Gastric sleeve in Turkey: indications, risks and the follow-up to plan for

How does a gastric sleeve work?

Longitudinal gastrectomy, known as the sleeve, consists of removing a large part of the stomach in order to leave a narrower gastric tube. It is usually carried out under general anaesthetic by laparoscopy. The intestinal route is not diverted as it is in a bypass, but the operation permanently changes the anatomy and the physiology of your digestive system.

Reducing the volume makes it easier to feel full sooner. The operation also acts on hormonal mechanisms that take part in the regulation of appetite. It cannot therefore be reduced to a device that would mechanically prevent you from eating. The American Society for Metabolic and Bariatric Surgery describes these principles as well as the fact that the removal of part of the stomach cannot be reversed.

The sleeve is not the same thing as endoscopic sleeve gastroplasty, which is sometimes called an endoscopic sleeve. The latter uses internal sutures without removing the same portion of the stomach. The indications, the results and the risks are not identical. Check the exact name of the operation being proposed, because a similar-sounding label does not allow you to compare two quotations properly.

Surgery treats a chronic condition. Its value is judged on weight, on associated conditions, on how comfortably you function and on your quality of life. The guide to bariatric surgery sets out the general framework for the decision and the other approaches available when the sleeve is not the most suitable option.

Does a surgical indication apply to you?

In France, the 2024 HAS recommendations set out in particular a BMI of at least 40 kg/m², or of 35 to under 40 kg/m² with a severe coexisting condition that is likely to improve. The decision remains one taken jointly by a team, after medical treatment has been properly conducted and after a documented multidisciplinary preparation. The BMI figure does not, on its own, amount to authorisation to operate.

Metabolic surgery can also be discussed for some cases of type 2 diabetes with a BMI of 30 to under 35 kg/m², where blood sugar targets are still not being reached despite suitable management for at least 12 months. This situation calls for specialist selection. It does not mean that a sleeve would be indicated for everyone whose BMI falls within that range.

The French recommendations do not automatically describe the criteria applied in another country. If an operation is offered to you abroad when it has been ruled out in your own country, ask for a precise medical explanation of that difference. Faster access, or criteria presented as more flexible, is no substitute for an analysis of the expected benefit and of the risk.

The team examines your associated conditions, your treatments, the history of your weight and the difficulties you have had with previous care. Some problems have to be treated before the operation; others may change the choice of technique. The aim is not to prove that you are sufficiently determined, but to build a medical plan that can actually be carried out and to reduce the obstacles to follow-up.

Why reflux matters particularly in the choice

The sleeve can bring on or worsen gastro-oesophageal reflux. Report any burning, acid coming back up, night-time coughing, difficulty swallowing and any antacid treatments you take. Digestive investigations before the operation help to decide whether this technique is suitable or whether another procedure deserves to be preferred.

The randomised SLEEVEPASS trial, with follow-up at ten years, found more oesophagitis after a sleeve than after a Roux-en-Y bypass. Both operations led to lasting weight loss in the population studied, with differences in results and in complications. These data show how important a personalised comparison is, rather than a universal ranking of the operations.

Significant reflux should not be played down on the grounds that your weight will come down. You need to discuss how it might develop, the medicines involved, the monitoring required and the situations in which a further operation could become necessary. Ask as well how the investigation will be organised if the symptoms appear once you are back home.

The comparison between a sleeve and a bypass also rests on diabetes, on your treatments, on your medical history and on your eating habits. An initial preference may change after the assessment. The technique has to be chosen on the basis of your own case, and not simply because it is the one you have heard of or the one included in a package.

The pre-operative pathway is not limited to tests on site

Preparation brings together several professionals: a doctor specialising in obesity, a surgeon, a dietitian, a mental health professional and an anaesthetist, depending on the pathway. In France, the HAS recommends multidisciplinary pre-operative management lasting at least six months. It makes it possible to identify deficiencies, conditions that are insufficiently controlled, and the dietary or psychological difficulties that need support. A series of tests carried out just before the operation is no substitute for that work over time.

In France, the Assurance Maladie sets out the place of medical follow-up, of medicines and of surgery in the management of obesity. Your plan has to take in the alternatives you have already tried and those that could still be relevant. Surgery can be appropriate without being the only solution that could be considered in every situation.

The assessment looks in particular for risk factors linked to anaesthesia and for sleep-related breathing disorders. If you use a ventilation device at night, ask how it will be managed during your hospital stay. Report any history of a blood clot in the leg or in the lungs, any smoking, and all your medicines, including injectable treatments for obesity or for diabetes.

Psychological support serves to explore your expectations, your relationship with food and the support available to you. Psychological distress deserves suitable care and should not be reduced to an administrative formality. You need to understand the changes ahead and to be able to ask for help if restricting what you eat, or the change in your body, becomes hard to live with.

Before you book, clarify who coordinates your case in your own country and who will take over after the operation. A doctor may agree to take part in follow-up without having all the necessary skills on their own. Specialist consultations, blood tests and access to a surgical team if a problem arises therefore have to be planned in concrete terms.

