The routine approach is to evaluate the patients in the preoperative period and to take possible precautions by determining the risks. All patients should be examined in detail during the process of planning the surgery. The main purpose is to detect and treat possible deficiencies and diseases before the operation, and, if necessary, postpone the surgery.

The assessments that have to be done for this purpose, are; evaluation of the lung (such as chest X-ray, pulmonary function tests, consultation from a pulmonologist), assessment of the heart (ECG, ECHO, cardiology consultation, and further examinations like stress ECG, Holter, or angiography if necessary), psychiatric evaluations (questioning the history of drug use, substance abuse, presence of psychiatric disease, and psychiatric consultation), surgical tests (abdominopelvic ultrasonography, doppler ultrasonography, history of previous abdominal surgeries), internal medicine (non-surgical) evaluations (existence of other diseases and treatments being used, internal medicine consultation, etc.), endoscopic exploration (visual assessment of the esophagus, stomach, and small intestine with endoscopy), laboratory tests (blood work, assessment of liver functions, kidney functions, and establishing the bleeding time).

The medications used by the patients should also be taken into account (such as blood thinners, antihypertensive and antidiabetic drugs, and psychiatric drugs). During the operation, some drugs should be discontinued or replaced with other medications, and re-continued after the surgery, as soon as possible.

In the presence of additional comorbidities (like previous operations, heart attack, lung infections, neurological and psychiatric diseases, hypertension, diabetes, and obstructive sleep apnea syndrome), the patient should be checked in the relevant department, and the evaluations and suggestions of the specialist there should be taken into account.

The medications used by the patient must be evaluated, and their use, dosage, or discontinuation in pre-and post-operative time should be planned.

High-risk patients must be hospitalized and treated before the operation.

Patients who have undergone surgery are evaluated by the anesthesia team and if allowed, taken up their rooms for further follow-up after waking up. There is no need for the patient to be followed in the intensive care unit after the surg ery (except for special cases such as sleep-apnea). 6 hours after the operation, the patient can start to drink water in a controlled manner, while the patient stands up and takes mini walks. One day after the operation, the patient’s walking frequency is increased and the patient is supported with breathing exercises. Consumption of liquid foods (such as seedless soup, compote) is started in a controlled manner following the gas discharge. The drain is removed during this process. In order to observe the clinical situation and to catch possible complications, the patient stays in the hospital for a total of 3 nights and is discharged on the 4th day.

Before discharge, all details of nutrition are explained to the patient and their relatives, under the control of a dietitian, and the drugs that the patient will use and the points to be considered are explained in detail.

Postoperative diet and nutrition are explained under the control of a dietitian. Questions such as what should be eaten in the early process, at what speed and interval should it be consumed, what should not be eaten are answered.

Patients are given a 1-month diet program to follow. The main purpose here is not to weaken the patient quickly, but to ensure the safe healing of the surgical field and not to endanger the safety of the suture line with excessive-incorrect consumption.

From the first month, nutrition returns to normal in terms of consistency. In order to ensure a healthy life and controlled weight loss, foods that should not be consumed are explained in detail and the patient’s adaptation process and weight loss are monitored monthly.

The drugs that should be used in the first month after the surgery are stomach protectors, multivitamins and pain relievers if needed. These drugs are released in a controlled manner after the first month.

The drugs used in the pre-operative period are started again. In the case of regression of some weakening-related diseases (such as hypertension, hypercholesterolemia), the drugs used are left in a controlled manner in line with the knowledge and recommendation of the relevant physician.

Although every surgical intervention has some complications and risks, there are complications and risks specific to each surgery. What scientifically important is the occurrence and treatability of these complications.

Complications that can be seen in laparoscopic metabolic surgery are; bleeding through surgical incisions, wound problems (such as surgical site infections, and poor wound healing), specific complications (like surgical site bleeding, and leaks after the disruption of the site’s integrity), positional complications of the structural integrity of the stomach (strictures throughout the passage, twisting of the stomach around itself (torsion), etc.), post-surgical complications unrelated to the surgical site (such as lung infections, urinary tract infections, heart problems), long-term complications (weight loss faster or slower than expected, ineffective/inactive weight loss or weight gain, vitamin and mineral deficiencies).

The incidence of these complications ranges from one percent to 1 in 10 thousand to even 1 in 100 thousand. At this point, what’s important is the early diagnosis of preventable complications and the application of appropriate treatment when they occur. Likewise, identification of the causes that increase the risk of complications even before the surgery (such as the presence of other diseases, smoking, alcohol, other factors affecting wound healing, or other diseases that may increase the adverse side effects of anesthesia) and if necessary removing these risk factors first, reduces the prevalence of the complications considerably. Similarly, precautions for postoperative complications can be taken (such as early mobilization, respiratory muscle training, strict aftercare and follow-up, and early initiation of appropriate medical treatment) to ensure the process is completed without any problems.

Another important point in the postoperative period is the early detection and appropriate treatment of undesirable complications. The fact that “Early diagnosis saves lives”, which is always said in diseases such as cancer, is valid for every aspect of medicine, especially in surgical complications. Unfortunately, failure to diagnose a complication at an early stage that can be brought under control with appropriate treatment can cause the situation to worsen and may become uncontrollable and untreatable. Therefore, it is important to inform and check in with the patients at every step and to follow up with the patient closely after the surgery. It should never be forgotten that the experience and knowledge of the surgical team is the most important component in the management of surgical complications.