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Laparoscopic Sleeve Gastrectomy

Sleeve gastrectomy is a bariatric procedure in which the surgeon reduces the size of the stomach and creates a small, sleeve-shaped stomach which is about the size of a banana. The procedure is particularly considered as a treatment option for patients with a BMI of 60 or higher. It is often the first procedure in a two-phased treatment prior to a gastric bypass.

Highlights of sleeve gastrectomy/vertical gastrectomy:

  • Novel surgical alternative for selected patients where 70% to 80% of the stomach is removed
  • Associated with low perioperative risks, even in high-risk patients
  • Necessitates long-term supplementation of minerals and vitamins
  • No need for a foreign device implantation
  • Associated with weight loss as much as 85% of excess body weight
  • Non-reversible, but can be converted to a gastric bypass surgery
  • No reports of outcome data beyond seven years

Eligibility

If you meet the following criteria, laparoscopic sleeve gastrectomy may be the ideal solution for you.
  • Your BMI is at least 35
  • You weigh at least 100 pounds more than your ideal weight
  • Your BMI is 35 to 40 and you are suffering from health problems like diabetes, hypertension, osteoarthritis or obstructive sleep apnoea
  • You are at least 18 years old
  • You have a history of morbid obesity for at least three years
  • You have tried losing weight but have not succeeded
  • Your weight has not been caused by medication or an underlying hormonal problem
  • You are healthy overall, and do not have diseases such as significant heart disease, serious psychiatric disability, hepatic cirrhosis and impaired liver function, and active peptic ulcer disease
  • You do not indulge in alcohol or drug abuse
If you find yourself to be eligible please continue on to our Procedure Guide.

Sleeve gastrectomy procedure guide

The decision to opt for a weight-loss surgery is an important one. You should be aware of its outcome. The following overview will help you get started.

Pre-Op

Being completely aware of your procedure from the beginning is very important. Before the procedure, you will meet our physicians and staff so that you can get all your questions answered and all doubts clarified. You will also meet our dieticians, physical therapists and psychologists who also play a great role in the overall success of your treatment. You may also be asked to perform certain pre-operative tests, such as a blood work, sleep study, cardiac workup, and psychological evaluation depending on your age and medical history.

Pre-Op

DietA specific diet is prescribed prior to the procedure, which is vital to your success. The advantages of a pre-op diet are:
  • It makes you nutritionally adequate for your surgery.
  • It reduces fat in and around your liver and spleen to lower the chances of bleeding during and after the operation.
Your physician may postpone the surgery if the pre-op diet is not followed properly. Here are the guidelines you need to follow:
  • A strict liquid protein diet should be followed ten days before surgery if you weigh more than 300 pounds.
  • You should take three to four protein shakes per day instead of meals, along with a cup of fresh vegetables in the evening
  • Recommended shakes include Carbs for Life, Atkins Advantage and Slim-Fast Low Carb.
  • If your weight is less than 300 pounds, stop eating fried and sugary foods, fatty meats, butter, carbonated drinks, whole milk and other carbohydrates, and instead follow the below diet:
Meal 1 Meal 2 Meal 3 Meal 4
Any two of the below:
  • Fruit
  • Yogurt
  • Toast
  • Bagel
  • Waffle
  • Cereal
  • Egg
  • Muffin
  • Oatmeal
One protein shake:
  • Carbs for Life
  • Atkins
  • Advantage
  • Slim-Fast Low Carb
One serving of any lean meat or fish and one serving of green vegetables such as broccoli, lettuce, peas, green beans and spinach. One serving of protein powder supplement mixed with Lactaid, skim milk, fruit, fruit juice or yogurt.

Living with Sleeve Gastrectomy

The rule of thumb in living with sleeve gastrectomy is to accept the fact that weight loss after surgery is a gradual process. You should expect one to two pounds of weight loss per week, and this success depends upon making healthy lifestyle choices. Here are our recommendations for a healthy diet, exercise and lifestyle.

Post-Op Diet

Week 1 Week 2 Weeks 3-5 Week 6
Clear liquids Pureed foods Soft foods Begin regular foods
Eating Guidelines for Life
  • Consider eating solid foods that make you feel full faster and for a longer time
  • Eat three well-balanced meals in a day
  • Avoid snacking
  • Eat small amounts of foods at a time
  • Eat slowly. Ensure that your meal lasts for 30 to 45 minutes
  • Avoid gulping foods and fluids
  • Do not swallow chunks of food as it may obstruct the pouch outlet, so chew your food to the consistency of paste.
  • To control portion size use a small fork or spoon
  • Place your utensils down for about a minute between bites
  • Listen to the signs of fullness, which include pain in the upper chest, nausea or pressure below the rib cage. Stop eating as soon as you feel full.
  • Avoid high sugar- and fat-containing foods
  • Drink lots of non-caloric liquids fluids between meals

Fluids

The right intake of fluids is very important to prevent dehydration and constipation. However, avoid drinking with meals or close to meals. It may cause nausea, bloating or vomiting, or quickly wash away foods, leading to hunger and over eating. So, avoid taking in liquids 30-45 minutes before and 40-60 minutes after meals. You can follow these simple guidelines to get the right benefits from fluid intake:
  • Sip water all day.
  • Avoid the use of a straw, as your stomach can get filled with air.
  • Avoid adding sugar to beverages and drinking soft drinks.
  • Avoid drinking carbonated beverages for a month after surgery. This will help prevent bloating.
  • Drink only calorie-free liquids such as water, coffee, unsweetened tea, Crystal Light and sugar-free Kool-Aid. Avoid high-calorie liquids, which provide calories without making you feel full.
  • Avoid alcoholic beverages.

