It has become a popular option for patients seeking significant weight loss in a simple procedure that requires no maintenance.
On January 1, 2010, UnitedHealthcare (a US health insurance company) added gastric sleeve surgery to its list of covered surgeries for weight loss.
Over the next two years, almost all the other major insurance companies followed suit. From 2010 to 2015, gastric sheaths became the fastest growing bariatric surgery procedure.
It is very difficult to get insurance companies to approve new procedures. So, why would they approve gastric sleeve surgery?
- The evidence showed significant weight loss with low complication rates.
- The surgeons were already doing the procedure and the insurance was paying!
Number 2 deserves some explanation:
Super obese people (people with a body mass index greater than 45) have a higher risk during any surgery. And the longer the time under anesthesia, the greater the risk.
Gastric bypass surgery can last more than 2 hours. Duodenal switch surgery often takes more than 4 hours. That’s a long time to be under anesthesia.
Then the surgeons began to divide the procedure into two stages. The first stage was to reduce the size of the stomach. The second stage would be done a year later after the patient lost some weight.
The second stage of the procedure would include circumventing some of the intestines to reduce the absorption of calories. Then, the surgeons began coding the first part of the procedure as the first half of a duodenal change. The insurance was paying.
When the patients returned a year later, they had lost so much weight that a second procedure was not necessary.
Studies like this one started to emerge (randomized clinical trial of laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy for the treatment of patients with BMI <50 kg / m2).
The complication rates were low and the weight loss was as good, if not better, than gastric bypass. And because the surgery took less time and was less complicated to perform, the surgeons liked it.
The patients also liked the procedure. After the surgery and often for months after the procedure, the patients noticed that they were not hungry. Some patients had to remind themselves to eat.
Soon patients asked their doctors about gastric sleeve surgery.
Later, the research showed that the hormone that produces hunger, ghrelin, was significantly reduced in patients with gastric sleeve. It is believed that the stomach area removed during gastric sleeve surgery produces much of the hormone ghrelin.
While patients with gastric bypass experienced less hunger, it appeared to be more pronounced in patients with gastric sleeve.
Potential Benefits for Patients
Gastric sleeve surgery has the following benefits:
- It can reduce hunger: The hormone ghrelin that induces hunger is reduced by removing a portion of the stomach that is largely responsible for its production. The reduction of hunger occurs in most patients, but not in all.
- Shorter operating time compared to gastric bypass.
- It does not redirect the intestines.
- No dumping syndrome: While dumping syndrome can be a tool to reinforce good eating habits, it is very unpleasant. The pylorus remains intact and the sugars have time to digest as the intestines remain intact.
- No adjustments needed : The adjustable gastric band requires regular adjustments (doctor visits).
- No foreign objects remain in the body: The adjustable gastric band leaves a band of silicone around the upper part of the stomach.
- L to weight loss occurs during 18 months: Weight loss gastric bypass is very fast. The majority of weight loss occurs in the first year. Adjustable gastric band is gradual and requires large lifestyle changes to be successful. The majority of weight loss occurs for 3 years.
Gastrectomy of Gastric Sleeve over Adjustable Gastric Band
Guess what? Your surgeon may prefer the gastric sleeve or bypass over the adjustable gastric band. Surgeons want you to succeed. Most surgeons worry about their health. But they also know that you are a future source of reference. You are a success story in the future.
If your surgeon has been performing bariatric surgery for long enough, he or she has seen patients who lose little or no weight with an adjustable gastric band.
This does not mean that the band is not working. It simply means that certain patients can not implement lifestyle changes (3 small meals a day, high protein content, exercise, low carbohydrate levels, etc.) that are needed to succeed with adjustable gastric banding.
The failure to lose weight is significantly less with gastric bypass or gastric sleeve surgery. Okay, after the weight is released, it’s up to the patient to maintain it.
For a surgeon who is trying to help, it is difficult to identify patients who are really dedicated to implementing exercise and healthy, nutrient-rich foods in their diet. It is a much better bet and ‘safer’ to recommend bypass or manga.
So, do you want to know what to expect on the day of surgery? Expect to be scared, nervous and hope that everything goes well.
Again, gastric sleeve surgery is a very simple procedure with low complication rates. When serious complications occur, they usually occur the first few days after surgery. So rest easy for your procedure.
It is likely that surgery is scheduled early in the morning. However, this depends on the surgeon’s and the hospital’s schedule.
Before surgery, you will have followed your two-week preoperative diet. You must know what to take to the hospital. And he’ll know he can not eat anything after midnight the night before.
Do not cheat! Surgeries are canceled all the time because people eat or drink before surgery. And if you vomit during the procedure, you can get a lung aspiration.
