Gastric Sleeve / Stomach Reduction / Longitudinal Gastrectomy / Vertical Gastrectomy
The gastric sleeve (stomach reduction) is a new procedure that induces weight loss by limiting the consumption of food. Through this procedure, the surgeon removes about 75% of the stomach so that the new stomach is in the form of a tube or sleeve. The remaining stomach will have a volume of approximately 100-150 ml.
Gastric sleeves candidates are those with a body mass index (BMI)> 40 or BMI> 35 that have other obesity-related disorder such as: type II diabetes mellitus, hypertension, sleep apnea, severe arthritis, asthma, hypercholesterolemia and cardiovascular diseases.
Studies have shown that the production of glargine, a hormone regulating hunger, is diminished significantly after gastric sleeves. This is due to the removal of a stomach segment that is responsible for producing this hormone. Higher weight loss after the gastric sleeve, as compared to the effects of a stomach ring, is due precisely to the lack of hunger.
The Gastric Sleeve (stomach reduction) surgery is performed laparoscopically and is proven to be safer and with comparable results to the gastric bypass procedure. Because there is no malabsorption component in this surgery, the requirement of vitamin and protein supplements after the surgery is diminished as compared with gastric bypass surgery. Moreover, the possibility of intestinal occlusion and dumping syndrome is near zero. Unlike in the case of the gastric band, there is no implantable component in the gastric sleeve, eliminating the need for adjustment or the risk of complications caused by a foreign body. Unlike the gastric ring intervention, the gastric sleeve isn’t, however, a reversible operation.
Consultation at the surgeon at the Provita Medical Center on Monday and Wednesday - between 17:00 and 20:00.
For appointments call: 0799 112 578.
If after this consultation with the doctor, you decide to go ahead with the surgery, you will be given a diet that should be kept for 14-21 days before surgery. This is a high protein diet designed to prepare the liver for surgery, eliminating fat and decreasing its size. The actual preparation consists in specific medical tests and investigations. They last for 1-2 days and take place within 2-10 days prior to surgery, depending on the location and schedule of the medical team. On the day of the tests, the anesthetist is also consulted. If after this stage the results of the investigations do not contraindicate surgery and the anesthesiologist concludes that the patient is ready, surgery follows.
The high protein diet is discontinued on the day before the surgery. On this day it is recommended that you consume only LIQUIDS. Also on this day, between 18:00 -20:00, you will be given an anticoagulant injection, as indicated by the anesthetist. This can be done at home or at the hospital. It is a subcutaneous injection that can be administered in the shoulder or in the abdomen, and the anticoagulant will be provided by the hospital.
In the morning of surgery, you mustn’t eat or drink. If the surgery takes place in the afternoon, you will benefit from hydrating infusions. It is very important for the stomach to be absolutely empty at the time of surgery.
The gastric sleeve intervention, as all surgeries, can lead to complications that may occur both during and after the procedure itself. The first 24 to 48 hours are critical in terms of non-specific complications, while the following 30 days for the most feared complication, the gastric fistula. The first ten days are the most critical, with the risk of complications falling substantially after this initial period.
The most common complications of gastric sleeves and their associated symptoms include:
If a patient begins to bleed, it will usually take place in the first 24 to 36 hours.
Gastric fistula after gastric sleeve surgery
A serious infection can result if a hole appears in the stiching of the stomach. The gastric juice, which is very acidic, can reach the abdominal cavity causing peritonitis. This can lead to a condition known as Sepsis (a complication that spreads the infection throughout the body). If the measures aren’t taken on time, the general condition deteriorates and death may occur. Therefore, the physician will monitor the patient post-surgery for various signs that may suggest the occurrence of gastric fistula.
Signs that may suggest the appearance of a stomach fistula after the gastric sleeve surgery:
The gastric fistula is a rare, but very serious complication if not discovered in time. Currently there no medical test can fully confirm the appearance of this complication. Therefore, it is necessary for the patient and the surgeon to pay attention to any symptoms occurring within the first 30 days after surgery.
The surgeon will evaluate all of the patient's symptoms and decide, based on experience, the need for a new operation to confirm and treat the gastric fistula. The rate of occurrence of these complications is 1-3% depending on the literature cited.
If you do not feel well or have any of the above symptoms, do not hesitate to contact your surgeon.
Appear in less than 1% of the gastric sleeve operations. Blood clots can block the flow of blood (even leading to death), thus posing a high risk risk for obese patients undergoing any type of surgical procedure. This is why administering anticoagulant injections and installing special sockets are common practice in gastric sleeve surgeries. The most important measure to avoid this complication is early mobilization post-surgery. Even on short walking distances, early postoperative mobilization proves to be useful after surgery. Walking should take place as soon as possible after surgery, as soon as two hours, but this is the case for each patient.
