Gastric Sleeve Surgery: What You Need to Know
More than one-third of the adult population in the U.S. struggle with obesity. Bariatric surgery has been a blessing for millions of Americans who have struggled to lose weight without success. For those battling morbid obesity, bariatric surgery can be a literal lifesaver.
There are several kinds of bariatric surgery, including sleeve gastrectomy, gastric bypass surgery (Roux-en-Y), and gastric banding. Which surgery is most appropriate will depend on your specific needs, which your bariatric doctor will work with you to assess.
Gastric sleeve surgery (Sleeve gastrectomy) has many advantages, including fast weight loss, minimal recovery time, and a low rate of complications compared to other types of bariatric surgery. Ahead we’ll explore gastrectomy in more detail, including who is a candidate for this type of surgery and how to prepare for the procedure.
When Non-Surgical Weight Loss Attempts Fail
Surgery is usually the last option for people who have tried to lose a significant amount of weight through other methods without success. Some doctors recommend that patients try a medical weight loss program before opting for surgery, which typically involves a combination of supervised diet, nutritional supplements, probiotic supplements, and protein meal replacements.
When all other methods have failed, surgery is usually the next step.
Types of Bariatric Surgery
Bariatric surgeries generally help patients lose weight through restriction or malabsorption (or both).
Restriction limits the amount of food the stomach can hold, which, in turn, limits the number of calories a person can eat.
Malabsorption alters the structure of the digestive tract (by shortening or bypassing the small intestine, for example), which reduces the amount of nutrients the body can absorb.
Gastric sleeve surgery is restrictive, as is gastric banding (“lap band”). Gastric bypass (Roux-en-Y) is both restrictive and malabsorptive. These are the three most common bariatric surgeries. Additional types of weight loss surgery include duodenal switch surgery and biliopancreatic diversion.
Let’s look at gastric sleeve surgery, the focus of this article, in more detail.
Sleeve Gastrectomy (gastric sleeve) is a restrictive surgery in which part of the stomach is separated and removed. The surgery reduces the size of the stomach by an average of 75%, which limits the amount of food a person can eat at any given time. The new, much smaller stomach pouch is shaped like a sleeve or banana.
Gastric sleeve surgery is minimally invasive and is performed laparoscopically, which involves making 4-5 small incisions in the abdomen through which the surgeon sends a camera and very thin surgical tools to perform the surgery. No major incisions are made, reducing recovery time and pain after surgery substantially.
The procedure takes just 60-90 minutes to complete, which helps improve patient safety. The surgery is usually performed at a hospital or bariatric surgery center.
Gastrectomy is not a malabsorption procedure and thus does not cause decreased absorption of nutrients. After gastric sleeve surgery, patients will feel full much faster after eating and experience a decrease in appetite. This is in due to the much smaller size of the stomach, as well as a reduction in the amount of a hunger hormone (ghrelin) the new stomach produces. Having a reduced appetite helps patients exercise better control over their food intake.
After the Surgery
You will likely have some belly pain after the surgery and may need pain and other medications for the first week or two. “ Most patients do not use any pain medication beyond the first two days after surgery” Since the procedure is done laparoscopically, you will generally heal more quickly than with more invasive (open) surgery; however, you will need to reduce your activity post-surgery to allow your body to heal. Patients are walking hours after surgery, and Most can return to work within 5-7 days after Sleeve gastrectomy.
Average weight loss is 2-5 pounds per week, and most patients will lose an average of 70% of their excess weight over time. Importantly, most patients experience resolution of obesity-related health problems, such as joint pain, diabetes, sleep apnea, infertility, and high blood pressure, which can improve the quality of life tremendously.
Eating After Surgery
Your doctor will give you instructions on what you can eat after surgery. You will eat a liquid diet at first, followed by a period of pureed/soft foods only, and, over time, solid foods can be reintroduced little by little. most patients are able to eat normal soft diet four weeks after surgery.
It’s important to sip water throughout the day to avoid dehydration and to eat food slowly and chew food thoroughly, since eating too fast can cause nausea and vomiting. Dumping syndrome, which occurs when food empties too quickly into the intestine is very rare after Sleeve Gastrectomy, While it is Common after Gastric Bypass surgery. Dumping syndrome can make you feel nauseated, faint, and shaky, and you may have diarrhea. It can happen soon after you eat (early phase) or 1-3 hours after you eat (late phase). Avoiding sugar and other sweets, alcohol, and dairy products can help prevent dumping syndrome.
