TABLE OF CONTENTS
Rapid weight loss with gastric sleeve begins immediately after surgery. On average, patients can expect 65% excess weight loss (%EWL) after one year. Gastric sleeve surgery, or vertical sleeve gastrectomy (VSG), removes a significant portion of the stomach along the greater curvature where the hunger hormones called Ghrelin reside. The surgery makes neurohormonal changes within the brain and stomach, completely changing the quantity, hunger, and relationship with food.
1. Obesity Treatment: Our brain plays a major role in our weight management. The brain gets used to our body weight and considers it as a set-point. Trying to lower the body’s set-point (metabolic thermostat) with diet releases hormones to trigger metabolism decrease and hunger increase.
That is why dieting and exercise alone are not a long-term solution for weight loss. The gastric sleeve surgery procedure shrinks the stomach to create a long-term tool to aid in effective weight loss.
2. Bariatric Surgery for Effective Weight Loss: Bariatric surgery procedures, like vertical sleeve gastrectomy and gastric bypass, have grown exponentially around the world because of the low complication rate and high success rate.
Bariatric surgery, commonly known as weight loss surgery, changes a patient’s set-point and provides them a new outlook and chance in life.
3. Treatment for Obesity: Gastric sleeve surgery has proven to be a successful, long-term cure for obesity. With a low complication rate and high success rate, the sleeve is one of the most common bariatric procedures today.
1. Gastric sleeve surgery works by reducing the size of the stomach by 85%.
2. The new stomach holds about 85% less food (and thus calories) and the patient feels full sooner and for longer periods of time.
3. The smaller stomach secretes fewer gut hormones that impact hunger, satiety, and blood sugar control.
The sleeve procedure is performed laparoscopically almost 100% of the time unless situations arise to dictate the need for open surgery.
Gastric sleeve surgery results in patients having a banana-shaped stomach “sleeve” connecting the esophagus to the small intestines. The new sleeve stomach size is reduced from 30-40 ounces in volume to 3-4 ounces. Eventually, the stomach size grows to 6-8 ounces in volume preserving “normal” healthy eating habits.
Unlike gastric bypass, gastric sleeve leaves the anatomy intact and the food already combined with digestive enzymes in the mouth gets mixed with the bile and pancreatic fluid from the liver and pancreas to completely get absorbed in the bowel.
There are three leak tests performed during and after surgery. Two leak tests take place during surgery with a blue dye and with air. The third leak test is performed with hydrosoluble contrast solution and X-rays. It is common to for the gastric sleeve surgeon to leave a drain in the abdominal cavity as a precaution for early detection of leak or bleeding.
The bougie is the device inserted within the mouth that goes down the esophagus to form an outline for your new stomach sleeve. This outline is cut and stapled by the bariatric surgeon laparoscopically.
The bougie size is important as it guides the shape of the stomach to be cut properly. As a surgeon, technique matters because it depends how close they cut the bougie to the stomach. This impacts the sleeve size of the patient’s new stomach and the new stomachs holding capacity. Some surgeons are known to cut/staple along the bougie loosely, and some surgeons do it tightly.
Below are diameters of bougie/ “guides” in inches (as you see is very little difference in diameter).
There are many advantages shown through major health benefits of gastric sleeve surgery. Beside rapid and long-term weight loss, the sleeve procedure increases the quality of life and improves overall health. Here is a list of health benefits patients can expect:
Abdominal fat (waistline) is one of the predictors of a health risk as well. If the waist circumference (measured at the belly button) is greater than 35 inches for women or greater than 40 inches for men, the risk is higher for heart disease and type 2 diabetes. Waist-To-Hip Ratio (WHR) should be also considered for abdominal obesity; women > 0.85 and men > 0.9.
Bariatric surgery is not a cosmetic procedure. While you will lose weight and typically look better and healthier, the success of bariatric surgery, like gastric sleeve surgery, should be based on a reduction of co-morbidities, improved longevity, and an improved quality of life, not numbers on a scale.
