Gastric Sleeve Surgery Comprehensive Guide [2021] - Vertical Sleeve Gastrectomy (VSG)

Gastric Sleeve Surgery is a bariatric procedure that removes up to 85% of the stomach creating restrictions. In this comprehensive guide, we introduce the 21 Facts About Gastric Sleeve Surgery. The gastric sleeve procedure is one of the most prominent weight loss bariatric procedures worldwide to rid yourself of excess weight and stubborn body fat.

Gastric Sleeve Surgery Overview

Laparoscopic Gastric Sleeve Surgery, also known as Vertical Sleeve Gastrectomy (VSG), is a restrictive procedure in which the stomach is resected. Almost 85% of the stomach is removed along the greater curvature where the hunger hormones (called Ghrelin) reside. The surgery makes changes in the brain and stomach’s neurohormonal interaction, completely changing the amount of food intake, desire for food, and the relationship with food.

Rapid weight loss with gastric sleeve begins soon after surgery. On average, patients can expect over 65% excess weight loss (%EWL) after one year. The obesity-related health conditions are also resolved after this procedure.

TABLE OF CONTENTS

Why Choose Gastric Sleeve?
How It Works
Step by Step Surgical Procedure
Health Benefits
Eligibility and Qualification
Insurance Coverage
Surgery Day
Diet and Life After
Pre-Op Diet
Post-Op Diet
Nutrition, Vitamins, and Supplements
Complications, Risks
Advantages and Disadvantages
Comparison to Other Bariatric Procedures
Weight Gain After Surgery
Can My Sleeve Stomach Stretch?
Long-Term Expected Results
Essential Tools for Long-Term Success
Gastric Sleeve with Hiatal Hernia
Exercise After Surgery
History of VSG
Hiatal Hernia

1. Why Choose Gastric Sleeve?

The gastric sleeve surgery procedure shrinks the stomach to create a long-term tool to aid in effective weight loss. With a low complication rate and high success rate, the sleeve is one of the most common bariatric procedures today. There are two main reasons why to choose gastric sleeve surgery for weight reduction,

Treatment of Obesity: Bariatric surgery, such as gastric sleeve, is a quick and long-term solution for overweight and obese individuals. Sleeve operation changes the patient’s set-point and provides them a new outlook and chance in life.
Our brain plays a major role in 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 remedy for weight loss.
Treatment of Comorbidities: Underlying medical conditions associated with being overweight, such as diabetes, cardiovascular disease, sleep apnea, and a certain type of cancers, are cured or subdued with bariatric Surgery.

2. How Gastric Sleeve Surgery Works

After sleeve gastrectomy, the new stomach holds about 85% less food (and thus calories), the patient feels full sooner and longer. The gastric sleeve works based on these three mechanisms,

Gastric sleeve surgery is a restrictive procedure; a smaller stomach volume means fewer calories. The patient cannot eat a big meal at one time and learns to do portion control.
Most of the hunger hormones that reside on the upper part of the stomach are removed. The new stomach secretes much fewer gut hormones (Ghrelin) that impact hunger.
The body recovers its sensitivity to Leptin levels in the blood flow after gastric surgery. Leptin hormone is responsible for satiety and feeling full.

The small new pouch makes gastric emptying faster and as a result, there is less time for food to get digested – a similar effect on malabsorption as gastric bypass.

3. Step-by-Step Sleeve Surgical Procedure

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, a 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 for the gastric sleeve surgeon to leave a drain in the abdominal cavity as a precaution for early detection of a leak or bleeding.

Surgical Steps:

While the patient is lying on their back with the arms spread apart, general anesthesia is administered by inserting the breathing tube into the windpipe.
First, the abdomen is inflated with CO2 to have room to comfortably work in the abdominal cavity.
The surgeon will make between 1 (single-incision) to 5 small incisions in your abdomen and insert trocars to be able to get various laparoscopic instruments into the stomach cavity.
The liver is lifted out of the way with a retractor.
The greater curvature is released by longitudinal resection of the stomach starting from the antrum to about two inches from the pylorus.
A bougie is inserted through the mouth as a guide for cutting the stomach.
Then, the majority of the stomach is removed by cutting and stapling at the same time alongside the bougie by a special instrument. Three lines of titanium staples (Johnson & Johnson or Covidien brand) seals the newer, smaller stomach pouch.
Some surgeons will then reinforce the staple line with PROLENE suture, called an inverted sleeve.
The surgeon also repairs hiatal hernia if present.