Avoid Drinking Your Calories
It is possible to stretch the new stomach pouch by overeating, and consuming a lot of sugary beverages or fruit juices can halt weight loss. Working with your doctor and/or a dietician to develop a balanced nutrition plan with the right amounts of protein, vitamins, and minerals will be essential for success. You will likely need to take vitamin and mineral supplements, since you may not be able to get everything you need from food after surgery.
Advantages of Gastric Sleeve Surgery
Gastrectomy has become one of the most popular weight-loss surgeries, and for good reason. Advantages of the surgery include:
Minimally-invasive, with tiny incisions
Short hospital stay and fast recovery
Effective weight loss results; patients lose an average of 70% of their excess weight in 6-12 months
Decreased appetite from the reduction in hunger hormone (ghrelin)
Low rate of complications compared to other bariatric surgeries
No foreign body (e.g., gastric band) to worry about that might cause problems
Low risk for nutritional deficiencies
High rate of resolution of obesity-related medical problems (e.g., diabetes)
Complications of Gastric Sleeve Surgery
As with any bariatric surgery, there are several risks with gastrectomy, including infection at the incision site, leaking from the stomach into the abdominal cavity that can lead to an infection called peritonitis, and blood clots in the lungs. Some people will develop gallstones, anemia, or osteoporosis, and nutrition deficiency is possible (though not as common as with other bariatric surgeries).
Your doctor can help you better understand all of the risks and possible complications associated with gastric sleeve surgery.
It is important to know that in good candidates those risks are very limited, and are way less than the health risks of morbid obesity, choosing a well trained, experienced surgeon, and program, and researching into their credentials, and the surgery, are keys to understand and make a good decision.
Who Is a Candidate for Gastrectomy?
Weight-loss surgery is a serious decision. All bariatric surgeries are life-altering, limiting the amount and kinds of food you can eat. Some questions to ask before you commit to surgery:
Have you made sincere attempts to lose weight in other ways?
Are you fully committed to making the serious lifestyle changes that will be required after surgery?
Are your expectations realistic?
Are you committed to seeing your doctor and/or a dietician regularly?
Are you prepared for the possibility of additional surgeries down the line, including necessary procedures to address complications or excess skin removal surgery?
Generally, individuals with a BMI of 40 or greater, or those with a BMI of 35 plus a serious coexisting condition, such as diabetes, are candidates for gastric sleeve surgery. Your weight loss doctor will take your complete medical history to determine whether surgery is an option for you.
Preparing for Gastric Sleeve Surgery
Once you’ve discussed all options with your doctor, weighed the risks, and decided you’re ready to move forward with gastric sleeve surgery, you’ll need to do the following:
Change your diet. Gastric sleeve surgery is a serious, permanent procedure. It’s important to prepare the body for this new lifestyle. Two to three weeks before (check with your doctor), you’ll need to start an all-liquid diet, which will shrink the liver and make surgery safer.
Quit smoking. Smoking can make it more difficult for your body to heal, Increase the possibility of complications, and increase your recovery time. Your doctor could even refuse to perform the surgery if you do not quit smoking at least a month before your surgery. Quitting smoking can only benefit your health, in any case.
Shop for food in advance: Make sure your home is well-stocked with items like clear broths, skim milk, sugar-free Jello, and protein drinks before the surgery. Getting enough protein is important, and it’s even more challenging to get enough when you’re on a liquid diet—test out different protein powders in advance to see which ones you like best. Usually, your surgeon and dietitian will recommend to you the protein supplements recommended, and many Bariatric surgery practices have these products available at the office for purchase or trial. It will be weeks before you can eat solid food after your surgery.
Prepare your support. Make sure your friends and family know what to expect so they can support you both physically and emotionally. Studies show good family support improve patients success, and safety.
Food is central to most families and cultures—it will be important to resist temptations and pressures from family and friends to eat things you can’t or shouldn’t in the months and years following surgery. Your doctor may encourage you to seek out a formal support group after surgery.
Take Control of Your Weight and Your Health
If obesity is negatively affecting your health and quality of life, contact Bariatric Care Centers to discuss your bariatric surgery options. Dr. Brian MD, FACS, FASMBS is a highly-skilled weight loss surgeon with more than 15 years of surgical experience. He is board-certified with fellowship training in laparo-endoscopic and laparoscopic bariatric surgery from the world-renowned Cleveland Clinic Foundation.
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