Hospital stay and journey home: a timetable guided by your condition

The operation is followed by monitoring of pain, of breathing, of hydration and of any signs of a complication. Getting you moving again and preventing blood clots are part of your care. The length of the hospital stay depends on how you progress and on the protocol; it should not be promised as a fixed period independent of your health.

Fluids and then food are restarted according to the team’s instructions. The criteria for discharge include being able to drink enough and having no problem that requires monitoring in hospital. Being discharged does not mean that healing is complete or that any complication is now ruled out.

The flight home deserves a decision taken case by case. Recent surgery, reduced mobility, the length of the journey and your medical history all influence the risk of a blood clot. Ask when you can travel and what precautions to take, rather than deciding on your own about an anticoagulant injection or about stopping a treatment. A ticket you can change, and some flexibility in your accommodation, can avoid unnecessary pressure on the medical timetable.

Before you leave, collect the operation report, the relevant results, the prescriptions and the team’s contact details. Have the exact name of the operation and the course it took set out clearly. These documents need to be understandable for the professionals you consult afterwards, so that you can be treated quickly if that becomes necessary.

Eating and drinking after a sleeve

The progression through textures is organised by the team according to how well you tolerate food and how you are healing. It usually goes through suitable stages before a return to a more varied diet, and no timetable found online applies to everyone. Repeated vomiting or an inability to drink should not be read as simply an unavoidable stage.

The practical advice covers small amounts at a time, careful chewing and a slow pace. Your protein intake and your hydration have to be monitored with the dietitian. The UCLH guide to life after a sleeve or a bypass illustrates these day-to-day adjustments and the need to follow the instructions given along the pathway.

Your diet has to become varied enough again over time. Avoiding many categories of food for a long period, out of fear of symptoms, can lead to an inadequate intake. If certain foods are hard to get down, describe their texture, the quantity and the sensations you notice when you attend your appointment, so that an adjustment can be found or a medical problem treated.

Drinking regularly in small amounts can make hydration easier. The daily target is set individually, particularly if a heart or kidney condition imposes restrictions. A marked drop in how much urine you pass, dizziness or unusual tiredness should be reported. Suddenly forcing down large volumes is not the right answer to persistently poor tolerance.

Hunger, fullness and the emotions attached to food may each change in different ways. Snacking, difficulty with meals or a craving for very high-calorie drinks should be something you can discuss without judgement. Nutritional support helps you find solutions that fit with your work, your budget and your family life.

Vitamins, medicines and long-term follow-up

A sleeve does not rule out nutritional deficiencies, even though there is no intestinal diversion. The quantity you eat, how well you tolerate food and certain digestive changes can all reduce your intake. The BOMSS nutritional guidance provides for blood monitoring and supplementation adapted to the operation performed and to the results obtained.

Do not replace a prescription with a general supplement chosen only on price. The doses, the forms and the combinations answer specific needs. Conversely, piling up supplements without any blood tests can lead to excesses or to interactions. Repeat prescriptions and what they cost have to be built into the plan from the start.

Weight loss can change what you need in the way of treatment for diabetes or for high blood pressure. Some medicines call for particular monitoring after surgery, and their form may have to be adapted. BOMSS sets out these questions about medication in detail; any change is decided with the prescriber, without waiting only for the next surgical check-up.

Follow-up also covers reflux, muscle mass, bone health, your state of mind and any plans for a pregnancy. Adapted physical activity supports your recovery and develops gradually. Keeping up lifelong follow-up remains necessary even when your weight appears stable and you feel well.

Which complications should you know about?

Early complications

The possible complications include bleeding, a leak along the staple line, an infection and a thromboembolic event. A leak can show itself after you have been discharged and may require specialist care, sometimes over a long period. An operation that appeared to go without difficulty therefore does not remove the need to watch for symptoms.

The NHS describes in particular the risks of a digestive leak and of a blood clot after surgery for obesity. Severe or increasing abdominal pain, a fever, an abnormally fast heartbeat, breathlessness or chest pain all warrant urgent assessment. Tell the healthcare staff that you have recently had a sleeve, even if the pain seems to be far from the incisions.

Persistent vomiting, being unable to keep fluids down, bleeding or feeling faint also call for prompt advice. In France, call 15 or 112 if your condition is worrying, rather than waiting for a reply from the clinic abroad. Messaging can pass on information, but it should not delay an examination that is needed.

Later problems

Persistent reflux, a narrowing of the gastric tube, difficulties with eating or deficiencies can appear some time later. Rapid weight loss can also encourage gallstones. What to do depends on the diagnosis; going back on medication or radically changing your diet without an assessment risks masking the cause.

The absence of pain is not enough to confirm that your nutritional state is good. Some deficits are picked up by blood tests before they cause obvious symptoms. Conversely, tiredness, muscle weakness, pins and needles or significant hair loss deserve to be discussed, without automatically putting these signs down to the weight loss you were expecting. Balance problems or confusion combined with prolonged vomiting can suggest a vitamin B1 deficiency and call for urgent assessment.

