Bariatric surgery makes patients feel fuller faster. It is a treatment for obesity that is intended for patients who are at an advanced level of obesity. They must have a significant weight load to lose. Namely, a BMI over 40 or 35 with comorbidities. The preoperative follow-up for this type of operation is very thorough. Indeed, before being able to claim a bariatric surgery there is a whole process to follow. Appointment with the surgeon, a nutritionist and a psychologist. For several months, they assess whether or not a patient is fit for surgery.
There are four main operations in bariatric surgery:
- Gastric Sleeve
- Gastric Bypass
- Gastric Botox
- Gastric Balloon
Depending on the chosen operation, hospitalization varies between 1 and 7 days (gastric band placement is performed on an outpatient basis in more and more centers). The results obtained in the early stages and in the long term are very important. Ultimately, the loss of overweight, depending on the operation and the patient, varies between 40% and 80% of overweight. This weight loss helps reduce or eliminate the comorbidities associated with obesity.
Bariatric surgery: who is it for?
Bariatric surgery is a treatment for obesity that requires long and consistent follow-up. Whether before or after surgery. To qualify for this type of treatment, you must have a BMI between 35 and 40. This corresponds to moderate (or severe) and morbid obesity. This implies that the complication has at least one comorbidity that can be treated with surgery. Added to this are diet failures in an attempt to lose weight.
Adverse effects, depending on the operation chosen, may appear. They largely correspond to vomiting and nutritional deficiencies.
Gastric sleeve is a surgical procedure that induces weight loss by restricting food intake. With this procedure, which is usually performed laparoscopically, the surgeon removes approximately 75 percent of the stomach. This results in the stomach taking on the shape of a tube or "sleeve" which holds much less food.
Sleeve gastrectomy is considered one of the safest plastic surgery procedures. Its duration does not exceed a minute only. But it needs criteria for its success:
- High-Quality Hospital
- A skilled surgeon
- Full commitment to the instructions after the operation in the first year in particular
- And your life will change forever...
Sleeve gastrectomy is a surgical weight-loss procedure in which the stomach is reduced to about 15% of its original size, by surgical removal of a large portion of the stomach along the greater curvature. The result is a sleeve or tube-like structure. The procedure permanently reduces the size of the stomach, although there could be some dilatation of the stomach later on in life. The procedure is generally performed laparoscopically and is irreversible.
Sleeve gastrectomy was originally performed as a modification to another bariatric procedure, the duodenal switch, and then later as the first part of a two-stage gastric bypass operation on extremely obese patients for whom the risk of performing gastric bypass surgery was deemed too large. The initial weight loss in these patients was so successful it began to be investigated as a stand-alone procedure.
Sleeve gastrectomy is the most commonly performed bariatric surgery worldwide. In many cases, sleeve gastrectomy is as effective as gastric bypass surgery, including improvements in glucose homeostasis before substantial weight loss has occurred. This weight-loss independent benefit is related to the decrease in gastric volume, changes in gut peptides, and expression of genes involved in glucose absorption.
The procedure involves a longitudinal resection of the stomach starting from the antrum at the point 5–6 cm from the pylorus and finishing at the fundus close to the cardia. The remaining gastric sleeve is calibrated with a bougie. Most surgeons prefer to use a bougie between 36 and 40 Fr with the procedure and the ideal approximate remaining size of the stomach after the procedure is about 150 mL.
Use in children and adolescents is endorsed by the International Federation for the Surgery of Obesity and Metabolic Disorders and the American Society for Metabolic and Bariatric Surgery
FAQ on Gastric Sleeve
Is the gastric sleeve safe?
Gastric sleeve surgery is considered a relatively safe procedure. However, like all major surgeries, there can be risks and complications. Some complications can occur after almost any surgery
How long does gastric sleeve last?
Generally, sleeve gastrectomy may last about 6 years after the initial operation. At least 60% of excessıve BMI should have gone with a considerable improvement or even remission of comorbidities.
Can you ever eat normally after a gastric sleeve?
After six weeks you should be able to resume a normal solid food diet. Your gastric sleeve will allow you to eat almost any type or texture of food. You should aim for three well-balanced meals each day
Can you eat pizza after gastric sleeve surgery?
Pizza and pasta are normally favorites, but after bariatric surgery, they should be consumed in moderation. If you are having pizza, order a thin crust and add veggies and lean meats, such as chicken or Canadian bacon. Overall, you should choose a menu item that is centered on protein, like grilled chicken or seafood.
