The Gastric Sleeve, is performed by the English speaking doctor, laparoscopically in Antalya.

 

A large part of the stomach is removed, so that only one tube remains along the small stomach curve as a connection between the esophagus & intestine

 

Thus, the stomach loses a large proportion of its filling volume & only small portions can be taken.

 

In addition, the hunger hormone ghrelin is influenced, which has a positive effect on the feeling of hunger.

Ghrelin is mainly produced in the parietal cells in the epithelium of the stomach fundus, but also by the ε cells of the abdomen-salivary gland, as well as converted to the active form in a preliminary stage in the hypothalamus and pituitary gland and by cleavage of some amino acids.

 

Ghrelin is a hormone that regulates food intake and the secretion of growth hormone.

In periods of hunger, the level of ghrelin in the blood rises, after eating it decreases.

 

Lack of sleep induces increased ghrelin secretion and in this way probably contributes to the development of Obesity.

Other hormones that control the feeling of hunger or satiety are leptin, orexin & cortisol.

In the fasting state, the ghrelin secretion is increased, after eating, the ghrelin level decreases.

 

From the frequency of the procedure, the gastric reduction, meanwhile, is significantly ahead of the gastric bypass. An advantage over gastric bypass surgery is that no intestinal diversion is required and therefore this procedure is more suitable, for example, for patients with a chronic inflammatory bowel disease Crohn's disease or intestinal adhesions. Further, the absorption of drugs is undisturbed.

 

But the disadvantage is the irreversible loss of a large part of the stomach.

 

After a bariatric surgery, the affected person must switch to a special, balanced diet.

Due to the weight reduction, a significant improvement in the general state of health can occur, since many secondary diseases are also favorably influenced.

 

The tube magenop, is a purely restrictive procedure in which a large part of the stomach is removed.

This means that food can now be taken only in small portions.

About 30% of patients lose 60% of their excess weight after gastric sleeve surgery, as well as a substantial elimination of their concomitant diseases. About 10% of patients do not achieve this reduction in their weight, but lose so much weight that they are satisfied with the result, since most of the concomitant diseases have been eliminated or significantly improved. The rest experience only a minimal weight reduction and are not satisfied with the result.

 

The cause of insufficient weight reduction are:

 

No change in eating habits, insufficient physical activity and continued behavioral errors regarding food intake.

 

Rarely there are anatomical reasons for the lack of weight loss. In some cases, too little was removed from the stomach during the operation. In most cases, however, patients have taken too large amounts of food per serving in the long run and thus gradually caused an increasing dilation of the tubular stomach (dilatation). The gastric tube is a muscle that wears out with constant overstretching, thereby getting bigger again and also allowing larger portions.

 

Cicatricial narrowing in the gastric tube (stenosis), as a rule, leads to more frequent vomiting and heartburn. This condition, if it occurs early, can possibly be treated with an expansion. This is done without surgery with the gastric mirror over which a balloon is inserted for dilation. Another possibility, in the case of a narrowing that occurred at an early stage, is to insert a self-expanding stent (a tube widening the narrowing). This also happens with the level of the stomach. The stent is removed again after 4-6 weeks. If these measures do not bring about a permanent improvement, an operative correction must be made. The tubular stomach is then preferably converted into a bypass.

 

Many patients suffer from heartburn even before the operation. Heartburn is provoked by gastric juice flowing back into the esophagus. In many patients, these complaints improve when the body weight decreases. However, in some patients there is no improvement or even an increase in heartburn. In about 8% of patients who did not have heartburn before gastric sleeve surgery, these complaints are newly formed. For the most part, it is possible to improve or eliminate heartburn with acid-blocking drugs. However, when gastric juice, especially when lying down, passes through the esophagus to the larynx, coughing attacks occur, which can be very excruciating and cannot be eliminated by tablets. In this case, only a corrective operation remains, which, as a rule, also consists in the transformation of the tubular stomach into a bypass.

 

With insufficient weight loss and a greatly expanded tubular stomach, the re-reduction of the tubular stomach rarely leads to good results. This measure should then be combined with an additional bypass operation. That is, the tubular stomach is reduced in size, and in addition, in front of or behind the exit from the stomach, a partial shutdown of the small intestine is made.

 

Laparoscopic surgery 

This is done by keyhole technology, i.e. laparoscopically or minimally invasively, over five small holes in a size of 1.5 to 2.5 cm. The abdomen is first filled with a gas so that the surgeon has a better view of the abdominal interior. Now, the surgeons use a special technique to loosen the stomach from adhesions, for example to the spleen, in order to subsequently perform the actual reduction.

 

An important sub-step of the operation is the so-called leak test:

at the end of the procedure, the doctor briefly fills the new stomach with a blue liquid via a small gastric tube to ensure that the sutures are absolutely tight. 

Thus, the rate of complications in the hands of experienced surgeons is very low. 

 

Wound drainage 

Wound drainage is a drainage system for body fluids (drainage), which is usually used after major surgical procedures to temporarily drain blood & wound secretion to the outside or to promote the initial wound healing. The most common wound drainage is redondrainage (named after the Parisian maxillofacial surgeon Henry Redon). At the end of major operations, a wound drainage is inserted into the wound by the surgeon in front of the skin suture in the subcutaneous fatty tissue (subcutis) and guided out of the skin a few centimeters from the wound.

The drainage hose is connected to a container under negative pressure, which allows a continuous suction.

The suction on the drainage causes wound secretion (blood and serous fluid) to be discharged to the outside and the wound surfaces to be contracted. This should bring about a better healing of the wound surface.

A postoperative wound drainage (redondrainage) is usually left for 2-3 days.