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WHAT IS GASTRIC SLEEVE SURGERY AND HOW IT IS APPLIED ?
Gastric Sleeve operation is technically removal of stomach which enables the duty of depot. Therefore, Normally stomach has 1.5 and 2 lt volume transformed into a tube(seems like a big banana) which can contain 30-150 ml volume. The purpose is to decrease nutrition intake however , treatment can’t be applied on digestion system’s natural absorption decrease. This is the most popular weight loss surgical operation.
%85 of stomach is cut with a stapler and stamped and then removed and remained stomach is tube shaped. Nutrient intake is seriously decreased and it enables early state of saturation. This is the limitation effect of this operation.
However, it is not only a limited tube stomach operation , it is also hormonal and metabolic effective operation. The removed part of stomach is the part which triggers hunger hormone Ghrelin. Removal of this part decreases the level of hormone in blood and generally leads to pressure on hunger.
Laparoscopic sleeve operation resets these mechanisms and an operation way to cope with obesity . However, It is not effective on its own. When supported with healthy nutrition system and exercise , it can enable you to lose %60-80 of your excessive weight within one year. For sure , when rules are not obeyed and continuation of unhealthy nutrition habits , there is risk of put-on on weight again and not losing weight.
Gastric sleeve operation is done with laparoscopic method which means 4 or 5 cut is done on stomach. Operation takes around one hour. For sure , it is about previous operations or anatomy. Generally , hospital stay takes 3 or 5 days , getting back to normal conditions takes 6 or 8 weeks.
WHAT ARE THE MOST FRIGHTENING GASTRIC SLEEVE OPERATION COMPLICATIONS ?
Laparoscopic sleeve operation or which is also known as vertical sleeve gastrectomy is a kind of surgical operation which is applied on patients whose BMI is over 35 who called are morbid patients. This operation means removal of serious amount of stomach and it is not reversible. There are complications after operation and some of them are not known.
What is gastric sleeve leaking ?
According to declaration of New York Bariatric Group , when you have a LSG , surgeon has to stamp stomach to create the stomach after removing %75-80 of it. There can be leakage through stamp line after operation , and if those stamps leave apart or if you body is not recovered in an accurate way and if there is no saturation , the content of stomach and intestine can leak out. It can be resulted in death if the liquid leaks into abdomen and causes infection because it contains bacteria.
A study which has been published by Alexandria Journal of Medicine, the highest leakage percentage he’s been seen on people who have LSG. %70 of patient who has leakage informs that there is leakage on stamp line which is under esophagogastric junction of stomach.
In this surgery, the stomach remaining from the excised tissue is stapled with the help of a stapler. Suturing a hollow organ in this way can cause problems such as stomach and bleeding leakage from the staple line associated with the pressure build-up. Leaks seen at a rate of 1-2% can create life-threatening risks. Sometimes it is a small amount and can be closed by cessation of oral feeding and intravenous nutrition therapy. Sometimes, an abdominal drain may be required in the interventional radiology laboratory. In some cases, endoscopic stent placement may facilitate closure. At worst, the patient may need to be reoperated and the staple line repaired. Non-surgical treatment methods are methods that can take a very long time and require patience.
WHAT ARE THE SYMPTOMS OF GASTRIC SLEEVE LEAKAGE ?
Alexandria Journal of Medicine study has recorded that diagnosis of leakage is difficult after operation and there is increase on morbidity and mortality. On this study leakage diagnosis period is between 3,9 + 2,6 days. Among symptoms there are tachycardia
(high heart rate) , fever , tachypnea (fast breath) , pain on left shoulder , stomachache , chest ache , oliguria (less urination) or hyper tension (lower tension).
IS LEAKAGE OF GASTRIC SLEEVE COMMON ?
On disputatious study of Alexandria Journal of Medicine , they have found that %1,6 patients who had bariatric surgery had leakage. The most important thing which needs to be emphasized is this study covers several bariatric procedures including with LSG , laparoscopic gastric bypass (LGB) and gastric bypass . SpeciJically , When observed LSG applied patients , they have found that %6,3 patient had leakage. Interestingly , in contrast to other bariatric procedures , on LSG applied patients leakage rate were more common. The study claims that LSG procedure applied patients increased leakage incidents can be related to high pressure on epigastric fossa.
A study which is on World Journal of Gastrointestinal Surgery has found that %1,2 of LSG applied patients has leakage. Even if studies demonstrates difference on data , A research which is published on World Journal of Gastrointestinal Surgery mentions that during first laparoscopic sleeve operation , %1-3 of patient’s leakage rate can differ.
What happens if I have revision operation ?
Advanced Surgeons – Westchester Bariatric and Weight Loss Surgery , American Metabolic and Bariatric Surgery Association (ASMBS) specifies that there are three different category classification on revision operations ; transformation , correction and reversal. A transformation operation contains original bariatric procedures’ transformation into a different procedure kind of adjustable stomach band’s transformation into tube stomach. Correction operation changes the original operation in order to make it more effective or correction of a problem. Finally, Reversal procedure transforms stomach in to previous condition.
Canada Surgical Journal mentions that if you have revision operation , unfortunately complication risk is higher. On their studies , patients who had revision operation %41 , patients who had their first bariatric operation %15 had a kind of complication. And again , It is important to focus on this study not just covers patients who had LSG and many gastric bypass patients.
Unfortunately , In addition with the increase of all complication risks ,leakage risk also increases. Trauma Surgery and Acute Care Open journal has published a study which has determined leakages are more common on revision operations. On their study they have observed %18 of patients who had revision operation had leakage. Generally , World Journal of Gastroenterology has found that %10 of patients who had revision surgery had stomach leakage.
