Laparoscopic Sleeve Gastrectomy

Sleeve gastrectomy, in other words; stomach’s cutting in vertical axis and forming it anatomically to a tube structure began to be practiced in 1988 as a part of duodeneal switch surgery.

By-pass surgery (duodenal switch-Rny gastric) began to be implemented on patients who have high body mass index and then as the first step, sleeve gastrectomy surgery’s implementation and after patients’ losing weight, passing to the last surgery plan made laparoscopic surgery popular in the early 2000’s. Comparatively, sleeve gastrectomy with low complication began to expand on medium-leveled obesity patients and for those who has unseccessful gactric band story.

Technically, it’s being simpler than other obesity and metabolic surgery operations is the most important factor in the expansion of it’s usage. Laparoscopically, it is completed between 4-5 entry points averagely between 20-40 minutes and it does not cause a significant metabolic change on patients. Although it changes with the size of the stomach, it shrinks by 80% on average and about 60-110 ml stomach space remains. It has a low success in preventing liquid flow transition but it restricts solid food intake in the early period and it provides patients lose weight. Stomach and bowel connections such as transit bipartition or loop bipartition can be added to increase the metabolic rate of the surgery.

Besides the restrictive effects of sleeve gastrectomy on food intake, also, hormonal mechanisms should not be ignored. As the main mechanism, it accelerates the gastric emptying and it accelerates the transition of the small intestine. This fast transition has brought up a hypothesis that satiety grade is stimulated faster. In response to eating, the hormone GLP-1 is excreted from the last part of the small intestine, it regulates sugar metabolism by supporting secretion, it slows gastric emptying, it suppresses glucagon production and it suppresses sugar production from the liver.

“Ghrelin”, which we all describe as the appetite hormone, is mainly released from the cells located in the fundus, the upper part of the stomach. In physiological situations, the level of ghrelin begins to increase with hunger, it peaks just before eating and is suppressed with food. It shows diabetic effect by suppressing ghrelin secretion. Since ghrelin reaches the basic level after sleeve gastrectomy, the feeling of hunger begins to decrease and resistance may disappear. The point that should not be forgotten is that as the person approaches their target weight, the level of “ghrelin” will begin to increase again with compensatory mechanisms.

As the satiety hormone, leptin which acts on the central nervous system is synthesized in adipose tissue. It has been found out that the sensitivity to leptin is reduced in obese individuals and therefore, despite high energy storages, the feeling of satiety does not occur. After sleeve gastrectomy no definitive information could be found regarding the improvement in leptin resistance. Recent studies show that a protein-based diet after surgery improves the leptin resistance.

The sophisticated connections between the stomach-intestines, adipose tissue and the central nervous system may cause the activation of compensatory mechanisms for the slimming process and thus the slimming process mechanisms mentioned above may end that might start gaining weight process again. In contrast to the negative energy balance, after sleeve gastrectomy, regarding reaching the weight which the body is used to, an unstoppable increase in the desire to eat and a tendency to high-calorie foods are the main reasons for weight gain seen in 40% of patients.

You should see sleeve gastrectomy surgery only as a medical support that helps in the slimming process and you should ensure the calorie balance in order to achieve success in the long term. You should not forget that personal factors determine the success of sleeve gastrectomy.