Kidney and liver:
Liquid diet. While still in hospital and after the medical team allows you to, you will have to drink cold, unsweetened liquids. Useful information:
Gases are a common post-operative occurrence, so try not to make things worse by following the advice above. If you have diarrhea or if you vomit, replenish your electrolytes (sodium, potassium, chlorine) by drinking Gatorade to rehydrate and rebalance.
Mashed foods (puree). Your diet will consist in no-fat, sugar-free food:
You will follow the below diet, until your doctor decides otherwise, i.e. for about 2 weeks:
Solid foods - If you tolerate the above diet, after 2 weeks you can gradually introduce solid foods in your diet, such as weak protein, fruit / vegetables and whole grains, and limits fats and sugar.
This diet needs to be customized. It’s normal to develop temporary intolerance to certain foods. Try to reintroduce these foods into your diet, slowly, at a later time and don’t forget: eat slowly, chew well and don’t eat excessively! You will eventually end up tolerating various foods in each food group.
In order to success with your weight loss, it’s important to adjust your lifestyle and behavior:
1. Eat three meals a day and limit unnecessary in-between snacks
This surgery is a restrictive procedure, which means that your weight loss depends very much on what you eat. Snacks in-between meals (pretzels, peanuts, cakes, biscuits, etc.) or frequent eating can slow weight loss or even cause weight gain due to the calory excess.
2. Eat slowly and chew food until it becomes pasty
Not chewing food properly can lead to stomach aches, nausea, vomiting, etc. It’s important to chew your food wel, until it becomes pasty
Avoid sugar. Read the product label carefully.
Ingredients are listed in order of quantities, so try to buy products which don’t have sugar listed as one of their first 3 ingredients. Try to eat less than 15 grams of sugar at a meal, to limit "empty calories" (with no nutritional benefit).
Simple sugars can be found on labels as: sugar, dextrose, corn syrup, sucrose, glucose, molasses and honey.
You can use artificial sweeteners such as:
4. Cut on high-fat foods
Low fat content means that the food contains less than 7% fat. Examples of high fat foods: chips, fried foods, fast food, bacon, sausage, hot dog, cold cuts, cheese, butter, whole milk, donuts, cakes, biscuits and other pastries.
5. Stop eating when you feel full
Overeating can cause nausea, vomiting, and affect the stomach size (it can stretch it). The stomach size stabilizes in approximately 6-9-12 months after surgery.
6. Drink adequate fluids to prevent dehydration
Your objective is at least 6-8 glasses of liquid per day. Drink slowly, with small sips. Avoid carbonated drinks, beverages containing sugar and alcoholic drinks. Carbonated drinks can increase stomach due to the build-up of additional air in the stomach. It’s recommended not to drink alcohol (at least during the first year) or limit the amount, as it’s absorbed rapidly and you will light headed very easy. In addition, alcoholic beverages are excluded from most diets due to their high sugar content.
Choose sugar-free beverages: flat water, fruit compote with sweeteners, skim milk, unsweetened coffee (preferably without caffeine), tea with sweeteners, natural juices (without added sugar). Tips:
The main signs of dehydration: dark urine, headaches, dizziness, lethargy, a white layer on the tongue.
7. Don’t drink while eating!
This dilutes the gastric juice and hinders digestion. Drink 30 minutes before eating. Wait 30-45 minutes after your meal to drink (meat is harder to digest).
8. Choose wisely what you eat
Firstly, every meal should include proteins. Then your daily nutrition should include vegetables and fruits, then whole grains.
Your goal is to exercise at least 30 minutes each day. This helps you lose weight and maintain it on the long-term. You can start with 5 minutes and increase the time as you gain strength.
During the first four weeks, walking should be your main exercise. After four weeks try to introduce more complex exercises (weight lifting, moderate aerobics, dancing, jogging, etc.). Always discuss this with your doctor beforehand, if you heven’t exercised before. An effective physical exercise is where you sweat abundantly. Choose the type of physical exercise you enjoy, so you won’t be tempted to quit.
You need to eat at least 60-80 grams of protein per day, as food and / or supplements. Proteins are the most common substance in the human body after water. Unlike other substances, proteins can’t be stored in the body, therefore daily intake is essential. Among other things, proteins accelerate wound healing, increase metabolism to burn fats, and protect the muscles (thus helping you lose weight only from the adipose tissue).