Preoperative Period

Obesity is a condition that physically and psychologically exhausts a person, directly affecting health and greatly reducing quality of life. Today, sleeve gastrectomy (gastric sleeve) has become an important treatment option for achieving permanent weight loss and controlling obesity-related comorbidities. However, there are many preparations that must be made before this surgery. These preparations are extremely important to increase the success of the surgery and minimize potential risks. 

Why Is a Preoperative Diet Necessary?

You can think of the preoperative diet for sleeve gastrectomy like the training you do before a football match. The body, much like an athlete preparing to perform at a high level on the field, needs to prepare for this major operation. So why is this diet so important? 

Reducing Liver Size: In obesity, the liver is generally fatty and enlarged, which can make it more difficult for the surgeon to reach the stomach during the operation. A preoperative low-calorie, low-carbohydrate diet helps reduce the percentage of fat in the liver, thereby shrinking liver size. This allows the surgeon easier access to the relevant parts of the stomach during surgery. 

Preparing the Body for the Operation: Sleeve gastrectomy is an operation that involves anesthesia and a surgical intervention. With the preoperative diet, the body can gradually lose weight and prepare the circulatory system and metabolism for this process. Reducing fat in blood vessels and around organs contributes to performing the surgery more safely. 

Lowering Surgical Risks: By shrinking the liver and making the body generally lighter, the potential risks that might occur during the operation, such as bleeding or organ injury, can be reduced. Likewise, when the excessive fatty tissue in the chest and abdomen decreases, the surgery may be shorter and complication risks may diminish.

Acclimating to Postoperative Nutrition: Dietary habits change completely after sleeve gastrectomy. Applying a diet before the operation makes it much easier to adapt to future eating and drinking habits and learn portion control. As a result, possible difficulties that might arise post-surgery diminish.

In brief, you can think of the preoperative diet as preparing and adjusting the stage lights before a theater performance. If the stage is well-prepared, the play (i.e., the surgery) will go more smoothly and successfully.

How Long Should This Diet Be Followed?

Many people wonder, “Exactly how many days or weeks should this diet last?” The duration can vary depending on the patient’s overall health status, Body Mass Index (BMI), and any comorbidities (for example, diabetes, hypertension, or sleep apnea). In general, it can be said that the recommended duration is between 1 and 3 weeks.

The goal is to achieve maximum benefit in the shortest time. Diets that last too long can both psychologically challenge the patient and cause unnecessary strain. Conversely, diets that are too short may not reduce liver size sufficiently. Therefore, a period of about 2–3 weeks is known to be particularly effective in reducing liver volume.

Which Foods and Beverages Should Be Avoided?

During this period, the focus of the dietary plan is on shrinking the liver and easing the body’s burden. Hence, the fundamental principle of the diet can be summarized as “high protein, low carbohydrate, and low fat.” So what should be taken into consideration?

• Sugary Foods: Desserts like baklava, chocolate, sugary soft drinks, and fruit-based sweets hinder liver recovery. It’s crucial to avoid sugary foods during this period.
• White Bread and Pastries: Traditional pastries, börek, pasta, and white rice—foods made with refined carbohydrates—can quickly raise blood sugar levels and contribute to liver fat accumulation.
• Excessively Fatty Foods: Fried foods, mayonnaise, creamy sauces, and full-fat cheeses can further burden the liver. These should be avoided.
• Alcohol: Alcohol is one of the biggest enemies of the liver and is definitely not recommended before surgery. Alcohol can be considered “empty calories” and increases liver fat.
• Carbonated and Caffeinated Drinks: Carbonated beverages are high in sugar and can cause gas in the stomach and intestines, potentially leading to undesirable situations during surgery. High caffeine intake can dehydrate the body.

During this period, it’s important to focus on high-protein foods (for example, lean meat, fish, chicken, eggs, low-fat dairy products) and fiber-rich vegetables (broccoli, cauliflower, zucchini, leafy greens). Cooking vegetables by steaming or grilling can be healthier. Additionally, maintaining a balanced water intake is also crucial; taking in sufficient fluids without overdoing it helps protect the kidneys and facilitates the elimination of metabolic waste.

Why Is Quitting Smoking So Important?

Those who smoke may often wonder, “What does this have to do with anything? I’m just trying to lose weight.” However, the negative effects of smoking on the body directly appear in both the pre- and postoperative stages.

Slower Wound Healing: Nicotine and other harmful substances in cigarette smoke cause blood vessels to constrict, reducing the amount of oxygen delivered to tissues. This can slow wound healing after surgery and increase the risk of infection.

Lung and Respiratory Functions: Ensuring the lungs function properly is crucial during and after anesthesia. Smoking reduces lung capacity, leading to respiratory complications. Lung infections that commonly appear post-surgery are harder to overcome in smokers.

Cardiovascular Risk: Smoking adversely affects the heart and vascular system, triggering blood pressure issues. This can lead to serious cardiovascular risks during or after surgery.