This is when the contents of your stomach regurgitate and get stuck in your airways. This can be fatal or cause aspiration pneumonia. Do not chew gum, drink water, chew tobacco or take medications not approved by your surgeon.
This can cause your surgery to be canceled. Verify preoperatively and you will meet your nurse and your anesthesiologist. You will put on the hospital gown, remove jewelry, watches, etc. Then you will sign the necessary consents and you will get an IV.
They will give you medicines to help you relax. Your circulating nurse (the nurse who will be with you in the operating room) will come to meet you and take you back to the operating room. Then you will be asked to breathe out of a mask and count back.
When you wake up you will be in recovery and your family will be invited soon after. Once cleared, they will transport you to your room where the TV and your pain pump will be your new best friend for the night.
Usually, within the first 5 hours after surgery, you will be asked to get up and take a few steps. This helps reduce the risk of blood clots and helps relieve some of the pain in the shoulder associated with the CO2 left in the abdomen after surgery.
Recovery from gastric sleeve surgery is painful for some and “not too bad” for others. Each person experiences pain differently and different pain medications work better than others for different people.
Some sleeve procedures are ambulatory (you can leave the same day as your procedure) and many require 1 or 2 days in the hospital to recover. Some surgeons prefer 3 days while others feel comfortable allowing you to leave the day after surgery.
As always, it is important that you follow the doctors’ orders.
Below you will find some general guidelines after you are discharged from the hospital. You should have more specific guidelines to follow in your discharge instructions or postoperative manual.
1. Drink liquids constantly.
- It is easy to become dehydrated. You will not receive any liquid from the food in the first week after the operation. Drink slowly, but make sure you drink a lot.
2. Intestinal movements.
- Intestinal movements can be difficult or painful. This is normal.
- However, do not hesitate to call your surgeon if you have problems.
- Constipation is normal the first postoperative week. Your analgesics can increase constipation.
- Do not be a tough guy. Take your pain reliever when you need it.
- You can receive a Protonix prescription to decrease the acidity in your stomach. This helps with the acidity and can reduce the pressure in your healing bag.
- Unless your surgeon indicates otherwise, you can continue taking your medications. It is likely that all medications not released in time should be crushed.
- Any medication that is released over time should be changed, if possible, to a time not released. Do not crush the drugs released over time. Ask your doctor about your diabetes medication.
- Walk, walk, walk, walk as much as you can. This helps the healing process and starts you on the path to include exercise every day.
- Do not lift anything heavy. This can put undue pressure on the stitches and the torso that will hurt him.
- You will feel fatigued and tired for up to a month after surgery. This is due to the low consumption of calories. Your body is adjusting.
5. Shower and bathe.
- Do not bathe or sit in a whirlpool bath for the first 3 weeks after surgery.
- Showering normally is fine.
6. Going back to work.
- Generally, you can return in 2 to 4 weeks depending on the amount of physical effort of your work.
- Most people return after 4 to 6 weeks with full force.
This article explains the details of recovery from gastric sleeve surgery.
Pre Diet and Post Operative Diet
Your diet will change after gastric sleeve surgery.
In fact, your diet should change 2 weeks before surgery. So, if you plan to have a “last meal”, you will want to do it before starting the preoperative diet.
Your preoperative diet will begin 2 weeks before the date of surgery. The preoperative diet is important because it helps reduce the size of your liver before surgery. This makes surgery easier for your surgeon and reduces your intraoperative risks.
They say you need to taste a food 20 times to develop a taste for it. Keep this in mind as you struggle during the first months of adopting a new diet after surgery.
With a small stomach, it is absolutely important that the food you eat is rich in nutrients. This means that you should eat foods such as vegetables, lean protein sources and whole grains.
Most doctors recommend that you consume a good portion of your calories with lean meat. However, it should be kept in mind that there are some very successful vegetarians who have had gastric sleeve surgery.
Your postoperative diet depends to a large extent on how far you are from the surgery. The stages below are typical recommendations after gastric sleeve surgery. For a more detailed analysis of what you can and can not eat after surgery, we recommend this article.
Stage 1: the first week after surgery
Clear liquids only These include:
- Decaffeinated tea
- Ice cream without sugar.
Step 2 – Week 2
- Complete liquid diet with protein shakes.
Step 3 – Week 3
Soft puree foods. These include:
- Scrambled eggs.
- Cottage cheese.
Step 4 – Week 4
- Cooked chicken.
- Mashed potatoes.
Step 5 – Week 5
Presenting real meals.
- Enter small amounts of food.
- Chew well and eat slowly.
- Eat 3 small meals a day.
- Eat small, healthy, nutrient-rich foods as a snack if necessary.
- Get your protein, but do not forget about vegetables and fruits.
