Sleeve gastrectomy, is one of the obesity surgeries and is the most common type of obesity surgery performed worldwide. With minimally invasive surgery, that is, with the laparoscopic method, 4-5 small incisions are used to enter the abdomen with special instruments and 70-80% of the stomach is removed.
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Yes, because you are performing a stomach-only operation. You do not perform any operation with the small intestines or other intra-abdominal organs. You do not create a path between the intestine and the stomach, which we call any anastomosis? It is only the operation of cutting and reducing the stomach.

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Gastric bypass is a type of surgery of bariatric surgery or metabolic surgery. It also has several types. They have different names depending on the length of intestine you use and how much of the stomach you cut. The most commonly applied type is the type of surgery we call Roux-En-Y. Here, unlike sleeve gastrectomy, gastric bypass is both a restrictive and absorption-regulating surgery. We cut and reduce the stomach, we reduce its volume, at the same time, you bring the small intestine close to the large intestine and combine it with the stomach. Therefore, by providing less absorption from the things you eat less, we enable you to lose weight in two ways.

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We usually decide together with our patients which method we should apply in obesity surgery or metabolic surgery. Of course, we also have certain medical criteria. In general, sleeve gastrectomy surgery is the appropriate method for the majority of obese patients, but in some cases, we may decide that one of the gastric bypass surgeries is more appropriate. If the patient has a large gastric hernia, a serious reflux, metabolic problems are at the forefront, for example, if there is an uncontrollable type 2 diabetes, if the hypertension is uncontrollable, we can recommend gastric bypass to our patients. Here, the patient’s weight, body mass index, comorbidities help us to make this decision.

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For surgery, we look at the height-to-weight ratio rather than weight. We calculate weight / height square meters. We call this the body mass index. Based on this value, we decide whether the patient is suitable for surgery. Of course, we don’t just make a decision. The World Health Organization and the health system of our own country, the health system in Europe, we all act according to this guideline. So our measure is body mass index. If a 90 kg person of the same weight is 1.55 tall, his body mass index is higher, so he may be suitable for surgery, but a 90 kg 1.70 tall person may not be suitable for surgery.

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According to the World Health Organization, people with a body mass index of 20-25 are considered normal weight. Between 25 and 30 is considered overweight. But when we go over 30, obesity begins. Between 30 and 35 is 1st degree obesity and here we still have time to lose weight by other non-surgical methods, but when we go above 35, especially if an obesity-related metabolic condition has arisen, for example an insulin resistance, hypertension, sleep apnea or hyperlipidemia If an additional discomfort has occurred, the World Health Organization, local health organizations and European health organizations also state that an operation will be more beneficial. Overweight patients with a body mass index of 35-40 are interpreted as 2nd degree obesity. Those with a body mass index over 40 are called morbid obesity. Morbid literally means deadly. In other words, it means being overweight enough to cause diseases that will cause death and trigger death. And in those over 40, the criteria for the onset of an additional disease are not sought. It is accepted by the World Health Organization that surgery would be much more beneficial for these people.

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We all hesitate for a while when it comes to an operation – minor or major surgery – even us. For this, we do some research on whether I should have surgery or not, and we ask ourselves questions. Most of our patients definitely made such a decision when they came here, but they postponed it a little because they were afraid, but this is what 100 percent of those who had the surgery said: I wish I had done this before. As a result, you have an operation, you take a certain risk, but nothing in life gives you anything without taking risks. However, in studies conducted around the world, the following emerged: When we sought an answer to the question “Is it more risky to continue life as morbidly obese or is it more risky to have surgery?”, it was revealed that continuing life as morbidly obese is much more risky.