Are you happier, healthier and going to live longer? Let’s take a look at some non-scale victories:
Obese individuals spend $395 more on medical care per year than non-obese individuals – 36% more on health care services and 77% more on medications. Even though the obesity costs the U.S. alone $117 billion for healthcare costs and lost productivity, getting approval from the insurance companies is like jumping through hoops.
Health insurance plans, including Medicare and most Medicaid plans, have coverage for bariatric surgery. However, their coverage & criteria vary and it is important to examine what insurance plans cover bariatric surgery.
If you don’t see your plan here, please contact us as terms change frequently. For more information on bariatric surgery insurance coverage for gastric sleeve surgery, visit https://obesityreporter.com/weight-loss-surgery-insurance-costs/
Acquire a copy of the Medical Policy statement of bariatric surgery for your insurance coverage. Some policies require a medically supervised weight loss program. These are additional questions you to ask your insurance company for gastric sleeve coverage:
– Do they cover bariatric surgery under your plan?
– What are the covered bariatric surgery options?
– What criteria is needed for coverage?
– Do they have a pre-existing clause?
– What is the co-pay amount?
– How much is left to meet your annual deductible and when does it renew?
Insurers need to know that it takes at least 3 months from attending an orientation seminar to get to the operating room. To take advantage of the end of the year deductible and get surgery by the new calendar year, people should start the process early enough to give themselves enough time.
Pre-approval is sometimes required for weight loss surgery. It is a way to make sure the procedure is covered by your Bariatric Surgery Insurance policy. Typically, our surgeon’s office will submit the required information to your insurance provider to gain pre-approval.
Some of the most common bariatric insurance coverage requirements include:
The surgeon’s office will be notified of the denial of coverage and will assist you the appeal process if you choose to appeal.
Standard insurance requirements include;
Mexico is the largest destination in the medical tourism industry for bariatric surgery. Medical tourism to Mexico offers extremely affordable, yet competitive pricing for safe and high-success rate weight loss procedures.
Mexico Bariatric Center has been a part of the medical tourism industry for a decade with over 10,000 bariatric surgeries performed among our surgeons. We offer all-inclusive packages at the best price for top-quality, certified bariatric surgeons. Gastric sleeve surgery is extremely popular and growing fast as an effective treatment for obesity, with similar results to gastric bypass surgery.
Surgery Day – What to bring with you:
If you are nervous, please let your nurse know and they will have the anesthesiologist give you some medication that can help you relax. When you wake up you feel a little pain, but medication should help. You can have ice chips after surgery. Gas-X strips help you deal with the gas. 25% of patients have nausea for the first 24 hours after surgery for which medication will be given for.
Drains are installed for the first 2 days to help detect a possible leak. 24 hours after surgery, fluoroscopy is performed to make sure there is no leak or obstruction. Patients can shower after 24 hours. Staying hydrated is very important as swallowing is hard during the recovery period. Make sure you sip fluid. Larger pills than M & M needs to be crushed and mixed with applesauce.
No driving, no sex, no climbing ladder, no swimming and no lifting heavy objects (more than 25 lbs) for at least 2 – 4 weeks after surgery.
The gastric sleeve gives patients a renewed life and a new beginning. Life after sleeve surgery is a process and needs to be followed up with good aftercare and lifestyle changes for long-term success. Recovery is important to stay healthy and achieving your weight loss goals.
In the weeks after sleeve gastrectomy surgery, there are instructions to follow for nutrition and activity. Post-op diet needs to go from liquid to soft or pureed foods, and eventually to solid or regular food. It is important to get enough fluid and stay hydrated (64 oz per day).
Patients can start exercise 3 to 6 months after surgery. Increasing muscle mass and using it moves your set-point lower, and as a result, your hunger goes down and metabolism increases. Follow the pre-op and post-op diet within our gastric sleeve bible for the best success.
