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Another method for hemostasis involves the use of buttressing materials. Several buttressing products made from different materials have been introduced into the market, including bovine pericardium (Peri-Strips Dry with Veritas, Synovis, Deerfield, IL, USA), absorbable synthetic polymer membranes (SEAMGUARD ®, Gore ®, W. L. Gore & Associates, Inc., Newark, DE, USA, or Tri-Staple™ 2.0 Reinforced Reload, Medtronic, Minneapolis, MN, USA). Many previous studies have been conducted to elucidate the efficacy of these buttressing products in preventing bleeding from staple lines and leakage from staple line disruption. Although the results from these studies were not entirely consistent, using the buttressing product along the staple line during SG appeared to reduce the incidence of staple line bleeding; its efficacy on leakage has not been clearly demonstrated [ 4, 11, 15, 16]. However, these buttressing products are not commercially available in Korea yet. glass of skimmed milk (add 1-2 tsp of skimmed milk powder) or high protein shake or high protein yoghurt or low fat custard or low fat yoghurt Suitable fluids: When applied to posts that meet the requirements of BS8417:2012 - UC4 (Use Class 4). See guarantee for details Kraljević M, Cordasco V, Schneider R, et al. Long-term effects of laparoscopic sleeve gastrectomy: What are the results beyond 10 years? Obes Surg. 2021;31(8):3427-3433. doi:10.1007/s11695-021-05437-3 Abou Rached A, Basile M, El Masri H. Gastric leaks post sleeve gastrectomy: review of its prevention and management. World J Gastroenterol. 2014;20(38):13904-13910. doi:10.3748/wjg.v20.i38.13904

Sleeve gastrectomy can provide long-term weight loss. The amount of weight you lose depends on your change in lifestyle habits. It is possible to lose approximately 60%, or even more, of your excess weight within two years.

Now is a good time to plan ahead for your recovery after surgery. For instance, arrange for help at home if you think you'll need it. What you can expect Always prioritise protein rich fluids over others such as tea, coffee etc. Begin with sipping your drinks little and often and gradually increase the quantity until the sensation of feeling full occurs. It is important to stop as soon as you feel full. If you drink too much, your stomach may overfill and cause pain, nausea and vomiting. Which liquids are suitable? Levy JL, Levine MS, Rubesin SE, Williams NN, Dumon KR. Stenosis of gastric sleeve after laparoscopic sleeve gastrectomy: clinical, radiographic and endoscopic findings. Br J Radiol. 2018;91(1089):20170702. doi:10.1259/bjr.20170702

Endoscopic internal drainage (EID) with double-pigtail stents is another method to treat sleeve leaks. The stent keeps the fistula tract open and facilitates drainage of the abscess in the gastric lumen, which eventually leads to the collapse of the abscess cavity and the closure of the leak. It can be used for well-contained leaks and usually requires a nasojejunal feeding tube for enteral feeding for a couple of weeks. EID with endoscopic pigtail stents showed a success rate of up to 95% at relatively lower costs and fewer complications than SEMS, as well as minimal discomfort for the patients [ 39, 40, 41]. Therefore, it is rapidly gaining popularity as a therapeutic modality for leaks among bariatric experts.

Right before your procedure, you may have restrictions on eating and drinking and which medications you can take. It is important to complete this stage as your stomach pouch will be very small and tight at first. Puree foods are smooth and can pass through your stomach easily. You will need to use a blender, liquidiser or food processor to puree your food to the correct consistency. Aim for a smooth consistency like ‘yoghurt’. It's important to keep all of your scheduled follow-up appointments after weight-loss surgery so that your doctor can monitor your progress. If you notice that you aren't losing weight or you develop complications after your surgery, see your doctor immediately. Clinical trials

