Gastric Sleeve

Is Gastric Sleeve Surgery Right for Me?

Gastric sleeve surgery is the "default" option for many people who have not had previous bariatric or stomach surgery before, and do not have severe reflux.  Sleeves make up approximately 80% of all bariatric surgeries performed across Australia.

How Much Weight Will I Lose?

By following the post-operative recommendations patients can expect to lose approximately 1 kilogram per week until their body weight reaches a "new" set point.

Benefits of Gastric Sleeve

The Gastric Sleeve procedure restricts the amount of food the stomach can hold this in results in:

• A rapid and significant weight loss that comparative studies find similar to that of the Roux-en-Y gastric bypass,
• Weight loss of >50% for 3-5+ year data, and weight loss comparable to that of the bypass with the maintenance of >50%,
• Requires no foreign objects (other than the staples), and no bypass or re-routing of the food stream (like a bypass),
• Involves a relatively short hospital stay of approximately 2 days, and
• Causes favourable changes in gut hormones that suppress hunger, reduce appetite and improve satiety.
   

How Sleeve Gastrectomy Works

Due to a reduction in ghrelin, a hormone that affects appetite, patients are also less likely to feel hungry between meals.

 

This procedure works by several mechanisms.

• Restricts the amount of food the stomach can hold - the new stomach pouch holds a considerably smaller volume than the normal stomach and helps to significantly reduce the amount of food (and thus calories) that can be consumed.
• The greater impact, however, seems to be the effect the surgery has on gut hormones like Ghrelin, the hunger hormone, which favourably suppresses hunger, reduces appetite, improves satiety and improves blood sugar control.

 

Why Consider Gastric Sleeve Surgery?

Gastric Sleeve surgery has a number of advantages over other weight loss procedures. These are:

• Digestion functions are maintained as the only change is made to the size of the stomach.
• Stomach openings and nerves remain intact and unaltered.
• The procedure for Gastric Sleeve surgery is laparoscopic, rather than open, meaning it is less invasive, scarring will be minimal, and recovery will be quicker.
• As Gastric Sleeve surgery does not affect the digestive system, recovery times are slightly faster than in other procedures.
• Lower chance of complications such as ulcers and other risks associated with gastric bypasses and lap-band surgeries.
• Involves a relatively short hospital stay of approximately 2 days

 

If you have type 2 diabetes, evidence suggests that this should be easier to control.

 

The disadvantages of Sleeve Gastrectomy are the potential for long-term vitamin deficiencies, but this can be addressed by diet.

 

What are the Dangers of Having Part of Your Stomach Removed?

Whilst the sleeve operation for obesity is still relatively new, similar operations that involve the removal of part or all of the stomach have been performed for over 100 years for conditions such as cancer, benign lesions, and stomach ulcers.

 

We have learnt from these operations that a person can survive perfectly well without part of their stomach. Because the lower part of the stomach (the Antrum) is kept during the Gastric Sleeve procedure, vitamin B12 absorption is largely maintained, and Iron, Calcium and folate levels remain unaffected.

 

There is a small risk of malabsorption with the Sleeve, and every nutrient that is consumed will travel through the gastrointestinal tract normally.

 

Do I Need to Take Multivitamins?

Yes, a single daily multivitamin is recommended however as you will be eating less food.

 

It’s also a good idea to check that your essential vitamin and element levels remain normal by having an annual blood test.

 

Our Dietitian will go through your supplement requirements in your first or second visit. Because of changes to gastric and bowel function caused by the sleeve or bypass, you will need to take a multivitamin and mineral supplement daily for the rest of your life. Vitamins and minerals may become depleted and require supplementation such as iron and vitamin B12. Regular blood tests will help determine this.

 

What Tests are Needed Before Surgery?

At our practice, we like to make your surgery as safe and predictable as possible.

 

We routinely perform a blood test on all patients before surgery, this test includes

• a full blood count,
• blood group,
• cholesterol levels,
• kidney, liver and thyroid function, and
• a diabetes screening test.
• Minerals and vitamins base level

 

Depending on your medical history and as required we may also arrange:

• a chest X-ray
• an ECG
• sleep apnoea testing

 

Other Preoperative Consultations

Sometimes a referral to another specialist such as an

• Bariatric physician
• endocrinologist,
• cardiologist, or
• a respiratory physician

 

This will be determined at your Initial Consultation with Dr Blackham. If you already have other specialists involved in your care, we will also correspond with them.

