Pros and Cons of Gastric Sleeve Weight Loss Surgery
What is Gastric Sleeve Anyway?
Gastric Sleeve, or Sleeve Gastrectomy, is a surgical procedure for individuals with obesity. Obesity is defined as being 100 pounds over ideal body weight, having a Body Mass Index (BMI) over 40 or a BMI over 35 with co-morbid conditions including Diabetes or High Blood Pressure. The Gastric Sleeve is performed under anesthesia, typically laparoscopically. During the procedure, the surgeon removes a large portion of the stomach, leaving the patient with a smaller stomach which holds less food. This allows the patient to feel full while eating less, thus resulting in weight loss.
Would you consider having the Gastric Sleeve done?
Would you consider having the Gastric Sleeve done?
Stomach size after Gastric Sleeve
Requirements for Gastric Sleeve Approval
The Gastric Sleeve is a life-altering procedure and as such must not be taken lightly. There are strict requirements from both bariatric surgeons and insurance companies which must be met in order to be approved for the procedure.
- Physician monitored diet for up to 6 months (depending on insurane company) prior to approval for surgery
- Psychological evaluation - to determine you understand the lifestyle changes necessary and are capable of making them
- Dietary consultation - meeting with a dietician to discuss lifestyle and dietary changes required
- Labwork and medical tests per the surgeon's discretion
Benefits of Gastric Sleeve
Obviously, weight loss is the sought after benefit of bariatric surgery such as the sleeve. But, there are added health benefits that accompany weight reduction.
Benefits of Gastric Sleeve:
- Weight Loss
- Reduced or eliminated sleep apnea
- Reduced or eliminated high blood pressure
- Reduced or eliminated high cholesterol
- Reduced or eliminated Type 2 Diabetes
- Improved Fertility
- Reduced or eliminated migraines
A systematic review of 52 studies were compiled from two major databases (Pubmed and The Cochrane Library) to review outcomes of bariatric surgery. Average excess weight loss was 52%. There were significant decreases in cardiovascular risk factors such as high blood pressure, dyslipidemia and diabetes. According to the Framingham risk score, there was a 40% reduction in relative risk for 10-year coronary heart disease risk.
These health improvements provide for a longer, happier, more energetic life.
Risks/Side Effects possible with Gastric Sleeve
Like all medical procedures, the Gastric Sleeve has potential risks. It is the responsibility of the patient to be fully informed so they can decide if the benefits outweigh the risks.
Risks/Side effects can include:
- Blood clots
- Aversion to food
- Gastroparesis - delay in food leaving the stomach for the small intestine
- Vitamin deficiencies
- Loose skin
Pre-Op Prep for Gastric Sleeve
Before surgery, the liver needs to shrink so the surgical instruments can safely reach the stomach. Most obese patients have an enlarged liver due to fatty liver disease. Patients undergo a liquid diet, ranging in duration based on their surgeon's recommendations. The diet ranges from 2 days to 2 weeks pre-op.
Liquid diet typically includes:
- sugar free popsicles or Jell-o
- low sodium broth
- carbonation and caffeine free drinks such as Crystal Light, Propel, Powerade Zero, etc.
- Protein shakes - brand/type to be recommended by individual's surgeon
Gastric Sleeve Video
Following surgery, you wake up in recovery until you are moved to your hospital room. You are started slowly on very small sips of water to make sure you can tolerate it. Once you are alert and stable, you are encouraged to walk every couple of hours. This reduces the risk of blood clots as well as keeps your system active. The hospital stay is typically 2-3 days, unless there are complications.
Upon discharge you are given specific instructions regarding your diet. It advances slowly to allow the stomach to heal, while minimizing the risk of complications such as a leak at the incision site. You will slowly progress in stages from clear liquids to full liquids, then on to pureed foods and eventually to regular foods. You will learn the foods that you cannot tolerate and should therefore avoid. Protein is of the upmost importance and should always be the main part of your intake, followed by vegetables and fruit. Carbohydrates should be complex instead of simple sugars so they offer nutritional benefit. Fats and sugars should be very limited. While dumping syndrome is less common than with the Gastric Bypass, consuming too much fat and sugar will derail your weight loss efforts.
Weight loss can occur rapidly if the surgeon's instructions for diet and exercise are followed. The main points to remember are:
- Drink between meals, stopping 30 minutes before eating and not resuming until 30 minutes after to maintain satiety.
- Consume a minimum of 60 grams of protein daily from varied sources as recommended by your surgeon/dietician
- Avoid excess fat and sugar
- Concentrate on your meal so that you enjoy it and realize when you are full
Lifestyle changes are a must in order for gastric sleeve to be successful. You have to drink alot of water, but in between meals rather than with it. This is one of the most difficult transitions to make. It is easier if you begin pre-op so that you are used to it when it becomes a necessity. I wish that I had listened to my dietician when she suggested this, as I still struggle with wanting to sip after every few bites - it is a lifelong learned behavior after all! One tip that does help me when dining out is to automatically order water - you typically get tap water which is unappetizing and a deterrent in itself, yet it is available if you absolutely need a sip to moisten what you are chewing.
You eat a much smaller amount of food due to your smaller stomach and must make protein your primary focus. Some people find that they are full after eating their protein and are unable to eat anything else. This can sometimes lead to vitamin deficiencies needing supplementation.
It is difficult to find high protein, low fat/sugar food options when dining out. While dumping syndrome is less common with gastric sleeve than more extreme surgeries, eating too much fat or sugar can still make one sick. You do not want this to happen away from home, so choose wisely. It is often a better choice to pack food with you wherever you go. Some items I try to keep on hand in my purse are peanuts, string cheese or protein bars. When I traveled for work, I packed things such as individual yogurt cups and slices of lean lunchmeat in a cooler.
Pre-planning definitely helps you stay on track because you will find yourself in situations where there just isn't anything protein packed and healthful to choose from. If you know ahead of time that you will be dining at a particular restaurant you can research their menu to decide what is your best option before you get there. This helps you to minimize temptation if you already have a plan of action.
Gastric Sleeve is a life-altering surgery which should be thoroughly researched before undertaking. It is important to know the risks as well as benefits. Patients with a good support system are more successful in achieving the most effective outcome.
If you are debating whether or not to have this surgery, I strongly encourage you to attend a seminar with a local surgeon. Research the pros and cons on the internet. There are articles from respected medical facilities. There are forums and social media groups where patients tell their stories warts and all. You can see unsolicited, realistic before and after pics from patients.
I can say from personal experience that the surgery was the right thing for me. I have lost 70 pounds so far. I have gained energy and stamina. I have had my slips along the way. I have learned that overeating is painful. I have to remind myself to drink enough fluids, it helps to keep a water bottle in sight at all times. I sometimes forget to take my vitamins - I am deficient in Vitamin D and Iron.
I have been fortunate that I have not had any major complications. I did have my gallbladder removed because it wasn't functioning properly, but was told this is common due to the decreased fat intake causing it to atrophy. Many surgeons elect to remove the gallbladder during bariatric procedures because of this.
I have had some emotional setbacks in which I found myself resorting to old eating habits yet I have had victories as well. I am less self-conscious going to public places. I no longer automatically go to the handicapped stall because it's bigger. I even helped coach my daughter's flag cheerleading squad last year, a major change from the wallflower that I used to be. I hate having more loose skin, but I love wearing an XL shirt instead of a 4X. While I am still a work in progress, I have to give myself credit for coming a long way. One of my favorite quotes is "This too shall pass" and it is a great mantra to use to stay motivated when life inevitably gets complicated.
Questions & Answers
© 2017 Michelle Mollohan