examinations will be repeated, and the drain will be removed. You can be also discharged.
After the hospital:
Medications:
Painkiller (oral), 1-2 times daily if necessary
Anti-emetic (oral), if necessary
Blood thinner (vial), once daily (for 1 week)
Gastric acid inhibitor (oral), once daily (for 2 weeks)
Vitamin supplement (oral), once daily (for at least 3 months)
Protein powder supplements, in line with the recommendation of the dietitian
You should continue your medication, that you were using before surgery, also after surgery if your surgeon did not recommend otherwise.
Precautions:
After surgery, the treatment of your existing diseases like hypertension and diabetes mellitus will be re-organized.
The most important complication of sleeve gastrectomy is the gastric leak. It emerges mostly within the first week. Although the risk drops in time, you should be cautious for a couple of weeks. The leak can be treated if detected at an early stage. If the diagnosis is delayed, it may have a dangerous course. The most important symptoms of gastric leak are tachycardia, fever, and abdominal pain.
Follow-up:
At home, keep a thermometer and pulsimeter available. If you have fever, tachycardia, abdominal pain, or you feel uneasy, check your fever and heartbeat. At rest
If your fever is over 38 degrees and heartbeat over 100 more than a few hours, consult your physician.
Diet after Surgery:
First two days
Clear liquids without sugar, caffeine, carbonate and particles are allowed.
30-60ml liquid is drunk in one-hour intervals, the targeted daily total intake is 1500-2000ml.
Between 3rd and 14th days
The goal is to consume at least 60g protein daily.
Protein supplements, particle-free soups, vegetable/fruit purees, milk, yogurt, ayran can be consumed in addition to the liquid prescribed for the first two days.
60-90ml liquid should be drunk within 20-30 minutes and a total of 1500-2000ml should be consumed daily.
Between 15th and 28th days
In addition to the previous diet; egg, cheese, well-cooked vegetables, well-cooked meatball/chicken/fish can be eaten.
The liquid volume should be between 120-180ml in each meal and no liquid should be drunk during food intake. Liquids should be taken 30 minutes before or after the meal.
Each bite should be chewed at least 15-20 times and then swallowed. Patients should eat frequently (6-8 meals) but in small portions.
+28th Day
The patient can switch to a protein-rich and balanced diet.
At least 1900ml liquid should be consumed daily.
Diet Follow-up
The abovementioned diet recommendations reflect general principles, you should be in contact with the dietitian for diet and follow-up special for you. After a successful surgery, the diet follow-up programs should not be delayed.
Activity:
Activity: You can have a bath after a week, can moderately walk, and drive.
After two weeks, you can go longer walks, swim and have sexual intercourse.
Avoid the following
Physical exercise (1 month)
Heavy lifting (4 months)
Smoking
Alcohol consumption (6 months). You can drink alcohol in amounts recommended by the dietitian after 6 months.
