Gastric sleeve surgery is a medical procedure that aims to reduce excess weight and treat the problem of obesity. This procedure depends on reducing the size of the stomach by up to 70% of its normal size, which helps to feel full when eating small amounts of food. The procedure also contributes to reducing the secretion of the hormone ghrelin, which is produced by the removed part of the stomach and is responsible for the feeling of hunger. Gastric sleeve surgery is considered simple, as it is performed using an endoscope through 4 to 5 small incisions, and the procedure takes about 40 to 45 minutes. There are many questions about the first hours after the sleeve, and we will try to answer all your inquiries through the        Dalili Medical website.

**What is gastric stapling?**

 

Gastric stapling is a surgical procedure performed through a surgical incision (not endoscopically) and depends on creating a small pocket in the stomach by stapling it without cutting it, with a ring or mesh placed around the stomach outlet to prevent food from exiting easily.

**Which is better: gastric stapling or gastric sleeve?**

 

Gastric stapling operations are reversible and can be removed in the event of complications, as the doctor can separate parts of the stomach and the metal ring fixed at the stomach outlet. While gastric sleeve surgery depends on removing a large part of the stomach.

**What is the purpose of gastric stapling?**

 

Gastric stapling aims to treat extreme obesity that may affect some people for various reasons.

**History of gastric stapling:**

 

This operation was invented by  University of Iowa. Thousands of cases were performed until 1991, where it began to decline until it completely disappeared in 2005. During this period, an attempt was made to perform the operation laparoscopically under the name "Butterfly Operation" without success.

**How ​​the operation is performed:**

 

1. The operation is performed under general anesthesia.

2. An incision is made in the upper abdomen with a length ranging from 10 to 15 cm.

3. Staples are used to create a pocket in the stomach.

4. The size of this pocket is carefully measured so that it does not exceed 10% of the original stomach size, which is equivalent to 3 or 4 spoons, and a mesh of prolene is placed around the new stomach outlet to prevent it from expanding.

**What is the difference between stapling and gastric sleeve?**

 

Gastric sleeve and gastric stapling are two surgical procedures that help people lose weight by reducing the size of the stomach, but there are key differences between them:

- **Surgical procedure:**

- **Gastric sleeve:** A large part of the stomach is removed and converted into a sleeve-like shape, reducing a person's ability to eat large amounts of food.

- **Gastric stapling:** A rubber ring is placed around the upper part of the stomach, reducing the size of the stomach and restricting the flow of food.

- **Reversibility:**

- **Gastric sleeve:** It is a permanent procedure and cannot be easily reversed.

- **Gastric stapling:** It can be easily modified or removed if necessary.

- **Complications and Risks:**

- **Gastric Sleeve:** Complications such as leakage or bleeding may occur.

- **Gastric Stapling:** Problems may occur with the rubber band such as slippage or erosion.

- **Speed ​​of Weight Loss:**

- **Gastric Sleeve:** Usually more effective in achieving rapid weight loss in the first period after the operation.

- **Gastric Stapling:** Weight loss may be slower compared to gastric sleeve.

People considering either of these procedures should consult a specialist in weight loss surgery for advice and to choose the most appropriate procedure based on their health condition and weight loss goals.

**What is Laparoscopic Gastric Stapling?**

 

Gastric stapling is not considered a laparoscopic procedure, but rather is performed through traditional surgery as mentioned above.

**What are the most important differences between gastric stapling and gastric sleeve?**

 

In gastric sleeve surgery, 75% to 85% of the stomach is removed, which reduces the amount of food consumed and also reduces the hunger hormone, making the person feel full after the operation. As for gastric stapling, a new stomach is formed using staples without removing any part of it. The goal of both operations is to reduce weight and get rid of excessive obesity. However, recurrent reflux and esophageal reflux are common problems after gastric stapling, while they are less common after gastric sleeve. Gastric stapling is no longer recommended as an option for treating excessive obesity, as it is noted that 50% of patients who underwent this operation suffer from weight gain again after two years, in addition to many of them suffering from recurrent reflux, difficulty eating proteins, and esophageal reflux.

**- Is gastric sleeve surgery performed laparoscopically?**

 

Yes, the operation is performed laparoscopically, as we use the latest advanced high-precision endoscopes in Egypt.

