Gastric Sleeve Surgery - The Benefits and Harm
(Update: ) - Digestive System Diseases
Increasing seriously in our country lately sleeve gastrectomy I will mention some information about (sleeve gastrectomy) that is not known by the public. I wish to get well soon to the patients who have undergone surgery and not yet, and hope to receive useful information on this subject. Op.Dr.Ertan BEYATLI
What is all Stomach surgery?
It is a weight loss surgery. In latin Sleeve Gastrectomy, tube gastrectomy known as. It is popularly known as stomach shrinking surgery. During this surgery, approximately 75% of the stomach is removed and the reduction procedure is performed.
When sleeve gastrectomy is performed for the first time It was not made for weight loss. Actually tube stomach The word was later added to the name of this surgery. The real name of the surgery sub-total or near-total gastrectomyso your stomach 50-80% means that part of it is cut out.
The history of this surgery is very old. The surgery was initially applied in patients with gastric cancer, gastric ulcer and gastric bypass. During the follow-up of these patients, serious weight loss was observed in the first year. However, in the follow-up period of 2-3 years, very severe electrolyte and mineral deficiency, severe decrease in protein levels, and advanced atrophy of muscle mass It began to be observed, and the bodies of the patients were almost composed of skin and bones.
Since the majority of patients were gastric cancer and elderly patients, deaths occurred due to various causes in the early period (within 5 years). For this reason, the long-term results of the operations could not be determined. Over the years, the number of applications has decreased due to the high mortality rate of these surgeries.
In the late 90's, a group of surgeons in San Francisco started performing this surgery primarily for weight reduction. In these studies, which continued until 2009, the morbidity and mortality rates were lower compared to the previous years. However, severe enlargement and weight gain were observed in the remaining stomach part of 5-70% of the patients who survived after the 90th year.
In the light of these results after 2009, gastric sleeve surgery was no longer performed in many centers abroad. Only super-morbid obese patients were selected as candidates for surgery (BMI-BMI ratio of these patients is more than 50%, for example patients> 250kg). These patients were now nominated as overweight is higher than the risks of surgery.
Gastric sleeve surgeries have become very common in our country in recent years. Especially, the number of these operations performed in the private sector is quite high. While the long-term side effects and complications of this surgery are not yet known even in developed centers abroad, it is thought-provoking that it is applied so frequently in our country.
So why is Gastric Sleeve surgery in demand in our country?
We can summarize this situation with a few headings.
- especially in recent years in our country increase in the number of obese people. There are many reasons for this, especially the increase in consumption of fast food and irregular nutrition.
- in our country promotions and advertisements its widespread and uncontrolled use. Public use of patient photos taken before and after surgery by many centers in an encouraging manner
- obese patients for the future hopes and expectations.
- The large percentage of operations performed in private hospitals.
- Gastric sleeve surgery long-term consequences and its complications are not yet known in detail by humans. (Tube Stomach Damages are not explained clearly before surgery)
How is stomach reduction surgery performed?
Tube Stomach Reduction surgery can be applied as open or closed (laparoscopic). The hormone-releasing part of the stomach that stimulates the feeling of hunger is removed. The procedure is applied to the wide area of the stomach (great curvature). As a result of the procedure, the remaining stomach part is thin and long and cylindrical, so it is compared to a sleeve or tube.
Although this procedure is a permanent surgical intervention, enlargement and growth may be observed in the stomach part over time after the procedure. This is very important because only 50% of the stomach is removed in many surgeries. Therefore, over time, the remaining 50% of the stomach tissue grows and enlarges again.
Advantages of Stomach Reduction Surgery
- relief from the troubles of stomach bypass surgery (for example, protein and vitamin deficiency, bowel obstruction, anemia "anemia", and osteoporosis "osteoporosis")
- removal of the hormone-releasing part of the stomach that stimulates the feeling of hunger
- low risk of indigestion (dumping syndrome) and stomach ulcer after the procedure
- It can be easily applied in cases where bowel bypass surgery is not performed (for example; anemia, Crohn's disease, etc.)
- Recovery (remission) in 2-50% of type 65 diabetics
These advantages are highlighted by many centers. On the other hand, not much information is given about the harms of this surgery.
The damages of the tube stomach
What are the known harms of Gastric Sleeve Surgery?