Weight loss, stabilisation and possible regain

Weight loss varies according to your starting weight, your health, the operation and the way follow-up develops. Studies may express it as a percentage of total weight or of excess weight, which are two different measures. Before you interpret a figure, ask for its definition, the period over which it was observed and the population concerned. No average percentage can guarantee the course you will take.

Stabilisation is part of the pathway. Weight can come back on, and that deserves a medical, nutritional and sometimes anatomical analysis. It is not necessarily linked to a lack of effort. Treatments for obesity can be readjusted according to the context, without reducing the options to another operation.

Converting to a different procedure may be discussed for certain complications or where the response has been insufficient. It requires a specific assessment and carries its own risks. Ask first which problem it is trying to solve and which alternatives exist. The file from the original sleeve is particularly useful at that point.

Excess skin can remain once you have lost weight. Reconstructive surgery is neither automatic nor urgent; it is discussed according to the discomfort involved, the stability of your weight and your nutritional state. The first goals remain your health, your recovery and adapting to an adequate diet, before any additional plan is considered.

The price of a sleeve in Turkey: working out the full cost

The quotation has to set out the fees, the anaesthesia, the hospital stay, the investigations, the medicines and the check-ups. A first sleeve and a revision operation are not the same procedure. Check as well whether a specialist consultation or an investigation requested after your file has been reviewed changes the initial amount.

Travel expenses come on top of the care: flights, accommodation, someone to come with you, transfers and a possible extension. Follow-up once you are home, blood tests and supplements also represent lasting costs. The costs linked to a complication or to an unplanned hospital stay have to be clarified in writing; a follow-up package does not mean that all of those expenses are covered.

Whether your insurer or, in France, the Assurance Maladie will cover any of this has to be checked before the operation for your particular situation. Do not assume that an indication recognised in France means that treatment abroad will be reimbursed. Ask for a written answer about planned treatment, about possible complications and about the exclusions in your travel policy.

Without a current and detailed quotation, advertised amounts do not allow a reliable comparison. A low price does not prove that the care is poor, any more than a high price proves that it is good. Your medical file, the facilities available, the team’s experience and the continuity of care are criteria to examine independently of the price.

Preparing a decision and a follow-up plan you can keep to

Before you commit to anything, you should be able to explain why the sleeve was chosen, which alternatives were discussed and who will provide your follow-up. The surgeon and the hospital should be identified. Ask how to obtain an opinion if a complication arises, both on site and after you get home, and which documents will be sent to the healthcare professionals in your own country.

Take the time as well to assess how your daily life is organised: how available you are for appointments, your access to blood tests, the support of the people around you and your scope for adapting meals to your working day. Follow-up that exists on paper but is hard to carry out has to be reorganised before the operation. This preparation is part of the treatment, just as much as the choice of technique.

The guide devoted to life after a gastric sleeve goes into the dietary changes and the follow-up in more depth. You can use it to prepare your questions, then build an individual pathway with the team. A well-informed decision always keeps open the possibility of postponing the operation when essential points remain to be clarified.

Sources

1. Haute Autorité de Santé. (2024). Obésité de l’adulte : prise en charge de 2e et 3e niveaux. Partie II : pré et post chirurgie bariatrique. https://www.has-sante.fr/upload/docs/application/pdf/2024-02/reco369_recommandations_obesite_2e_3e_niveaux_ii_cd_2024_02_08_preparation_mel.pdf
2. American Society for Metabolic and Bariatric Surgery. (s. d.). Sleeve gastrectomy. https://asmbs.org/condition_procedures/sleeve-gastrectomy/
3. Assurance Maladie. (2026, 12 juin). Obésité de l’adulte : suivi, médicaments et chirurgie. https://www.ameli.fr/assure/sante/themes/surpoids-obesite-adulte/traitement-medicamenteux-chirurgical
4. Salminen, P., Grönroos, S., Helmiö, M., Hurme, S., Juuti, A., Juusela, R., Peromaa-Haavisto, P., Leivonen, M., Nuutila, P., & Ovaska, J. (2022). Effect of laparoscopic sleeve gastrectomy vs Roux-en-Y gastric bypass on weight loss, comorbidities, and reflux at 10 years in adult patients with obesity: The SLEEVEPASS randomized clinical trial. JAMA Surgery, 157(8), 656–666. https://doi.org/10.1001/jamasurg.2022.2229
5. British Obesity and Metabolic Surgery Society. (2023). BOMSS post-bariatric surgery nutritional guidance for GPs. https://bomss.org/bomss-post-bariatric-surgery-nutritional-guidance-for-gps/
6. British Obesity and Metabolic Surgery Society. (2023). BOMSS guidance on medications post-bariatric surgery for GPs. https://bomss.org/bomss-guidance-on-medications-post-bariatric-surgery-for-gps/
7. National Health Service. (2024, 5 février). Complications of weight loss surgery. https://www.nhs.uk/tests-and-treatments/weight-loss-surgery/complications/
8. University College London Hospitals NHS Foundation Trust. (s. d.). Life after a gastric bypass/sleeve gastrectomy. https://www.uclh.nhs.uk/patients-and-visitors/patient-information-pages/life-after-gastric-bypasssleeve-gastrectomy