Fibre

Constipation can occur after surgery and is typically caused due to decreased consumption of high-fibre foods and fluids. To prevent constipation, increase your intake of fibre-rich foods and drink plenty of fluids. A daily minimum of 64 ounces is usually recommended. Eating baby prunes or unsweetened prune juice also helps. High-fibre foods also slow down the rate at which your stomach empties. Foods you should avoid:
  • Red meat such as beef, lamb and pork
  • Shrimp
  • Un-toasted bread
  • Doughy bread
  • Rice and pasta
  • Peanut butter
  • Skins, seeds of fruits and vegetables
  • Dried fruit
  • Nuts
  • Coconut
  • Fibrous vegetables such as asparagus, celery and corn
  • Popcorn
  • Greasy or fried foods
Techniques for Behaviour Modification There are certain behaviour modifications that could help you maintain a healthy weight:
  • Avoid eating in front of the TV and while reading
  • Divide your foods into portions
  • Keep tempting foods out of site and healthy foods readily available
  • Avoid shopping for grocery while you are hungry
  • Make a shopping list and stick to it
  • Practice portion control by using smaller plates and bowls
  • Divert your attention from eating by focusing on other activities
  • Brush your teeth after meals or when you feel tempted to eat
  • Avoid eating standing up at buffets or parties
  • Park your car at a distance; far away from your destination
  • Avoid using elevators; instead take the stairs
  • Maintain a food and exercise diary
Importance of Exercise

Exercising is an integral part of life and is necessary for long-term treatment success. Spending 30-minutes exercising every day is advised. This can include any kind of activity such as swimming, aerobics, walking, running and hiking. The ultimate goal is to find activities that you enjoy and include them into your daily routine.

Weight Loss

The amount of weight you lose after surgery varies from individual to individual. Various factors determine the amount of weight loss after surgery, which includes starting weight, age, eating habits, exercise level and metabolism. However, the most essential factor is your overall commitment to a new lifestyle, as the goal is not just to lose weight, but to improve your quality-of-life. Remember, the overall aim is to achieve good health, which is why weight loss must be a gradual process. Losing weight too rapidly is just as harmful as gaining weight. Losing one to two pounds a week in the first year is ideal. On an average, patients lose about 45-60% of their initial weight in the first 12 to 18 months.

Compare Your Weight Loss Surgery Options

 

Sleeve Gastrectomy

Gastric Bypass

Gastric Banding

Procedure
  • Minimally invasive
  • Requires stapling
  • Irreversible procedure
  • Minimally invasive
  • Involves multiple regions of the abdomen
  • Changes normal digestive process
  • Irreversible procedure
  • Minimally invasive
  • Does not involve stomach cutting, intestinal re-routing or stapling
  • Reversible procedure
       
Device Implantation
  • Requires no significant implant
  • Requires no significant implant
  • Requires medical device to be implanted
       
Advantages
  • Good option for patients who are not good candidates for other weight loss surgeries due their health conditions
  • Stomach openings are intact, allowing normal digestion
  • Low surgical complications
  • No dumping syndrome*
  • Conditions associated with obesity improve after surgery
  • Better quality of life
  • Slightly increased total weight loss
  • Rapid initial weight loss
  • Conditions associated with obesity improve after surgery
  • Better quality of life
  • Low mortality and complication rate
  • No change in nutrient absorption and digestive process
  • Low surgical complications
  • No dumping syndrome*
  • Lowest rate of mortality
  • Conditions associated with obesity improve after surgery
  • Better quality of life
       
Risks or Complication
  • Ulcers
  • Dyspepsia (indigestion or upset stomach)
  • Staple separation or leakage
  • Fistula (abnormal connection between vessels or organs)
  • Esophageal dysmotility (dysfunctional food pipe)
  • Staple separation or leakage
  • Inability to view certain organs using X-ray or endoscopy
  • Ulcers
  • Dumping syndrome*
  • Increased gas
  • Changes normal digestion
  • Tube and port complications (infection, kinking and disconnection)
  • Esophageal spasm
  • Gastroesophageal reflux disease (GERD)
  • Esophagus or stomach inflammation
  • Band may leak, slip or erode
       
Recovery
  • Can resume normal activity within a few days; full recovery is observed within two to four weeks
  • Can resume normal activity within one week; full recovery within two to four weeks
  • Can resume normal activity within one week; full recovery within two to three weeks
       
Follow-Up
  • To track progress, regular follow up is required
  • To track progress, regular follow up is required
  • For best results, regular follow up and adjustments are required
     
Weight Loss
  • Within two years, about 50% of weight loss is achieved. At three years about 80% of desired weight loss can be obtained. A BMI > 60 may require additional malabsorptive procedure to achieve total weight loss goal.
  • At over 3-6 months, rapid weight loss occurs. Final results can be obtained after18-24 months of surgery
  • Weight loss is slow and steady. Final weight loss results can be obtained around five years after surgery
*After gastric bypass, intolerance to some carbohydrates, sugars and fats may develop. Patients may experience light headedness, watery diarrhoea, nausea, flashing and sweating. However, these risks can be reduced significantly by following your dietician’s guidelines especially during the first two months after surgery.