Eight foods to avoid after bariatric surgery
- Food with Empty Calories
- Dry Foods
- Bread, Rice, and Pasta
- Fibrous Fruits and Vegetables
- High-Fat Food
- Sugary and Highly Caffeinated Drinks
- Tough Meats
Recovery period and advice after the operation
The patient needs to stay 22 hours after the operation in the medical center to be completed to recover.
And the doctors reassure the success of the operation and the functioning of the digestive system and if no complications occur, after that the patient returns home. A strong antibiotic should be taken for a week or two to prevent any infection as well.
Use the anti-inflammatory that the doctor prescribes for you.
The patient has to rest for two days and then can walk slowly, but must not do any hard labor for at least a month after the operation.
Regarding food, the doctor will tell you about your eating plan: You should take fluids after the operation, clear and light juices, for 13 days.
You should eat slowly and drink juice to relieve pressure on the stomach until your wound has healed.The recovery period may take a whole month for you to return to your life and carry out your activities.
You must drink water during this period in large quantities to avoid stress.
Your doctor may prescribe some vitamins and supplements that you may need to take for a while.
Gastric bypass is a very sophisticated operation that aims to completely remove the stomach from the elements of the digestive system due to the increase in fat mass above the normal number recommended in the body mass index.
The operation decision is final and not reversible
The main criterions
- Patient decision
- Doctor opinion / Doctor’s advise
The esophagus will be connected directly to the small intestine without any barrier
Instructions after the operation are lifetime instructions.
Eligible all persons over the age of puberty, provided the conditions are met
Other stomach operations are reversible, but here the issue is not at all reverse, and the patient must adapt to the new situation for life, especially with a precise medicinal diet.
Gastric bypass surgery refers to a technique in which the stomach is divided into a small upper pouch and a much larger lower "remnant" pouch and then the small intestine is rearranged to connect to both.
It is like sleeve gastrectomy to solve obesity and diabetes
But the body mass index must be irreversible with diets of all kinds or even sports
Accommodation: 2 nights in hospital
Recovery period and advice after the operation
- The patient needs to stay at least 24 hours after the operation in the medical center until the recovery is complete, and the doctors are assured of the success of the operation, the progress of the digestive system movement, and the absence of complications, after which the patient returns home.
- You should take a strong antibiotic for a week or two to prevent any infection, as well as the anti-inflammatory that the doctor prescribes for you.
- The patient has to rest for two days, and then you can walk slowly, but you should not do any strenuous work for at least a month after the operation.
- Concerning food, the doctor will tell you about your diet plan, as after the operation, you will take clear and light liquids and juices, for 10 days. Then, full fluids and food squeezed in a blender are consumed, then light meals gradually until regular foods are eaten. While consuming food or juice, you must eat slowly to reduce pressure on the stomach till your wound is healed.
The recovery period may take a full month for you to return to your life and practice your normal activities, but you have to drink water during this period in large quantities to avoid stress and dehydration. Also, the doctor may prescribe some vitamins and nutritional supplements that you may need to take for a while.
After your gastric bypass surgery, your doctor is likely to recommend that you:
Eat and drink slowly.
Keep meals small.
Drink liquids between meals.
Chew food thoroughly.
Focus on high-protein foods.
Avoid foods that are high in fat and sugar.
Take recommended vitamin and mineral supplements.
How long do you have to take off work after gastric bypass?
Most patients return to work in less than two weeks. Gastric bypass recovery time: A one- to three-day hospital stay, followed by four to six weeks for a full recovery. Most patients will need one to three weeks off work.
After surgery, it's important to get adequate nourishment while keeping your weight-loss goals on track. Your doctor is likely to recommend that you: Eat and drink slowly. To avoid dumping syndrome, take at least 30 minutes to eat your meals and 30 to 60 minutes to drink 1 cup of liquid.
Applying Botulinum toxin (Botox) to the stomach is a relatively new method of weight loss based on endoscopically injecting Botulinum toxin into certain areas of the stomach.
Gastric Botox injections are used for weight loss. Endoscopic outpatient procedure speeds up weight loss by using gastric injection to temporarily relax the muscles of the stomach, which will cause the muscles to contract less.
How long does Botox last for gastroparesis?
Based on the available studies the beneficial effects of Botox lasted between 3-8 mo. Therefore, patients may require additional BT-A injections.
Can Botox cause stomach problems?
Side effects of Botox injections can include pain at the injection site, flu-like symptoms, headache, and upset stomach.
The feeling of hunger decreases within 2-3 days after applying stomach Botox. Loss of weight begins to appear after 2 weeks. The targeted 10-20 kgs are lost.
