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Gastric Sleeve Surgery

Weight Loss Surgery

Overview

Gastric sleeve, also called a sleeve gastrectomy or a vertical sleeve gastrectomy, is a surgical weight-loss procedure. This procedure is typically performed laparoscopically, which involves inserting small instruments through multiple small incisions in the upper abdomen. During gastric sleeve surgery, about 75-80 percent of the stomach is removed, leaving a tube-shaped stomach about the size and shape of a banana.

Limiting the size of your stomach restricts the amount of food you are able to consume. In addition, the procedure prompts hormonal changes that assist with weight loss. The same hormonal changes also help relieve conditions associated with being overweight, such as high blood pressure or heart disease.

Why it's Done

Gastric sleeve surgery is done to help you lose excess weight and reduce your risk of potentially life-threatening weight-related health problems, including:

  • Gastroesophageal reflux disease
  • Heart disease
  • High blood pressure
  • High cholesterol
  • Obstructive sleep apnea
  • Type 2 diabetes
  • Stroke
  • Infertility

Gastric sleeve is typically done only after you’ve tried to lose weight by improving your diet and exercise habits.

In general, sleeve gastrectomy surgery could be an option for you if:

  • Your body mass index (BMI) is 40 or higher (extreme obesity).
  • Your BMI is 35 to 39.9 (obesity), and you have a serious weight-related health problem, such as type 2 diabetes, high blood pressure or severe sleep apnea. In some cases, you may qualify for certain types of weight-loss surgery if your BMI is 30 to 34 and you have serious weight-related health problems.

You must also be willing to make permanent changes to lead a healthier lifestyle. You may be required to participate in long-term follow-up plans that include monitoring your nutrition, your lifestyle and behavior and your medical conditions.

Check with your health insurance plan or your regional Medicare or Medicaid office to find out if your policy covers weight-loss surgery.

What are the Benefits

Gastric sleeve surgery is similar to gastric bypass procedures because it restricts the size of the stomach and its ability to hold food. However, there are some benefits of gastric sleeve surgery that make some people prefer this option of weight loss surgery over gastric bypass.

Benefits include:

  • There’s no rerouting of the intestines
  • No band is being introduced into the body
  • Can be performed if you are ineligible for gastric bypass or LAP-BAND

However, unlike LAP-BAND, the removal of part of the stomach during the gastric sleeve surgery means that the procedure is not reversible and is therefore a permanent surgery.

Risks

As with any major surgery, gastric sleeve surgery poses potential health risks, both in the short term and long term.

Risks associated with the gastric sleeve surgery can include:

  • Excessive bleeding
  • Infection
  • Adverse reactions to anesthesia
  • Blood clots
  • Lung or breathing problems
  • Leaks from the cut edge of the stomach

Longer term risks and complications of gastric sleeve surgery can include:

  • Gastrointestinal obstruction
  • Hernias
  • Gastroesophageal reflux
  • Low blood sugar (hypoglycemia)
  • Malnutrition
  • Vomiting

Very rarely, complications of gastric sleeve surgery can be fatal.

How You Prepare

If you qualify for gastric sleeve surgery, your health care team gives you instructions on how to prepare for surgery. You may need to have various lab tests and exams before surgery.

Food and Medications

Before your surgery, give your doctor and any other health care providers a list of all medicines, vitamins, minerals and herbal or dietary supplements you take. You may have restrictions on eating and drinking and which medications you can take.

If you take blood-thinning medications, talk with your doctor before your surgery. Because these medications affect clotting and bleeding, your blood-thinning medication routine may need to be changed.

If you have diabetes, talk with the doctor who manages your insulin or other diabetes medications for specific instructions on taking or adjusting them after surgery.

Other Precautions

You’ll be required to start a physical activity program.

You’ll be required to stop any tobacco use 12 weeks before surgery and may be tested for nicotine prior to your surgery.

You may also need to prepare by planning ahead for your recovery after surgery. For instance, arrange for help at home if you think you’ll need it. People who have a sleeve gastrectomy are typically off work for four weeks.

What You Can Expect

Gastric sleeve surgery is done in the hospital. Depending on your recovery, your hospital stay may last one to two nights.

Before the Procedure

Before you go to the operating room, you will change into a gown and will be asked several questions by both doctors and nurses. In the operating room, you are given a general anesthetic before your surgery begins. The anesthetic is medicine that keeps you asleep and comfortable during surgery.

During the Procedure

The specifics of your surgery depend on your individual situation and the hospital’s or doctor’s practices. Some gastric sleeve surgeries are done with traditional large (open) incisions in the abdomen. But gastric sleeve surgery is typically performed laparoscopically, which involves inserting small instruments through multiple small incisions in the upper abdomen.

The surgeon then creates a narrow sleeve by stapling the stomach vertically and removing the larger, curved part of the stomach.

Surgery usually takes one to two hours. After surgery, you awaken in a recovery room, where medical staff monitors you for any complications.

After the Procedure

After gastric sleeve surgery, your diet begins with sugar-free, noncarbonated liquids for the first seven days, then progresses to pureed foods for three weeks, and finally to regular foods approximately four weeks after your surgery. You will be required to take a multivitamin twice a day, a calcium supplement once a day and a vitamin B-12 injection once a month for life.

You’ll have frequent medical checkups to monitor your health in the first several months after weight-loss surgery. You may need laboratory testing, bloodwork and various exams.

You may experience changes as your body reacts to the rapid weight loss in the first three to six months after sleeve gastrectomy, including:

  • Body aches
  • Feeling tired, as if you have the flu
  • Feeling cold
  • Dry skin
  • Hair thinning and hair loss
  • Mood changes
Results

Gastric sleeve surgery can provide long-term weight loss. The amount of weight you lose depends on your change in lifestyle habits. It is possible to lose approximately 60 percent, or even more, of your excess weight within two years.

In addition to weight loss, gastric sleeve surgery may improve or resolve conditions related to being overweight, including:

  • Heart disease
  • High blood pressure
  • High cholesterol
  • Obstructive sleep apnea
  • Type 2 diabetes
  • Stroke
  • Infertility

Gastric sleeve surgery can also improve your ability to perform routine daily activities, and can help improve your quality of life.

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