Therefore, smoking can be imagined as a “fog” over the operation. The heavier the smoking, the cloudier the setting! Clearing away this fog before surgery has a large positive impact on the course of the operation. Ideally, quitting smoking at least 2 weeks before surgery is recommended, giving the body time to recover and improve its oxygen-carrying capacity.

Which Medical Evaluations Are Done Before Surgery?

Sleeve gastrectomy is not a simple weight loss procedure but an intervention aimed at changing the body’s metabolic and anatomical system. Therefore, various medical tests and examinations form the basis of the surgical plan.

• Comprehensive Blood Tests: Complete blood count (hemoglobin, white blood cells, etc.), liver and kidney function tests, blood sugar level, blood lipids (cholesterol, triglycerides), thyroid tests, and vitamin-mineral levels. These are important for assessing surgical risk and balancing any deficiencies or excesses.
• Cardiovascular Evaluation: An ECG (electrocardiogram) and, if necessary, an echocardiogram may be performed. Particularly in obesity, there is an added strain on the heart. Potential risks for arrhythmias, valvular heart disease, or coronary artery disease are evaluated.
• Pulmonary Tests: A chest X-ray and pulmonary function tests help anticipate respiratory problems that may arise during and after surgery. If sleep apnea is suspected, a sleep study (polysomnography) might be required.
• Gastrointestinal Evaluation: An upper endoscopy (gastroscopy) is recommended by many centers. This identifies the condition of the stomach, the presence of any ulcers, or reflux issues.
• Psychological Evaluation: As lifestyle will drastically change after bariatric surgery, the person’s mental readiness for this process is assessed. If there is a history of eating disorders, depression, or significant anxiety disorders, early intervention is necessary.

These tests and assessments work like a “control station” for the body, identifying any issues or deficiencies. While preparing for surgery, it is as important to ensure the body and mind are truly “ready” as it is to lose weight quickly.

How Should Medications Be Managed? 

Many people use medication regularly due to chronic conditions: diabetes, hypertension, heart disease, blood thinners, or depression medications, among others. How these medications are managed during the preoperative period is a common concern.

• Hypertension Medications: High blood pressure medications are generally continued up to the day of surgery, but some may be discontinued on the morning of the procedure. Your doctor’s advice will guide you here.
• Diabetes Medications and Insulin: Controlling blood sugar is crucial. For example, oral antidiabetic drugs may not be taken on the morning of surgery or their doses may be reduced. Special adjustments can be made for insulin.
• Blood Thinners: Drugs such as aspirin, warfarin, and direct oral anticoagulants (DOACs) can increase the risk of bleeding during surgery. They might be discontinued for a certain period before surgery or “bridged” with low molecular weight heparin (LMWH).
• Psychiatric Medications: Antidepressants and anxiolytics are generally not discontinued; if discontinuation is necessary, it must be done gradually. Some drugs may interact with anesthesia, so the doctor may adjust them accordingly.
• Herbal and Vitamin Supplements: Particularly herbal products with blood-thinning effects (such as garlic, ginkgo biloba, or green tea extract) and high-dose vitamin supplements should not be used before surgery. These supplements are usually stopped 1–2 weeks prior.

The key point here is that any medications you regularly take should be reported to your doctor or surgical team. Decisions about which medications to stop, continue, or adjust must be personalized.

How Long Should One Fast?

Fasting before surgery is a common protocol in almost all surgical procedures. The aim is to ensure there is no food in the stomach and intestines, reducing the risk of vomiting and aspiration (stomach contents getting into the lungs) while under anesthesia.

• Solid Foods: Usually, no solid food is consumed for 6–8 hours before surgery. Some centers follow an 8-hour rule, others 6 hours.
• Liquids: Water or very clear fluids (such as unsweetened tea, unsweetened and milk-free coffee) are generally allowed until about 2 hours before surgery. However, because each center’s protocol may differ, it’s important to confirm exact timing with your medical team.
• Milk, Fruit Juice: These are not considered clear fluids. Typically, they must be stopped about 6 hours before surgery, much like solid foods. Acidic or concentrated fruit juices may delay gastric emptying.

This fasting period can be viewed as “resting” the stomach and preparing a sterile environment, much like ensuring your car’s fuel tank is empty; the goal is to have the stomach as empty as possible during the surgery.

How to Prepare Mentally Before Surgery?

Sleeve gastrectomy is not just a physical transformation but also a process that rebuilds one’s relationship with food and oneself. Being mentally prepared when going into the operation is crucial for long-term success.

Setting Realistic Goals: Expecting all problems to vanish immediately as if by magic after surgery is not realistic. Although surgery facilitates weight loss, adhering to dietary and lifestyle changes is essential.

Seeking Professional Support: The support of a dietitian and psychologist can be highly beneficial during the transition prompted by surgery. Mental health directly influences eating habits; if there’s a history of an eating disorder, depression, or significant anxiety, early intervention helps prevent potential setbacks.

Family and Social Support: Understanding and support from one’s close circle help maintain motivation. Transitioning to new dietary habits can be challenging at home or at work, and support from family and friends is invaluable after the operation as well.