It is known that the effect of the drug used in gastric botox is eliminated from the body within 4-6 months. Therefore, it is unlikely to cause any permanent damage.
Diet after stomach Botox
Nutrition should be paid attention after the Botox procedure. After stomach Botox, feeding should not be done by excess fat and carbohydrate contented food such as fast-food style. Maximum benefit can be obtained from the Botox procedure by being adapted to a healthy diet program as much as possible.
Patients are put into sleep with an anesthesiologist during the procedure. Hospitalization is not required. Generally, 1-2 hours of observation is sufficient after the procedure. Decrease in appetite and control in appetite are provided within approximately 3 days after the stomach botox procedure.
At what age should you start getting Gastric Botox?
18 years. Gastric Botox is approved for patients who are 18 years and older and most experts agree that patients in their mid to late 20s and early 30s are at a good age for preventative Botox treatment.
Gastric balloon is the second most common stomach operation after sleeve gastrectomy thanks to its very few side effects and good results without cutting the stomach.
A gastric balloon, also known as an intragastrical balloon (IGB) or a stomach balloon, is an inflatable medical device that is temporarily placed into the stomach to help reduce weight. It is designed to help provide weight loss when diet and exercise have failed and surgery is not wanted or not recommended for the patient.
Currently, there are three FDA-approved balloons in the USA. These approved devices are placed via the esophagus using endoscopy. This can be done in an outpatient setting under sedation. One further balloon, Allurion’s Ellipse, has European CE approval and does not require endoscopy for placement or removal.
It is a non-surgical procedure performed with local anesthesia that is performed to lose weight for those who suffer from excess weight by an amount not exceeding 25 kg. The idea of this process is based on reducing the stomach area, to reduce the amount of food consumed until the feeling of satiety, which works to lose weight. Months
Once in place, the balloon is filled with saline and remains as a free-floating object in the stomach cavity, too big to pass through the pylorus. In addition to saline, the balloon that is made from silicone may contain some radio-opaque material as a radiographic marker and a dye such as methylene blue to alert the patient if the balloon leaks. Studies have suggested that fluid is superior to air for distending gastric balloons. Inflated balloons reduce the operative volume capacity of the stomach. While the typical gastric volume is about 900 ml, an inflated balloon may take up most of the space, about 700 (+/-100) ml.
Safety and side effects
Gastric balloons are generally considered to be safe and effective in the short. Existing clinical data shows an acceptable safety profile. One of the largest intragastrical balloon studies ever performed, which included 1770 patients, demonstrated an excellent safety profile.
There can be procedure-related side effects due to endoscopy and anesthesia on balloons that require medical intervention for placement or removal. On very rare occasions, the endoscopic placement of a balloon has led to death.
Several studies have demonstrated that the data on both the efficacy and safety for the non-endoscopic Allurion Elipse gastric balloon compares favorably with balloons that require endoscopy. It showed an acceptable safety profile with 0.2% of serious adverse events, which is comparable to the Orbera balloon, which requires endoscopy
Post-placement side effects of gastric balloons are common and may include nausea, vomiting, reflux, and stomach cramps.
Other side effects include indigestion, bloating, flatulence and diarrhea.
Rare side effects include esophagitis, gastric ulcer formation, or gastric perforation. The device can become deflated and slip into the lower intestines. The migration of a balloon can lead to bowel obstruction.
What is a gastric balloon made of?
Gastric Balloon is a balloon made of soft, smooth silicone rubber. The empty balloon is passed through your mouth, down your esophagus, and into your stomach. Once in place, it is filled with saline. It then becomes about the size of a grapefruit.
How does a gastric balloon work?
It causes weight reduction by making you feel fuller more quickly during meals. The gastric balloon is a round, soft, fluid-filled balloon (around 700ml volume) lined with specially developed silicone to prevent your stomach acid from damaging it.
What can I eat with a gastric balloon?
Starting the day after your balloon you can start drinking protein shakes and other calorie-free, non-carbonated beverages such as water, Crystal Light, and sugar-free Kool-Aid. Other “liquid food” can be included such as low-fat, strained soups, non-dairy milk, or skim milk.
Is Gastric Balloon painful?
You may experience some pain that can be caused if your esophagus or stomach is punctured whilst inserting the gastric balloon, although this is very rare. You may also feel pain from the inflation of the balloon, however, most people refer to this as more of a discomfort.
How much weight can you lose with a gastric balloon?
