...IS SLEEVE GASTRIC SURGERY DANGEROUS?

The clearest and quickest answer: Sleeve gastric surgery fits into the group of low-medium risky operations.

Forget about such explanations:
It is a surgery with no risk=Wrong.
It is a high risky operation=Wrong.

For those who want to know more, let's explain it in details.

Every surgery carries out a certain complication rate with itself. In other words; Even in the most perfect prepaired conditions in which all the knowledge, experience, equipment, care, measures and attention required for one surgery to be properly carried out are obtained, there is still a certain rate of risk of facing undesirable results, present within each type of surgery.

Approximately 1-2% of the patients who have undergone laparoscopic sleeve gastrectomy surgery may experience significant problems. About 3-4 of them percent may experience mild problems. More than 95% are discharged from the hospital without any problems and return to normal daily life within few days.

According to the medical reports showing the follow-up results of thousands of patients who have undergone sleeve gastric surgery, the surgery related life-threat risk is one out of three hundred and fifty patients, ie around 3 per 1,000 (0.2% - 0.5%).


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There are few examples above of life-threatening risks compared with some other surgeries;

Appendicectomy ⇒ 1 per thousand (0.1%)
Sleeve gastrectomy ⇒ 3 per thousand (0.3%)
Hip replacement surgery ⇒ 4 per thousand (0.4%)
Heart surgeries ⇒ 20 per thousand (2.0%)
Large bowel surgery ⇒ 35 per thousand (3.5%)

In other words, the risk of sleeve gastric surgery as an obesity treatment is roughly 3 times higher than the risk of appendicitis surgery , but on the other hand sleeve gastrectomy is 7 times less risky than one heart surgery.

Detailized pre-operative, intra-operative and post-operative precaution measures undertaken in experienced and well-equipped centers maybe could not reset, but can surely greatly reduce the risks.

However, these risks are higher in elderly patients, in patients with additional health problems due to obesity, and in patients with chronical diseases that can be kept under control more difficult.



WHAT ARE THE RISKS?

The most serious complication that can be seen after sleeve gastric surgery is dreap-leakage from the remaining stomach part into the abdominal cavity. In the surgery, a staple line of approximately 25-30 cm is formed along the left edge of the stomach to reduce the stomach to a tube. This line consists of approximately 300 tiny millimetric punches extending in 3 rows. If there is leakage, this is caused by millimeter openings that may occur on the line. Details are provided below.

There is a small chance of bleeding into the stomach or into the abdomen from the gastric line that was cut , in the early postoperative period. Rarely, in such cases a few bags of blood infussion may be needed .

In the long-term postoperative period, condition of stenosis of the newly formed stomach may rarely be seen. It can be treated with endoscopic expansion.

Problems such as lung infection and wound infection that may occur after all operations may also occur after sleeve gastric surgery, also. Most of these are mild and do not disrupt the healing process. Some may extend the length of hospital stay. Antibiotic use, deep breathing exercises and early postoperative mobilization may reduce these kinds of complications.

Fluid deficit, protein, vitamin and mineral deficiencies may be seen in the patients especially in the first month after surgery. Therefore, close follow-up of all patients is essential, especially in the first couple of months. Supporting measures such as intake of plenty of liquids, stomach protectors, vitamin pills and protein powder are necessary.



IS LEAK (DRIPPING) POSSIBLE?

Leakage after sleeve gastric surgery occurs in approximately one ın hundred patients. All over the world, teams working in the field of obesity surgery are tryıng hard to reduce this rate. Many ways had been tried, such as sewing the staple line, putting artificial or organic reinforcing tapes, but the ratio has not changed. Some progress has been made only in the treatment of leaks when occurred.

Of course, centers that can report low complication rates should be preferred. However, even the official medical reports of world leadıng centers in this field, state on 1-2% leakage rates , so “We have performed hundreds of surgeries wıth no leakage after “ kinds of statements should always be approached with precaution.