 

Preparation Before the Sleeve Gastrectomy

Preparing for Gastric Sleeve Surgery

Patients may need to lose weight, start exercise, or change their diet to prepare for the procedure. Our doctors will go over the specific instructions for pre-operative care, but generally, patients will need to:

• Go on a liquid diet two to three weeks before surgery.
• Avoid eating after midnight, and on the day before surgery.
• Ask a friend or family member to be at the hospital for support and comfort.

Other Pre Operative Preparation

Patients may also want to arrange for the food, drink, and medications they will require after surgery before they go to the hospital.

 

What Should I Bring with Me to the Hospital?

A hospital representative will call you before your admission and advise you on everything you need to know.

 

Generally, only a few things are required. These include

• Bathroom items & personal toiletries
• Clothing for your stay that is easy to put on and take off including pajamas, bathrobe, slippers
• Your regular medications
• Mobile phone, iPod, tablet, laptop, books, photographs, etc
• Do not wear jewelry
• If you have sleep apnea, bring your CPAP mask, tubing and machine.

 

Don’t forget to bring any X-rays and other important medical documents that may be relevant to your surgery.

Day of the Sleeve Gastrectomy

Before Your Procedure

If you are diabetic or pre-diabetic, an accucheck will be done and women may have a urine pregnancy test. You will then be:

• Given an IV drip and start with an antibiotic as well as a blood thinner shot to reduce your chance of developing a blot clot in your leg veins during surgery
• Given compression stockings to be placed on your lower legs
• Asked to void before going back to the Operating Room
• Able to meet the anaesthetist who may give you a sedative through the IV, and
• Meeting Dr Blackham before you go into the theatre

 

Transfer to Theatre

You will be transferred to the Operating Room with large ceiling lights and many machines. Then:

• Moved onto the operating table, lying flat on your back with your arms extended on arm boards and be covered with a blanket
• Heart monitors will be placed on your chest
• An oxygen monitor will be placed on your finger
• The anaesthetist will place an oxygen mask on your face, then will give you your initial anesthetic drug through the IV and you will go to sleep

 

Once you are asleep, he will place a breathing tube in your trachea (windpipe) through which you will receive oxygen and anaesthetic gas throughout the operation. You will not feel this.

 

What is involved in Gastric Sleeve Surgery?

The Sleeve Gastrectomy procedure involves your surgeon:

• Making some small (keyhole) incisions on the upper abdominal wall (the umbilicus may also be used for one of these to minimise visible scars)
• Insert specialised surgical tools, including a camera, through the incisions.
• Remove the outer section of the stomach (which makes up 70-80% of the stomach).
• Use a specialised stapling device to close the sides of the stomach tube (or sleeve) which remains inside the patient and is not removed.
• These incisions are deliberately placed within your natural skin lines to minimise any visible scarring. All skin wounds are closed with hidden absorbable sutures that do not need to be removed.
• All you will see when the dressings are removed is a neat line.

 

These incisions are deliberately placed within your natural skin lines to minimise any visible scarring. All skin wounds are closed with hidden absorbable sutures that do not need to be removed.

 

All you will see when the dressings are removed is a neat line.

 

After Weight Loss Surgery Will I Feel Pain?

Because weight loss surgery is performed using laparoscopic (keyhole) surgery, pain after surgery is greatly reduced.

 

Immediately after surgery, some patients report sensations of

• chest tightness, or
• a stitch feeling in the upper abdominal area (especially on the left side, up under the rib cage), or
• an ache in the left shoulder tip

These sensations usually resolve within 3-4 days.

 

This discomfort is generally not limiting and you will still be able to sit up comfortably and walk.

 

You will be provided with adequate analgesia, both in the hospital and after discharge, to make sure you are comfortable and be offered a variety of medications to make sure you are not in pain, most of the patients will not require any analgesics more than panadol when they return home.

 

How Long Does Sleeve Gastrectomy Take?

The actual procedure takes less than an hour, but the pre-operative checks and postoperative observation and recovery will require a two night stay in the hospital.

Stages of Recovery After a Sleeve Gastrectomy

Waking Up After Surgery

Because your procedure is performed laparoscopically, any initial discomfort quickly passes, and virtually all patients feel completely awake, alert and able to have a normal conversation within an hour or two.

 

Although you will be awake in the recovery room, it is common to still feel a little drowsy. Our anaesthetists will ensure your comfort. Occasionally this may be a self-administered pain management system.

 

In addition, our surgeons routinely infiltrate all skin wounds with long-acting local anaesthetic prior to making the incisions (this technique is called ‘pre-emptive analgesia’ and works by blocking the nerves before they are stimulated).