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Morbid obesity is a disease that triggers many diseases. It is accepted all over the world that this is no longer called overweight but a disease. We know that obesity triggers many diseases such as insulin resistance, type 2 diabetes, hypertension, sleep apnea, high blood fat, hyperlidemia and joint disorders. We also know that obesity is effective in some types of cancer. For example, it is known that obesity is effective in types such as breast cancer and ovarian cancer. Obesity is not just the fat we see from the outside. At the same time, it should be considered as the lubrication of all organs. That’s why we call it a metabolic disease. You have lubrication under the skin, you see it from the outside, you realize it, but in fact, in patients who come to us, we see the damage it causes to the organs in the abdomen rather than that. Even if we are operating, this is our primary reason. If you have an accumulation of fat under the skin, it also causes an accumulation in your heart vessels, it causes fat in your liver, and we need to know that this fat is also present in all other organs. Therefore, if we are making an operation decision, our main goal is to reverse them.

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Surgery performed within the scope of obesity and metabolic surgery largely reverses the metabolic effects of obesity. Most of our patients come to us after they have stopped almost all of the 5-6 drugs they used before the operation after the 3rd month after the operation. Because your sugar is definitely regulated. Sleep apnea is a very serious condition. Many people are forced to sleep with the device. This device may not be needed after the surgery. They either use the drugs used for hypertension at a very low level or stop them completely. Therefore, we see the great benefits of obesity surgeries in terms of many effects.

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In our first meeting with our patient, we talk about his expectations, our expectations, and which method would be appropriate for the surgery. It has to be thought of as a process. This process includes not only the day of surgery or the 2 days spent in the hospital, but also a period of time that the patient will spend at home. If there is no exercise in his life, we are talking about that he should do this exercise now, that we have a certain diet program and that he should follow these rules. People who are ready for this have a much more comfortable process. As in every surgery, tests related to obesity surgery need to be done, but we do a little more detailed examination in our patients who will have obesity and metabolic surgery. For example, if there is a weight gain due to a hormonal problem, we need to determine this beforehand. So we want some hormone tests. We usually do an endoscopy, to see if there is any problem in the stomach that will hinder us, delay the surgery or change the way of surgery. Apart from that, we would like to see if there is any different situation in the abdominal organs, whether there is a situation that needs to be intervened, or if there is a situation that will change the type of surgery or cause the surgery to be postponed. We are usually able to walk the patient after 5-6 hours after the operation. We’re going to get up and running.WE WALK THE PATIENT 5-6 HOURS AFTER THE SURGERYWhat we want most during this operation is to walk as soon as possible. We are trying to prevent the accumulation of blood in the veins, so we definitely  getthe patient up after 5-6 hours. There is no eating or drinking on the first day. We feed it with serum. The next day, after taking a test to check our stitches, we slowly start off with a soup-style watery diet. On the second day, we usually discharge our patient in good health.

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We do the first leak test during the operation. At the end of the operation, we inject a blue dye through a tube that we place in the stomach of the patient. We observe whether this blue dye escapes from the seams. If there is a problem, we intervene immediately. On the 1st postoperative day, we perform the leak test by using this blue dye or by taking a tomography or x-ray by containing a contrast liquid to the patient.

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Most of our patients come from outside the city or abroad. One of our patients, who is discharged from here after 2 days, can easily go to his country by getting on the plane on the same day. This does not cause any problems. Being out of the hospital means that he can go home, fly and travel with peace of mind. For our patients coming from abroad, we make our program accordingly. We determine our surgery appointment beforehand, we make our surgery preparations before our patient arrives. Thus, we can keep the time to be spent in the hospital before the surgery as short as possible.

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During the pre-operative preparation process, our dietitian sees the patient. Preliminary information is given about the issues to be done before and after the operation. As doctors, we always talk about these when meeting with patients. Because you are creating a new stomach. This new stomach has a small volume of approximately 150-180 milliliters. We explain the rules to our patient in this new process. The first month of the recovery process is very important for us. 1 month must be passed without any problems. Our patient, who was discharged on the second day, is recovering, but the stitches in the stomach should not be forced. He needs to take a liquid food for the first 15 days. Our dietitian explains in detail which foods the patient can consume. The second fifteen-day period is the mash period. Food in the form of baby food should be consumed. Then we gradually switch to solid foods, but while taking solid food, it is necessary to eat healthier foods rather than foods with plenty of calories. All of these are written in the booklets we give to our patients after surgery. It is also controlled by our dietitian. Dietitian control should be continued at regular intervals. We talk to our patients over and over again at the 1st month, 3rd month, 6th month and 12th month. In this way, we follow our patient.

