Gastric Sleeve Surgery for Weight Loss: Procedure, Risks, and Life After Procedure
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Weight loss surgery also called bariatric or metabolic surgery, is sometimes used as a treatment for people who are very obese. A surgeon removes part of the stomach in gastric sleeve surgery and makes a narrow tube or “sleeve” out of the rest. The new, banana-shaped stomach is much smaller than the original stomach. Part of the stomach that’s removed makes hormones that increase appetite and help control insulin. So, after surgery, a person’s need decreases, and their insulin resistance gets better.
The person will eat less, feel full sooner, and be less hungry. The gastric sleeve procedure is not reversible.
It can lead to significant weight loss and help improve many obesity-related conditions, such as type 2 diabetes or high blood pressure.
But it’s a major operation and in most cases should only be considered after trying to lose weight through a healthy diet and exercise.
Who Gets Gastric Sleeve Surgery?
This surgery can help people who are very overweight and have serious health problems because of their weight. But it isn’t a “fix it and forget it” kind of surgery.
To be considered for surgery, a person must commit to changing their eating and exercise habits over the long term. Not everyone who wants surgery will be eligible to get it.
Doctors consider many things when deciding if weight loss surgery is the right choice for teens. These include whether a teen:
- Is he healthy enough to handle surgery?
- has a high body mass index (BMI) (of 40 or more) with serious medical problems caused by weight, like diabetes, heart disease, liver disease, or sleep apnea, or are 100 or more pounds over their ideal body weight
- has proved that they can stick to a healthy diet and get regular exercise
- has family members who will provide emotional and practical support (like driving to every doctor’s visit or buying healthy food)
If you’re worried about your weight or think weight loss surgery could help, talk to your doctor.
What Happens Before Gastric Sleeve Surgery?
Getting ready for this significant operation takes months of work. Patients need to show that they can make substantial changes in their eating and exercise habits before the surgery.
The best place for teens to get gastric sleeve surgery is at a hospital with a bariatric surgery program whose team of specialists treats kids and teens. Members of the team will explain what’s involved, help you prepare for your surgery, and care for you after it.
For several months before surgery, you’ll work with the medical team to build the skills needed for success. Here are some of the people who work as a team to help teens prepare for gastric sleeve surgery:
Doctors and surgeons. Several months before your surgery, you’ll meet with a medical doctor and surgeon. They will explain what happens during surgery, examine you, and talk about what to expect before and after surgery. They’ll also let you know about some of the things that can go wrong (the possible “complications”).
Psychologists. People go through lots of emotions before and after surgery. A psychologist can help you understand your feelings and help you prepare emotionally for surgery and the changes after it. Most people feel better about themselves after weight loss surgery. But some may still struggle, especially if they’re dealing with depression or anxiety.
The psychologist will help you develop coping strategies as you learn to change your relationship with food. They’ll also help you with things like worry, stress, or emotional eating. It’s important to keep seeing the psychologist after surgery, especially if you feel overwhelmed, sad, or have other emotional concerns.
Dietitians. Because patients often depend on parents or other family members for meals, a dietitian will teach you and your family healthy eating basics like good nutrition and regular meals and fit portion sizes.
Gastric sleeve surgery permanently decreases the size of the stomach. You will have to eat less than you did before. Your dietitian will explain what and how much you can eat after surgery, both right after the operation and for the rest of your life.
Exercise specialists. These experts help patients get more active. They’ll work with you to develop an exercise program you’ll like and workouts you can stick with. Exercising during the months before surgery helps patients get in better shape for the operation. This makes recovery easier. It also makes it easier after surgery to get back into working out. Many patients find that having a workout routine helps them feel better after surgery, but you will have to go slow. Talk to your doctor and exercise specialist about how to get back into your exercise routine gradually.
Gastric Sleeve Surgery: Procedure
Gastric sleeve surgery is a significant operation. Doctors will give you anesthesia, so you sleep through the surgery. After you’re asleep, the surgeon will take out three-quarters of your stomach. Your smaller banana-shaped stomach is called the gastric sleeve.
You’ll probably stay in the hospital for a couple of nights so doctors and nurses can keep an eye on your recovery. They will give you medicine for pain or nausea (feeling sick), help you to get up and move around, and make sure you can drink liquids without throwing up.