Is there any leakage after Gastric Sleeve Surgery ?
Is there any leakage after Gastric Sleeve operation ?
On %1-3 of LSG patients’ leakage has been observed. After having your LSG , it is important to observe yourself with the risk of increased heart beat , fever and/or including with fast breathing. If you have any of these symptoms , you have to communicate with your doctor as fast as possible to have advanced examination.
Especially , if you are having an revision operation which has common leakage rate. If you are concerned about stomach leakage , it is important to discuss with your doctor about your options before having your operation.
Is there any Gastroesophageal Reflux complaint after Gastric Sleeve Surgery?
After Gastric Sleeve operation , there can be %50 of Gastroesophagalgia complaint. Every two person applies into clinic because of reflux complaint.
It is leakage of nutrient into gullet. Acids and stomach secretion can leads to irritation on gullet. This is also known as heartburn , it is characterized as burn on behind the chest wall and sometimes can be so annoying. Reflux which is decreased with medication is generally about the change of stomach shape.
After Gastric Sleeve Surgery, can Gastric Fistula happen ?
It is leakage line on stomach wall which is remained as tube , irregular and empty. This situation may happen after in any kind of gastric system operation or laparoscopy. In addition with trying non-surgically methods , second surgery can be necessary.
After Gastric Sleeve , can stoma tightness happen ?
Laparoscopy can lead into tightness on the way. Stoma is a term which defines the way between stomach and intestines. To correct this condition second surgery may be necessary. Prior to operation a way can be tried to open with a dilator.
After Gastric Sleeve Surgery , may there be vitamin and mineral absorption disorder ?
Long term complication of Gastric Sleeve Surgery his vitamin and mineral absorption disorder. This situation can cause vital deficiencies. Iron deficiency can cause anemia and B12 deficiency can cause neurological illnesses. Phosphate , Calcium and Oxalate absorption disorder can cause kidney stone. Similarly , Vitamin D absorption disorders can cause various bone illnesses.
What are other possible complications after Gastric Sleeve surgery ?
- The most common complications are microbic infections.
- One of the most serious complication is deep vein thrombosis.
- Hair loss.
- Thinning of hair.
- Emotional disorder.
- General exhaustion and weakness.
- Dry skin condition.
- Increase on nutrient intake connected with sleeve dilatation.
In order to preserve from the most serious complication deep vein thrombosis , patients must walk at early stages after Gastric Sleeve Surgery. Possible complications after Gastric Sleeve Surgery requires advanced treatment and care. Afterwards the operation it is essential for patients not to solve problems themselves. The only effective way to prevent complications is obeying the suggestions and treatments of your surgeon.
WHAT NEEDS TO BE DONE AFTER GASTRIC SLEEVE OPERATION
First 4 hours after operation :
Patient should walk at least 20 steps in room or on the corridor with the help of nurse and companion. It is really important to do this to prevent blood clot which may happen in veins on legs. It is the most essential thing to do for the patient. It is allowed to take low- cal liquid after walking. At the first stages it is allowed to take it as a sip. In addition to these, broth and low-cal non carbonated liquids can be suggested.
First Night:
Patients who had Gastric Sleeve Surgery must stay 3 day in hospital and be observed on the first night. Serious bleeding which requires blood transfer can happen within 12 hours. Even if there wasn’t any bleeding finding , some clues about bleeding should be observed such as fast heart rate and low tension. If there wasn’t any finding which may cause bleeding , patient can have blood diluent injection every 24 hours. Within this time , patient regularly continues to take low-cal liquid meals .
First Week at Home
Medication :
All suggested drugs must be taken regularly after coming back from hospital. Tabs must be smashed and capsules must be opened while taking on the first week. Medication must be taken with sip of water. After one week all of the medication can be quitted included with the cholesterol pills , pain killers , relaxant pills and private vitamins. Obligatory medications like Aspirin , Plavix or Kumadin which are blood diluent should be taken after 48 hours. If there is any finding which is connected with bleeding , these drugs must be quitted immediately and patient must call the doctor. Diabetes pills can be reduced into half dose. Patients’ who use insulin blood sugar levels must be checked every 6 hours. If you use diabetes pill , you must go to your doctor to arrange your dosage within 2 or 3 weeks.
Activities:
Patients can walk and take shower on their own. There is no need to any companion. Patient shouldn’t stay in bed for a long time , walking and mild exercises should be encouraged. Weight lifting shouldn’t be allowed.
Medical Dressing:
Patients must remove the upper layer of their medical dressing after 48 hours. This includes gauze patch and plastic cover . Steristrips must stay over scar. Those can be removed after one week. But lower stitches material shouldn’t be touched. Most of the time absorbed stitches are used so there is no need to remove.
Taking Shower:
After removing upper layer medical dressing in 48 hours , shower can be taken with water and soap. It isn’t important to let steri- stripe wet. It is important not to stay in water with stitches within 3 weeks. Similarly, patients shouldn’t go swimming for a few weeks.
Diet:
After gastric sleeve surgery patient must take liquid diet for 7 days. Taking soft or solid nutrient intake may cause opening on stapler line and it can also lead to leakage in this period. Carbonated liquids must be avoided until 1 month after surgery.
Concentrated fruit juice and sugary liquids must be avoided which can cause cramps and diarrhea.
NOT HAVING EXCESSIVE EATING is certainly obligatory after laparoscopy surgery. After surgery at early stage (first 6 weeks) , through the stapler line on stomach whose most part removed , there is risk of stapler line torn and leakage risk. Low-cal diet is suggested to the patients who had sleeve surgery from 1 week to 1 month. Nutrient can be smashed and it must be low-cal , low sugar and low fat.
