What is gastric sleeve surgery?

Sleeve gastrectomy (also called gastric sleeve surgery) is surgery to remove part of the stomach. It helps with weight loss. The surgery limits the amount of food your stomach can hold. This can help you eat less and feel full sooner.

The surgery is usually done through several small cuts in the belly. These cuts are called incisions. The doctor will place small surgical tools and a camera, called a laparoscope, through the incisions.

The doctor will separate the upper part of your stomach from the rest of your stomach. This forms a small pouch. The pouch will hold the food you eat.

The doctor will close the cuts in your belly with stitches or surgical staples.

Activity

• Rest when you feel tired. Getting enough sleep will help you recover.
• Try to walk each day. Start out by walking a little more than you did the day before. Bit by bit, increase the amount you walk. Walking boosts blood flow and helps prevent pneumonia and constipation.
• Avoid lifting anything that would make you strain. This may include heavy grocery bags and milk containers, a heavy briefcase or backpack, cat litter or dog food bags, a vacuum cleaner, or a child.
• Avoid strenuous activities, such as bicycle riding, jogging, weight lifting, or aerobic exercise, until your doctor says it is okay. Do not take part in any activity where you could be hit in the belly. This could be sports or playing with children.
• Hold a pillow over your incision when you cough or take deep breaths. This will support your belly and decrease your pain.
• Do breathing exercises at home as instructed by your doctor. This will help prevent pneumonia.
• You can shower, if your doctor okays it. Pat the incision dry. Do not take a bath for the first 2 weeks, or until your doctor tells you it is okay.
• Ask your doctor when you can drive again.
• You will probably need to take 2 to 4 weeks off from work. It depends on the type of work you do and how you feel.
• Ask your doctor when it is okay for you to have sex.

Diet

• Your doctor will give you specific instructions about what to eat after the surgery. For the first 2 to 6 weeks, you will need to follow a liquid or soft diet. Bit by bit, you will be able to add solid foods back into your diet.
• Your doctor may recommend that you work with a dietitian to plan healthy meals that give you enough protein, vitamins, and minerals while you are losing weight. Even with a healthy diet, you probably will need to take vitamin and mineral supplements for the rest of your life.
• Sometimes the stomach empties food into the small intestine too quickly. This is called dumping syndrome. It can cause diarrhea and make you feel faint, shaky, and nauseated. It also can make it hard for your body to get enough nutrition.
  • Avoid high-sugar foods—such as desserts, soda pop, and fruit juices— which are most likely to cause dumping syndrome.
  • Do not drink liquids within a half hour before eating and up to an hour after eating. Liquids move food even more quickly into the small intestine. Quick emptying of the stomach increases the chance of diarrhea.
  • Eat slowly. Try to chew each bite about 20 times. Allow 20 to 30 minutes for each meal.
  • Eat 5 or 6 small meals or snacks a day. This may keep you from feeling too full after eating and may reduce problems with diarrhea and dumping syndrome.
• Check with your doctor before drinking alcohol. Your body may absorb alcohol more quickly after surgery.
• You may notice that your bowel movements are not regular right after your surgery. This is common. Try to avoid constipation and straining with bowel movements. Your doctor may suggest fiber, a stool softener, or a mild laxative.

Medicines

• Your doctor will tell you if and when you can restart your medicines. You will also be given instructions about taking any new medicines.
• If you stopped taking aspirin or some other blood thinner, your doctor will tell you when to start taking it again.

• Take pain medicines exactly as directed.
  • If the doctor gave you a prescription medicine for pain, take it as prescribed.
  • If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.
  • Do not take two or more pain medicines at the same time unless the doctor told you to. Many pain medicines contain acetaminophen, which is Tylenol. Too much acetaminophen (Tylenol) can be harmful.
• If you think your pain medicine is making you sick to your stomach:
  • Take your medicine after meals (unless your doctor has told you not to).
  • Ask your doctor for a different pain medicine.
• If your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics.

Incision care

• If you have strips of tape on the incision, leave the tape on for a week or until it falls off.
• Wash the area daily with warm, soapy water and pat it dry. Don't use hydrogen peroxide or alcohol, which can slow healing. You may cover the area with a gauze bandage if it weeps or rubs against clothing. Change the bandage every day.
• Keep the area clean and dry.

Research has shown that people who have either gastric sleeve or gastric bypass surgery have similar weight loss and improvements in other health conditions, such as diabetes. Both gastric sleeve and gastric bypass have better results than gastric band surgery. Success is higher for people who are realistic about how much weight they'll lose and who go to appointments with the medical team, follow the recommended eating plan, and are physically active.

Surgery can be stressful. This information will help you understand what you can expect. And it will help you safely prepare for surgery.

Preparing for surgery

• You may need to follow a clear liquid diet for several days before surgery. Your doctor will tell you how to do this.
• Be sure you have someone to take you home. Anesthesia and pain medicine will make it unsafe for you to drive or get home on your own.
• Understand exactly what surgery is planned, along with the risks, benefits, and other options.
• If you take a medicine that prevents blood clots, your doctor may tell you to stop taking it before your surgery. Or your doctor may tell you to keep taking it. (These medicines include aspirin and other blood thinners.) Make sure that you understand exactly what your doctor wants you to do.
• Tell your doctor ALL the medicines, vitamins, supplements, and herbal remedies you take. Some may increase the risk of problems during your surgery. Your doctor will tell you if you should stop taking any of them before the surgery and how soon to do it.
• Make sure your doctor and the hospital have a copy of your advance directive. If you don’t have one, you may want to prepare one. It lets others know your health care wishes. It’s a good thing to have before any type of surgery or procedure.

