If you're among the millions grappling with obesity, you might be exploring gastric sleeve surgery as a path to a healthier life after unsuccessful attempts with diets and exercise. This article provides a detailed look at gastric sleeve surgery, including expected weight loss, the procedure itself, and associated costs.
What is Gastric Sleeve Surgery?
Gastric sleeve surgery, or sleeve gastrectomy, is a bariatric procedure designed for individuals with a body mass index (BMI) of 35 or higher. It works by restricting the amount of food the stomach can hold, leading to a feeling of fullness with smaller portions. The procedure involves removing 75-85% of the stomach, effectively reducing its volume.
How Gastric Sleeve Surgery Works
The effectiveness of gastric sleeve surgery extends beyond just restricting food intake. Removing a significant portion of the stomach leads to decreased levels of ghrelin, often referred to as the "hunger hormone." Ghrelin, produced in the stomach, stimulates appetite, promotes food intake, and encourages fat storage. After surgery, patients generally report feeling less hungry and experience satiety with smaller meals.
Furthermore, lower ghrelin levels can positively impact individuals with type 2 diabetes by influencing blood sugar metabolism. However, it's worth noting that gastric bypass or duodenal switch surgeries are typically more effective in resolving type 2 diabetes.
A significant advantage of gastric sleeve surgery is that, unlike some other bariatric procedures, it doesn't involve implanting foreign objects or rearranging intestinal organs. After recovery, most patients can enjoy a diverse range of foods, albeit in smaller quantities than before.
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Qualifying for Gastric Sleeve Surgery
To be eligible for gastric sleeve surgery, certain criteria must be met:
- Severe Obesity (Class III): Defined as a BMI of 40 or higher, or a BMI of at least 35 with one or more related health conditions, such as hypertension, type 2 diabetes, sleep apnea, fatty liver disease, or hyperlipidemia.
- Prior Weight Loss Attempts: A documented history of unsuccessful attempts to lose weight through other methods. Insurance companies may require a three- to six-month medically supervised weight loss plan before approving the surgery.
- Physical and Mental Preparedness: A thorough evaluation by a team of dietitians, psychologists, and medical specialists to ensure readiness for the surgery and recovery process.
Preparing for Gastric Sleeve Surgery
If you meet the health screening requirements and are deemed eligible for bariatric sleeve surgery, the next step involves a two-week liquid diet. Your surgeon will provide specific guidelines to follow, with the goal of reducing fat in the abdomen and liver to enhance the safety of the surgery.
Additionally, you'll be instructed to abstain from eating or drinking anything for 12 hours before the operation to ensure an empty stomach during the procedure. This precaution minimizes the risk of unpleasant or dangerous side effects.
The Gastric Sleeve Surgery Procedure
How Gastric Sleeve Surgery is Performed
A sleeve gastrectomy is typically performed laparoscopically or robotically. This minimally invasive approach involves small incisions, leading to an easier recovery. However, in certain cases, open surgery may be more appropriate depending on the patient's specific condition.
What Happens During Gastric Sleeve Surgery?
- Anesthesia: General anesthesia is administered, ensuring the patient is asleep throughout the procedure.
- Incision and Port Placement: A small incision (approximately 1/2 inch long) is made in the abdomen, and a port is inserted. Carbon dioxide gas is pumped through the port to inflate the abdomen, providing the surgeon with a better view of the organs.
- Laparoscope Insertion: A small, lighted video camera (laparoscope) is placed through the port, projecting images of the internal organs onto a screen.
- Surgical Tools: Additional ports are inserted through one to three additional incisions, allowing the surgeon to use long, narrow tools to perform the procedure.
- Stomach Resection: The gastric sleeve is measured, and the remaining portion of the stomach is divided and separated using a surgical stapler.
- Stomach Removal and Closure: The excess stomach is removed, and the incisions are closed.
How Long Does Gastric Sleeve Surgery Take?
Sleeve gastrectomy is a relatively quick procedure, typically lasting about 60 to 90 minutes. Patients may need to stay in the hospital for one to two days afterward for pain management and monitoring of any temporary side effects, such as nausea.
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What to Expect After Gastric Sleeve Surgery
Follow-Up Care
Following the surgery, frequent check-ups with your healthcare provider are essential. They will monitor your weight loss progress, assess any related health conditions, and address any potential side effects. They will also ensure adherence to necessary lifestyle guidelines for maintaining health and weight loss.
Dietary Guidelines
In the short term, strict dietary guidelines are necessary to ensure proper healing of the stomach. After a few months, a more normal diet can be gradually introduced, with a focus on making nutritious food choices. Since the capacity to eat is reduced, prioritizing nutrient-dense foods is crucial to meet energy needs.
Diet Progression After Gastric Sleeve Surgery
- Day 1: Clear liquid diet.
- Days 2-21: Full liquid diet, including protein shakes, yogurt, broth, milk, and juice.