The New Stomach Size

The bougie is the device inserted within the mouth that goes down the esophagus to form a guide 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 on 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).

32F = .40″
34F = .425″
36F = .45″
38F = .476″

4. Health Benefits of Gastric Sleeve Surgery

There are many advantages shown through the major health benefits of gastric sleeve surgery. Besides 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:

Obesity-Related Comorbidities Improved with Gastric Sleeve

Arthritis
Obstructive Sleep Apnea
Asthma
High Blood Pressure
High Cholesterol
Type 2 Diabetes
Hyperlipidemia
Migraines
Infertility
Stress Urinary Incontinence
Metabolic Syndrome
Cardiovascular Disease
Polycystic Ovarian Syndrome (PCOS)*
Dyslipidemia hypercholesterolemia
GERD
Venous Stasis Disease
Soft Tissue Infections
Depression

The Dangers of Excess Belly Fat

As the waistline grows, so do the health risks. Abdominal fat is one of the main predictors of obesity-related comorbidities. It’s a visual gauge of health with warning signs that expand as more belly fat accumulates.

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. The waist-To-Hip Ratio (WHR) should also be considered for abdominal obesity; women > 0.85 and men > 0.9.

That is where gastric sleeve surgery comes into play. Not only does this bariatric procedure help shed significant excess weight, but it also reduces the life-threatening medical problems that are often attributed to being morbidly obese.

Quality of Life Benefits

Improved Quality of Life (QoL) is realized for men and women after sleeve gastrectomy.

Romantic Interests
Self Confidence
Stamina and Energy
Reduced Disability
Reduced Anxiety

Non-Scale Victories (NSV)

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:

Be able to ride in a sports car
No need for an extender belt on an airplane
Shave your legs easily without a mirror
Make it up the stairs without the struggle
Not embarrassed to be in pictures
Fit in one leg of your old pants
Wear old rings that you once grew out of
Not having to walk around with constant pain
Wear the clothes you couldn’t fit in
Be able to cross your legs
Not the biggest person in the room
Be able to wrap a bath towel around your body
Don’t have to shop at plus size stores
Go out wearing a nice bathing suit
Be able to walk outside without feeling bad
Going to a wedding and looking great

5. Am I a Candidate for Gastric Sleeve?

Eligibility for gastric sleeve surgery is determined by you;

BMI
Health Concerns/Medical Problems
Realistic Expectations
Commitment to Life Change

Eligibility and Qualification Requirements

Qualifying Requires Age: 15 to 65 years with
BMI (Body Mass Index) of 30+ or 100 pounds overweight
BMI Under 30: Obesity-Related Health Problem; Diabetes, High Blood Pressure, Sleep Apnea, etc.
Unable to Achieve a Healthy Weight for a Period of Time Despite Weight Loss Efforts
Failed Diets, Nutrition Plans, or Weight Loss Attempts

When Considering Gastric Sleeve, Make Sure You:

Understand and accept the surgery risks
Motivated by realistic expectations
A life-long commitment to lifestyle changes and follow-up care

If you are obese, taking more pills for your medical problems is not the answer. Your life expectancy is 7 years shorter if your BMI is 35. The higher your BMI, the greater health risks, and the decrease life expectancy.

Take charge and consider gastric sleeve surgery before obesity becomes a major problem. It is time to take this problem seriously and reclaim your life!

6. Gastric Sleeve Insurance Coverage

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 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.

Insurance Providers

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.

Around 25% of individuals looking to get bariatric surgery coverage are denied 3 times before getting their approval.
Patients are required to complete a six-month medical weight loss program before being accepted. Around 60% of patients report their health worsened during this waiting period.

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/

How to Find Out if You’re Covered

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 are 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?
– Medical Policy
– Copay
– Coverage

Insurance Process

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.

Is Pre-Approval Necessary?

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.

Insurance Questions and Answers

What are some of the most common bariatric insurance coverage requirements?