Here are some risks common to all surgeries for weight loss:

• You could get an infection in the incision.
• You could get a blood clot in your legs (deep vein thrombosis, or DVT) or lung (pulmonary embolism).
• You may not get enough of certain vitamins and minerals. This can lead to problems such as anemia and osteoporosis.
• Some people get gallstones.
• Some people get kidney stones.
• You could get a leak from the stomach into the abdominal cavity or where the intestine is connected. (This can cause an infection called peritonitis.)
• You may gain the weight back if you don't follow your eating and lifestyle plan.

Another risk is dumping syndrome. It causes nausea, weakness, sweating, faintness, and possibly diarrhea soon after eating. These symptoms get worse if you eat highly refined, high-calorie foods (like sweets). Sometimes you may feel so weak that you have to lie down until the symptoms pass.

You will have some belly pain and may need pain medicine for the first week or so after surgery. The cut that the doctor made (incision) may be tender and sore.

Most people need 2 to 4 weeks before they are ready to get back to their usual routine.

Because the surgery makes your stomach smaller, you will get full sooner when you eat. Food also may empty into the small intestine too quickly. This is called dumping syndrome. It can cause diarrhea and make you feel faint, shaky, and nauseated. It also can make it hard for your body to get enough nutrition.

Your doctor will give you specific instructions about what to eat after the surgery. You'll start with only small amounts of soft foods and liquids. Bit by bit, you will be able to add solid foods back into your diet. If you drink a lot of high-calorie liquid such as soda or fruit juice, you may not lose weight. Even with a healthy diet, you probably will need to take vitamin and mineral supplements from now on.

Depending on how the surgery was done (open or laparoscopic) you'll have to watch your activity during recovery. If you had open surgery, it's important to avoid heavy lifting or strenuous exercise while you recover so that your belly can heal. In this case, you will probably be able to return to work or your normal routine in 4 to 6 weeks. But the surgery is most often done as a laparoscopic procedure, which means the recovery time is faster.

Weight loss

You probably will lose weight very quickly in the first few months after surgery. As time goes on, your weight loss will slow down. You will have regular doctor visits to check how you are doing.

Emotions

It's common to have many emotions after this surgery. You may feel happy or excited as you start to lose weight. But you may also feel overwhelmed or frustrated by the changes that you have to make in your diet, activity, and lifestyle. Talk with your doctor if you have concerns or questions.

Think of bariatric surgery as a tool to help you lose weight. It isn’t an instant fix. You will still need to eat a healthy diet and get regular exercise. This will help you reach your weight goal and avoid regaining the weight you lose.

Your doctor will give you specific instructions about what to eat after the surgery. For about the first month after surgery, your stomach can only handle small amounts of soft foods and liquids while you are healing. It's important to try to sip water all day long to avoid becoming dehydrated. You may notice that your bowel movements are not regular right after your surgery. This is common. Try to avoid constipation and straining with bowel movements.

Bit by bit, you will be able to add solid foods back into your diet. You must be careful to chew food well and to stop eating when you feel full. This can take some getting used to. That's because you'll feel full after eating much less food than you are used to eating. If you don't chew your food well or don't stop eating soon enough, you may feel discomfort or nausea. You may even vomit. If you drink a lot of high-calorie liquid such as soda or fruit juice, you may not lose weight. If you continually overeat, the stomach may stretch. If your stomach stretches, you will not benefit from your surgery.

Your doctor will probably recommend that you work with a dietitian to plan healthy meals that give you enough protein, vitamins, and minerals while you are losing weight. Even with a healthy diet, you probably will need to take vitamin and mineral supplements from now on.

• Follow the instructions exactly about when to stop eating and drinking. If you don't, your surgery may be canceled. If your doctor told you to take your medicines on the day of surgery, take them with only a sip of water.
• Take a bath or shower before you come in for your surgery. Do not apply lotions, perfumes, deodorants, or nail polish.
• Do not shave the surgical site yourself.
• Take off all jewelry and piercings. And take out contact lenses, if you wear them.

At the hospital or surgery center

• Bring a picture ID.
• The area for surgery is often marked to make sure there are no errors.
• You will be kept comfortable and safe by your anesthesia provider. You will be asleep during the surgery.
• The surgery will take about 1 to 3 hours.

Weight-loss surgery is suitable for people who are severely overweight and who have not been able to lose weight with diet, exercise, or medicine.

Surgery is generally considered when your body mass index (BMI) is 40 or higher. Surgery may also be an option when your BMI is 35 or higher and you have a life-threatening or disabling problem that is related to your weight.

It is important to think of this surgery as a tool to help you lose weight. It is not an instant fix. You will still need to eat a healthy diet and get regular exercise. This will help you reach your weight goal and avoid regaining the weight you lose.