Each patient will be placed on a gastric sleeve pre-op diet prior to surgery. The instruction and length of time that sleeve patients need to be on the pre-op diet is based on BMI:
BMI less than 32: 2 days clear liquids
BMI 33-39: 1 week (including 2 days clear liquids)
BMI 40-45: 2 weeks (including 2 days clear liquids)
BMI 46-49: 3 weeks (including 2 days clear liquids)
BMI 50-59: 6 weeks (including 2 days clear liquids)
BMI 60+: 8 weeks (including 2 days clear liquids)
Each patient with a BMI 33 and above will be placed on a meal plan consisting of 2-3 protein shakes a day and two meals with 4-7 ounces of lean protein and unlimited non-starchy vegetables.
Every patient will have to do two full days of clear liquids just prior to surgery. During these two days the patient will be instructed to only have:
Every patient is also instructed to have 2 greek yogurts per day during the Clear Liquids Phase ONLY. This is only a requirement if the patient is not taking a probiotic.
Start taking a probiotic with a minimum of 50 billion CFU as soon as possible before surgery. This will help create a healthy balance of bacteria and will help with digestion.
Vitamins need to begin 7-10 days after surgery.
Make sure you take chewable or liquid bariatric multivitamins that meet American Society of Metabolic and Bariatric Surgeons (ASMBS) guidelines.
It is advised:
Gastric sleeve surgery complications are separated into two key categories; immediate complications and long-term complications:
The surgeon can accidentally inflict a cut (laceration) to the stomach that goes unnoticed and does not get repaired prior to closing. The proper pre-op diet is crucial for patients to follow in order to shrink the liver for easier surgery.
According to ASMBS, the mortality rate for weight loss surgery is about 0.1 percent, however, it can increase the life expectancy by up to 89 percent.
Hair loss after surgery is a concern among patients. It starts as early 3 months out, peaks at 6 months, and resolves around 9 to 12 months. It is more of an issue among females and depends on the amount of hair they have and how thin it is. An Iron deficiency can cause hair loss; less common is a zinc deficiency. Biotin (10 mg per day) can help prevent hair loss as well as taking adequate protein (especially first 3 months).
Patients may experience loose, sagging skin due to rapid weight loss. The excess skin is common with weight loss more than 100 lbs. It is not so bad in so many individuals and depends on factors like:
This can be fixed with plastic surgery if it becomes too much of an issue; it is a personal choice.
Gastric sleeve surgery is becoming the fastest growing bariatric procedure because of it’s high expected weight loss and the low complication rate because of it is “less-invasive”. It results in comparable excess weight loss (5% less than bypass) and success rate (~80% of patients are successful with long-term weight loss).
Patients are also able to get bariatric revision surgery if they are not successful with gastric sleeve. The most popular revisions are gastric bypass and duodenal switch in case their surgery is not successful whereas patients with gastric bypass have limited options for revisional surgery.
Although hard, patients can stall or plateau after gastric sleeve surgery. If patients form unhealthy habits, weight regain is possible. There are many possible factors involved such as:
Preventing weight regain is about eating lots of high quality and nutrient food rather than starving yourself! If you ate 3 lbs of spinach (low-glycemic food) every day, you do not gain weight but lose weight. Also, staying active is a huge part of weight loss after surgery. Exercise with intensity rather than focusing on low-intensity long-duration movements.
Can it be Stretched?
When patients get concerned about their stomach stretching, they need to know the following facts. In general, the stomach stretches to hold food and contracts once it empties. Repeated expansion beyond the normal size gradually can lead to permanent over-stretching of the stomach. With gastric sleeve surgery patients, there is a progressive increase in the capacity for food. There is also a shift in the way that the brain and stomach & intestine interact as time goes by. It is more than anatomy and the size of the stomach, there is a hormonal impact of the surgery and metabolic mechanism involved.