Becoming Informed About the Process: Learning in detail how surgery is performed, what to expect in the postoperative period, and which diet to follow decreases fear and anxiety. Uncertainty is often the biggest source of anxiety, so obtaining answers to all your questions helps you feel secure.

These can be considered “mental exercises.” Just as we strengthen our muscles with workouts, in the preoperative period we must consciously prepare our minds for this major change, which is crucial for achieving successful and sustainable outcomes.

What Should Be Planned for Postoperative Care?

Sleeve gastrectomy doesn’t end on the operating table; the real process begins right after surgery. Certain arrangements must be made to enable quick recovery, avoid unwanted complications, and ensure permanent weight loss.

• Early Mobilization: Instead of being confined to bed for a prolonged period, it’s recommended to get up and walk around as soon as possible after surgery. This regulates blood circulation and reduces the risk of clots, and short walks help the lungs function better.
• Pain Management: Postoperative pain is possible. Multimodal pain control (using drugs from different classes together) keeps pain to a minimum. Painkillers prescribed by the doctor can be used if needed.
• Dietary Stages: After sleeve gastrectomy, nutrition passes through several stages. First, one starts with a liquid diet, progresses to puréed foods, then soft foods, and finally solid foods. This process helps the stomach adapt to its new size without overstraining. A slow and controlled transition helps stitches heal.
• Vitamin and Mineral Supplementation: In the postoperative period, particularly iron, vitamin B12, vitamin D, and calcium supplements may be recommended. Since the amount of absorptive surface in the stomach and intestines is reduced after a sleeve gastrectomy, preventing deficiencies is important.
• Regular Check-Ups and Follow-Up: In the postoperative period, there will be a series of check-ups. These are important both for monitoring stitches and the general healing process as well as evaluating whether weight loss is proceeding healthily.
• Physical Activity: After the stitches have healed and doctor approval is given, one can begin light exercise. Swimming, walking, or low-intensity cycling are beneficial to prevent muscle loss and regulate the pace of weight loss.
• Psychological Support and Behavioral Change: It should be remembered that returning to “old eating habits” or “relapsing into emotional eating” can greatly diminish the surgery’s effect. Therefore, psychological counseling may be used to support the process if necessary.

The postoperative care process is somewhat like ensuring that the “repaired” system continues to function smoothly. Just as we check a roof for leaks after fixing it, we also need to monitor the body’s adaptation to its new condition.

What Should Be Considered for Long-Term Success?

Sleeve gastrectomy does not place a “magic wand” in one’s hands; it merely provides a powerful tool that facilitates weight loss. Long-term success is possible only with a sustainable lifestyle change after surgery.

• Healthy Eating Habits: Considering the reduced size of the stomach, one must eat meals slowly and chew thoroughly. In the long run, although there may be no completely “forbidden foods,” it is crucial to be conscious of portion sizes and food choices to avoid regaining weight.
• Fluid Intake: Particularly after surgery, water consumption is very important. However, taking in large amounts of fluid with meals can fill the stomach quickly and cause discomfort. Drinking enough water throughout the day (outside of meal times) protects kidney health and aids in the removal of metabolic waste.
• Stress Management: During periods of stress or emotional turmoil, turning to junk food for “relief” can slow weight loss or even cause weight regain. Techniques such as regular walks, meditation, or taking up hobbies may be helpful in managing stress.
• Physical Activity Habits: Embedding an exercise routine into daily life helps preserve muscle mass and maintain a higher metabolic rate. As a small example, 30–45 minutes of brisk walking at least 3 days a week both aids weight loss and benefits heart health.
• Regular Medical Check-Ups: While the frequency of check-ups is higher in the first year, it might become less frequent in subsequent years. Still, it’s not recommended to discontinue them altogether, as it is important to track vitamin-mineral levels, the rate of weight loss, and overall health over time.

In short, the surgery “renews” the stomach, opening the doors to a new, healthier life. However, walking through that door and continuing forward depends closely on one’s willpower and motivation.

What Should Be Done Now for a Healthy Future?

The preoperative period for sleeve gastrectomy—encompassing diet, quitting smoking, medication management, psychological preparation, and detailed medical evaluations—is among the most critical steps that shape the success of the surgery. This process is akin to preparing for a marathon: before the race, you train, watch your nutrition, check your equipment, and mentally motivate yourself. Thus, you increase your chances of successfully finishing the marathon.

Of course, every patient is unique, and what needs to be done before surgery may vary depending on the individual’s comorbidities, general health status, and lifestyle. The information shared here is intended to help you understand the general outline of the preparation process for sleeve gastrectomy. The surgery can only achieve success if there is a good preoperative plan and, after surgery, a sustainable transformation in lifestyle. Patients who take good care of themselves, remain informed, and stay patient typically feel much more satisfied with the results.

Starting a new chapter can sometimes be worrying and sometimes exciting. This journey offers the opportunity for physical and mental reinvention. The preparations made during this period show that this operation is not merely a technical procedure but the first steps in a change that encompasses the entire body, and even the spirit. These steps must be taken correctly and consciously. It should not be forgotten that the goal is not just to lose weight, but to achieve a healthy future with a solid foundation.