**When can I start drinking fluids and how to drink?**

 

You can start drinking water from the first day, but in a specific way. It is preferable to drink water in small sips, as you do when drinking tea or hot soup, to ensure the slow drinking process. You should avoid using a straw to prevent air from entering the stomach. It is recommended to walk while drinking, and if you feel pain, stop drinking and walk for two or three minutes, then you can resume drinking in the same way.

**What are the permitted drinks and their quantities?**

 

At first, you must adapt to the small size of the stomach, so you can only drink liquids. The required daily amount is 2 liters, where one liter should be water and the other liter should be clear liquids without sugar such as mint, apple juice, pineapple juice or berry juice. This amount is necessary to hydrate the body and prevent dehydration and clots, as fluids help stimulate blood circulation.

**What is the permitted sleeping position and movement?**

 

All sleeping positions are permitted, so you can choose what suits you. The operation will not affect the sleeping position. As for going up and down stairs, it is allowed from the first day of the operation.

** What type of staplers are used in laparoscopic sleeve gastrectomy?**

 

Modern staplers made of titanium are used, which is an inert metal that does not react with the body, and has been used in surgical operations for several decades without any negative effects. We are keen to use American staplers that were manufactured in the United States and have been used in obesity surgery centers in America and Europe for a long time.

**- What happens to the staples on the edge of the stomach? Do they have an effect on the body or when performing an MRI?**

 

A month after the operation, the stomach has completely healed, and the staples become worthless and do not cause any problems. They also do not interfere with performing an MRI.

**- Does the use of staples pose an obstacle at airports?**

 

No, it does not pose any obstacle.

**- Does the quality and efficiency of the endoscope used in the sleeve gastrectomy affect the results?**

 

Yes, it is preferable to use a high-definition (HD) endoscope in advanced laparoscopic operations. We use a high-resolution endoscope with advanced capabilities, which is one of the latest endoscopes in Egypt.

**- What are the tests required before the operation?**

 

- Complete blood count

- Liver functions

- Kidney functions

- Fasting blood sugar

- Thyroid functions

- Blood fluidity

- ECG and chest x-ray (sometimes)

- Television scan of the abdomen and gallbladder to check for gallstones and liver size sometimes.

**- What is the purpose of these tests?**

 

The anesthesiologist needs to conduct a comprehensive assessment of the patient's health condition before the operation. He must ensure that the thyroid functions are normal, and know if the patient suffers from diabetes or if the heart condition is healthy, and other matters, in order to reassure the surgeon and the anesthesiologist and take the necessary precautions during the operation.

**- How long will I stay in the hospital?**

 

One day only.

**- Will I feel pain after the operation?**

 

The pain after the sleeve gastrectomy is less compared to traditional surgeries, and this is one of the most prominent benefits of using the endoscope in obesity surgeries. After the operation, we seek to control the pain using painkillers to speed up the recovery period, and patients are often surprised that they do not feel much pain after the operation, knowing that the level of tolerance varies from one person to another.

**- When can I walk after the laparoscopic sleeve gastrectomy?**

 

The patient can start walking two hours after the operation, and it is recommended to walk every two hours during the hospital stay. This helps avoid staying in bed for long periods, which reduces the possibility of complications.

**- When can I expect to pass stool?**

 

This is usually within 3-5 days after leaving the hospital.

**- How painful is it when leaving the hospital?**

 

The degree of tolerance varies from one person to another, but the pain is usually very mild and can be controlled with oral painkillers for two or three days.

**- Is a drain (barbesh) used during the recovery period?**

 

In most sleeve gastrectomy operations at Dr. Mahmoud Zakaria Center, a drain is not used.

**- What should I do if constipation becomes annoying?**

 

1. Drink plenty of fluids.

2. Exercise helps regulate the bowel movement process.

3. You can use a laxative if you feel severely constipated.

**- When can I drive?**

 

You can usually return to normal activities after a week, so you can drive after this period.

*- Should I take vitamins after laparoscopic sleeve gastrectomy?**

 

It is recommended to take vitamins during the first year to compensate for the body's needs for minerals and vitamins.

**- Does the stomach expand after the operation?**

 

This is a common question, but stomach expansion depends mainly on the amount of food the individual eats. If the amount exceeds what the stomach needs, expansion may occur, especially in the first months after the operation. Therefore, it is recommended to stop eating when you feel full.