 

Will I Still be Hungry?

Patients can expect to eat smaller portions and have a reduced appetite following surgery leading to a steady loss of weight over time.

 

Will I have a Surgical Drain, Nasogastric Tube, or Urinary Catheter After the Surgery?

No surgical drains, nasogastric tubes and urinary catheters are routinely used by Dr Blackham for sleeve gastrectomy surgery.

 

An intravenous drip in your arm is usually the only thing that you will have when you wake up. This is removed as soon as you are drinking enough fluids.

 

How Long will the Hospital Stay be?

The vast majority of patients feel well enough to be discharged within 24-48 hours of their procedure. This means staying overnight or two in the hospital.

 

Because everyone heals at different rates and surgery can vary in its complexity depending on a patient’s past medical history. You will be allowed home when you feel ready.

 

How Soon Will I be Able to Walk?

As soon as you feel up to it. In fact, we encourage you to get up and walk about the ward the day of your procedure. This helps avoid problems like blood clots and chest infections.

 

On leaving the hospital, you should be able to care for all your personal needs but may need a little help with shopping, lifting and transport for the first few days.

 

Patients also need to commit to a healthy lifestyle as part of the recovery and weight loss process. This involves eating healthy foods and exercising regularly.

 

How Long Will it Take to Recover After Surgery?

Patients having a Gastric Sleeve recover quickly in the first few days after surgery, and by 2 weeks most patients feel they have adequately recovered and are back at work.

 

Gentle exercise such as walking can be restarted straight away, but you should wait four weeks before resuming swimming or more vigorous activities such as the gym or interval training.

 

What About Other Medications?

You will still be able to take prescribed medication. Large tablets may need to be broken in half or dissolved in water so they do not get stuck, however, most of the common tablets for high blood pressure, diabetes are fine.

 

Will I be Constipated?

This is one of the most common side effects of surgery.  This is caused by being relatively dehydrated, the surgery itself as well as less movement.  It is important to maintain adequate fibre intake, and our dieticians will assist you in this.  We recommend taking a soluble fibre supplement (such as Benefiber) in the liquid phase after surgery to help maintain normal bowel movements.

In addition, if you have not opened your bowels by day 5 after the operation, do take an over the counter laxative like Lactulose or Movicol. Try to avoid Senna as it can irritate the lining of the gut.

If difficulties do arise, just let us know.

 

How Soon Can I Drive?

It is illegal to drive within 24 hours of a General Anaesthetic, therefore it is important that you arrange for someone to pick you up from the hospital.

 

Most patients feel ready to drive again after 7 days, however for your own safety; you should not drive until you have stopped taking any strong pain medications, and feel comfortable that you can break in a hurry.

 

Can I Have Visitors?

Spouses, significant others, parents, or a friend are encouraged to help you in your hospital recovery, by encouraging you, walking with you and helping you to remember to drink your water and use your incentive spirometer.

 

One individual may be permitted to sleep in the hospital room with you.

 

Visitors are not permitted to bring food into the hospital room.

 

Do not bring family members or friends who are not supportive of your decision to have bariatric surgery. We do not encourage several or frequent visitors during your hospitalization. We want you to concentrate and participate in your recovery.

 

Eating After a Sleeve Gastrectomy

What can I Expect After the Surgery when I Eat?

You will only be able to eat a few mouthfuls of food at a time. You will not be able to drink and eat at the same time as your new stomach will not be able to hold both.

 

Following surgery patients will need to eat a liquid and then pureed diet for two weeks each, before progressing to soft foods for another two weeks after that.

 

6 weeks after surgery, patients should be able to resume eating normal foods.

You will also have to concentrate on eating slower and chewing your food thoroughly.

Post Surgery Follow Up Appointments?

Our Care Plan has been carefully designed to allow you to get the most out of your bariatric surgery.

 

Your first visit after surgery will be scheduled within two to four weeks. After this you are required to visit your team regularly – two months, six months and then annually.

 

At each follow-up visit, please keep your doctor informed of your recovery/progress and contact your doctor for any health concerns you have in between visits.

 

Regular visits will provide an opportunity to check-in or assist you with any dietary advice and health support.

 

You will also be seeing our dieticians before you progress to the next phase of your diet. After this transition is completed, you should see our dietician regularly.

 

Post-operative Outcomes

Our aim is to both maximise weight loss and enjoy freedom from post-operative problems.

