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Patients undergoing Gastric sleeve surgery are generally more conscious compared to other types of surgeries and want to learn about the stages and methods of the operation. In this article, we will provide you with information about how gastric sleeve surgery is performed and its stages. Sleeve gastrectomy is an effective method commonly used in the treatment of obesity.
Sleeve gastrectomy constitutes more than fifty-five percent of obesity surgeries performed worldwide. This surgery has different features compared to other methods such as adjustable gastric band and gastric bypass. Sleeve gastrectomy is a more effective method than gastric band in terms of influencing eating behavior, glycemic control, and significant hormonal changes in bowel functions. Additionally, it is technically a simpler procedure compared to gastric bypass and does not require an anastomosis between the stomach and the intestines. The surgery is considered a straightforward procedure, focusing solely on the stomach. Furthermore, issues like vitamin, mineral, and protein deficiencies do not arise in gastric sleeve surgery when compared to surgeries like gastric bypass.
The Preoperative Process
The preparation stage for stomach reduction surgery begins 12 hours before the surgery with an injectable blood-thinning medication due to the risk of obese individuals being prone to embolic events. This prophylactic application is an important part of gastric sleeve surgery. Starting 12 hours before the gastric sleeve operation, the patient’s oral intake is stopped, and nothing solid or liquid is allowed through the mouth.
On the day of the gastric sleeve operation, all of your examinations should be completed, and approval for the surgery should be given by the anesthesia, internal medicine, endocrinology, and psychiatry departments. Before commencing on sleeve gastrectomy, the inside of the patient’s stomach and the possibility of a hiatal hernia are evaluated through an endoscopy performed by the surgeon. Endoscopy plays a critical role in the preliminary steps of the gastric sleeve operation.
Following the endoscopy, the patient is prepared for the gastric sleeve operation in the operation room. The operation room is prepared by the anesthesia doctor and anesthesia technician to receive the patient. At this stage of the sleeve gastrectomy, the patient is sterilized, covered, and placed on the operating table. The patient’s intravenous access is established, and they are monitored before being put to sleep. These steps are essential for the safe and effective execution of the sleeve gastrectomy.
How Gastric Sleeve Operation Is Performed?
Gastric sleeve operation is the most critical stage of the stomach reduction process and is performed laparoscopically. In this operation, the patient lies in a position with both legs apart while the surgeon performs the surgery between the legs. First, it is necessary to inflate the abdomen. This stage is done by entering the abdomen with a Veres needle and inflating it with carbon dioxide gas.
After the abdomen is inflated, a trocar, one of the surgical instruments used in gastric sleeve surgery, is placed inside the abdomen with the assistance of a camera. This stage is important for the surgery to be safe and effective. While there are different techniques for placing trocars inside the abdomen, our clinic recommends using a camera for entry. This way, the risk of abdominal injury is minimized.
After the initial placement of the trocar, we can assess all organs with the help of the camera. Then, other trocars are safely placed by seeing through the camera from the first trocar. In the stomach reduction process, since the stomach is not a fixed organ, the first step of the surgery is to release the stomach from these attachments. This is done by using an energy device called Ligasure.
Once the stomach is completely freed, we move on to the most crucial stage of the stomach reduction process, which is turning the stomach into a tube. A 32 French-sized bougie is placed into the stomach through anesthesia, and the stomach is cut and removed around this tube. This procedure is carried out using special tools that both cut and staple the stomach, known as staplers. Proper selection and use of this tool prevent complications that may arise in sleeve gastrectomy.
Another crucial point in gastric sleeve operation is the complete removal of the fundus region of the stomach. This region secretes hunger hormones, and if not completely removed, adequate weight loss may not be achieved.
The stomach, now in tube form, is supported with stitches to reduce the risk of bleeding and leakage. Then, a leakage test is performed on the stomach, and the integrity of the new stomach’s stapled and stitched line is measured. After these procedures, the patient is awakened and taken to the service room. All of these processes are critical stages of the stomach reduction and sleeve gastrectomy.