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During the pre-operative preparation process, our dietitian sees the patient. Preliminary information is given about the issues to be done before and after the operation. As doctors, we always talk about these when meeting with patients. Because you are creating a new stomach. This new stomach has a small volume of approximately 150-180 milliliters. We explain the rules to our patient in this new process. The first month of the recovery process is very important for us. 1 month must be passed without any problems. Our patient, who was discharged on the second day, is recovering, but the stitches in the stomach should not be forced. He needs to take a liquid food for the first 15 days. Our dietitian explains in detail which foods the patient can consume. The second fifteen-day period is the mash period. Food in the form of baby food should be consumed. Then we gradually switch to solid foods, but while taking solid food, it is necessary to eat healthier foods rather than foods with plenty of calories. All of these are written in the booklets we give to our patients after surgery. It is also controlled by our dietitian. Dietitian control should be continued at regular intervals. We talk to our patients over and over again at the 1st month, 3rd month, 6th month and 12th month. In this way, we follow our patient.

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Weight gain is possible after a certain period of time after both sleeve gastrectomy and bypass surgery. We shrink the stomach and reduce it to a certain volume. But the stomach is an elastic organ and has the ability to expand up to a certain stage. We definitely talk about this situation with our patients before the surgery. With these surgeries, we actually provide the patient with the following: We provide less eating that he cannot do with his own will, and we eliminate the feeling of hunger because we remove a certain part of the stomach. In 3-4 years, the stomach actually stops in such a way that its volume does not expand too much. During this process, the patient cannot eat much, even if he wants to. Therefore, he continues to lose weight. At the end of 4 years, there is a slight enlargement of the stomach. But the real weight gain is not the enlargement of the stomach, but the patient’s return to his old habits. This is the biggest danger here. Therefore, we suggest the following: You have embarked on a path, you are undergoing an operation, this operation may have been something you were afraid of, but you dared to do it and you had the operation. This offers you a great opportunity, you both eat less and you feel full with this surgery. You have to act accordingly for the rest of your life. Because when it comes to obesity, some things have definitely been done wrong in the past. Either you ate too much, or you spent less, or you have a habit of snacking, or you have a habit of consuming high-calorie foods, or you have a habit of eating at night. You must have one or more of them that you have obesity.You had one or more of these habits that’s why you were obes Therefore, after this surgery, we provide a few years to avoid these habits, but it is in the hands of the patients to maintain them.

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In our patients with sleeve gastrectomy and patients with gastric bypass, if there is a weight gain and this does not change with diet or by rearranging their life habits, then revision surgeries are in question. According to the first surgery, there are several types of revision surgery. If the patient had a sleeve gastrectomy in the first operation, revision surgery can be easily performed. Because we did not use the small intestine there before, now we have a chance to use it. However, if the first operation is gastric bypass, it may be a little more difficult to perform revision surgery since we have already used this option. In summary, we have several alternatives for revision. We can either convert sleeve gastrectomy to mini gastric bypass, or we can convert it to gastric bypass. If the stomach is overly enlarged, we can do this in the form of a re-sleeve or a second sleeve.

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As a result, when you have an operation, there is more or less pain. However, these surgeries are what we call minimally invasive surgery, that is, those performed with very small incisions. Therefore, post-operative pain usually does not go away after the first 1-2 hours. In the first 1-2 hours, there is a slight pain, not intense. On the other hand, the pain threshold is a phenomenon that varies from person to person. You do the same surgery on 5 people, you get a different response in all of them. But generally, 90 percent of our patients describe the pain in the first 1-2 hours as “mild”. Again, nausea in the first 1-2 hours after surgery is natural, but it is also mild. Other than these, there are no very disturbing situations. After 4-5 hours, our patients can easily get up and walk

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Although the weight and condition of the patient are also effective, the operation time is usually around 45 minutes. The time between the start and the end of the surgery is 45 minutes, but patients have a preparation period. After entering the operating room, there is a preparation period for anesthesia first. Then, since these operations are performed with laparoscopic instruments and devices, they have a preparation. A certain amount of time is required for the patient to be fixed on the table. After we start and finish the surgery, there is the wake-up phase. After the patient is awakened at the table, if he has any pain or nausea, he is kept there for a certain period of time to relieve them. After that we go to our room.

