Gastric sleeve surgery, also known as sleeve gastrectomy, has emerged as a popular and effective bariatric procedure for individuals seeking significant weight loss and improvement in obesity-related health issues. This article provides a comprehensive overview of the gastric sleeve procedure, including how it works, expected weight loss timelines, health benefits, eligibility criteria, recovery process, potential complications, and comparisons to other bariatric surgeries.
How Gastric Sleeve Surgery Works
Gastric sleeve surgery involves the removal of approximately 70-85% of the stomach, leaving a small, banana-shaped pouch. This reduction in stomach size leads to weight loss through several mechanisms:
- Reduced Stomach Volume: The smaller stomach capacity restricts the amount of food that can be consumed, leading to a feeling of fullness with smaller portions. People feel full much quicker after the surgery.
- Hormonal Changes: The surgery reduces the secretion of hunger hormones, such as ghrelin, which helps to decrease appetite and cravings. The hormones in your gut make you feel fuller faster and hungrier slower.
- Increased Stomach Motility: The procedure may increase stomach motility, allowing food to pass through the stomach and intestines more quickly.
History and Trend of Gastric Sleeve Surgery
Initially, the gastric sleeve was the restrictive component of the biliopancreatic diversion duodenal switch operation. It later became a standalone procedure, particularly for high-risk patients, after it was observed that some individuals lost substantial weight after the sleeve gastrectomy alone and did not require the second-stage duodenal switch. The first laparoscopic gastric sleeve was performed in 2000.
Over the past decade, the popularity of gastric sleeve surgery has increased steadily, now accounting for more than half of all bariatric surgeries performed in the US.
Expected Weight Loss After Gastric Sleeve Surgery
The weight loss timeline following gastric sleeve surgery can vary based on individual factors such as starting weight, metabolism, diet, activity level, and overall health. However, on average, patients can expect to lose a significant portion of their excess weight within the first year.
Read also: Comprehensive Guide to Gastric Bypass Diet
- The First 2 Weeks: Most patients lose about one pound a day. Expect a loss of 10-20 pounds.
- The First 3 Months: Expect to lose 35-45% of excess weight.
- The First 6 Months: Expect to lose 50-60% of excess weight.
- The First Year: Expect to lose 60-70% of excess weight.
Most individuals reach their lowest weight between 12 and 24 months after surgery. The gastric sleeve success rate is approximately 80-90%.
Gastric Sleeve Weight Loss Timeline: Month by Month
- Month 1: Weight loss averages 10-20 pounds, primarily due to the liquid diet and reduced calorie intake. Focus on recovery and adhering to dietary guidelines.
- Months 2-3: Expect an average weight loss of 8-12 pounds per month. Energy levels and physical appearance often show noticeable changes. Gradually introduce soft foods while maintaining a focus on protein and hydration. Incorporate light exercise, such as walking.
- Months 4-6: Weight loss may slow to 5-10 pounds per month. Solid foods are reintroduced, emphasizing balanced, nutrient-dense meals and portion control. Increase exercise intensity and incorporate strength training.
- Months 7-9: Expect a weight loss of 3-8 pounds per month. Many patients reach significant weight loss milestones during this period. Maintain a well-balanced diet and regular, varied exercise routine.
- Months 10-12: Weight loss slows to 2-5 pounds per month. Patients often reach or approach their target weight. Maintain healthy eating habits and a consistent exercise regimen.
- Year 1 and Beyond: Continue monitoring weight and adjusting habits as needed. Most patients achieve 60-70% excess weight loss within the first year. Maintain a lifelong commitment to healthy eating and staying active.
Improvement of Obesity-Related Health Problems
Gastric sleeve surgery has been shown to lead to significant improvement or resolution of many health problems associated with obesity, including:
- Type 2 Diabetes: Studies indicate that 60-80% of patients with type 2 diabetes experience disease remission or improvement after gastric sleeve surgery. Many patients report that there is a remarkable improvement in blood sugar levels, and even in some cases people have to stop using medications and insulin.
- Hypertension: Reduction in body weight can lead to lower blood pressure levels, thereby decreasing the risk of heart disease and even stroke.
- Fatty Liver Disease
- High Cholesterol: Patients often see improvements in their cholesterol levels. High cholesterol is a risk factor for heart disease, and its management is crucial for overall cardiovascular health.
- Sleep Apnea: Weight loss can reduce the severity of sleep apnea, leading to better quality sleep and a lower risk of associated complications such as heart problems and daytime fatigue.
- Decreased Cancer Risk
- PCOS (Polycystic Ovary Syndrome)
- Asthma
- Migraine
- Joint Pain
- Depression and Other Psychosocial Problems
- Infertility
- Low Testosterone: Gastric sleeve can naturally lead to increased testosterone levels.
- Urinary Incontinence
- Gout
Eligibility and Insurance Coverage
Most insurance companies cover bariatric surgery when patients meet the following criteria:
- BMI greater than 40, or
- BMI of 35-39.9 with one or more obesity-related health problems such as:
- Hypertension
- Type 2 Diabetes
- Sleep Apnea
- Fatty Liver Disease
- Hyperlipidemia
For patients with a BMI of 30-34.9, insurance coverage is typically not available for bariatric surgery procedures. However, self-pay options are often available for individuals who have struggled with obesity for a long time, especially those with obesity-related health problems.