Risks of Gastric Sleeve Surgery
Because it’s major surgery, a gastric sleeve operation has some risks, including:
- leaking of stomach contents into the belly from where the surgeon cut the stomach
- a bad reaction to anesthesia
- blood clots
- gastroesophageal reflux
- vitamin and mineral deficiencies
- weight regain
You’ll have treatment to reduce your risk of blood clots after surgery, such as special leg stockings or blood-thinning medicine, but you can sometimes still get them.
Common places to get blood clots are in the lower leg (deep vein thrombosis) or lungs (pulmonary embolism).
Symptoms can include:
- your lower leg becoming painful, achy and tender
- swelling, redness or warmth in your lower leg
- a sharp, stabbing chest pain that may be worse when breathing in
- shortness of breath or a cough
- feeling faint or dizzy
Sometimes the wounds from your surgery can become infected while they’re healing.
Signs of a wound infection can include:
- pain in or around the wound
- red, hot and swollen skin
- pus coming from the wound
Gastric band slipping out of place
If you have gastric band surgery, there’s a small risk that the band could move out of position.
This can cause:
- feeling sick
Leak in the gut
In the days or weeks after a gastric bypass or sleeve gastrectomy, there’s a small chance that food could leak out into your tummy.
This can cause a serious infection inside your tummy.
Symptoms of a leak can include:
- a high temperature
- a fast heartbeat
- tummy pain
- chills and shivering
- fast breathing
Sometimes the stomach or small intestine can become narrower or blocked after weight loss surgery. This can happen as a result of the side effects of the surgery, such as scarring and reduced blood flow to the area.
The blockage can cause a number of complications, including food getting stuck and your gut becoming kinked or twisted.
This can then cause the following symptoms:
- difficulty swallowing
- you keep being sick (vomiting)
- tummy pain
- not needing to poo as often as usual
Weight loss surgery can make it harder for your gut to absorb vitamins and minerals from food, so there’s a risk you could become malnourished.
This might not always be obvious, but possible symptoms can include:
- feeling tired or lacking energy all the time
- shortness of breath
- noticeable heartbeats (palpitations)
- pale skin
- pins and needles
- feeling weak
Having a balanced diet can help reduce the risk of malnutrition, but most people need to take extra nutritional supplements for life after surgery.
It’s common to develop gallstones in the first year or two after weight loss surgery. These are small, hard stones in the gallbladder that can form if you lose weight quickly.
The main symptom of gallstones is episodes of severe tummy pain that come on suddenly and can last a few minutes to a few hours.
They can also sometimes cause:
- a high temperature
- a fast heartbeat
- yellowing of the skin and eyes (jaundice)
- itchy skin
- chills or shivering
What Happens After Gastric Sleeve Surgery?
People usually recover from gastric sleeve surgery in a week. But it will take several weeks before you can eat regular food again. Gastric sleeve surgery makes your stomach smaller — permanently. For the rest of your life, you’ll always have to eat much smaller portions. You’ll also feel full faster.
To ease into having a much smaller stomach, you’ll need to follow a special diet that starts with liquids only. Your dietitian will give you an eating plan that gradually works up to solid foods. For example:
- For the first 2 to 3 weeks after surgery, you’ll get all your nutrition from high-protein drinks.
- For the next 2 weeks or so, you’ll eat puréed foods.
- Finally, you’ll move on to soft foods for another couple of weeks before you can eat regular food.
Because you can’t eat as much, the foods you choose to eat matter. Your dietitian will teach you how to put together a healthy, balanced diet that includes fruits and vegetables, and protein. Snacks like chips and candy are high in calories and don’t have the nutrition you need, so try to avoid them. Your dietitian also will recommend vitamin and mineral supplements, so you don’t miss out on critical nutrients.
What Else I Should Know?
Here are some things to be aware of in the weeks and months after gastric sleeve surgery:
- If you overeat food or eat too fast, you might throw up, have diarrhea, or get acid reflux.
- Food might move too fast through your digestive system, causing nausea, cramps, and diarrhea (doctors call this “dumping syndrome”).
- Suppose you don’t eat healthily and don’t take your daily vitamin and mineral supplements. In that case, you won’t get enough essential vitamins and minerals you need, like iron, vitamin B12, folate, and vitamin D.
- After you lose lots of weight, you may have loose skin.
If you have a lot of pain or bloating in your belly or you throw up a lot, call your doctor right away. It could be a sign there’s a problem that needs medical care.