Gastric balloons are an alternative to bariatric surgery for people with lower body mass indexes. Most patients lose between 20 and 50 pounds over six months (about 10 to 20% of total body weight).
How long does a gastric balloon stay in?
After the procedure, you'll probably be able to start eating regular food around three weeks after the insertion of the intragastrical balloon. Intragastrical balloons are left in place for up to 6 months and are then removed using an endoscope
How successful is a gastric balloon?
Gastric weight loss balloon patients typically lose about 10 percent to 15 percent of their total body weight during the first six months. One study found that patients lost about 29 percent of their excess weight when they also received behavioral therapy in addition to the procedure.
What happens if the gastric balloon pops?
The balloon displaces stomach volume which produces a sense of early satiety when eating. Severe adverse complications include gastric perforation (more likely in those with previous upper GI surgeries), gastric obstruction, gastric ulcer, esophagitis, and esophageal perforation.
Tips after the balloon operation
- You should know that adhering to a diet after the stomach balloon process is one of the most important conditions for obtaining the results you want. Simply inserting the balloon into the stomach is not sufficient to lose weight.
- It is necessary to adhere to the specific diet, taking into account drinking water in abundance before and after meals.
1- What kind of anesthesia is used?
Local. sedation and general.
2- What are the most contraindications to surgery?
In general, we do not have any contraindications as long as your doctor does not reject the case.
3- Is it painful?
Not at all since the operation is performed under anesthesia.
4- In the event of rejection, what is the alternative? solution?
We have 5 options depending on your BMI.
5- How long should I stay in Istanbul?
6- How can I predict my results?
You can guess the results depending on your BMI and the type of your operation. Also, you can get a consultation from our experts.
7- Do the operations have a warranty?
They have and we have a follow-up procedure for a year.
8- Who is completely rejected for surgery?
In general, no one is rejected.
9- What are the most important medications that must be stopped before the operation?
10- What are the completely unacceptable diseases?
If you are having chemical dosing therapy, and during pregnancy.
11- What are the instructions before and after surgery?
◾ Do not eat or drink anything after midnight before the morning of your surgery.
◾ Do not wear makeup, lotions, or perfume to surgery.
◾ Do not wear fingernail polish to surgery.
◾ Do not plan to drive yourself.
◾ Do not take any medications without your doctor's advice.
◾ Do not take vitamins or herbal tea.
◾ Stop all blood thinner medications before a week.
◾ Stop drinking green tea or alcohol and coffee before 3 days of operation.
◾ Stop smoking 3 days before the operation.
◾ Stop sexual relationship 2 days before the operation.
◾ Keep on your medications from your doctor except we reject them.
◾ Keep on drinking a lot of water.
◾ Keep on wearing comfortable loose-fitting clothes: We recommend a button-up top and pull-on pants with easy-to-slip-on flats. Do not wear a shirt or other clothing that has to be pulled over your head.
◾ Keep on making sure you have a close friend with you, it is generally better
◾ Take a shower the night before the operation.
◾ Do not do any excess exercises.
◾ Do not swim for 2 months.
◾ Do not do bodybuilding for 2 months.
◾ Do not take a bath for a week.
◾ Do not take a sauna or Turkish bath for 2 months.
◾ Stop drinking alcohol for a week.
◾ Stop smoking for a week.
◾ Stop drinking coffee, herbal tea for a week.
◾ Keep on following our instructions strictly and carefully.
◾ Keep on wearing the corset for 3 weeks to 3 months.
◾ Keep the wound sterilized for two or three weeks.
◾ Keep your necessities close to you and not on the high shelves.
12- Which operations are performed under local anesthesia?
Gastric Balloon and Gastric Botox.
13- How much do I lose weight later week by week?
It depends on your operation.
14- Are there any solutions for sagging skin?
You can have a tummy tuck or other operations.
15- Should I apply for another operation for sagging and lifting?
Sometimes yes. Especially after gastric sleeve and bypass.
16- Is a diet after operation enough for lifting my body?
Sometimes yes, especially for Gastric Balloon and Botox.
17- How can I know if I am a candidate for operation or not?
By your BMI and by asking our consultant.
18- Is age important for the operation?
Yes, but we can start from age of 16.
19- Is there any pain in the stomach especially after the operation?
No. Only like mild heartburn that gradually subsides with medication and diet.
20- What are the symptoms after operation in general?
Mild heartburn that gradually subsides with medication and diet.
21- May I eat everything later?
Yes, but not immediately maybe after weeks.
22- Do you provide me with a diet after the operation?
Yes, we do, for a whole year.