Some of the most common bariatric insurance coverage requirements include:

Body mass index (BMI) greater than 40 or BMI greater than 35 with co-morbidities (diabetes, high blood pressure, etc.). To see if you meet these requirements, you can calculate your BMI using our calculator.
18 years of age or older.
Diagnosis of morbid obesity.
A few insurance plans require participation in a physician-supervised weight loss program for extended time periods (this can vary from 3 to 12 consecutive months, depending on your insurance plan).
Psychological evaluation before surgery. Our bariatric clinic will either provide this service or refer you to a psychologist.
Documentation of failed diet and exercise plans.

What if my insurance provider denies the coverage?

The surgeon’s office will be notified of the denial of coverage and will assist you with the appeal process if you choose to appeal.

Insurance Requirements

Standard insurance requirements include;

Body Mass Index (BMI) of 40 or a Body Mass Index (BMI) of 35 with one or more of the following co-morbidities:
- Hypertension
- Type 2 Diabetes
- Heart Disease
- Obstructive Sleep Apnea
- High Cholesterol
- Or other health-related issues.

Must have:
- six-month medically-supervised diet program.
- private consultation with a bariatric surgeon.
Must get a medical clearance from your primary care physician (PCP).
Must seek out a psychological consultation and get clearance.
Must schedule nutritional evaluations with a Registered Dietician (RD).

Basic Guidelines and Rules

Stop smoking as soon as possible
Avoid NSAIDs such as ibuprofen (Advil, Motrin)
Lose as much weight as possible
Begin to exercise so your body is ready to be active
If you’re a woman and take birth control pills, try an alternative contraception

Medical Tourism to Mexico

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.

7. Surgery Day

Surgery Day – What to bring with you:

Your CPAP machine
A comfortable robe and slippers
Personal toiletries, chapstick
Computer, iPad, phone, iPod
Paper and pen
A book, puzzle, or a game
Your post-op instructions
Photo ID and insurance card

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.

Walk, Walk, Walk! Walking helps fast recovery, prevents blood clots in calves & pulmonary embolism, and fewer gas problems.
Sip, Sip, Sip! Get used to sip after surgery.
Breathe, Breathe, Breathe! Use a barometer breathing machine to open up your air-sacs (alveoli).

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.

The No-Nos for Patients

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.

8. Life After Gastric Sleeve 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 achieve 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.

9. Pre-Op Diet

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 of 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.

Protein shake needs to have 20g or more of protein and less than 5g sugar.
Protein needs to be considered lean and/or has very little visible fat.
Avoid starchy vegetables such as potatoes, corn, and peas.
Approved to have up to ½ cup berries or ½ banana a day. No additional fruit.
64oz Water or sugar-free drinks only.
No additional snacks, grains, or desserts.
Must wean off coffee, caffeine, and carbonated beverages.

The Liquid-Only Diet (2 Days)

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:

Water
Sugar-free beverages such as crystal light, propel, vitamin zero water, Powerade zero
Broth
Apple, cranberry, or white grape juice is approved if it is diluted 50/50 with water
Sugar-free Jello
Sugar-free popsicles

Yogurt

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.

10. Post-Op Diet

Each patient will transition through four phases of post-op diet after gastric sleeve surgery:

Phase 1: Begins the day of surgery, lasts 5-7 days

Clear Liquids: Just as advised two days before surgery.

Water
Sugar-free beverages such as crystal light, propel, vitamin zero water, Powerade zero
Broth
Apple, cranberry, or white grape juice is approved if it is diluted 50/50 with water
Sugar-free Jello
Sugar-free popsicles

Phase 2: Begins 5-7 days after surgery, lasts a minimum of 5 days

Thick Liquids:

Protein shakes
Pureed soups
Apple Sauce
Pureed fruits and vegetables
Thinned oatmeal or cream of wheat
Thinned Greek yogurt
Milk (Dairy or non-dairy such as almond milk)

Phase 3: Begins 10-21 days after surgery

Soft Solids (anything that can be mashed with a fork):

Beans
Avocado
Cottage Cheese
String Cheese
Well-cooked vegetables
Tuna mixed with mayo
Mashed potato or sweet potato
Fish
Peanut or Almond butter

Phase 4: Begins 21 days or later following surgery (depending on the individual)

Solid Foods (Creating a healthy meal plan that lasts forever)

Lean meats (red meat may take longer to be able to digest)
Fish/Seafood
Vegetables (raw may take longer to be able to digest)
Beans
Healthy fats (avocado, nut butter, oil, butter)
Nuts
Whole grains (oats, quinoa, Ezekiel bread)
Cheese
Berries and other fruits in moderation

11. Nutrition, Vitamins, and Supplements

What Vitamins Should I Take After Gastric Sleeve Surgery?

