About Sleeve Gastrectomy

In 2008, Memorial Health Bariatrics began offering sleeve gastrectomy. Like the gastric band, the sleeve is a purely restrictive procedure.

During this procedure, the stomach is remodeled and a large portion is removed. The remaining stomach is shaped like a thin tube with a pouch at the bottom. The pouch holds the same amount of food as the pouch created by the lap band or the bypass (approximately one-quarter cup of liquid). The stomach remains attached in its normal fashion to the intestines. The pylorus, a muscular valve at the bottom of the stomach, is left in place. This helps to prevent “dumping.”

Sleeve gastrectomy removes the portion of the stomach that stretches the easiest. However, the remaining portion can still be stretched over time, so measuring food portion is essential. As is the case with other forms of weight loss surgery, careful eating habits and exercise patterns are vital for long-term success.

Sleeve gastrectomy is not a new procedure. It is actually the first step in another surgical process called a duodenal switch. However, duodenal switch patients had such great initial weight loss that the second stage of the procedure was often abandoned. This gave rise to the idea of using the sleeve as a stand-alone procedure.

Sleeve gastrectomy does have some distinct advantages over other types of weight loss surgery, including:

  • Sleeve patients do not require adjustments after surgery.
  • There is no implanted device to fail or become infected.
  • Intestinal obstruction is very rare.
  • There are fewer issues with vitamin deficiency. The exception is that sleeve patients cannot produce enough intrinsic factor to process vitamin B12, so those supplements are necessary for life.

During the first year after surgery, sleeve gastrectomy patients may lose 33 to 80 percent of excess body weight.

Not all insurance companies will cover sleeve gastrectomy. Please check your coverage policy.

Risks of Sleeve Gastrectomy

It is important to remember that there are no ironclad guarantees in any kind of medicine or surgery. There can be unexpected outcomes in even the simplest procedures. Sleeve gastrectomy is irreversible and does carry a small risk of a leak or bleeding from the new staple line in the early post-operative period.

Sleeve gastrectomy patients cannot produce enough intrinsic factor to process vitamin B12, so they must take B12 supplements for life. We also recommend that you take regular vitamin supplements to replace what you may not get in your new diet.

In order for the procedure to be successful, you must follow a strict diet after surgery. Careful eating habits and exercise patterns are vital for long-term success.

Patients who undergo sleeve gastrectomy are at an increased risk of developing blood clots in their legs that can travel to their lungs. Early walking, the use of compression boots, anti-embolism stockings, and small doses of blood thinning agents help lower this risk.

Other Post-Surgery Issues

Patients who undergo bariatric surgery must make a lifelong commitment to eat healthy, exercise, and adhere to strict dietary guidelines. The lifestyle changes can seem overwhelming at first and can strain relationships within families and between married couples. To help patients achieve their goals and deal with the changes surgery and weight loss can bring, Memorial Health Bariatrics offers support groups, counseling, and continuing education.

Ultimately, the decision to have the procedure is entirely up to you. After having heard all the information, you must decide if the benefits outweigh the side effects and potential complications.

This surgery is only a tool. Your ultimate success depends on strict adherence to the recommended dietary, exercise, and lifestyle changes.

After Sleeve Gastrectomy

After surgery, you will stay two to three nights at Memorial Health University Medical Center. When you’ve recovered from your anesthesia, you will start a liquid diet that you will follow for several weeks. You will begin doing simple exercises from your bed just four hours after surgery. You will have some discomfort after surgery and will receive pain relief as needed.

Follow-Up

You will return to Memorial Health Bariatrics after two weeks, four weeks, three months, six months, one year, and then annually for the rest of your life.  At each of these visits, we will check your weight, measure certain parts of your body, check your strength, and perform other tests as needed. These check-ups are necessary to help us ensure that you are healthy and are following your diet and exercise guidelines.

Support

You will be asked to attend a support group regularly. Research has shown that adequate support is a vital part of weight loss success. We offer meetings at least twice a month here in Savannah in the Mercer Auditorium located in the Hoskins Center on the Memorial Health campus. We also hold monthly meetings in outlying communities.

You will meet with an exercise physiologist and dietitian. You will be given telephone access to a nurse 24 hours a day, seven days a week. Additional counseling and workshops will be available if you need them.

Changing the Way You Eat

The modifications made to your gastrointestinal tract will require permanent changes in your eating habits. Some of the changes include:

  • When you start eating solid food, it is essential that you chew thoroughly and eat very slowly.
  • You are not to drink fluids while eating. You need to wait 90 minutes after eating before drinking any fluid.
  • Omit desserts and other items with sugar listed as one of the first three ingredients.
  • Omit carbonated drinks, high-calorie nutritional supplements, milk shakes, high-fat foods, and foods with high fiber content.
  • Avoid alcohol.
  • Limit snacking between meals.
  • Take vitamin supplements as directed by your doctor.

Returning to Work

Your ability to resume pre-surgery levels of activity will vary based on your physical condition and the nature of the activity. Many patients return to full pre-surgery levels of activity within six weeks of their procedure. Patients who have had a minimally invasive laparoscopic procedure may be able to return to these activities within a few weeks.

Birth Control and Pregnancy

It is strongly advised that women of childbearing age use at least two effective forms of birth control during the first 16 to 24 months after weight loss surgery. A woman's ability to become pregnant returns within a week or two after you start to lose weight. The added demands pregnancy places on your body and the potential for fetal damage make this requirement very important.