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Restrictive operations like gastric sleeve surgery make the stomach
smaller and help people lose weight. With a smaller stomach, you will feel full a lot quicker than you are
used to. This means that you will need to make big lifelong changes in how you
eat—including smaller portion sizes and different foods—in order to lose
This surgery can be done by making a large
incision in the abdomen (an open procedure) or by making several small
incisions and using small instruments and a camera to guide the surgery (laparoscopic approach). More than half of your stomach is removed, leaving a thin vertical sleeve, or tube, that is about the size of a banana. Surgical staples keep your new stomach closed. Because part of your stomach has been removed, this is not reversible.
Sometimes this surgery is part of a larger approach to weight loss done in several steps. If you need to lose a lot of weight before you have duodenal switch surgery, gastric sleeve surgery may help you.
You will have some belly pain and may need pain medicine for the first week or so after surgery. The cut that the doctor makes (incision) may be tender and sore.
Because the surgery makes your stomach smaller, you will get full more quickly when you eat. Food also may empty into the small intestine too quickly. This is called dumping syndrome. It can cause diarrhea and make you feel faint, shaky, and nauseated. It also can make it hard for your body to get enough nutrition.
Your doctor will
give you specific instructions about what to eat after the surgery. For about the
first month after surgery, your stomach can only handle small amounts of soft foods and liquids while you are healing. It is important to
try to sip water throughout the day to avoid becoming dehydrated. You may
notice that your bowel movements are not regular right after your surgery. This
is common. Try to avoid constipation and straining with bowel movements.
Bit by bit, you will be able to add solid foods back into your diet. You
must be careful to chew food well and to stop eating when you feel full. This
can take some getting used to, because you will feel full after eating much
less food than you are used to eating. If you do not chew your food well or do
not stop eating soon enough, you may feel discomfort or nausea and may
sometimes vomit. If you drink a lot of high-calorie liquid such as soda or
fruit juice, you may not lose weight. If you continually overeat, the stomach may
stretch. If your stomach stretches, you will not benefit from your surgery.
Your doctor will probably recommend that you work with a
dietitian to plan healthy meals that give you enough protein, vitamins, and
minerals while you are losing weight. Even with a healthy diet, you probably
will need to take vitamin and mineral supplements for the rest of your life.
Depending on how the surgery was done (open or laparoscopic) you'll have to watch your activity during recovery. If you had open surgery, it is important to avoid heavy lifting or strenuous exercise while you are recovering so that your belly can heal. In this case, you will probably be able to return to work or your normal routine in 4 to 6 weeks. The surgery is most commonly done as a laparoscopic procedure, which means the recovery time is faster.
Weight-loss surgery is suitable for people who are severely
overweight and who have not been able to lose weight with diet, exercise, or
Surgery is generally considered when your
body mass index (BMI) is 40 or higher. Surgery may
also be an option when your BMI is 35 or higher and you have a life-threatening
or disabling problem that is related to your weight.
It is important to think of this surgery as a tool to
help you lose weight. It is not an instant fix. You will still need to eat a
healthy diet and get regular exercise. This will help you reach your weight
goal and avoid regaining the weight you lose.
Research has shown that people who have had a sleeve gastrectomy on average lose more than half of their excess weight.1 Success is higher for people who are realistic about how much weight will be lost and who keep appointments with the medical team, follow the recommended eating plan, and are physically active.2
Over time, you may have problems from poor nutrition. Some vitamin and minerals may not be well absorbed, because a large portion of your stomach has been removed. You should expect to work with your doctor over a long period of time to prevent problems.
Risks common to all surgeries for weight loss
include an infection in the incision, a leak from the stomach into the
abdominal cavity (resulting in an infection called
peritonitis), and a blood clot in the lung (pulmonary embolism). Some people develop
gallstones or a nutritional deficiency condition such
Weight-loss surgery does not remove fatty tissue. It is not cosmetic surgery.
Some studies show that people who have
weight-loss surgery are less likely to die from heart problems, diabetes,
or cancer compared to obese people who did not have the surgery.3
Complete the surgery information form (PDF)surgery information form (PDF)(What is a PDF document?) to help you prepare for this surgery.
Brethauer SA, et al. (2009). Systematic review of sleeve gastrectomy as staging and primary bariatric procedure. Surgery for Obesity and Related Diseases, 5: 469–475.
Heber D, et al. (2010). Endocrine and nutritional management
of the post-bariatric surgery patient:
An Endocrine Society clinical practice guideline. Journal of Clinical Endocrinology and Metabolism, 95(11): 4823–4843. Available online: http://www.endo-society.org/guidelines/final/upload/FINAL-Standalone-Post-Bariatric-Surgery-Guideline-Color.pdf.
Adams TD, et al. (2007). Long-term mortality after
gastric bypass surgery. New England Journal of Medicine, 357(8): 753–761.
April 6, 2011
E. Gregory Thompson, MD - Internal Medicine & Ali Tavakkolizadeh, MD, FRCSC - General Surgery, Bariatric Surgery
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