This stomach reduction attempt (tube stomach) procedure, known as eve sleeve gastrectomy de in the English literature, was first described by U.S. Pat. including all over the world and turkey most often applied is that obesity relieving operation. How much 90s since the year if applied stomach reduction surgery, the most popular of the performed surgery to lose weight nowadays tubes are stomach surgery.
Tube gastric surgery technique was firstly performed by surgeon Dr. Gagner performed the first step surgery for weight loss super obesity patients who could not undergo conventional gastric by-pass and biliopancreatic diversion operations. However, when the patients who underwent tube gastric surgery for this purpose were found to lose more weight than expected and more importantly, this technique entered medical literature as an obesity surgery that can be performed alone.
How is Tube Stomach Applied?
This type of surgery is performed by laparoscopic (closed) method. In other words, approximately 75-80% of the stomach is cut and removed laparoscopically through the millimeter holes without making a large incision in the anterior abdominal wall and the stomach is turned into a tube. Tube stomach operations are “restrictive”, which means attempt restricting food intake. As the lid (pylor) of the stomach is preserved, the function of the stomach does not change, there is no problem in the absorption of vitamins and minerals such as iron and it ensures the continuity of the digestive system. In this way, some unwanted side effects after surgery is less. Approximately 80% of obesity patients are sufficient for this operation. It is technically easy to perform surgically and is performed in about one hour.
The approximate capacity of our stomach is 1 and a half-2 liters. With this surgery, the esophagus, stomach, small intestine and small intestine are intervened and a calibration tube is inserted into the stomach, starting from the lower part of the stomach and towards the edge of the esophagus. This ensures equal volume for all. The remaining part is removed from the cut and sewn stomach. This is the easiest and most functioning part of the stomach. The expansion capacity in the remaining part is low. In this way, stomach capacity is reduced from 1 and a half to 2 liters to 150-200 ml. However, eating and calories entering the body is reduced. Since the part removed from the stomach provides the secretion of the hormone that gives the feeling of hunger, a significant decrease in hormone level occurs when 75-80% of the stomach is deactivated. The first effect of tube gastric surgery is to achieve early satisfaction by consuming less nutrients with a small stomach volume. In a normal metabolism, the sensation of saturation occurs by stretching the stomach wall. So the stomach has enough dollars with food, then goes to the saturation signal to the brain with wall tension and the eating action is completed. Foods taken after surgery cause an immediate tension and a feeling of saturation occurs with a small amount of food. Because the stomach volume is reduced and the amount of food taken is small, foods quickly leave the stomach and rapid discharge does not allow the stomach to expand. Following tube gastric surgery, the fund gyrelin ”level, known as the fasting hormone, is reduced by the removal of almost the entire stomach fundus and the feeling of hunger is prevented.
Patients after this surgery The patient comes to normal weight within one year. Nowadays, patients stay in the hospital for an average of 4 days and begin to consume liquid foods from day 1 after surgery.
Rules to be Followed Before Tube Gastric Surgery
In fact, the rules to be followed in all obesity surgeries are the same down. A special diet is applied before the tube stomach surgery. This diet plan, where you can get an average of 1100-1300 calories per day, should be rich in protein, vitamins and minerals and lack fat, refined sugar and carbohydrates. In the preoperative period; fatty foods, fries, pastries, all kinds of nuts, sugary foods and acidic beverages should be avoided. You should not smoke and use blood thinners at least one week before surgery.
What are the Surgical Risks in Tube Gastric Surgery?
As in every operation, there are surgical risks in tube gastric surgeries even if there is very little. The most important risks that may occur during or after surgery are leakage and embolism.
In tube gastric surgery, a long suture line is formed in the stomach which is cut and removed. One or more of the sutures may not hold from this suture line after surgery. This rate is less than 1%. Some of these leaks are micro-leaks, and the patient or surgeon heals without notice, and there is no problem.
In case of leakage, small abscesses may occur around the suture line. In this case, radiological deposits are drained. In this way, the leak is expected to close. With a small possibility of re-operation or endoscopic leakage point, a stent called a stent can be fitted.
Embolism (Blood Clot)
Embolism is the presence of a clot in the foot and the clot going to other places in the body vessel and blocking a vessel. The risk of embolism can be fatal and persists for 3 weeks after surgery. . In order to minimize and eliminate the risk of embolism, the risk is greatly reduced by administering blood thinners to the patient, conducting the patient early, using embolism socks and anti-embolic pump systems.
What are the Advantages of Tube Gastric Surgery?
- As it is applied laparoscopically, wound healing is faster and hospital stay is shortened. Fewer lung problems, less pain and faster recovery.
- Weight loss starts from the moment of surgical intervention.
- The volume of the stomach is reduced so that it can be consumed at a minimum rate in many food groups.
- As the fundus region of the stomach producing ghrelin (hunger hormone) is cut and removed, appetite decreases and weight loss occurs.