Experience should be taken into consideration when choosing the right surgeon. The most important question is: How well does your surgeon know the technique of laparoscopic(closed) surgery? What is the general surgical experience of your surgeon? Is his experience limited to stomach reduction surgery or does he apply other types of closed surgery (reflux, gastric hernia, spleen, etc.) in that area?

Be realistic. Even from the most experienced surgeons, leakage rates are not expected to be zero. It could be an expectation of a low rate. Experience does not mean not been ever encountered to difficulties. A surgeon who has had very few operations may have never had a leak. Experience is, in a sense, a feature that can be developed by experiencing and overcoming resolvation of the encountered difficulties.



WHAT HAPPENDS IF LEAK OCCURS?

Another point that needs to be considered as much as the leakage rate is the question of what will be the encounters if a leak occurs. Most of the leaks after sleeve gastric surgery occur within the first week after surgery. Patients who develop leakage from the staple line often begin to feel a pain that develops rapidly in the upper abdomen and worsens immediately after ingestion. Abdominal pain, fever and palpitations are the alarmating symptoms.

Patients should be well informed about this condition and their communication with the surgeon must be active all the time. Especially during the first one or two weeks after the operation, patients should be able to reach the surgical team easily within few hours.

In case of leakage, intravenous feeding may be required for a while, CT drainage insertation in the abdomen may be required, endoscopic stend placement may be needed in the stomach also. As a result, the duration of hospitalization and treatment will be extended. After fast and appropriate treatment, most of the patients can be taken under control and get stabilised.

ARE WE PREPARED FROM THE START?

Whether a patient has a leak or not can be considered as an issue related to the patient's own characteristics, surgical procedure and operator. However, the improvement of the patient is additionally related to the staff, scope and facilities of the hospital. In this respect, the standards of the operating hospital and its competence in critical patient management are of vital cruciality.

In this respect, an institutional addressee and organization are necessary in all stages of the treatment of obesity, from patient selection to surgery preparation, from operation to late follow-up. Therefore, it is not enough to make a choice on the basis of a surgeon from the very beginning. In case of leakage development, there is a need for a full time present and wide ranged staff that can manage the whole process accompanied with high standard technical facilities at the disposal of that team.

Even if complications are rare to be seen,

DO NOT HESITATE TO ASK AND LEARN THE FOLLOWINGS

How many years of experience in surgical expertise your surgeon has got? What is his experience of various closed (laparoscopic) surgeries? What is his training and experience in the field of obesity surgery?

* Is there a nutritionist who is certified in bariatric nutrition in the hospital?

* Is there an endocrinologist at the hospital who will monitor any endocrine-metabolic problems?

* Are you going to be consulted and followed-up by a psychologist or a psychiatrist?

* Are there any specialists in cardiology and pulmonology that will be able to follow previously not noticed heart and sleep apnea problems which may develop during the surgery ?

* Are there anesthesia-intensive care specialists available 24/7 in the hospital for monitoring critical patients?

* Advanced scanning, percutaneous catheter, etc. if necessary. Is there an interventional radiologist who could conduct the interventions such as advanced scanning, percutaneous catheter etc. if necessary?

* Is there any gastroenterologist who can perform endoscopic stent insertion if needed?


Did you ask these questions when deciding which hospital you are planning to undergo?
Have you received the appropriate answers?
Wouldn't it be unfortunate if these questions came to your mind after
complication got developed?

COSTS-FINANCIAL-PREFERENCES

Health safety and health standards should come before costs.

It is known that obesity operations, which have a considerable cost, are performed at low wages in some small hospitals. This is only possible by compromising the medical and surgical standards. There are patients who hadn`t been checked up before or even got operated without having seen an endocrinologist, remained in the middle of noware after a few days of hospitalization and applied to us for follow-up.

There are sensations in the surgery in a way that there are medically unacceptable cuts in terms of materials and equipment, and that there are unethical practices going on. These should be kept in mind when making cheap choices!