Multivitamin
Calcium with vitamin D
Iron (in some cases)
Vitamin B12 supplement

Make sure you take chewable or liquid bariatric multivitamins that meet the American Society of Metabolic and Bariatric Surgeons (ASMBS) guidelines.

It is advised:

Take in 60 to 100g protein daily in several servings of 230g each
Eat primarily whole foods (whole grains)
Avoid fibrous, starchy, and greasy foods
Eat fruits and vegetable
Limit processed and high-fat foods

12. Potential Complications and Risks Complications

Gastric sleeve surgery complications are separated into two key categories; immediate complications and long-term complications:

Immediate Complications:

Hemorrhage – The risk of postoperative hemorrhage or bleeding is at 4%* (1% to 6%)**.
Sleeve Leaking – Sleeve leak, the most serious complication, occurs in up to 2.8%*** of patients.
Abscess – Fistula formation after the gastric sleeve is about 3% to 7% of patients****.

Possible Long-Term Complications:

Blood clots (happens 1% of the time)
Wound infections – Surgical site infections occur in about 10-15% of post-op patients.
Stomach Strictures – Symptomatic stenosis occurs in 3.5% of post-op patients.
Aversion to food and nausea
Damage to the vagus nerve will cause constant nausea
Gastroparesis, with a delay in moving food from the stomach to the small intestine
Vomiting
Esophageal spasm/pain
Gastroesophageal Reflux Disease (GERD)
Constipation
Hair Thinning
Dumping Syndrome
Stomach Stretching
Nutrient Deficiency 12%

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.
Risks & Downsides
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).

13. Advantages & Disadvantages of Gastric Sleeve Surgery

Advantages

Induces rapid and significant weight loss (>50%) similar to that of the gastric bypass
Requires no foreign objects, like Adjustable Gastric Band (AGB)
No bypass or re-routing of the intestine and the food stream, like RYGB
No malabsorption
Relatively short hospital stay (2 days)
Causes favorable changes in gut hormones that suppress hunger, reduce appetite, and improve satiety

Disadvantages

Is a non-reversible procedure
The potential for long-term vitamin deficiencies
Higher early post-op complication rate than the AGB

Loose, Excess Skin After Surgery
Patients may experience loose, sagging skin due to rapid weight loss. Excess skin is common with weight loss of more than 100 lbs. It is not so bad in so many individuals and depends on factors like:

Age
Smoking
Skin elasticity

This can be fixed with plastic surgery if it becomes too much of an issue; it is a personal choice.

14. Comparison to Other Weight Loss Procedures

Gastric sleeve surgery is becoming the fastest growing bariatric procedure because of it’s high expected weight loss and the low complication rate because 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.

15. Not Losing Weight and Weight Gain After Gastric Sleeve Surgery

Although hard, patients can stall or plateau after gastric sleeve surgery. If patients develop unhealthy habits, weight regain is possible. There are many possible factors involved such as:

Binge, emotional, impulse eating
Stress, Depression
Lack of activity, mobility
Injury
Sugary foods
Alcoholic beverages
Hormones in Meat
Genetics
Lack of sleep
Medication
Yo-yo dieting
Pregnancy or Menopause
Poor meal planning

Preventing Weight Gain

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.

16. Can the Gastric Sleeve Stretch to Normal Stomach Size?

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.

Sleeve Size Growth

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.

17. Gastric Sleeve Weight Loss Timeline

Long-term (3+ years) weight loss depends more on diet and environment and the following clinical predictors:

Food Intake
Sleep
Level of Physical Activity
Medications
Stress

The weight you lose after gastric sleeve surgery does not bring you happiness. Success is reached once you develop good eating habits and lifestyle changes. Here is a sleeve weight loss timeline to see expected results.