The stomach will not grow to the original volume after surgery. Do not worry about your stomach stretching, worry about falling into the same traps that made you get surgery in the first place. We will work closely with you to learn good eating habits and portion sizes to optimize your outcome and enhance the long-term result.
Long-term (3+ years) weight loss depends more on diet and environment and the following clinical predictors:
The weight you lose after gastric sleeve surgery does not bring you happiness. Success is reached once you develop good eating habits and lifestyle change. Here is a sleeve weight loss timeline to see expected results.
It can be common to not always lose weight, in fact, sometimes weight can be regained periodically. Following the gastric sleeve post-op diet and changing your lifestyle will ensure the best chance of staying healthy. Some patients also experience digestive issues which often resolve on their own with time or by altering the diet.
Food journaling is very useful to keep track of snacking, meal planning, and calorie intake. Journaling helps patients to document their calories, carbs, and proteins to set the best goals for their weight loss journey. While food journaling, there are very useful apps to log the types of meals and snacks you eat to determine everything you need to stay on top of your diet.
Most gastric sleeve patients don’t realize they have a hiatal hernia until they are in surgery. Past studies have shown that hiatal hernia is common in around 42% of bariatric patients.
A hiatal hernia occurs when the stomach moves to a different area of the chest where it should not be. The stomach then pushes through a section of the muscle creating a bulge. Typically, small hernias go unnoticed. The larger they grow, the more problems they create. Hiatal hernias are typically removed when laparoscopic sleeve gastrectomy is performed.
There are two types of hiatal hernia; a paraesophageal hernia, known as PEH hernia, and the sliding hernia. The PEH hernia is rare, occurring in only 5% of hiatal hernia patients. A paraesophageal hernia is when the hiatus pushes through the muscle lining of the upper stomach. A sliding hernia is more common, occurring in 95% of hiatal hernia patients. This type of hernia occurs when a portion of the stomach slides through the muscle into the chest cavity.
In some cases, a hiatal hernia is not serious enough to need repair. These mild hernia cases can generally be resolved by diet, nutrition, or lifestyle changes. In more serious cases, hiatal hernia repair through a surgical procedure is needed.
Obesity, defined as having elevated levels of excess body fat, has become an epidemic worldwide. Clinically, obesity is measured with a 2-digit number, Body Mass Index (BMI = weight / height2). A body-mass index (BMI) of greater than 25 is considered overweight and over 30 is considered obese.
The overweight rate in the U.S. is 70% whereas this rate is 30% for rest of the world. As the BMI goes up, so does the risk of early death due to obesity-related comorbidities. Obesity is a metabolic disease and the health consequences of obesity are devastating. It is associated with multiple comorbidities such as:
There is also a strong association between self-reported abuse in childhood (sexual, verbal, fear of physical abuse and physical) and severe obesity – a study conducted jointly by Kaiser-Permanente and The Centers for Disease Control and Prevention (CDC).
Do not wait any longer. Do not just keep putting it off. Life is very short. Make a decision sooner so that you can get started on the healthy journey sooner. You need to be mentally happy with yourself. This isn’t going to cure that, but it can improve a lot of things for you. Just know that you’re not alone and no matter what you choose you are a beautiful person inside!
We have seen weight loss occur quicker for sleeve patients versus other bariatric procedures. Also, with all bariatric surgeries, there are food intolerances that occur in patients. With VSG, patients often see fewer food intolerances than other procedures. While expected weight loss is up there with the top bariatric procedures, like gastric bypass and duodenal switch. The sleeve has a lower risk than bypass and duodenal switch and is minimally invasive.
No, gastric sleeve surgery is not reversible. It involves removing up to 80% of the stomach, meaning the stomach will stay small, although it can slightly stretch over time.
To qualify for Vertical Sleeve Gastrectomy at Mexico Bariatric Center, patients must have over a 30 BMI. The only candidates under 30 BMI typically need one or more comorbidities or health concerns. Sleeve patients should have tried other weight loss methods, like diet, exercise, etc., although it is not required.