Daily Vitamins and Supplements
You should make sure you get enough vitamins after your sleeve surgery. This is also true for gastric bypass (a few more supplements are required) and is true for adjustable gastric band patients (fewer vitamins are required).
Below is a list of vitamins and protein supplements typical for patients with gastric sleeve.
Multivitamins with Minerals : you will want to use vitamins or chewable patches during the first month after surgery. Follow the directions. You may need to take one in the morning and one in the evening (depending on the brand).
Here are some options for a good bariatric multivitamin:
- Bariatric fusion
A company now offers vitamin patches. These patches eliminate the need to swallow pills. Your new stomach / bag no longer has to process capsules. Simply place a patch on your skin for 8 hours a day and that’s it.
A decent option for a specific non-bariatric multivitamin is the following:
Centrum : you can find it at your local pharmacy.
Iron : iron can be recommended. It is important to talk with your doctor and follow his recommendation.
- Check with your surgeon when to begin iron treatment after the operation.
- Take on an empty stomach.
- Do not take with your calcium citrate.
Calcium citrate: taken 3 times a day.
- Start 1 month after surgery.
- Liquid or chewable form and should be taken in doses of 500 mg with at least one hour between doses.
- DO NOT take calcium at the same time as iron.
- Wait at least 2 hours between taking your multivitamin / iron and your calcium.
- 1500 to 2000mg daily.
Vitamin B12 : can be recommended. Check with your doctor
- It is usually taken once a week.
- 5000 a 7500mcg.
- Available in sublingual spray (under the tongue), injection or nasal spray.
- It should NOT be taken as a pill after surgery.
Protein is important after gastric sleeve surgery. It is recommended that you get at least 60 grams of protein per day after surgery. However, most doctors prefer a specific bariatric protein supplement.
Below are some common options for bariatric protein supplements.
- Bariatric fusion
These can be purchased at online stores of bariatric supplements.
You should understand well the possible complications during and after your surgery. The most worrisome complication of gastric sleeve surgery is a leak in the staple line.
Leakage of staple lines can occur during or after surgery. During surgery, they are usually noticed and repaired before completing the surgery; it is not a big thing. However, if they go unnoticed, you will begin to get sick soon after surgery.
Leakage of staple lines usually occurs during the first month after surgery. They can be triggered by eating inadequate foods (always follow their postoperative diet) or by not healing the stomach tissues.
This, in turn, leads to the staples detaching from the thin devascularized tissue, which leads to a leak.
A leak from the staple line leads to a major infection as the juices from your stomach enter your abdomen. The signs and symptoms are tachycardia (rapid heartbeat), fever, chest pain and pain in the abdomen.
The majority of staple line leaks occur within 14 days after surgery. Consult your doctor immediately if you experience any of these symptoms. The risk of death from gastric sleeve surgery is low.
Can it be Stretched?
You can stretch your stomach after a gastric sleeve surgery. The inside of your stomach is full of ruga. These are folds of tissue that expand and contract in relation to the amount of food that enters your stomach.
When they expand, your stomach sends a signal to your brain that you are full. When they contract, they push the food into the intestines for further processing. Once the stomach is empty, a hormone called ghrelin is released that triggers hunger again.
These signals can be skewed when your stomach is constantly stretched due to too much food. This article details how this happens and why it is important to get back on track quickly after crossing.
Here are some tips to reduce the risk of stretching the stomach.
Drink water one hour before and one hour after eating : this gives your body time to digest food and make room for liquids and vice versa. Do not eat or drink at the same time.
Do not drink carbonated beverages : carbonation can put unnecessary pressure on your stomach.
Eat snacks : small and healthy if you are hungry between meals.
Plan your meals : concentrate on small portions of nutrient-rich foods. Nutrient-rich foods keep you full longer and provide the nutrients you need.
Remember, if you overeat once, you have not ruined your new stomach. Get back on track as fast as possible.
Expected Weight Loss
On average, patients with gastric sleeve will lose approximately 60% of their excess weight. Excess weight does not mean total weight. If you weigh 300 pounds, you will not weigh 120 pounds after surgery. To calculate your expected weight after surgery, use our calculator.
You should know that you can lose more or less than 60%. There are many examples of people who have implemented exercise (including marathons) in their daily lives and who have far exceeded the 60% mark. Some people who return to bad eating habits lose less than 60%.
The key to success (which exceeds 60%) is to implement the necessary changes to maintain the weight.
Gastric sleeve surgery will make you lose weight fast. However, similar to any diet, you will reach a limit at some point. This means that you will lose weight and lose it quickly, and then, suddenly, you will lose it.
When weight loss stops, often only 6 months after surgery, patients become frightened (that’s the technical term).