- Postoperative morbidity (complications) and mortality (death) rates are high. Many factors are effective in this regard. Patients were prepared hastily before surgery, lack of indication, insufficient endocrinological and psychological examinations. In addition, postoperative gastric contents leakage, embolism, atelectasis, etc.
- Long-term severe weight loss and muscle atrophy. Particular attention should be paid to this situation. This situation can be understood better, especially when looking at the patient photos taken before and after the operation. Photographs usually show patient photos for 3, 6, 9 months and rarely 1 year later. Photo after 3 years
you cannot seeis rare. There are 3 options in this regard. 1-the patient is in a skin and bone state 2-the old kilos have been regained, even if not much 3-There is no patient to take a photo.
- Severe loss of electrolytes, minerals and vitamins in patients.
- Damage to the vagus nerve during the procedure; In this case, severe nausea and vomiting occur.
The stomach is many and even the most important organ for the survival of living things and for the maintenance of the metabolism (anabolism and catabolism) balance in the body. The part where the nutrients, toxins and fluids that enter our body are first processed and prepared is the stomach. In sleeve gastrectomy, almost 3/4 of this organ is cut, removed and thrown into the garbage, although it is intact. Thus, in the long term, various diseases, germs and yet unknown complications are invited.
When is Gastric Sleeve Surgery performed?
Super-morbidly obese patients (these patients have a BMI-BMI of more than 50%, eg patients> 250kg). In short, patients who have lost their mobility, have difficulty in breathing, and have advanced heart failure.
Then what should obese patients do?
Other methods should be tried in obese patients. For example, balanced diet, various weight loss diets, sports, gastric band ligation, Stomach Botox, Endoscopic Gastric balloon etc.
- Terrible Side Effects and Harm of Obesity Surgery (Prof. Dr. Yavuz Yörükoğlu)
- Studies on the risks of Mayo Clinic Bariatric Surgery
- Warning to those who will have a tube stomach surgery! (Assoc. Dr. Aziz Sümer)
Stomach Folding Surgery
It is a weight loss surgery. Latin Gastric Plicationstop. In this surgery, approximately 70% of the stomach is folded and stitched on itself and the reduction procedure is applied.
The procedure is applied to the wide part (great curvature). Any part of the stomach is not cut, and the stitches can be removed and the stomach fold can be corrected in the future. After the operation, enlargement may be observed in the remaining stomach area over time. It can be applied as open or closed method.
Advantages of Gastric Folding Surgery
- It is a non-invasive surgery (reversible)
- no need for gastric bypass surgery
- Less postoperative complaints (indigestion, nauseadumping syndrome peptic ulcer)
- In cases where bowel bypass surgery is not suitable (for example, anemia, crohn's disease, etc.)
- 2-50% improvement (remission) in Type 65 Diabetes patients
What is Ghrelin Hormone?
Ghrelin hormone one is the hunger hormone. To us "I'm hungry, let's eat”Is the hormone that makes you say. Ghrelin hormone is produced in the upper part of the stomach and the dome (fundus) by P / D1 and epsilon cells of the pancreatic gland.
Gehrelin levels rise before meals and decrease after meals. Ghreln is considered to be the opposite of leptin hormone, which is released from adipose tissue and creates a feeling of satiety. Ghrelin hormone strongly stimulates the release of growth hormone (Growth Hormone GH) from the anterior pituitary. Ghrelnin receptors are located in the hypothalamus, pituitary and vagal afferent nerve endings and trunks located along the digestive system.
Effects of Ghrelin hormone
GHRELIN hormone plays an important role in nerve development, especially in the hippocampus, adapting to changing environmental conditions and learning. It has also been shown in recent clinical studies that it activates the endothelial form of nitric oxide synthase enzyme.
Studies have found that when obese people lose weight, the amount of ghrelin in the blood increases, and when anorexic people gain weight, the amount of gehrelin in the blood decreases. These results prove that the amounts of gehrelin vary by being affected by nutrition.
This is another of the main reasons behind the fact that those who lose weight have difficulty maintaining the weight they have lost. As you lose weight, the hunger hormone in the blood increases and this comes back to you as an appetite.
It is understood from new studies that GHERLIN provides growth hormone release, increases appetite and has various effects on almost every part of the body and almost every system. Therefore, more and more detailed studies will open new horizons for us to have new information on this subject, which is still up-to-date.