In Mexico, the sleeve is affordable and inexpensive. At Mexico Bariatric Center, VSG procedure starts at only $4,695*, depending on the surgeon. In the United States and Canada, it can cost upwards of $20,000 to $30,000.
Obviously, with any surgery, there are risks and complications that can arise. Sleeve complications include blood clots, gastritis (erosion or irritation in the stomach lining), vomiting, bowel blockage, and infection within lungs, kidney, or bladder. Some risks include heart attack, stroke, and death, although rare.
VSG is very expensive in the United States unless insurance covers it. There are many insurance companies that cover weight loss surgery, although the coverage can be tricky. In fact, if patients have health-related problems that continue to be future problems, insurance companies are more likely to cover bariatric surgery. Most doctors or surgeons can communicate directly with your insurance company to determine if you are covered for bariatric surgery. Insurance coverage is typically a strict process, patients have to document and display:
Depending on certain patients, different precautionary tests may need to be done before surgery. Either physical, psychological, or blood tests are needed depending if patients are going through insurance or not. If not, the only testing needed is if the surgeon requires it. This is usually rare or voluntary, and in very few cases mandatory. For gastric sleeve to be covered by insurance, there are generally many tests needed for approval and during pre-op. Dietary assessments may also be needed for some patients, mainly those insured. Some testing includes but not limited to EKG, psychological evaluation, standard tests, blood test, gallbladder test, urine test, sleep study, ultrasound or pregnancy test, pulmonary function, or cardiology evaluation.
In our experience, many patients have a change in taste-buds after surgery. Many times, old favorite foods aren’t as tasty as they used to be. Foods like ice cream, candy, and snacks don’t taste the same as they used to. By eating less food with small portions and eliminating certain foods – like carbonated drinks, sugary foods, and unhealthy fats patients see more weight loss. By going on the pre-op diet before gastric sleeve surgery, patients start building healthy eating habits and a diet routine that will be critical to emphasize after surgery.
With a lot of excessive, rapid weight loss, patients may need to get plastic surgery to compensate for their new body. Depending on age and length of time being obese, excess skin may build up in areas like the arms and stomach. Arm lift surgery, body lift surgery, and skin removal surgery are often sought for VSG patients. Obviously, your new body brings new happiness, but also more areas of improvement. Patients need to understand bariatric surgery is not a “fix-all” procedure and many patients don’t need plastic surgery after. We recommend waiting for at least one to two years after surgery to guarantee you won’t get skin removal surgery before all major weight loss has happened.
Gastric Sleeve Surgery takes between 30 minutes and an hour depending on surgeon experience and patient anatomy. Although, single incision gastric sleeve surgery is more difficult and takes up to two hours. The hospital stays in the United States is generally one day, as they try to get as many patients in as possible. At Mexico Bariatric Center, we keep our patients for 2-3 days, to make sure the procedure went well even as they begin healing. We also do our post-op tests within those days following surgery while still in the hospital.
Gastric sleeve surgery is very effective while not changing patients anatomies, like gastric bypass and duodenal switch. Losing weight after sleeve surgery usually starts when the post-op diet begins. In fact, VSG patients shouldn’t expect rapid weight loss until four to eight weeks after surgery. On average, patients should expect to lose 65% of excess body weight after 12-18 months post-op.
After sleeve surgery, patients generally need to follow up with their surgeon, doctor, and dietician or nutritionist. In order to check all your results, surgeons should perform certain tests after sleeve procedure. Following the surgery, patients should continue checking in with their primary physician at certain points, generally a few months after and at the one year mark. Follow-up care with a dietician or nutritionist is needed to ensure their diet works for patients.
Usually not. Although some patients lose a very little amount of hair just after surgery, it does not persist long term. As the stomach is reduced, the amount of protein that is usually absorbed in the body also reduces. The malnourishment of protein may cause some hair loss until the body evens itself out. A fix for hair loss is taking protein supplements after gastric sleeve surgery.