Why it happens?
Your body is constantly looking for something called homeostasis . Homeostasis is a process that maintains the internal environment of the human body in response to changes in external conditions.
Then, when the food decreases significantly (external condition), your body adjusts internally to create stability (stable weight).
Therefore, to counteract the lack of food in their environment, the body decreases its basal metabolic rate, its metabolism slows down and hits a wall.
You have not changed your eating or exercise habits and hit a wall before reaching your target weight.
How do you pass the weight loss limit?
To continue with the weight loss, you must add a new external change. This is typically done by increasing the exercise. Simply adding a couple of 30 seconds morning and night can be all you need. Can you take an extra walk before going to bed? Are you taking the stairs at work? etc.
It may be worthwhile to meet with a personal trainer and have them design a training plan that they can maintain. Your plan should be more intense than your current training.
You may need to consider adding a small healthy snack between meals to speed up your metabolism. Have your dietitian check your weight loss.
Emotional and Mentality Changes
This topic is often overlooked for topics with clinical studies that support them. However, it is important to know that emotional changes happen after surgery. And you should be prepared for them.
Immediately after surgery, you will begin to lose weight very quickly. The drastic loss of weight leads to changes in the production of hormones. Changing the levels of estrogen and testosterone results in mood swings.
Let your family know that this is likely, particularly in the first 2 months after surgery.
In addition to mood swings, you’ll be tired. People who are tired and cranky tend to be less than pleasant. Have faith, this disappears. And not everyone experiences mood swings.
Changes of Personality
Another interesting change, certainly anecdotal, is related to personality. About 50% of patients have mentioned that they noticed a change in their personality starting a few months after surgery.
After weight loss surgery, patients tend to be less demanding. Is this a result of the therapy / counseling sessions required before and after the surgery?
Is it because of a new self-confidence? Or is it because weight loss surgery requires a hard and honest approach, from eating habits, lifestyle habits and relationships? It’s probably a mixture of all those.
No matter what causes it, patients who experienced personality changes have said that changes are a good thing.
If you read enough about weight loss surgery, you will notice a fairly high incidence of divorce. There are no clinical studies to support this, so do not assume this will happen to you.
However, you should know that there are many divorce stories after a gastric sleeve surgery.
- Your partner may become insecure as you begin to lose weight and gain self-confidence.
- You may be less tolerant of certain behaviors of your spouse. Excessive alcohol consumption, tobacco, anger and aggressive passive behavior are examples of this.
- You may find that your husband does not share the same desire to eat and live a healthy life. This may be fine if you find friends to help you.
The people you surround yourself with should make you a better person and help you achieve your health and work goals. This does not mean you should get rid of all your friends. But it means that you should try to surround yourself with people who want to make you better.
Gastric Sleeve Maintenance
Gastric sleeve surgery does not require regular band fillings as does the adjustable gastric band. But it requires maintenance. There are no set-ups with a gastric sleeve.
Once done, it’s done. However, you must make sure you are doing the right thing to create a lasting weight loss.
Maintenance of the diet
It is absolutely important that you follow the new diet guidelines for the rest of your life. Going back to old habits is easy. You can recover weight after gastric sleeve surgery.
Maintenance of the exercise
You should make sure to continue training at least 3 times a week. It is preferable to train 5 to 7 days a week for 30 minutes. The exercise can be walks, races, exercise videos, etc. The goal is to move and increase your heart rate. In return, it will burn calories.
Maintenance of the state of mind
Maintaining a positive attitude 100% of the time is impossible. Everyone has bad days. For people with food addictions, a state of depression can trigger food cravings.
When you are depressed, food becomes comfort. Being healthy becomes secondary to finding immediate comfort. Daily you should take into account your state of mind. Are you motivated? Have you been spending time with friends? Are you abnormally tired?
Losing the battle with food often begins with a sad or angry mood. Be sure to pay attention to your mood and actively manage it by implementing healthy activities to improve your well-being.
While you will have bad days, do not let those bad days turn into bad weeks or months. If you have a bad day and look for the convenience of food, that’s fine. Tomorrow is a new day. Do not let overeating turn into a vicious circle that will lead you to stretch your stomach and gain weight.
Gastric sleeve surgery is a long journey. On average, it takes about two years to reach your target weight.
It needs to change a lifetime of unhealthy habits to maintain weight. It is not the easiest exit. It takes dedication, perseverance and daily work (forever). Keep learning, reinforcing good habits and celebrating your small victories.
The further you get away from surgery, the less you will think of yourself as a sleeve patient and the more you will consider yourself someone who chooses to be “healthy”.
Remember that the gastric sleeve is a tool. It helps you lose weight so you can implement the healthy changes that will change your life forever.