Al-Sanea O, Al-Garzaie A, Dernaika M, Haddad J. Rare complication post sleeve gastrectomy: Acute irreducible paraesophageal hernia. Int J Surg Case Rep. 2015;8C:88-91. doi:10.1016/j.ijscr.2015.01.040 Remember to space your vitamins and minerals across the day, as taking them all together will affect how well you absorb them. You will need to take your calcium supplement separately from your multivitamins and minerals and iron. As SG has become the most popular standalone bariatric procedure, surgeons need to be more aware of and prepared for possible postoperative complications. The overall incidence of postoperative complications was not very high. However, relatively common complications reported in the literature were postoperative bleeding, leakage, sleeve stenosis, and gastroesophageal reflux. There were also relatively rare but fatal complications like portomesenteric vein thrombosis (PMVTs). These complications may lead to unfavorable outcomes, ranging from prolonged hospital stays and deterioration in the quality of life to mortality. Therefore, it is critical to adequately assess patients when complications occur and to provide timely management. Arndtz K, Steed H, Hodson J, Manjunath S. The hidden endoscopic burden of sleeve gastrectomy and its comparison with Roux-en-Y gastric bypass. Ann Gastroenterol. 2016;29(1):44-9.

Sleeve gastrectomy

Cameron AM, et al. Management of morbid obesity. In: Current Surgical Therapy. 13th ed. Elsevier; 2020. https://www.clinicalkey.com. Accessed June 8, 2020. Ramadan M, Loureiro M, Laughlan K, et al. Risk of dumping syndrome after sleeve gastrectomy and Roux-en-Y gastric bypass: early results of a multicentre prospective study. Gastroenterol Res Pract. 2016;2570237. doi:10.1155/2016/2570237 Kellerman RD, et al. Obesity. In: Conn's Current Therapy 2020. Elsevier; 2020. https://www.clinicalkey.com. Accessed June 8, 2020. Another method involves the application of fibrin sealants. A recent meta-analysis including 2,136 SG patients from nine randomized controlled trials showed that there was a tendency toward less bleeding with fibrin sealant application compared to no reinforcement [ 8]. However, the hemostatic role of sealants was not evident in that meta-analysis of trials with larger samples [ 17]. It is still not clear whether applying fibrin sealant alone could reduce the incidence of postoperative bleeding. When surgical exploration was performed on leak patients in the earlier period, the goal of surgical management was not a definitive repair of the leak but to wash out and remove the necrotic debris and to place proper drains. A simple primary repair might be attempted in acute leaks within three days after surgery when promptly diagnosed [ 30]. Nonetheless, it is usually less successful, with a high incidence of recurrence owing to extensive inflammation in the surrounding tissue. In the latter phase, when non-surgical management fails after three to six months, surgery can be used as a step-up or salvage therapy. This includes conversion to RYGB and fistulojejunostomy.

Any foods that are hard or contain skins, seeds and pips as these will be difficult to mash into a soft consistency Bruze G, Holmin TE, Peltonen M, et al. Associations of bariatric surgery with changes in interpersonal relationship status: Results from 2 Swedish cohort studies. JAMA Surg. 2018;153(7):654–661. doi:10.1001/jamasurg.2018.0215Palermo M, Acquafresca PA, Rogula T, Duza GE, Serra E. Late surgical complications after gastric by-pass: a literature review. Arq Bras Cir Dig. 2015;28(2):139-143. doi:10.1590/S0102-67202015000200014 Lim RB. Bariatric procedures for the management of severe obesity: Descriptions. https://www.uptodate.com/contents/search. Accessed June 8, 2020. The day after your surgery, your surgical team will tell you when it is safe for you to begin to sip fluids. A member of the dietetic team will see you before you go home to discuss the post-operative diet and answer any questions you may have. Stage 1 – only smooth liquids for 2 weeks Sillén L, Andersson E, Olbers T, Edholm D. Obstruction after sleeve gastrectomy, prevalence, and interventions: a cohort study of 9,726 patients with data from the scandinavian obesity surgery registry (SOReg). Obes Surg. 2021;31(11):4701-4707. doi:10.1007/s11695-021-05574-9