The journey to get insurance approval for the surgery can be quite daunting and extensive. Insurance companies typically require a comprehensive set of tests and a thorough evaluation process before they will agree to cover the surgery to ensure that the surgery is actually medically necessary and that the patient is a suitable candidate for the surgery. The pre-surgical insurance requirements often include a mandatory period of documented weight-loss efforts, proving that you tried weight loss in other forms first. Most insurance companies require potential patients to have a recorded 6 to 12 months of attempts to lose weight through diet and other non-surgical methods. In addition to weight loss documentation, patients will likely have to go through various tests and evaluations, including nutritional counseling, psychological assessments, and other health screenings to ensure that the patient is physically and mentally prepared for what they are about to go through and the lifestyle changes that are required before and after surgery.
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Recovery After Surgery
The surgery typically takes 40-70 minutes. Hospital stay is usually 1-2 nights. Patients are encouraged to walk as early as 3-4 hours after surgery.
Pain is generally manageable after surgery, with most patients requiring less than the recommended pain medication. Most patients return to work and/or school after 2-4 weeks. Fatigue is common in the first 2 weeks due to the low-calorie liquid diet, but energy levels improve quickly after the introduction of soft foods, approximately 3 weeks after surgery. Patients can begin exercising 4 weeks after surgery.
Diet After Gastric Sleeve Surgery
Following a specific diet plan is crucial for recovery and maximizing weight loss after gastric sleeve surgery. The typical diet progression is as follows:
- 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.
- After 6 Weeks: Patients can begin introducing regular food. They are encouraged to eat a small amount of food each time and have meals that are more frequent. All patients must take a multi-vitamin and B complex after surgery.
Complications and Risks
While gastric sleeve surgery has become safer over the past decade due to improvements in surgical techniques, complications can still occur. The main risks include:
- Leakage from the staple line: This is a rare complication where the staple line opens after surgery. Most leaks can be treated with an endoscopic procedure.
- Stricture/stenosis: Another rare complication involving narrowing of the stomach after sleeve gastrectomy. Most strictures can be treated with endoscopic dilation.
- Bleeding
- Blood Clot
- Heartburn: While some patients experience improvement in heartburn symptoms due to weight loss, others may develop new heartburn, which is treatable with over-the-counter antacids in most cases.
- Nutrient or vitamin deficiency
- Weight Regain: Slight weight regain is common after 1-2 years, and about 10-20% of patients may experience significant weight regain. However, long-term data suggest that most patients maintain their weight loss after the Gastric Sleeve Surgery.
- Excess skin: In some cases, insurance may cover excess skin removal.
The risk of death from gastric sleeve surgery is low, even less likely than hip replacement or gallbladder surgery. Also, fewer than 1 in 20 patients develop major complications.
Read also: Guide to Pureed Foods Post-Surgery
Comparison of Gastric Sleeve to Other Bariatric Procedures
- Laparoscopic Gastric Banding (Lap-Band): Due to high rates of long-term complications and inferior weight loss, the number of Lap-Band surgeries has decreased significantly.
- Laparoscopic Roux-en-Y Gastric Bypass Surgery: While considered the gold standard of bariatric surgery, gastric sleeve has surpassed gastric bypass in popularity due to its technical simplicity and fewer long-term complication rates.
Advantages 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.
Maintaining Weight Loss After Gastric Sleeve Surgery
Maintaining the results of gastric sleeve surgery requires a lifelong commitment to lifestyle changes, particularly in diet and exercise. Diet plays a vital role in maintaining the results of gastric sleeve surgery. Due to the reduced size of the stomach, it becomes essential to practice portion control. It is never okay to overeat. Eating small meals more frequently will help avoid your stomach from overstretching. The main focus should be a balanced diet full of rich proteins, fruits, vegetables and whole grains. Regular physical activity not only helps burn calories but also allows your body to boost metabolism as well as improves cardiovascular health. After surgery, start with light exercise so you make sure you donât overdo it as you try to recover. You can amplify your workout as you get back 100%.
The drastic change in lifestyle can have an overwhelming impact on your mental state. In order to help with this you can get assistance from counselors, or join support groups. You should also be having regular follow-ups with healthcare providers to ensure that you are being monitored properly. Also, be honest about where you are mentally and physically. Despite gastric sleeve surgery reducing the size of your stomach, it can still stretch out again to accommodate more food as you ingest more. That will counteract the whole procedure.
Gastric Sleeve vs. Gastric Bypass
Gastric bypass and gastric sleeve are similar procedures, both resulting in an expected hospital stay of 2-3 days and are not reversible. Patients should expect to lose weight at a slower, steadier rate. Both surgeries can be effective tools in achieving long-term weight loss.
Endoscopic Sleeve Gastroplasty (ESG)
Endoscopic sleeve gastroplasty (ESG) is a non-surgical procedure that offers weight loss similar to gastric sleeve results. ESG works by using sutures that are placed from inside the stomach to make the stomach smaller and reduce its size by about 70%. ESG is minimally invasive and is performed as an outpatient procedure, so it does not require a hospital stay. With ESG, individuals can expect to lose approximately 20-23% of their total body weight in the first 12 months.