**- We often hear that the longitudinal reduction process may lead to weight regain after a while, is this true?**

 

The initial results of this process are very encouraging, but weight regain depends on dietary behavior. If calories are increased by eating sugars and foods rich in fats, weight regain may occur. Adhering to nutritional advice helps maintain weight for long periods.

**- Can I eat anything after the operation?**

 

It is recommended to reduce the intake of sweets and foods rich in fats until reaching the ideal weight.

**- How can I protect the stomach from expanding?**

 

Avoid eating after feeling full.

**- Will I be able to eat normally again?**

 

After the operation, you can eat anything in small quantities.

**- What are the reasons that lead to weight gain in some people after the operation?**

 

Gastric sleeve surgery is not suitable for people who are obese and love sweets. If this operation is performed for these individuals, the chances of success are low.

**- Is there a problem with pregnancy later after the longitudinal resection (sleeve) operation?**

 

It is recommended that pregnancy occur at least a year after the operation, so that the body can adapt to the changes in the digestive system and the amount of food. Vitamins, iron and calcium should be taken regularly after the operation, and then a comprehensive examination should be performed. After that, pregnancy can be safely done. The pregnant woman may need additional doses of iron and calcium based on the advice of a nutritionist. If pregnancy occurs during the first year, the pregnant woman should follow up closely with the nutritionist to ensure that she eats foods rich and beneficial to the fetus, and the fetus is often normal.

**Can gastric stapling be performed without surgery?**

 

Gastric stapling is performed through traditional surgery, i.e. through a surgical incision. While gastric sleeve surgery is performed using an endoscope, which differs from gastric stapling.

**Duration of Gastric Stapling:**

Gastric stapling takes between 40 to 70 minutes to perform the surgical incision and stapling the stomach using metal staples.

**Summary of stapling results:**

1. Rapid weight loss during the first six months.

2. The patient needs 18 to 24 months to achieve 50% weight loss.

3. The failure rate to maintain weight reaches more than 50%.

4. Rapid weight loss may lead to severe sagging skin, which may require a sagging skin tightening procedure.

**What is the difference between gastric stapling and gastric sleeve?**

 

Gastric stapling is performed through a traditional surgical incision, where the upper outer part of the stomach is stapled and converted into a pocket. While gastric sleeve surgery is performed using an endoscope through small openings in the abdomen, where 70-80% of the stomach volume is cut and stapled using American smart staples, with a leak test to protect the patient. Types of gastric sleeve surgeries include:

- Modified sleeve.

- Bikini sleeve.

- Single-port sleeve.

- Mini sleeve.

- Nanotechnology sleeve.

**What are the types of gastric stapling surgery?**

 

There are three types of gastric stapling surgery, all of which aim to reduce the size of the stomach, which helps you feel full quickly and suppress your appetite, thus reducing the amount of calories consumed. These types differ in how they are performed, as follows:

1. **Adjustable gastric banding (AGB):** This procedure involves attaching an inflatable band around the upper part of the stomach using a laparoscope, creating a small pouch that acts as a new stomach. The doctor can adjust the diameter of the band after the procedure, but this procedure may not achieve significant weight loss.

2. **Vertical band gastroplasty (VBG):** Also known as vertical gastric repair, it uses a combination of staples and a band to attach part of the stomach to create a small pouch. This procedure helps to lose approximately 50% to 60% of excess weight within a year after surgery.

3. **Vertical sleeve gastrectomy (VSG):** It involves removing a large part of the stomach, where the remaining part accommodates approximately a quarter cup of liquid foods. The stomach can expand over time to accommodate one cup of food. This procedure helps to lose 33%-80% of excess weight within a year after surgery.

**How ​​is gastric stapling performed: Steps of the procedure**

 

1. **Anesthesia:** The patient is given general anesthesia.

2. **Opening the incisions:** The doctor makes very small incisions in the abdominal wall area to insert surgical instruments.

3. **The operation:** Tubes are inserted into the stomach area to reduce the new size.

**Laparoscopic gastric stapling procedure**

In the laparoscopic gastric stapling procedure, the doctor creates a new, small stomach in the upper part of the stomach by stapling the front and back stomach walls, with a small opening for this new stomach. After that, a mesh is placed around the new stomach opening. As a result of this process, the person feels full and does not eat large amounts of food.