Results, Efficacy

The idea behind the gastric sleeve procedure originated back in 1988 with a world-renowned surgeon, Dr. Doug Hess. He utilized the gastric sleeve operation as the first part of a more complicated weight loss procedure known as the duodenal switch. The weight reduction chart was substantial after the first few months of the sleeve gastrectomy. This ultimately set forth further advancement on the gastric sleeve for a significant amount of weight in the months following surgery.

Most people lose about 60 percent of their excess body weight within the first 18 months following surgery. It’s at this point that you are more inclined to regain weight, as you may start to deviate from your dietary and physical regiments.

18. Tools For Long-Term Success

Join Online Forums
Join Facebook Support Groups (Closed groups)
Join Local Support Groups
Use a Bariatric App
Document Your Progress

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

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.

19. Hiatal Hernia Repair

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.

Types of Hiatal Hernia

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.
Symptoms

Severe or persistent heartburn: Usually becomes aware if your body shifts position (ex. leaning, stretching, or straining the body)
Chest pain when breathing, coughing, or swallowing
Regurgitation or belching

Repair and Treatment

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.

20. Exercise & Physical Activity

We recommend that the only type of exercise for the first 8 weeks post-op is walking. It takes about 8 weeks for your body to fully heal after gastric sleeve surgery.
Remember, if you exercise too much, you can slow down weight loss. Finding the perfect exercise balance between staying active but not over-exerting yourself.
After 8 weeks post-op, start exercising a few days a week for 30 minutes per day. As you progress, build up to longer or more frequent physical activity.
The amount of exercise you get depends on your diet. The goal is to eat between 1,000 to 1,200 calories per day. This amount should not negatively affect your exercise habits.

Types of Exercise for Sleeve Patients

Low, moderate-intensity cardiovascular – walking, elliptical, stationary bike
Weight training – free weights, machines, calisthenics, yoga
Interval training – boot camp, CrossFit

21. History of Gastric Sleeve Surgery

Obesity Epidemic: 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 the 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:

Factors Contributing to Obesity

Biology
Environment Exposure
Genetic Predisposition
Behavioral Factors

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).

Why Choose Gastric Sleeve Weight Loss Surgery?

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!

FAQs: Frequently Asked Questions

What are advantages of Gastric Sleeve Surgery versus other weight loss procedures?
Is it reversible?
Who qualifies for Gastric Sleeve Surgery?
Is Gastric Sleeve Surgery expensive?
What are the risks and complications?
How much is Gastric Sleeve Surgery and will insurance cover it?
What tests do I need before surgery?
Will my taste in food and diet change after surgery?
Will I need plastic surgery after Gastric Sleeve Surgery?
How long is the procedure and hospital stay length?
How much weight will I lose?
What follow-up care should I expect after Gastric Sleeve Surgery?
Will I lose my hair after surgery?
Want to see if you pre-qualify?

What are the advantages of gastric sleeve surgery versus other weight loss procedures?

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.

Is it reversible?

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.

Who qualifies for gastric sleeve surgery?

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.

Is gastric sleeve surgery expensive?

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.

What are the risks and complications?

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 the lungs, kidney, or bladder. Some risks include heart attack, stroke, and death, although rare.

Will insurance cover it?

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:

Previous and recent weight loss effects
Attend meetings up to 6 months before receiving acceptance or surgery date
Speak with a nutritionist and try out different diets
Speak with a psychologist for their approval
Must stay on pre-op diet and document for 2 to 8 weeks

What tests do I need before surgery?

Depending on certain patients, different precautionary tests may need to be done before surgery. Either physical, psychological, or blood tests are needed depending on 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 tests, gallbladder tests, urine tests, sleep studies, ultrasound or pregnancy tests, pulmonary function, or cardiology evaluations.

Will my taste in food and diet change after surgery?

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.

Will I need plastic surgery 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.

How long are the procedure and hospital stay length?

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.

How much weight will I lose?

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.

What follow-up care should I expect after gastric sleeve surgery?

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 the 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.

Will I lose my hair after surgery?

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.

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References:

ASMBS

* Prediction Model for Hemorrhagic Complications after Laparoscopic Sleeve Gastrectomy

** Complications associated with laparoscopic sleeve gastrectomy for morbid obesity

*** META-ANALYSIS OF LEAK AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY FOR MORBID OBESITY

**** Abscess after sleeve gastrectomy