Gastric Sleeve also called Vertical Sleeve Gastrectomy
The Gastric Sleeve is one of the most commonly performed weight loss procedures in St. Louis as well as in the country.
The Laparoscopic Sleeve Gastrectomy – often called the Gastric sleeve – is performed by removing approximately 80 percent of the stomach. General anaesthesia is used during gastric sleeve surgery. The part of the stomach that is left behind is a tubular pouch that resembles a banana. The procedure is done by Laparoscopy – typically tiny keyhole incisions placed on the upper part of the belly.
How does Gastric Sleeve Work?
The Sleeve Gastrectomy surgery works by multiple mechanisms:
The size of the stomach is reduced. This reduces the amount of food and calorie intake.
There is a significant reduction in hunger and craving for food. This happens due to changes in gut hormones and signals.
The body metabolism is favourably altered. This leads to better regulation of blood sugar, blood pressure and cholesterol.
Short term studies show that the sleeve is as effective as the roux-en-Y gastric bypass in terms of weight loss and improvement or remission of diabetes. There is also evidence that suggests the sleeve, similar to the gastric bypass, is effective in improving type 2 diabetes independent of the weight loss.
Advantages of Gastric Sleeve
- Restricts the amount of food the stomach can hold and thus restricts how much food a patient can eat.
- Requires no foreign objects as gastric banding does, and no bypass or re-routing of the food stream
- Involves a relatively short hospital stay of typically one night.
- Causes favorable changes in gut hormones that suppress hunger, reduce appetite and improve satiety
- Induces rapid and significant weight loss that comparative studies find similar to that of the Roux-en-Y gastric bypass.
Disadvantages of Gastric Sleeve
This procedure is non- reversible
Has the potential for long- term vitamin deficiencies.
Benefits of Gastric Sleeve Surgery:
Significant and long lasting weight loss
Increased energy, Less pain, more enthusiasm in the long term
Treats conditions such as:
Obstructive Sleep Apnea
Less risk of Malabsorption or dumping syndrome
Less risk for bowel obstruction or stomach ulcer compared to Gastric Bypass Surgery
Risks of Gastric Sleeve Surgery
Anesthesia related Risks:
Heart attack or Stroke
Blood clots in legs or Lungs
Reactions to medications
Surgery Related Risks:
Gastric Leak- leading to internal infection
Possible additional Surgeries
Long term vitamin deficiencies
Possible gallstone disease due to rapid weight loss
Like with any surgical operation, risk of death.
Gastric Sleeve is done for weight loss as well as to improve one’s quality of life and improve health by preventing or treating common medical conditions such as:
- Sleep Apnea
- High Cholesterol
- Heart Disease
- Type 2 Diabetes
It is a life saving intervention.
- If your BMI is over 40
- Anyone with a BMI of 35-39 and with associated comorbidities such as Hypertension, Diabetes etc is a good candidate for Gastric Sleeve.
- Select patients with Class I obesity ( BMI 30 to 35) with co morbid conditions have been shown to benefit from gastric sleeve surgery.
There is no specific wait period for gastric sleeve surgery at Arch Bariatrics. Most times the “wait period” is dictated by the type of medical insurance or your payment and financing options
At Arch Bariatrics every patient needing weight loss surgery is needed to complete the following
- A consultation and discussion with Dr. Kumaran Chinnappan
- Medical clearance from your Primary Care Physician
- Psychological clearance from a licensed professional
- Arrangement of finances or approval from your insurance
- Dietary evaluation and follow pre op diet as advised.
We have a Self Pay price of $11,111- all inclusive with no additional cost. This cost includes surgeon fee, facility charges, anaesthesia charges and hospital stay.
Many health insurances do cover gastric sleeve surgery for patients who qualify. There may be patient responsibility in terms of copay, coinsurance or deductibles. Please refer to your insurance contract for further information.
- You will be on diet as advised.
- You will do preoperative lab work as advised.
- Avoid anxiety and maintain a positive mindset.
- Prepare yourself for a one night stay in the hospital
- Arrange for someone to drop off and pick up from the hospital
Yes. You may be placed on a special pre-operative liquid diet for 1-2 weeks. This diet helps to shrink the liver and to reduce the fat inside the abdomen. This reduces the risk during the procedure.
In addition, some insurance companies might require you to participate in a physician monitored diet program for 3 to 6 months prior to them approving your surgery. This program is more about diet education and demonstrating behavioral changes and willingness to be compliant to the program.
- Arrange to arrive at the time as advised
- You will be received in a pre procedure room and change into hospital attire.
- Dr. Chinnappan and an anaesthesiologist will meet you and go over the procedure again and answer any questions you may have.
- An IV line will be started in your arm and fluids and medications will be administered.
- Your family member or friend can stay with you until you are taken to the operating room.
Usually the surgery takes about an hour to complete. This could be variable depending on an individual patient’s body habitus or scarring from previous surgery etc.
Since the procedure is done by laparoscopic (Key hole) method, the pain is not severe and typically well controlled by regular pain medications. In addition you may have a pain medication delivered through a pain pump placed during surgery.
There are two kinds of pain due to gas after the surgery.
We use carbon dioxide (CO2) to inflate the abdominal cavity to perform laparoscopic sleeve gastrectomy. Usually all the CO2 is evacuated completely at the completion of the procedure. Occasionally some CO2 may be trapped and cause abdominal discomfort or shoulder pain. This is rare and resolves in 24- 48 hours after surgery and the pain medication can be effective in giving relief.
