Sleeve Gastrectomy

What a sleeve gastrectomy is

In a sleeve gastrectomy, the portion of the stomach running along its greater curve is removed, leaving behind a narrow, tube-shaped stomach — which is where the name comes from. The immediate consequence is mechanical: a much smaller stomach means a much smaller meal produces a sense of fullness.

The less obvious consequence is hormonal. The part of the stomach that is removed is the main source of ghrelin, the hormone most closely tied to the sensation of hunger, and many patients describe a genuine drop in appetite rather than simply a physical limit on how much they can eat. Because the intestine is not rerouted, food continues along its normal path through the digestive tract. At İzmir Cerrahi Merkezi the operation is carried out laparoscopically.

Obesity is a disease, not a failure of willpower

Obesity is a chronic disease in which body fat accumulates to a degree that damages health — that is how the World Health Organization defines it. It is linked to type 2 diabetes, high blood pressure, sleep apnoea, fatty liver disease, joint problems, reduced fertility and several cancers. Bariatric surgery therefore belongs to the treatment of a medical condition, not to cosmetic practice.

It also helps to be clear about why weight is so difficult to keep off. The body defends its highest sustained weight through powerful hormonal and metabolic mechanisms, which is why weight lost through diet and exercise alone is so often regained in severe obesity. Surgery is considered precisely because it acts on those mechanisms — not because a patient has not tried hard enough.

Who is a candidate

Surgery is not appropriate for everyone who wants to lose weight. The widely accepted threshold is a body mass index (BMI) of 40 or above; or a BMI of 35 or above together with an obesity-related condition such as type 2 diabetes, hypertension or sleep apnoea that has not responded adequately to supervised medical management.

Those numbers are a starting point, not a decision. Assessment before surgery includes blood tests, endoscopy and any necessary imaging, alongside review by endocrinology, dietetics, psychiatry and anaesthesia. Whether an operation is suitable — and which operation — can only be answered after examination and these investigations. The decision is made individually, for each patient.

• BMI of 40 or above
• BMI of 35 or above with an obesity-related medical condition
• Supervised diet, exercise and, where appropriate, medication have not produced a lasting result
• Willingness and ability to follow the post-operative diet and long-term follow-up programme
• No condition that makes general anaesthesia or surgery unsafe

How the operation is performed

The procedure is done under general anaesthesia using a laparoscopic technique. A camera and fine instruments are passed through several small incisions in the abdominal wall. Once the greater curve of the stomach has been freed, the stomach is divided with surgical staplers along a calibration tube placed from above, and the separated portion is removed. The staple line is checked during the operation.

The purpose of the keyhole approach is to perform the same operation through much smaller incisions, which generally means less pain, smaller scars and an earlier return to ordinary activity. The operation usually takes one to two hours. Patients are typically walking the same day or the following day, and the hospital stay is a matter of days, varying from person to person.

Eating and recovery after surgery

Eating progresses in stages: clear liquids first, then liquids and puréed food, then soft food, and finally normal textures. A dietitian sets the pace of this progression. Moving through it too quickly is a common cause of nausea and discomfort. In the early weeks the priorities are small, frequent intakes and meeting a daily fluid target.

Some habits change permanently. Small bites, thorough chewing, protein first at every meal, no drinking during meals, and avoiding sugary and carbonated drinks all become part of everyday life. Because the stomach is smaller, the absorption of some nutrients falls, so vitamin and mineral supplements — typically including B12, iron, calcium and vitamin D — are taken regularly and monitored through blood tests.

• Liquid, puréed, soft and normal-texture stages, guided by a dietitian
• Protein first, small bites, slow chewing
• Fluids taken between meals rather than with them
• Regular vitamin and mineral supplementation
• Physical activity as an integral part of the programme, not an optional extra

Surgery is a tool, not a shortcut

A sleeve gastrectomy makes sustained weight control possible; it does not deliver it on its own. The restriction and reduced appetite the operation provides only translate into a lasting result when they are combined with real, permanent changes in how a person eats and moves. If old habits return, some weight can be regained over the years — this is a well-recognised part of the picture and should be discussed openly before any decision is made.

For that reason, follow-up matters as much as the operation. Scheduled reviews through the first year, blood tests to track vitamin and mineral levels, dietitian appointments and regular exercise are all part of the treatment, and the monitoring does not stop after twelve months. At İzmir Cerrahi Merkezi patients are followed from the first pre-operative assessment onwards. If your weight is affecting your health, an examination is the place to start the conversation about which option, if any, suits you.