Gastric Sleeve Surgery

Vertical Sleeve Gastrectomy (Gastric Sleeve)

For many people gastric sleeve surgery in San Antonio, Texas is appealing because it is not quite as drastic as a gastric bypass and yet it does not involve an implant like the lap band procedure. With gastric sleeve surgery, there is NO dumping syndrome because there is no re-routing of the intestines.

The vertical sleeve gastrectomy – also called a “sleeve” or “gastric sleeve” – is a hybrid operation in which eighty percent of the stomach is completely resected and removed from the body. The resection is done along the long axis of the stomach so that the new stomach looks like a hockey stick. The new stomach is very stiff, tubular, and narrow, therefore it does not let you eat very much food. The portion of the stomach that is removed is the most elastic.

With gastric sleeve surgery, the weight loss results are very similar to bypass surgery for the first year or so. The procedure is usually covered by insurance.

Why gastric sleeve surgery helps people lose weight

Gastric sleeve is a metabolic surgery. By removing part of the stomach, we dramatically alter the neuro-hormonal pathways that control the sensation of hunger and the way our body manages the calories that we put in.

There is a hormone called ghrelin that is made primarily in the part of the stomach that we remove. It is the primary driver in the hunger pathway, and with the dramatic drops in ghrelin levels seen after the gastric sleeve surgery, we see a commensurate decrease in hunger! We also see up-regulation of a hormone called GLP1, which is involved with our body’s control of glucose. In fact, many of the newer diabetes treatment medications are designed to up-regulate GLP1. The sleeve surgery does this without medication and in this way, it can cause remission of diabetes and metabolic disease quite rapidly.

Advantages of Gastric Sleeve surgery

Gastric sleeve weight-loss surgery offers the following advantages:

• May reduce hunger since less of the hunger-inducing hormone ghrelin is produced by your stomach following the procedure
• Simpler, shorter operation than a gastric bypass (unlike a gastric bypass, gastric sleeve weight-loss surgery doesn’t reroute the intestines)
• No adjustments are needed, unlike with lap bands
• No foreign objects are left in your body
• Significant weight loss is the norm
• Weight loss is usually maintained
• No “dumping syndrome” with unpleasant side effects that can be associated with gastric bypass surgery

Who makes a good candidate for gastric sleeve surgery?

The following are important criteria that can help determine whether you may be a good candidate for gastric sleeve surgery in San Antonio:

BMI
Gastric sleeve surgery may be a good option if you have a body mass index (BMI) of at least 40, meaning you’re at least 100 pounds overweight. You may also qualify with a BMI of 35 if you have a chronic weight-related health condition, such as type 2 diabetes, high blood pressure, or sleep apnea. Depending on your weight and BMI, you may be too heavy for gastric bypass surgery but still a good candidate for gastric sleeve surgery.

Overall health
If you’re considering sleeve gastrectomy surgery, you may also have weight-related health issues. However, you’ll need to be able to withstand the physical stress of surgery. That’s why we’ll talk to you at length about your medical history and current health, conducting any tests that might be needed to ensure you’re able to physically handle the surgery and recovery.

Commitment to diet maintenance
We’ll make sure you understand your dietary guidelines and help you avoid eating more than you should in the long term. If you do overeat, it’s possible to stretch your new, smaller stomach and regain weight. Our dietitians can help you follow a plan that meets your dietary requirements and maximizes nutrition.

You’ll learn some very important guidelines, which you’ll need to follow strictly. Some of these guidelines include:

• Chew everything well before swallowing. Your dietitian will help you develop this healthy habit so that you become a more mindful eater before you have gastric sleeve surgery.
• Consume food and drink separately. You won’t have a lot of room in there. And extra liquid with food will make you feel full too fast, which may prevent your ability to get proper nutrition.
• Drink a liquid 30 minutes before each meal. Hydration is also vital to health. And before gastric sleeve surgery, you actually get a lot of liquid from food that you’ll no longer consume after gastric sleeve surgery. So developing this healthy habit ensures that you still get adequate water for healthy kidneys, liver, skin, and every part of your body.
• Avoid calorie-packed foods and drinks that have little nutritional value. You’ll be eating much less after gastric sleeve surgery, so you need to ensure you have room for wholesome foods. That won’t leave much room for anything else.

As an important side note, some people are moderators by nature and others are abstainers. If you’re a moderator, then you may be able to occasionally and selectively have junk food. But, and this is a big BUT: If you have trouble moderating, as is the case for most patients who have the chronic illness obesity, you’re likely an abstainer. That means you will be most successful abstaining completely because once you get a taste, you have trouble stopping.

People often say “everything in moderation.” But this philosophy doesn’t work well for people who have trouble moderating. If you need to abstain to be healthy, you need to make that commitment to yourself. That often means never buying things you shouldn’t eat or drink. Just keep them out of your house. You learn these techniques pre-surgery to give you the tools to keep your commitment.