 

As you lose weight, the amount of fat around your stomach will shrink,

 

Once your goal weight has been reached (usually around 12-18 months after surgery) your follow-up appointments can then be scaled back to yearly once.

 

Regular check-ups are a normal and a very important part of bariatric follow-up. It is totally unethical for bariatric surgery to be offered by any surgeon or clinic without also providing a clear and comprehensive Care Plan.

 

How Soon Can I Return to Exercise?

As soon as possible after surgery, patients should begin walking. Maybe some rest for 2-3 weeks before, but a gradual increase in physical activity, eventually getting a minimum of 30 minutes of exercise each day is recommended.

 

Will My Hair Fall Out After Having this Operation?

Hair loss following weight loss surgery is common and usually due to the physiological stress resulting from shifting nutrients towards vital organs and away from the more cosmetic organs such as hair growth. It results from:

• Rapid weight loss
• Not eating enough protein or total calories
• Low iron, zinc or biotin intake
• Extended use of meal replacement shakes

 

To remedy this, take your multivitamin and mineral supplement. Eat foods high in protein at least 2 meals per day. High protein foods are often also high in iron and zinc, but not always. Aim for 60-80mg protein per day and the same carbohydrate. If your iron stores are low, you may need an iron supplement. Oysters are the richest food source of zinc. 4 weeks after surgery limit meal replacement shakes and bars to 1 per day.

 

Excess Skin

Rarely do patients require plastic surgery for surplus skin when they have lost a lot of weight.

 

The skin has an amazing ability to remodel and shrink, it just needs time. As a rule, plastic surgery should not be considered for at least a year or two after the operation, as your skin usually continues to contract long after you have reached your goal weight.

 

Most patients find that skin trimming surgery is not needed. Regular exercise and keeping well hydrated also helps remould your skin.

 

If excess skin does persist, either we can refer you to a plastic surgeon for an opinion.

 

Could Your Stomach Sleeve Stretch Over Time?

Yes - the stomach does have a tendency to stretch, particularly if a person regularly tries to eat more than can be comfortably held.

 

This is a longer-term problem rather than something that is seen in the first few years. It is important that a person having a sleeve gastrectomy respects their new smaller stomach and avoids overeating.

 

As with all weight loss procedures, there is a need to complement the surgery with changes in eating behaviours, lifestyle, and exercise levels.

 

The chances of sleeve stretching are greatly reduced when a patient works with their sleeve as a tool.

 

By maintaining regular contact with the clinic, and making a genuine attempt to improve diet and lifestyle this is commonly achieved.

 

In the event of a significant increase in the stomach capacity over time, there are a number of rescue procedures that have been proposed to make the stomach smaller again. These include

• using sutures to reduce the stomach,
• placing a Gastric Band around the top, or

converting to a Gastric Bypass procedure.

 

Is the Gastric Sleeve Reversible?

No - because part of the stomach is removed from the body, the sleeve operation cannot be reversed. Many patients are actually attracted to these weight loss surgeries because of this, as they feel it represents a more permanent solution to their weight problem.

 

Do the Staples Use in the Sleeve Cause Any Problems?

No, the staples are completely safe. The staples used in the sleeve procedure are the same as those used in a variety of other common procedures such as operations on the colon and lung and have been used for over 50 years.  You can still have CT scans and MRIs, and go through airport scanners without trouble.

 

Indeed, they are essential to the sleeve procedure as it would not be possible to perform the sleeve procedure without surgical stapler technology.

 

Will the Staples Activate Airport Security Metal Detectors?

No. The staples used in the sleeve procedure are way too small to activate airport and security metal detectors. They can barely be seen on a medical X-ray.

 

How Long has the Gastric Sleeve Procedure been Around?

The sleeve has been performed worldwide since the 1960s.

 

Since then it has been further refined and studied, and has now become the fastest-growing type of weight-loss procedure in Australia and around the world.

 

Avoid Future Weight Gain

To avoid this weight gain patients can:

 

• Sign up for dietetic counselling
• Seek psychological support
• Avoid fizzy drinks
• Continue to be mindful when eating
• Maintain a healthy diet
• Exercise regularly

 

Who is Sleeve Gastroscopy Not Suitable for?

The Sleeve Gastrectomy procedure may not be possible if you have had some type of surgery on your stomach organ in the past.

Examples of surgery that may make it impossible to have a Sleeve include anti-reflux or hiatus hernia surgery, and removal of part of your stomach to treat cancer or an ulcer. Please check with us if you have a history of any procedures on your stomach.