Initially, the Gastric Sleeve was the restrictive part of the biliopancreatic diversion duodenal switch operation. Then, the gastric sleeve became the first stage operation for very obese patients who underwent duodenal switch operation to reduce the perioperative risks. Some patients lost enough weight after the gastric sleeve surgery and did not undergo the planned second stage duodenal switch operation. These findings prompted bariatric surgeons to consider the gastric sleeve surgery as a standalone bariatric procedure. The first laparoscopic Gastric Sleeve was performed in 2000.

Over the past decade, the number of gastric sleeve surgeries continue to increase nearly every year. Now, more than half of all bariatric surgeries performed worldwide are gastric sleeve procedures.

• On average, people lose about 60-70% of their excess weight
  • The first 2 weeks: 10-20 pounds; most patients lose about one pound a day
  • The first 3 months: 35-45% of excess weight loss
  • The first 6 months: 50-60% of excess weight loss
  • The first year: 60-70% of excess weight loss
• Most people reach their lowest weight 12-24 months after surgery
• The Gastric Sleeve success rate is approximately 90%

Large clinical trials and studies have proven gastric sleeve surgery lead to resolution or improvement of many obesity related health problems such as:

• PCOS
• Binge eating
• Joint pain
• Depression and other psychosocial problems
• Infertility
• Type 2 diabetes: Most studies indicated that 60-80% of patients with type 2 diabetes could achieve disease remission or improvement after gastric sleeve surgery
• Hypertension
• Fatty liver disease
• High cholesterol
• Sleep apnea
• Decreased cancer risk
• Asthma
• Migraine
• Low testosterone
• Urinary incontinence
• Gout

• You are eligible for surgery when you meet the following criteria:
  • BMI greater than 40, or
  • BMI of 35-39.9 with one of the obesity related health problems such as:
    • Hypertension
    • Type 2 diabetes
    • Sleep Apnea
    • Fatty liver disease
    • Hyperlipidemia

• The surgery takes approximately 40-70 minutes
• Discharge from hospital typically occurs after 2-3 nights
• All patients are encouraged to walk as early as 3-4 hours after surgery
• In general, the pain is easily manageable after surgery. Most patients take less than the recommended pain medication
• Most patients go back to work and/or school after 2 weeks. Fatigue is common the first 2 weeks due to low calorie intake from liquid diet. However, the majority of patients do not feel hungry during this stage of the diet. The energy level improves quickly after the introduction of the soft diet, which is approximately 2 weeks after surgery. On occasion, we allow patients to work from home 2-3 days per week after surgery.
• Patients can begin exercising 4 weeks after surgery

• Leakage from the staple line – this is a rate complication of the gastric sleeve surgery. The staple line may slightly open after surgery. Most leaks can be identified within 2 days of post op and treated with endoscopic procedure.
• Stricture/stenosis – another rare complication with narrowing of the stomach after sleeve gastrectomy. Most stricture/stenosis can be treated with endoscopic dilation.
• Bleeding
• Blood Clot
• Heart Burn – The data about the heartburn is inconsistent. In our experience, most patients with heartburn before surgery see improvement of symptoms after surgery due to weight loss. Some patients may develop new heartburn, which is treatable with over-the-counter anti-acid medications, in most cases.
• Nutrient or vitamin deficiency
• Weight Regain – After 1-2 years, slight weight regain is common among all bariatric procedures and about 10-20% of patients can have significant weight regain after gastric sleeve surgery. After 5 years of follow up, global data show that the majority of patients can maintain their weight loss after the gastric sleeve surgery.

A gastric sleeve itself in not a reversible procedure. A majority of the stomach is removed during the gastric sleeve. However, it physically possible that the stomach can stretch back to its normal size.

There are a variety of factors that may contribute to some patients failing or regaining weight following the gastric sleeve surgery, but the truth is that the success of weight loss surgery is mostly dependent on the patient’s ability to follow particular lifestyle and nutrition requirements.

The leading factor contributing to being overweight is the eating behaviors. Weight regain years after gastric sleeve surgery is primarily due to personal changes and poor nutritional decisions, and most patients will tell you that they are well aware of what they are doing that is causing the weight to return.
The roadmap for this case as follows:

1. Pouch reset diet
2. Behavioral change to get back to healthy eating and exercise habits
3. In most cases, a revision surgery is not required unless the steps above are executed properly.

Because of the excessive weight they carry prevents them from becoming pregnant, many women choose to have a gastric sleeve. As you lose excess weight and your body gets to its healthy state, your fertility also restores and you may be more fertile. Obesity frequently results in abnormal estrogen levels, and this volatility or levels can be restored to normal when you lose weight.

The gastric sleeve has the advantage of allowing you to absorb nutrients normally, lowering your risk of vitamin shortage compared to a gastric bypass. When all aspects are considered, your fertility increases and pregnancy becomes much safer for both mother and baby.

Click to contact button and consult your patient coordinator about the cost of gastric sleeve in Turkey and the best suitable procedure for your needs.

For sleeve patients that didn’t find the success they were hoping for, options are available to renew weight loss.

Revisions for a complication like gastric reflux involves converting to a gastric bypass. This is a straightforward operation that results in a lower pressure pouch that improves reflux and makes swallowing easier.

Revisions for weight regain include two types that can be done simultaneously, if both are needed. The first is reducing the size of the sleeve to restore restriction. In some patients, the sleeve gets bigger over time, or was larger than was optimal, so more food is eaten before a sense of fullness is reached.

The most consistent way to restore restriction is to re-sleeve the stomach. We place a tube down the sleeve and staple along the tube the same way as we do during a primary sleeve gastrectomy. This works fairly well to restore restriction, but it will often not lead to as strong of a feeling as the first surgery did. This is partly because nerves become dulled, and restoring anatomy will not fully restore the restrictive feeling.

Another option is to convert to a duodenal switch. The duodenal switch is an operation we perform frequently, and it has the best weight loss of all the surgeries we perform. The duodenal switch begins with a sleeve gastrectomy and then involves a small bowel bypass. Converting an existing sleeve gastrectomy to a duodenal switch simply involves doing the small bowel bypass. This procedure is low risk and can be done as a single anastomosis, meaning with one connection, which minimizes the risk of the operation. This surgery is done laparoscopically, usually using all the same incisions from the sleeve gastrectomy.