Like other bariatric surgeries, gastric sleeve surgery has numerous benefits and is attractive to many people for a number of reasons. People often look to bariatric surgeries as a way to drastically lose weight and remove themselves from the complications/health risks that come with being obese (heart disease, diabetes, hypertension, etc.). Of the three major bariatric surgeries (gastric bypass, gastric sleeve and lap-banding), the gastric sleeve is particular attractive because of the strong view “that sleeve gastrectomy can deliver rapid short-term weight loss results similar to gastric bypass, but that sleeve gastrectomy is less drastic and has fewer complications” (1). It certainly does have a lower chance of reoperation or readmission than the gastric bypass surgery (4.62% versus 3.61%) (2). Of the people that do decide to partake in the surgery “women make up a whopping 80% of all weight loss surgery patients, despite roughly equal rates of obesity among men and women” (3). In terms of success for the gastric sleeve surgery, it has proved to be quite reliable. It is so successful that at the 12 month post-surgery mark patients have lost 45-64% of their starting bodyweight and at the 5 year post-surgery mark patients are, on average, still 57% under their pre-surgery weight (4). Due to the high rate of success and the appeal of rapid weight loss and fewer complications of other surgeries, sleeve gastrectomy has become quite popular as a (potentially) permanent solution to obesity.
The procedure itself is relatively simple. It takes roughly 60 minutes to perform and has a recovery period of 2-3 weeks. After the patient receives anesthesia, the surgeon will make several small incisions in the abdomen in order to insert a laparoscope with which to provide a view of the patient’s stomach. The surgeon then removes roughly 85% of the stomach along the outside curvature, leaving the remaining stomach looking much like a sleeve. This “sleeve” still spans the original distance from the esophagus to the small intestine and the pyloric valve continues to function as it normally would.
Though the surgery itself is relatively simple, there are many steps that must be accomplished before the surgery. One must first qualify for the surgery and then be accepted as a candidate to the program before the pre-surgery process can even begin. Once accepted to the program, patients are encouraged to start making positive lifestyle changes and form new habits before the surgery is performed. These include reducing calories to 1,200-1,500 kcal per day, increasing their daily physical activity, cutting all caffeine from the diet (30 days prior to surgery), partaking in meetings with a counselor, attending group support meetings and participating in educational programs on nutrition and exercise, among others (depending on the program). With all the requirements that must be taken to receive the surgery, it is apparent that the change in lifestyle begins long before the actual surgery itself.
After the surgery, there are numerous lifestyle changes that must be made due to the greatly reduced size of the patient’s stomach, and must be strictly adhered to. The changes in diet and exercise are of utmost importance, not only to obtain the benefits of the gastric sleeve surgery, but also to avoid serious side effects related to the surgery and rapid weights loss. Some of these side effects include hair loss, diarrhea/loose stools, nausea and vomiting, blood clots and esophageal pain/spasms (5).
Changes in diet and eating habits are the one of, if not the primary concern of post-surgery gastric sleeve patients. Not only are they now trying to eat healthy, nutrient dense foods within a healthy caloric range, but they also now have the “stomach capacity of 3 to 4 ounces, down from 60 ounces” (6); this is a major change and is one that completely goes against what the patient has been used to for their entire previous life. There are generally four stages of the post-surgery diet: clear liquid diet, full liquid diet, soft foods and regular foods diet. The clear liquid diet last for the first 7 days after the surgery and involves such parameters as only drinking 4 ounces of fluid at a time, avoiding caffeine, and focusing on protein intake. Foods that are normally consumed during this period are chicken/beef broth, protein supplements, flavored water, and skim milk, among others. The full liquid diet usually begins on the 8th day post-surgery and will last for two weeks. The main focus of the full liquid diet is to increase protein intake and prepare the body for soft foods. Liquids that are normally consumed during this time are 1-2% milk, soy beverages, fruit juices and creamed and blended chunky soups. The soft food diet is a relatively quick transition period into the regular goods diet and lasts for 1 week, with such foods as scrambled eggs, tuna, cottage cheese, and mashed fruits and vegetables being consumed. The regular foods diet is the last stage and will last for the rest of the patient’s life. Easing into the full-participation of this last phase is very important and can take as long as the patient feels they need. They are encouraged to consume a minimum of 60-80 grams of protein per day and avoid such irritating foods as alcohol, spicy foods, breaded/fried foods, pasta/rice, or any other foods that will cause discomfort or nausea.
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| Avoiding caffeine means avoiding coffee! |
Exercise is the second focus of post-surgery life, as it is a key component of any weight loss program and healthy lifestyle. Ultimately, the goal of the post-surgery patient is to partake in exercise lasting 30-40 minutes per bout, 4 or 5 days a week. Reaching this goal must be obtained slowly and carefully as to not traumatize the still recovering organs. Because of this it is strongly recommended that patients refrain from all strenuous exercise for the first 30 days after their surgery. Patients are encouraged to begin exercising “by walking 20 minutes for the first fourteen days after the surgery. After 15 days, patients can work up to 30-40 minutes of exercise per day” (6). After the 30 day mark is hit, the patient can begin to incorporate light to moderate resistance training if they so choose. Resistance training is encouraged, as it can help the patient burn more calories and add a modest amount of lean body mass. If the patient is to partake in resistance training it is important to avoid exercises and weights that are too strenuous or that put too much pressure on the thoracic cavity (heavy squats, deadlifts, etc.) until the 6 month mark is passed.
The gastric sleeve surgery is certainly a big deal: one must make a huge commitment to themselves (and often others), undertake many sacrifices, undergo surgery and then completely change the way they’ve been living for, presumably, their entire life. In my short time spent with a post-operation patient, I’ve learned just how much someone’s life can change due to the surgery and just how much is at stake, both physically and mentally. The process involves many risks and sacrifices, but it can also promise many benefits. The success rate is indeed high (as mentioned previously), but only when the patient adheres to the strict dietary and exercise guidelines. It is often seen as a last resort for many obese people, but the procedure is an overall safe, effective, and positive life-changing event.
Resources:
1. Considering Sleeve
Gastrectomy. Apollo Endosurgery, Inc., 2014. Web. 4 May 2014.
<http://www.lapband.com/Considering-Sleeve-Gastrectomy>.
2. Sleeve Gastrectomy Gets Boost
in Push for Insurance Coverage. Medscape. Jun 22, 2012. 4 May 2014.
<http://www.medscape.com/viewarticle/791247>.
3. Bariatric Surgery and Gender
Differences. Bariatric Surgery Resource, 16 Sept. 2013. Web. 3 May 2014.
<http://thebariatricsurgeryresource.com/articles/2013/09/16/bariatric-surgery-and-gender-differences/>.
4. Gastric Sleeve Success Rates.
Bariatric Surgery Resource, 3 Sept. 2007. Web. 3 May 2014.
<http://thebariatricsurgeryresource.com/gastric-sleeve-surgery/success-rates/>.
5. Gastric Sleeve Surgery Side
Effects. Mexico Bariatric Center, 2012. Web. 4 May 2014.
<http://www.mexicobariatriccenter.com/gastric-sleeve-surgery-side-effects/>.
6. Gastric Sleeve Surgery Diet -
Post Operative Guidelines. Mexico Bariatric Center, 2012. Web. 3 May 2014.
<http://www.mexicobariatriccenter.com/gastric-sleeve-surgery-diet-postoperative-guidelines/>.
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