Other Weight Loss Surgery Types
There are several different types of weight loss surgery.
They’re all usually done under general anaesthetic (where you’re asleep) using keyhole (laparoscopic) surgery, but they each work in a slightly different way.
Keyhole surgery is where a surgeon makes small cuts in the tummy and inserts a flexible viewing tube so they can see inside while performing the operation.
A gastric band is a band that’s placed around the stomach, creating a small pouch towards the top.
It takes less food to fill the pouch, so you do not need to eat as much before you feel full.
The band is connected to a small device placed under the skin (usually near the middle of the chest). This is so the band can be tightened after surgery.
The band will usually be tightened for the first time about 4 to 6 weeks after surgery. This is done by injecting the device with salt water solution using a needle passed through your skin. You do not usually need any anaesthetic for this.
The band will need to be tightened a few times to get to the ideal tightness for you.
A gastric bypass is where surgical staples are used to create a small pouch at the top of the stomach.
The pouch is then connected to your small intestine, missing out (bypassing) the rest of the stomach.
This means it takes less food to make you feel full and you’ll absorb fewer calories from the food you eat.
An intra-gastric balloon is a soft balloon filled with air or salt water that’s placed into your stomach using a thin tube passed down your throat (known as a gastroscopy).
This means you will not need or be able to eat as much before you feel full. But it’s only a temporary measure and the balloon is usually left in for a maximum of 6 months.
A biliopancreatic diversion is similar to a gastric bypass, except the stomach pouch is connected further along the small intestine.
This means you’ll absorb even fewer calories from the food you eat. But it can cause more side effects than a gastric bypass, so it’s less commonly used.
Primary obesity surgery endolumena
Primary obesity surgery endolumena is a new technique to shrink your stomach. A tube called an endoscope is passed into your stomach.
A surgeon then passes tiny tools through the endoscope, which are used to gather your stomach into folds to make it smaller.
Primary obesity surgery endolumena is not currently available on the NHS so you will have to pay for this treatment.
Exercise after weight loss surgery
As well as eating healthily, you’ll need to exercise regularly to help you lose as much weight as possible after the operation.
You may be given an exercise plan. This will usually involve increasing your activity levels gradually as you recover from surgery.
Once you’ve fully recovered, you should aim to do regular activities that are intense enough to leave you feeling out of breath and make your heart beat faster, such as:
- brisk walking
- gardening or housework
Choose something you enjoy as you’ll be more likely to stick with it.
Pregnancy and contraception after weight loss surgery
Women are usually advised to avoid becoming pregnant during the period of most significant weight loss in the first 12 to 18 months after surgery.
This is because weight loss surgery can affect your vitamin and mineral levels. If your levels are low while you’re pregnant, there’s a risk it could harm your baby.
It’s a good idea to:
- use contraception until advised it’s safe to become pregnant – ask your doctor about the best type, as some are not suitable for women who’ve had weight loss surgery (including the contraceptive pill and contraceptive injection)
- speak to your doctor if you become pregnant soon after surgery or you’re planning a pregnancy at any stage after surgery – they can check your vitamin and mineral levels, and advise you about supplements (find out about vitamins and nutrition in pregnancy)
When to get medical advice
In the days or weeks after surgery, talk to your doctor or call your local emergency line right away if you have one or more of the following symptoms:
- really bad tummy pain in your tummy, or tummy pain that does not go away or is getting worse
- an unusually fast heartbeat
- a high temperature
- chest pain or shortness of breath
- being sick (vomiting) or vomiting blood
- difficulty swallowing
- dark, sticky poo
- signs of a wound infection, such as pain, redness, swelling and pus
In the months after surgery, make an appointment to see a GP if you:
- have pain in your tummy that comes and goes
- vomit every now and again
- have heartburn
- keep coughing at night
- feel sick most of the time
- have diarrhoea that does not go away
- have times where you feel flushed, sweaty or faint
Gastric sleeve surgery makes a massive change to the way your body handles food. It can take a while to get used to your body’s new normal. Besides eating a sensible diet, exercising is a vital part of staying healthy and maintaining weight loss after surgery.
People who follow the recommended diet and exercise plan often lose weight in the months after gastric sleeve surgery. After that, the importance begins to stabilize.
Your team of specialists will keep seeing you after surgery to monitor your diet and health and help you stay on track. It’s essential to go to all return visits to maintain a healthy lifestyle and the bariatric team can watch for any problems.