- Weeks 4-6: Soft food diet.
- After 6 Weeks: Gradual introduction of regular foods, with an emphasis on small, frequent meals.
All patients are required to take a multivitamin and B complex supplements after surgery.
Expected Weight Loss After Gastric Sleeve Surgery
On average, individuals lose about 60-70% of their excess weight after gastric sleeve surgery. The weight loss timeline typically looks like this:
- First 2 Weeks: 10-20 pounds (approximately one pound per day).
- First 3 Months: 35-45% of excess weight loss.
- First 6 Months: 50-60% of excess weight loss.
- First Year: 60-70% of excess weight loss.
Most individuals reach their lowest weight between 12 and 24 months after surgery. The success rate of gastric sleeve surgery is approximately 80-90%.
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Weight Loss in Detail
- First Month: The initial month sees significant changes as the body adjusts and the diet consists mainly of liquids and pureed foods. Weight loss averages around five pounds per week. Men tend to lose weight more rapidly than women.
- Three Months: By this point, with increased activity levels, patients can expect up to a 35% reduction in total excess weight.
- Six Months: Weight loss continues, but at a slower pace of about 2 pounds per week. Around 50-55% of excess weight is typically lost by this stage.
- One Year: The target weight is usually within sight, with an average of 65% of excess weight lost.
- Eighteen Months: Some patients may lose as much as 80% or more of their excess weight.
Individual results can vary, and factors such as preoperative education, commitment to lifestyle changes, and postoperative diligence play a significant role in the outcome. Studies suggest that weight loss at one and three months is a strong predictor of total weight loss. Patients who experience an earlier plateau in weight loss (around 6 months) may be more prone to regaining some weight.
Gastric Sleeve Success Rate
The Gastric Sleeve success rate is approximately 80-90%. Large clinical trials and studies have proven gastric sleeve surgery lead to resolution or improvement of many obesity-related health problems.
Improvement of Obesity Related Health Problems
Gastric sleeve surgery can lead to significant improvements or even resolution of various obesity-related health problems, including:
- Type 2 diabetes (remission or improvement in 60-80% of patients)
- Hypertension
- Fatty liver disease
- High cholesterol
- Sleep apnea
- Decreased cancer risk
- Polycystic ovary syndrome (PCOS)
- Asthma
- Migraine
- Joint pain
- Depression and other psychosocial problems
- Infertility
- Low testosterone (increased testosterone levels)
- Urinary incontinence
- Gout
Recovery After Surgery
The surgery typically takes 40-70 minutes, and hospital discharge usually occurs after 1-2 nights. Patients are encouraged to walk as early as 3-4 hours after surgery. Pain is generally manageable, with most patients requiring less than the recommended pain medication.
Most patients can return to work or school after 2-4 weeks, although fatigue is common during the first two weeks due to the low-calorie liquid diet. Energy levels typically improve quickly after the introduction of soft foods, around three weeks after surgery. Exercise can be resumed four weeks after surgery.
Long-Term Weight Loss Maintenance
Maintaining weight loss after gastric sleeve surgery requires a commitment to healthy lifestyle habits. Regaining weight is possible if old dietary and exercise patterns are resumed. Long-term success depends on making informed food choices and maintaining consistent eating habits.
Potential Complications and Risks
While gastric sleeve surgery is generally safe, potential complications and risks can occur:
- Leakage from the Staple Line: A rare complication where the staple line opens after surgery. Most leaks can be treated endoscopically.
- Stricture/Stenosis: Narrowing of the stomach after sleeve gastrectomy, which can often be treated with endoscopic dilation.
- Bleeding
- Blood Clots
- Heartburn: While some patients with pre-existing heartburn experience improvement after surgery, others may develop new heartburn, which is usually manageable with over-the-counter antacids.
- Nutrient or Vitamin Deficiency
- Weight Regain: Slight weight regain is common after 1-2 years, and approximately 10-20% of patients may experience significant weight regain.
- Excess Skin: In some cases, insurance may cover excess skin removal.
Gastric Sleeve vs. Other Bariatric Procedures
Gastric Sleeve versus Gastric Bypass Surgery
Gastric Sleeve has replaced the Gastric Bypass Surgery as the most popular bariatric surgery in recent years due to its technical simplicity and fewer long-term complication rates.
- Technically, the Gastric Sleeve is a much simpler surgery. The operating time for gastric sleeve is usually 40-70 minutes, while gastric bypass surgery takes approximately 2-3 hours to complete.
- There is a much lower chance for nutrient or vitamin deficiency with the Gastric Sleeve procedure. In addition, there is no mal-absorption for Gastric Sleeve patients.
- Some long-term complications could occur with the Gastric Bypass patients including bowel obstruction, marginal ulcer, and internal hernias.
Cost of Gastric Sleeve Surgery
The cost of bariatric surgery varies depending on the procedure and the facility.