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We recommend starting work a little later in physically demanding jobs, but if you work at a normal desk job that does not require physical strength, you can start work 2-3 days after the surgery. I have many patients who go to work the day after they are discharged.

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In the upper part of the stomach, there are stomach cells where the grenile hormone is secreted more frequently. In fact, the hormone ghrelin is a hormone secreted in all parts of the stomach, but the point where it is higher is the upper part of the stomach near the esophagus. We completely remove that area. Therefore, this process suppresses the feeling of hunger and creates a feeling of satiety. In fact, I think this is one of the biggest reasons for the success of these surgeries. Because you don’t feel hungry and you lose weight without getting worn out psychologically. In the old surgical methods, for example, in gastric banding method, that is, in clamp surgeries, we were clamping the stomach with the help of a clamp, turning it into an hourglass. However, since the part containing the ghrelin hormone was not removed in these surgeries, you ate less but felt hungry, you vomited when you ate too much, you did not want to eat, but you felt hungry. In new generation surgeries, this does not happen at all. Even the patients who are very fond of food after an adaptation period of 3-4 days, even our patients who say that I can’t stop eating, and that they always eat something at night, say, “I don’t look for food at all, I don’t want to eat whatever is in front of me, I am satisfied with what I eat and I spend the process very comfortably”. Therefore, it is very important to eliminate the ghrelin hormone in these surgeries.

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Actually, there is an age limit. The more acceptable age range is 18-65 years old. The World Health Organization suggests this. But there is another situation. It can be performed under the age of 18 or over the age of 65 if there is a definite indication, both in terms of surgical performance and indication for surgery.

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We know that many metabolic diseases increase with obesity. One of them is polycystic ovary syndrome. Polycystic ovary is one of the biggest causes of infertility in women. There is a hormonal imbalance. Three months after sleeve gastrectomy, all these hormones begin to balance. After 6-7 months of weight loss, these hormones become so regular that women can get pregnant without the need for any IVF treatment or hormone replacement therapy. In summary, these surgeries definitely increase the probability of getting pregnant.

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We have very happy conversations with our patients. Obesity is not only a physical excess weight, but also a condition that will cause psychological distress and depression, but also a metabolic condition. We can see the improvement in our patients from the blood tests, but the real improvement is the psychology of our patient. For example, you are a young and overweight person, you go to a store, you do not get what you want. I understand how important even this is in my conversations with my patients. When I first talk to my patients, a person who is usually a little more shy, has less self-confidence, and has a slightly lower body image, completely renews himself 3 months after the surgery. Instead, there are people who talk a lot, always want to tell, and constantly express their self-confidence, which makes me very happy, of course.

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We use small incisions because we perform the surgery with a minimally invasive method. But no matter how small the incision is, if there is an incision, there will always be a scar. How obvious this scar will be depends entirely on personal wound healing. However, in the vast majority of patients, in 90-95% of patients, this scar is only a slight color change that is not obvious at all.

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In our post-operative follow-ups, we say to our patients: “We want to lose excess fat, we want our muscles to be protected in the same way.” For this reason, we definitely give protein powder supplements to our patients in the early period. After the first month of the operation, we strongly recommend that they protect their muscle mass with exercises. Whether there is sagging or not is related to the pre-operative weight of the person. If you have decided to have this surgery when you are 180 kilos, of course, because the weight you will lose will be too much, there may be a skin sagging. However, if you had this surgery when you were around 100-120 kilos and did the exercises, adjusted your eating habits, took protein foods, there may be only very small unobtrusive sagging. However, we recommend that people who lose a lot of weight and have sagging skin apply to plastic surgery after 2 years.

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