Another kind of “Gas Pain” is when some air is trapped in the lumen of the stomach. Intake of carbonated beverages (soda), using straw or chewing gum can precipitate this kind of pain and should be avoided. This is self limiting and resolves on its own. Improving ambulation or simethicone drops can provide relief.
After the surgery you will be moved to the Post Anesthesia Care Unit (PACU) for observation. When awake you will be shifted to your room on the hospital floor. You will be strongly encouraged to walk in the room as well as the corridor on the floor. Regular use of an incentive spirometer (provided) is also encouraged. You might feel very sleepy on the day of surgery and that is to be expected.
You will be started on a clear liquid diet next morning. It is normal to expect some nausea, vomiting or acid reflux during this time. As the day goes by your oral intake typically improves and you can expect to be released home after noon.
It is extremely important to maintain adequate intake of fluids and protein to prevent dehydration and weakness.
It is not advisable to drive within 24 hrs of general anaesthesia and when you are taking strong pain medications. Please arrange for someone to pick you from the hospital upon discharge. You may be able to start driving 3-4 days after the surgery.
Most patients can expect to return to work in 1 week after surgery. People working from home may be able to return sooner.
In the initial phase immediately after the gastric sleeve surgery, you might experience pain in the lower chest while swallowing. This is due to the narrowed food passage as well as some air trapped in the pathway. Drink/eat slowly, small amounts at a time and walk and try to be in an erect posture while swallowing. Do not drink while lying in bed. Do not stop trying!
Week 1- Clear liquid diet. We advise Protein water as a source of protein.
Week 2 – Full liquid diet. You may start taking Protein shakes.
Week 3- Soft diet.
Week 4 – Regular diet.
You will regain a normal diet gradually but will consume lesser quantities. You can expect to have weakened appetite and craving. Healthier food choices are very important for the rest of your life.
At Arch Bariatrics, we recommend you crush your pills for the 1st month after surgery if the size of your pill is bigger than an M&M.
The day of surgery! You will be encouraged to walk on the same day of surgery. We advise you to continue short walks and low impact exercise in the initial days after surgery. It is a good idea to avoid lifting heavy objects in the initial 4 weeks after surgery. After this time there are no restrictions to physical activity or limitations on exercise.
In the long term behavioral change to accommodate a regular exercise regimen is strongly advised. Regular exercise helps to burn calories as well as control appetite and stress. The exercise need not be intense and painful.
Most patients with obesity have GERD or acid reflux. Weight loss achieved through gastric sleeve surgery will help to resolve GERD. Additionally, some patients may have hiatal hernia (as evidenced by an upper endoscopy) which if repaired during the gastric sleeve surgery will help resolve GERD symptoms.
Regardless, gastric sleeve surgery can cause GERD symptoms. Many times this may be short lived and may be treated with acid medications. Rarely a revision surgery to gastric bypass may be indicated if the GERD symptoms are not responsive to medications.
Some amount of altered bowel movements can be expected after surgery. This is self limiting and usually not worrisome. You might experience diarrhoea when you are on liquid diet or constipation later on when the oral intake has significantly reduced after surgery. It is very important to maintain adequate fluid intake and is ok to take occasional stool softeners to regulate bowel movement.
Yes. The staplers used are safe and do not cause long term health issues.
- They are typically not seen on an ordinary X ray.
- They do not activate airport security and metal detectors.
- Usually do not prevent you from having MRI scans in the future.
Weight loss happens gradually after the surgery and can happen upto 12 months post op. Having unrealistic expectations or setting time bound weight loss goals may contribute to unnecessary anxiety.
It is very important to maintain motivation and follow the dietary guidelines. A regular exercise regimen, adequate protein and vitamin intake and making appropriate food choices are key to a successful outcome after surgery.
Some form of hair loss happens from 3-6 months after surgery. This is almost always temporary. Adequate intake of proteins, vitamins and minerals is very important to facilitate regrowth and prevent long term thinning of hair.
Many patients are able to go off their blood pressure and Diabetes medications after surgery. These changes can happen within the initial weeks after surgery even before the actual weight loss is realized. We strongly advise you to consult your personal physician to handle these changes.
You will have to take vitamins for the rest of your life. We advise daily Multivitamins, B 12, Calcium, Vit D and Iron supplements. In addition you will have to have annual lab work.
It is unusual and can easily be avoided by regular intake of vitamins and mineral supplements. Deficiency can cause health effects such as:
- Low blood count
- Vision impairment
- Decreased immunity against infections
- Nerve function deficiency
- Mental changes
Fortunately all of this can be avoided by regular intake of vitamins and a healthy diet. It is very important to be on regular follow up and complete annual lab work.
We usually recommend waiting for 12- 18 months after surgery prior to getting pregnant. Weight loss surgery significantly increases fertility and as a result some form of contraception is advised to avoid unexpected pregnancy.
After the surgery there is less risk of complications during pregnancy or childbirth and as a result most patients go on to have a healthy child.
Depending on the original pattern of body fat distribution, some patients may be left with excess skin- typically around the waist, arm or the thigh regions. A good exercise and workout regimen to build muscle and tone the skin might be very helpful and strongly advised after surgery. A decision to have the skin removed by plastic surgery is personal. We recommend waiting at least 12 months after surgery prior to considering plastic surgery.
No. A small number of patients may regain weight but the vast majority lose significant weight and keep their weight off.
Bariatric surgery before and after
Am I a candidate?
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