If you're among the millions grappling with obesity, you might be exploring various avenues for a healthier life, including gastric sleeve surgery. This article delves into the specifics of this bariatric procedure, addressing the anticipated rate and extent of weight loss, as well as the associated costs.
What is Gastric Sleeve Surgery?
Gastric sleeve surgery, also known as sleeve gastrectomy or vertical sleeve gastrectomy, is a bariatric procedure designed to aid weight loss. It's generally performed laparoscopically and is designed for people with body mass indexes (BMI) of 35 or higher. The procedure targets excess weight by limiting the amount of food you can eat.
During the surgery, a surgeon uses staples to divide the stomach vertically and removes 75-85% of the stomach, effectively reducing its size. This gastric restrictive procedure makes you feel full more quickly.
How Does Gastric Sleeve Surgery Work?
The gastric sleeve surgery works through a few mechanisms:
- Reduction in Stomach Volume: The reduced stomach volume causes people to feel full much quicker after the surgery.
- Hormonal Changes: Removing up to 85 percent of the stomach decreases levels of a hormone called ghrelin. Dubbed ‘the hunger hormone’ ghrelin is found in the stomach and has the primary functions of stimulating appetite, encouraging food intake and promoting fat storage. Patients report feeling less hungry in general and fuller after eating smaller portions after gastric sleeve surgery. Less ghrelin is also good news for sufferers of type II diabetes as it plays a role in blood sugar metabolism (though it should be noted that this kind of surgery is less effective than the gastric bypass or duodenal switch at resolving type II diabetes).
- Increased Stomach Motility: Increased stomach motility, which allows food to pass stomach and intestine quicker after surgery.
History and Trend of the Gastric Sleeve
Initially, the Gastric Sleeve was the restrictive part of the biliopancreatic diversion duodenal switch operation. Then, the gastric sleeve became the first stage operation for very obese patients who underwent duodenal switch operation to reduce the perioperative risks. Some patients lost enough weight after the gastric sleeve surgery and did not undergo the planned second stage duodenal switch operation. These findings prompted bariatric surgeons to consider the gastric sleeve surgery as a standalone bariatric procedure. The first laparoscopic Gastric Sleeve was performed in 2000.
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Over the past decade, the number of gastric sleeve surgeries continue to increase nearly every year. Now, more than half of all bariatric surgeries performed in US are gastric sleeve procedures.
Expected Weight Loss After Gastric Sleeve Surgery
The majority of gastric sleeve patients drop an average of 60-70% of their excess weight in a year. In two years, you may lose up to three-quarters of your excess weight. Some gastric sleeve patients saw resolution of comorbidities (such as the risk of heart attack, diabetes and other weight-related ailments) in 1-2 years.
While no two cases are the same and several factors contribute to the success of your gastric sleeve surgery, on average, you will probably lose 8 to 12 pounds per month.
Here's a general timeline of expected weight loss:
- The first 2 weeks: 10-20 pounds; most patients lose about one pound a day
- The first 3 months: 35-45% of excess weight loss
- The first 6 months: 50-60% of excess weight loss
- The first year: 60-70% of excess weight loss
Most people reach their lowest weight 12-24 months after surgery.
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Factors Influencing Weight Loss
Several factors can influence the rate and extent of weight loss after gastric sleeve surgery:
- Starting Weight: Your initial weight plays a role in how much weight you're likely to lose.
- Post-Surgery Diet: Adhering to a strict post-surgery diet is crucial for optimal weight loss.
- Age: Age can affect metabolism and, consequently, weight loss.
- Lifestyle: A healthy lifestyle, including regular exercise, contributes significantly to weight loss.
- Existing Health Issues: Pre-existing health conditions can impact weight loss.
- Commitment to Behavioral Transformation: While genetics cannot be changed, the biggest difference in results for most patients is the quality of their preoperative education, their commitment to behavioral transformation, and their post-operative diligence to continue what they have learned.
The Weight Loss Journey: A Month-by-Month Breakdown
- First 30 Days: In the first 30 days, the changes will be intense. Not only is your body responding to its new reality, but your diet of mostly liquids and pureed foods will also facilitate rapid changes. The average drop in weight is around five pounds per week.
- Three Months Post-Surgery: By this point, your body will be healed enough that you should be engaging in regular activities, and you could see up to a 35% reduction in total excess weight.
- Six Months Post-Surgery: Half a year after surgery, your body will likely continue to lose weight but not at the brisk pace you saw before (about 2 pounds per week). You will likely have lost around 50-55% of your excess weight at this stage.