- The likelihood of a condition such as an ulcer is minimized.
- Intestinal digestion and normal absorption of food taken intact.
- Even if it fails then it can be converted to bypass or doudenal switch with a second operation.
- Food leaves the stomach later. In this way, a feeling of satiety is provided for a longer time.
- Faster saturation and filling are felt. It is satiated for a long time.
What are the Disadvantages of Tube Gastric Surgery?
- It may not lose weight as fast as gastric bypass in the short term.
- In tube stomach operations, the stomach is cut through. For this reason, sometimes leaks and bleeding may occur in this sewing line.
- Reflux may occur.
- In order to reduce stomach acid, it may be necessary to use stomach protection drugs for a while after surgery.
- The incised part of the stomach is removed from the abdomen, so it is not a reversible surgery. However, it can be switched to bypass and doudenal switch.
- Gallstones can occur due to rapid weight loss. Normally, the risk rate in the community is 1%, while tube gastric surgery increases to 2%.
Nutrition After Gastric Surgery
After the stomach reduction (tube stomach) surgery, your eating habits should be reshaped. The new gastric bladder created by surgery has the capacity to receive approximately 150 ml of food. There are 4 basic stages to improve the healing of the stomach sac. In these stages, juicy-soft and pureed foods should be taken. The aim of these rules is to help you stay healthy while losing weight. This diet helps to heal wounds in your digestive system, and aims to help you recover quickly after surgery. The diet may vary according to the tolerance level of the person. It should be noted that each patient is special and the diet to be applied for each patient is different from each other.
The main rule that we must follow strictly after surgery is that you do not consume the solid and the liquid at the same time. Liquid drinks consumed during meals may cause your stomach to expand again.
Postoperative transition to normal nutrition consists of 5 stages;
Stage: Clear Diet (Day 1-2)
The patient is not allowed to take soft or solid food at this stage. Solid foods may cause stapler line opening and leakage after surgery. Likewise, liquid foods can be taken as low calorie and non-fat (apple juice, cherry juice, tea, linden, protein drinks). You should take these liquids in the form of small sips and stop when they create a feeling of fullness.
On the first day after the surgery, you start to drink a little sip of water. On the second day, the patient is asked to continue drinking small sips every hour. The aim here is to take daily water from the body starting from day 2. In order to prevent dehydration, the patient should consume at least 1.5-2 liters of liquid from day 2 onwards. Otherwise, headache, dizziness, nausea, weakness, white wounds on the tongue and dark urination, etc. situations.
Stage: Full Liquid Diet (Day 3-14)
Approximately 3 days after surgery, clear juicy foods (tea, water, compote, apple juice, broth, juice of boiled vegetables, jelly, etc.) are started. Your diet is 5th-6th. Soup, yoghurt biscuits + feta cheese are added as of the day. The patient should take these foods gradually and frequently. What is important here is that all food must be consistently and without pulp to pass through the clear pipette. But you should never take sips that are big enough to cause pain and nausea. As in the first stage, it is best to continue to consume 1.5-2 liters of water per day and also to drink tea, apple juice and soy milk as beverages.
In addition to the previous week, skim buttermilk is diluted with skimmed and lactose-free milk.
Stage: Puree – Soft Diet (Day 15-30)
At this stage, your stomach is now greatly improved. You can easily tolerate soft and semi-solid foods. At this stage, it is important that the foods are not particulate and that they are well blended. Mashed meat, potatoes and all kinds of fruit puree can be consumed. 3-4 times a day 100 ml puree will be enough. Again low calorie and fat-free should be considered. Consumption of carbonated beverages is strictly prohibited for 1 month after surgery.
Eating time should be at least half an hour. Eating fast can cause abdominal distension, tension and pain.
Stage: Semi-Solid Diet (Week 4-12)
In this stage, the purity of the purees can be enough to be eaten with a fork. Large bites or solid pieces are also inconvenient in this stage. You do not need extra milk, or nutritional supplements, as long as you eat regularly. Between meals should be at least 4-5 hours, and after meals should wait 30 minutes to take liquid. It is necessary to take care not to take liquid in addition to solids and to give priority to foods with low calorie protein content such as skim milk, skimmed feta cheese, skimmed yogurt, egg white, fish, chicken.
Nuts, carbohydrates, mayonnaise, refreshments, cream cheese, butter, margarine, cakes, ice cream, salad dressings, chips should be avoided.
Stage: Low Fat Solid Foods (From 4th Month)
Approximately three months after the surgery, the limitations were removed. You can eat red meat, raw fruits with raw vegetables. You can eat all solid dishes provided you chew well. You can now consume water provided that you do not exceed 1 tea glass during the meal.
However, foods such as rice, pasta, corn bread and fatty foods may not be tolerated until the 6th month.
The diets we apply vary according to the person. It’s not easy to change your eating habits. Besides diet, there will be an exercise program to be prepared for the application of our patients.