It is seen that some surgeons perform obesity surgeries in hospitals with limited facilities with part-time teams out of economic reasons. These operations require preparations and follow-up involving a large number of medicine branches in a full-fledged hospital. If you intend to have surgery within a part-time organization (such as hospitals with no regular full time employed surgeons, related specialties, teams), how can you find an interlocutor for post-operative follow-up or treatment of a complication? We suggest that you re-think over again.

Because complications are rare, centers that do not meet the standards may have not experienced problems very often. But this situation is somewhat similar to driving without safety equipment. "Once there is no accident ..." Such an account can be made for things of material value. Not suitable for human life.

If the hospital does not have an experienced specialist staff in all branches, it is difficult to cope with complications. It is necessary to think well: not only with excess weight but also experience with a chronic health problems complex surgeries counts too, how can a unexperienced center can guarantee the process resolvation that you will experience if there hasn`t been a problem in that limited center so far?

Most of the time it is seen that the cost of gastric sleeve surgery is the first criterion in serious confusion decision making. Cost is surely important, of course, but the first criterion should always be recieving health care based on solid standards.

Priority should be given to seeking satisfying answers to the above questions. Thus, more than half of the options will be eliminated. It would be a safer way to choose among the leftovers.


The criteria to be taken into consideration when choosing surgeons and hospitals should be protection of your health by choosing full-fledged centers that provide high standards of health services. If the conditions are sufficient and the standards are high, there will be a high chance of being discharged with healing in all circumstances. That's what good hospital selection means.




SHOULD WE HAVE GOT THE SURGERY, OR NOT?

YOU SHOULDN`T:
If your health status is thoroughly questioned, if you have been accepted directly for a surgery without examination-check-up-do not have surgery.
Do not undergo surgery if you are going to be operated in one day without ultrasound, endoscopy, nutritionist, psychologist and endocrinologist previous consultations .If you do not have an organizational identity and follow-up conditions where you will be continuously contacted in the long term after the surgery, do not have surgery performed.
Do not undergo surgery if the center you intend to have surgery in does not have an experienced full-time expert staff and sufficient facilities that you can entrust your health til the end under all circumstances.


YOU SHOULD:
If you are selected as a patient who needs to undergo a surgery after an objective and rigorous medical evaluation, a clearly defined screening for acceptance and rejection criteria, then have got the surgery.If you are comfortable talking to your surgeon face-to-face, including all of the above-mentioned questions, and if you get positive explanations of the misunderstandings, get the surgery.
If you are able to choose a full-fledged hospital with a large scoped staff that you can always reach and fully trust, after having thoroughly explored and evaluated all possibilities and possibilities, get the surgery performed.

WHICH IS MORE RISKY? SURGERY? OR LIVING AS OBESIS?

In fact, "Is obesity surgery risky?" This is more meaningful question than the above one . This is not a matter of discussion of a healthy person taking a certain risk and having surgery at a certain point.

The real choice matter in here is whether to keep on living with the morbid obesity that every day worsens human`s health and results in life-threatening consequences in the long run, or to get rid of it by taking constrained risk of getting the surgery done and go on with healthy life in total on the long run.



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Unfortunately, if a patient with morbid obesity is afraid of the risks of surgery on the one hand and stays away from the surgery, on the other hand, there is no chance of any other weight loss - that does not mean that she/he can live a risk-free life.

On the contrary, there is severe obesity is getting more severe in advancing age; diabetes, high blood pressure, joint problems, drowsiness in sleep, depression, breast and large intestine cancer risk increase, blood fat elevation to cardiovascular diseases are some of the many critical health problems that will be elevated by the obesity eventually.

Despite the often mentioned risks, the fact that obesity operations continue to be applied more and more widely is the fact that;

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In the long-term follow-up studies, morbid obesity patients with similar characteristics were initially separated and followed up with and without surgery. The possible problems that may be encountered in these surgeries are scientifically compared with the problems and risks of staying obese without having a surgery by putting them on a two sided scale. It has been scientifically approved as general truth that the side of risks of living a life as an obese with no surgery surpasses the risks of undergoing a surgery in terms of long term vital importancy.

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