- One Year Post-Surgery: A year from surgery, your target weight should be well in sight. By this stage, most people have lost an average of 65% of their excess weight.
- Beyond 18 Months: After a year and a half, some patients lost as much as 80% or more of their excess weight.
Importance of a Healthy Lifestyle
Regaining weight after gastric sleeve surgery is likely if you return to your old dietary and exercise habits. Research shows that long-term weight loss after surgery is directly tied to food choices and eating habits. If you don’t take the correct precautions, you can easily stretch your stomach sleeve and regain unwanted weight.
Benefits Beyond Weight Loss
Large clinical trials and studies have proven gastric sleeve surgery lead to resolution or improvement of many obesity related health problems such as:
- Type 2 diabetes: Most studies indicated that 60-80% of patients with type 2 diabetes could achieve disease remission or improvement after gastric sleeve surgery
- Hypertension
- Fatty liver disease
- High cholesterol
- Sleep apnea
- Decreased cancer risk
- PCOS
- Asthma
- Migraine
- Join pain
- Depression and other psychosocial problems
- Infertility
- Low testosterone: Gastric sleeve can naturally lead to increased testosterone level
- Urinary incontinence
- Gout
Eligibility and Insurance Coverage
Most insurance companies cover bariatric surgery, when you meet the following criteria:
- BMI greater than 40, or
- BMI of 35-39.9 with one of the obesity related health problems such as:
- Hypertension
- Type 2 diabetes
- Sleep Apnea
- Fatty liver disease, or
- Hyperlipidemia
For patients with BMI of 30-34.9, insurance will not cover bariatric surgery procedures. However, there are self-pay options for those individuals who have struggled with obesity for a long time, especially those with obesity related health problems.
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What Qualifies You for Gastric Sleeve Surgery?
To qualify, the general requirements are:
- That you have severe obesity (class III). This is determined by your BMI (body mass index), which is calculated by your weight and height, and your related health conditions. Class III obesity means a BMI of 40 or higher, or a BMI of at least 35 with at least one related disease.
- That you have tried to but not succeeded in losing weight prior to surgery. You may be required to spend three to six months on a medically supervised weight loss plan before your insurance company will approve and cover your surgery.
- That you are physically and mentally prepared for the surgery and recovery process. Before qualifying for weight loss surgery, you’ll meet with a team of dietitians, psychologists and other medical specialists for counseling and screening.
What Happens Before Gastric Sleeve Surgery?
If you’ve passed your health screening and qualify for bariatric sleeve surgery, the next step will be a two-week liquid diet. Your surgeon will give you specific guidelines to follow. The purpose is to lose some of the fat in your abdomen and your liver to make the surgery safer.
You’ll be asked not to eat or drink anything for 12 hours before your operation. That’s to make sure your stomach is empty during the procedure. Having food or liquid left in your stomach during the surgery could cause unpleasant or even dangerous side effects.
How is Gastric Sleeve Surgery Performed?
Most of the time, a sleeve gastrectomy is done by laparoscopic or robotic surgery. That means that instead of making a large incision (or cut) to open your abdominal cavity to access your organs, your surgeon will perform the operation through small incisions. This makes for an easier recovery, but some people may be better served by open surgery, depending on their conditions.
What Happens During Gastric Sleeve Surgery?
- Your surgeon will give you general anesthesia, so you’ll be asleep during the procedure.
- Your surgeon will make a small cut in your abdomen (about 1/2 inch long) and insert a port. They’ll pump carbon dioxide gas through the port to expand your abdomen.
- Then they’ll place a small lighted video camera (laparoscope) through the port. The camera will project your insides onto a screen.
- Through one to three additional incisions, your surgeon will insert additional ports and complete the procedure using long, narrow tools.
- They will measure out the gastric sleeve, then divide and separate the remainder of your stomach using a surgical stapler.
- Your surgeon will remove the remainder of the stomach, then close your incisions.
How Long Does Gastric Sleeve Surgery Take?
Compared to other weight loss surgery procedures, a sleeve gastrectomy is a relatively short and simple operation. It takes about 60 to 90 minutes. Your surgeon may still want you to stay in the hospital for one to two days afterward. This way, they can help manage your pain and any temporary side effects of surgery, such as nausea.
What Happens After Gastric Sleeve Surgery?
You’ll have frequent check-ups with your healthcare provider in the following weeks and months. They’ll monitor your weight loss progress, your related health conditions and any side effects of the surgery. They’ll also want to know if you’re taking good care of yourself and following the necessary lifestyle guidelines to maintain your health and weight loss.