**How ​​to perform laparoscopic sleeve gastrectomy**

 

Laparoscopic sleeve gastrectomy reduces the size of the stomach to no more than 30% of its original size. The doctor removes a large part of the stomach, in addition to removing the hormone responsible for the feeling of hunger, which explains the decreased desire to eat voraciously after the operation, which helps in losing weight effectively.

The gastric sleeve operation is performed using the endoscope through five openings, allowing the doctor to access the stomach and perform the necessary steps for the operation. With the advancement of medicine, new techniques have emerged in obesity surgeries, including:

**Gastric sleeve with the three-hole technique:**

 

This technique is performed through only three openings in the abdomen, which reduces the annoying effects and scars that may appear after the operation.

**Bikini cosmetic sleeve without scars:**

 

This technique is considered one of the latest procedures in obesity surgeries, as it does not leave any traces on the appearance of the abdomen after the operation. The doctor makes an incision in the navel, and the rest of the incisions are at the bikini line, which prevents any marks from appearing.

**Modified sleeve gastrectomy:**

 

Some cases face the risk of regaining weight due to the expansion of the stomach mouth. The modified sleeve technique provides a solution to this problem, as the doctor installs a silicone ring around the stomach mouth to prevent this expansion over time.

**Umbilical sleeve gastrectomy:**

 

This technique is ideal for people who are bothered by scars and marks on the abdomen after the operation. Using a single incision in the navel, the doctor can perform the operation completely without leaving any annoying marks.

**What are the types of laparoscopic gastric sleeve operations?**

 

1. **Cosmetic bikini gastrectomy:** It is performed through an incision in the bikini area, which prevents any marks or scars from appearing.

2. **Modified gastric sleeve:** It includes placing a ring around the stomach to prevent expansion and increase in size resulting from bad habits after the operation.

3. **Sleeve:** It is done using a modern and precise endoscope, which reduces the number and size of openings, thus reducing pain.

**What is the nutritional system after laparoscopic sleeve gastrectomy?**

 

You should be careful to eat smaller amounts of food, as the size of your stomach has changed and become much smaller than usual. Eating smaller amounts helps your stomach digest food comfortably and safely without being exposed to any harm.

It is better to drink fluids between meals instead of during the meal, and it is recommended to wait 30 minutes after the meal before drinking fluids.

Make sure to eat and chew food slowly and carefully after the operation to avoid annoying complications such as vomiting, nausea or digestive disorders.

Protein should be an essential element in your daily meals, while choosing foods with low fat and calories, and staying away from saturated fats.

Avoid smoking to protect your health from complications associated with it, and commit to taking supplementsFor nutritional vitamins and minerals under medical supervision.

Make sure to drink sufficient amounts of water and fluids to avoid dehydration, and it is preferable to walk and exercise instead of using the elevator or car for short distances.

Avoid caffeine from tea and coffee, as it can lead to acid reflux and dehydration. You should also stay away from spicy foods and sweets with a high sugar content, and reduce the salt in your meals.

Avoid canned foods that contain preservatives because of their negative effects on your health.

**Risks of gastric stapling surgery**

Possible risks of gastric stapling surgery include the following:

- Risks of general anesthesia, including allergy to the anesthetic used.

- Bleeding during or after the operation.

- Failure of the operation to achieve the desired weight loss.

- Exposure to severe reflux in the esophagus.

- Fibrosis of parts of the stomach after the operation.

- Severe vomiting.

- Anemia and malnutrition due to failure to adhere to the appropriate diet after the operation.

**Post-gastric stapling**

It is important to walk regularly, in addition to doing physical exercises to maintain fitness. A nutritional plan should be developed under the supervision of nutritionists to control the type and quantity of daily food.

Avoid returning to random eating, even if you work long hours. Accept the new changes in your lifestyle, and always remember that the goal of the operation is to lose weight and avoid chronic diseases associated with obesity with age.

Maintain your energy and positive thoughts, and avoid feeling hopeless or sad. You must strengthen your determination to overcome these stages and reach your goals.

Be sure to accompany people who adopt healthy lifestyles, and stay away from sugars and fats to avoid stomach expansion and return to obesity again.