Commitment to exercise
Exercise is another important component of your post-surgery success. You should be willing to commit to exercising at least three times a week – preferably even more. We have a staff of exercise physiologists who are specially trained to help bariatric patients.

Willingness to take needed nutritional supplements
Since your new, smaller stomach will hold a much smaller amount of food, you’ll need to take multiple vitamin and mineral supplements for the rest of your life.

Psychological readiness
Gastric sleeve surgery can have psychological effects as well as physical ones. For example, you may be used to dealing with stress by overeating, but if you do this after gastric sleeve surgery, you could stretch your stomach and regain the weight you’ve worked so hard to lose. You may also find that some of your relationships change. With this in mind, we have behavioral counselors on staff to help you navigate any psychological challenges you may face.

How is the gastric sleeve surgery performed?

Gastric sleeve surgery can be completed in around one hour and is minimally invasive. That’s because BMI of Texas takes a laparoscopic approach to the procedure. After you have gone to sleep thanks to general anesthesia, your BMI surgeon makes several small incisions in your abdomen. Through these incisions, your doctor inserts narrow tubes that house cameras and various tiny surgical tools.

With this approach, your surgeon can clearly see what’s happening inside without having to open you up as with normal open surgery. Your doctor can make the surgical adjustments to the stomach safely and remove pieces of the stomach, totaling about three-fourths of its original mass through small surgical incisions. This method reduces scarring, surgical risks, and recovery time.

Once the procedure is done, the incisions will need a few stitches. Then you’re ready to go into recovery. What is gastric sleeve recovery like, you may wonder? Let’s look at that next.

What to expect post-op with gastric sleeve weight loss surgery

With gastric sleeve, you should expect to stay in the hospital for one or two nights. Your immediate goals after surgery are to walk frequently and to do breathing exercises using a special tool called an incentive spirometer. In addition, we will give you some blood-thinning medication to prevent blood clots. Patients are usually allowed to begin sipping on liquids a few hours after surgery.

Post-op Day One goal: Transition completely from IV fluids and medications to oral intake and liquid pain medicine. We use a special three-day local anesthetic in the tiny incision sites so the pain will be very well-controlled.

Day Two: Most patients are ready to go home today. Don’t feel bad if you are not quite up to it, though. We realize that everyone is different, and we want you to be completely comfortable before we let you go home.

Post-Hospital Recovery: Once you leave the hospital you’ll be on a strict post-op regimen that will include extreme limits on what you can eat. But after one to two months you’ll re-establish the healthy eating and lifestyle habits you worked on with your dietitian and other professionals as you prepared for the surgery.

What type of weight loss can be expected after gastric sleeve?

Everyone is different, but people who have had gastric sleeve surgery usually lose about 60 percent of their excess weight over 12 to 18 months. In other words, if you’re 100 pounds overweight, you may lose 60 pounds within that time, although this amount can increase with proper diet and exercise. At the two-year mark, our patients have usually lost more than average thanks to our dietary, exercise, and psychological support.

How is a gastric sleeve different from a gastric bypass?
In a gastric bypass, a surgeon makes a small pouch that bypasses the lower part of your stomach, sending food from the top of the stomach straight into the small intestines. The gastric sleeve is similar, but the shape and size of the stomach after the procedure is more like that of a banana or hockey stick. This makes the functional stomach more like a tube than a bag.

Gastric bypass can be dangerous for people who have over 100 pounds (45.36 kg.) to lose. In these cases, the gastric sleeve is much preferred.

How do I prepare for gastric sleeve surgery?
Leading up to the surgery date, you’ll complete the evaluations and education described above. You’ll begin practicing the skills you need to have a successful outcome. Practice is important because it takes some time to develop a new habit, and in the case of a gastric sleeve procedure, your success depends on your ability to develop new habits.

You can expect to lose some weight leading up to the procedure because of these changes. This demonstrates your commitment to weight loss and maintenance success long term. The gastric sleeve surgery, as well as the tremendous support you receive from our Texas team, will help you be successful.

Two Weeks Pre-Op
In the two weeks before the surgery, you’ll be on a very strict diet that helps to shrink the liver and prepare your body for a smooth transition to a new way of living. An oversized liver would jeopardize your success and make the procedure more dangerous.

The pre-op diet generally consists of calorie restriction as well as low carbs and large amounts of lean protein.

Two Days Pre-Op
Two days before the procedure, your BMI of Texas doctor will normally have you switch to a liquid diet that may include broth and protein shakes. You may also be able to drink decaf coffee and tea and eat Jell-O. But your doctor’s orders may vary based on your unique needs. You should avoid caffeine as this can impact your procedure.

Your Gastric Sleeve Procedure at BMI of Texas

Gastric sleeve surgery in San Antonio can have a massive positive impact on your quality of life. To learn more about sleeve gastrectomy, contact us today, watch a free seminar or chat with a BMI expert. We’ll help give you the tools you need to succeed in losing a significant amount of weight and keeping it off in the long term, improving your health in the process!