Will I Have to Follow a Diet After Gastric Sleeve Surgery?
In the short term, you will have to follow strict dietary guidelines to make sure your stomach heals well. After a few months, you may begin to eat a more normal diet, but you’ll still have to choose your foods wisely. Because you won’t be able to eat as much as before, you’ll have to make sure that what you do eat is nutritious enough to sustain your energy needs.
Diet after Gastric Sleeve Surgery
- Day 1: Clear liquid diet. Some surgeons allow patients to drink water a few hours after surgery
- Days 2-21: Full liquid diet including protein shakes, yogurt, broth, milk, and juice
- Weeks 4-6: Soft food diet
- Patients can begin introducing regular food 6 weeks after surgery. They are encouraged to eat a small amount of food each time and have meals that are more frequent.
All patients must take multi-vitamin and B complex after surgery
Recovery after Surgery
- The surgery takes approximately 40-70 minutes
- Discharge from hospital typically occurs after 1-2 nights
- All patients are encouraged to walk as early as 3-4 hours after surgery
- In general, the pain is easily manageable after surgery. Most patients take less than the recommended pain medication
- Most patients go back to work and/or school after 2-4 weeks. Fatigue is common the first 2 weeks due to low calorie intake from liquid diet. However, the majority of patients do not feel hungry during this stage of the diet. The energy level improves quickly after the introduction of the soft diet, which is approximately 3 weeks after surgery.
- Patients can begin exercising 4 weeks after surgery
Potential Risks and Complications
Over the past decade, with the improvement of surgical techniques and surgeons’ experience, the gastric sleeve has become an overall safe bariatric surgical procedure. However, complications can still occur during and after surgery. Below are the main complications and risks of the gastric sleeve surgery:
- Leakage from the staple line - this is a rate complication of the gastric sleeve surgery. The stable line opens after surgery. Most leaks can be treated with endoscopic procedure.
- Stricture/stenosis - another rare complication with narrowing of the stomach after sleeve gastrectomy. Most stricture/stenosis can be treated with endoscopic dilation.
- Bleeding
- Blood Clot
- Heart Burn - This is a very controversial topic in bariatric surgery and the data from different centers is inconsistent. In our experience, most patients with heartburn before surgery see improvement of symptoms after surgery due to weight loss. Some patients may develop new heartburn, which is treatable with over-the-counter anti-acid medications, in most cases.
- Nutrient or vitamin deficiency
- Weight Regain - After 1-2 years, slight weight regain is common among all bariatric procedures and about 10-20% of patients can have significant weight regain after gastric sleeve surgery. After 5 years of follow up, many centers collected data to show that the majority of patients can maintain their weight loss after the Gastric Sleeve Surgery.
- Excess skin, in some cases, insurance will cover excess skin removal
Gastric Sleeve vs. Other Bariatric Procedures
Both sleeve gastrectomy and gastric bypass are bariatric surgeries that change the size of your stomach. But in a gastric bypass, your surgeon also connects the middle of your small intestine to your stomach. All weight loss surgeries have pros and cons. Your surgeon will help you decide which procedure is right for you based on your health risks, history, and preferences.
Advantage of Gastric Sleeve versus Gastric Bypass Surgery
- 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.
Comparison of Gastric Sleeve to other Types of Bariatric Procedures
- Laparoscopic gastric banding (Lap-band) was once very popular. However, due to its high rate of long term complications and inferior weight loss, the number of Lap-band surgeries went down every year in the US and worldwide. Most of the US large academic Bariatric Surgery Centers rarely perform the Lap-band procedure at this time.
- Laparoscopic Roux-en-Y Gastric Bypass Surgery is the gold standard of bariatric surgery. However, 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.
Gastric Sleeve Success Rate
The Gastric Sleeve success rate is approximately 80-90%.
Cost of Gastric Sleeve Surgery
Bariatric surgery costs vary depending on the procedure. At the Bariatric and Metabolic Center of Colorado in partnership with our non-profit center of excellence (Parker Adventist Hospital), a sleeve gastrectomy is much more affordable. Here your life-saving weight loss surgery costs $12,250.
Long-Term Weight Loss Maintenance
Recent studies reveal that 35 percent of American men and 40 percent of women are obese, with a body mass index (BMI) of 30 or higher.
People with severe obesity who had bariatric surgery maintained significantly more weight loss at 5 years than did those who did not have surgery.
It’s important to monitor patients closely for early signs of weight regain-and to intervene early with a detailed nutritional and medical evaluation to look for behavioral and surgical explanations for weight regain.