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Sleeve Gastrectomy

Sleeve Gastrectomy; Although bariatric surgeries have been practiced since 1990s, the sleeve gastrectomy technique currently carried out was last reported by Gagner, MD, an American surgeon, in 2001.

Gagner, MD considered this technique as the first-step surgery for weight loss to a certain extent prior to the actual operation for overweight super-obese patients who are unable to undergo conventional gastric by-pass and biliopancreatic diversion operations.

However, patients undergoing sleeve gastrectomy for this purpose were found to have lost much more weight than expected and most importantly sufficient weight, as a result, this technique was introduced into the medical literature as a bariatric surgery that can be performed alone.

Roux-en-Y gastric by-pass (RNYGP) is currently the most common type of bariatric surgery performed in the world, especially in the USA. (In the last year, the rate of sleeve gastrectomy surgery has increased and has been started to be performed almost evenly with RNYGP.) The indication for gastric bypass surgery is the same as for all other bariatric surgeries.

This procedure is preferably for performed patients who eat less but has a very high-calorie diet, called as sweet eater.

Since reducing the size of the stomach alone will not result in sufficient weight loss, a procedure to restrict the absorption should be added. It is not performed for patients with chronic intestinal disorders, because it will be an intervention also intended for small intestines, unlike sleeve gastrectomy.

How is Roux-en-Y gastric bypass carried out?

As in other types of bariatric surgery, gastric bypass is performed laparoscopically as well, in other words by using the closed technique. We see all the benefits of laparoscopic surgery in bariatric surgeries as well, such as an extremely low postoperative pain, a good cosmetic result and early mobilization.

It is a procedure lasting approximately between 120 and 180 minutes. The Roux-eN-Y gastric bypass procedure is performed at 3 stages;

Biliopancreatic Diversion/Duodenal Switch

It is one of the procedures that has been started to be performed in the 1980s and is still performed today. Just like gastric bypass surgery, the procedure both reduces the size of the stomach and restricts the absorption.

Unlike gastric bypass, the reduction of the size of the stomach is less and the absorption-reduction effect is much greater. The indications for the surgery are the same as for all other bariatric surgeries.

The difference of duodenal switch surgery from conventional biliopancreatic diversion is that the natural valve, called ‘pylorus’, in the output of the stomach, is preserved.

In duodenal switch (SADI-S) procedure with single anastomosis, the stomach is reduced in the form of a tube. Compared to the conventional sleeve gastrectomy, a larger stomach is prepared.

We use a 60-F calibration tube (a tube that is inserted into the stomach and helps to adjust the thickness of the remaining stomach during incising the stomach) in DS surgery while a 32-36-F calibration tube is used in conventional sleeve gastrectomy surgery.

The duodenum is then separated 3 cm beyond the stomach output. The point found by counting 2.5-3 meters from the junction of the small and large intestine is anastomosed to the upper part of the previously separated duodenum.

In this way, both the stomach becomes smaller and the vast majority of the small intestine is bypassed, considerably reducing the absorption. This method is more effective than other methods in terms of the control of diabetes and permanent weight loss. However, vitamin and mineral deficiencies are more common as they lead to severe malabsorption.