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The honest truth about gastric sleeve surgery

The gastric sleeve is one of the most popular weight loss operations I offer today. It’s safe, minimally invasive, and most importantly - it’s effective. But with all the malaligned information on the internet, I want to ensure that anyone considering gastric sleeve surgery is properly educated when it comes time to make a decision about this life changing surgery.

What is gastric sleeve surgery?

Also known as sleeve gastrectomy or vertical sleeve gastrectomy, the gastric sleeve is about permanently reducing the size of your stomach from a large football shape to a small banana shape. This is accomplished by removing up to 80% of the left side of your stomach. It is performed minimally invasively with 5-6 small incisions, takes less than an hour, and requires only 1 night stay in the hospital.

This smaller banana shaped stomach helps you feel full and satisfied with smaller meals resulting in significant, sustained weight loss. The gastric sleeve also reduces the production of ghrelin, the body’s so-called “hunger hormone,” so patients experience a dramatic reduction in hunger which allows you to make better food choices and control your overall calorie intake.

The Gastric Sleeve Pre and Post-Op Diet

One of the most common questions I get is “Do I have to do a 2 week pre-op liquid diet?” The sort answer is no. However, all patients have to be losing weight coming into surgery. Anytime we lose a little weight, our insides are affected greater than our outside. The body prefers to lose weight around its organs before it cares anything about its arms, buttocks or thigh area. So, a 10-15 pound weight loss right before surgery actually makes your insides look like you lost 50-75 pounds!

Instead of forcing people to lose weight with an extended pre-op liquid diet, I prefer they start eating healthily like what it's going to be like for the rest of their lives. Why wait until after surgery to start changing how you eat and approach food? It’s time to change your life now!

Some people’s response is “If I could lose weight on my own then I wouldn’t need this surgery.” What most people don’t realize is that they can lose weight pretty easily and have many times before, however they just aren't able to keep it off. These surgeries are as much about helping people keep weight off as they are about helping people lose weight. In my opinion, maintenance is much harder than losing weight. I joke with people all the time that my name should be Nashville Weight “Maintenance” Solutions.

Unfortunately, I do ask people to be on liquids 2 days before surgery to clean out their intestines and shrink their liver. The liver holds 2 days of food, so this allows us to lift it out of the way safely and work on the stomach underneath.

Many people believe the post-op liquid diet is about getting the stomach accustomed to food again, but that’s not the case actually. It’s more about not overstretching the stomach while it heals, so you don’t cause the stomach sutures or staples to pull apart and cause a complication called a leak.

After gastric sleeve surgery, the stomach needs approximately 3-4 weeks to be completely healed and like new again. So, patients are not allowed to eat solid foods until they are 5-6 weeks post-op. Basically, what changes over time is the consistency of the protein they have to eat to maintain nutrition. In addition, they have to drink > 64 oz of water a day and take vitamin supplements to get the micronutrients they need.

The typical timeline for advancing patients diet post-op is:

Stage 1: 10 days of liquids only, incorporating protein powder

Stage 2: 2 weeks of thicker protein shakes

Stage 3: 2 weeks of soft proteins like eggs, yogurt, cottage cheese, and tuna fish

Stage 4: Solid lean proteins (chicken, fish, tofu, etc) and vegetables

Recovery after Gastric Sleeve Surgery

Since the surgery is less than an hour and done with small incisions, the recovery is pretty straightforward. On the afternoon of surgery, patients are up walking the halls and able to start drinking fluids. Contrary to popular belief, the majority of patients are not nauseated or vomiting and are able to drink their fluid requirements without difficulty. The surgery isn’t very painful and many patients are able to avoid narcotics altogether. The majority of patients go home the day after surgery, and some can actually go home the same day.

Once you leave the hospital, there aren’t too many restrictions. You are able to shower, climb stairs, perform light aerobics, and even drive a car in a few days. Depending on the intensity of your job, most patients are able to return to work in 1 week.

Here’s the amount of time we recommend taking off work after gastric sleeve surgery:

One week: Those who work from home or have a simple desk job

Two weeks: Those who are a bit more mobile or physical on the job

Three weeks: Those with more strenuous roles like construction workers

Side Effects after Gastric Sleeve Surgery

One of the big fears of bariatric surgery is the potential side effects. Unfortunately, there are a lot of myths and incorrect information on the internet. I tell all my patients if you are compliant with my recommendations, side effects will be minimal, if any. The horror stories you hear about are typically non-compliant patients not following the strict post-op diet or not taking their vitamin and mineral supplements long-term. Patients that are taking their supplements and coming in for their follow-up appointments regularly, have little to no side effects.

Contrary to popular belief, patients are not vomiting all the time or having diarrhea for the rest of their lives after bariatric surgery. Vomiting is infrequent and usually related to overeating, not chewing your food well, or being in a hurry.

Bowel movements actually tend towards constipation not diarrhea in the beginning. This is because the diet is proportionately higher in protein in the early rapid weight loss phase. Most constipation is the result of not drinking the required 64 oz of water a day and just increasing your water intake will resolve this issue. If not, Miralax is an easy over-the-counter remedy that dissolves in your water and is tasteless. Once the diet becomes more balanced closer to the maintenance phase, constipation is no longer an issue.

Hair loss is another big concern for patients after these surgeries. I tell patients it’s more like hair thinning not hair loss. It’s also temporary and only lasts a couple months, generally from months 4-6. I also tell them the only people that will recognize the hair thinning will be you and your hairdresser.

Heartburn is probably the most common side effect after gastric sleeve surgery. Unfortunately, it’s hard to predict who will be affected, but the good news is that the symptoms are very manageable with the appropriate medication.

As with all bariatric procedures, nutritional deficiencies are a long-term risk. However, since the gastric sleeve leaves your anatomy more normal compared to gastric bypass surgery, the risk of nutritional deficiencies is minimal. With the appropriate education and follow-up regimen, these risks are close to zero for gastric sleeve.

Results of Gastric Sleeve Surgery

We’ve seen thousands of patients be successful with gastric sleeve surgery with the average weight loss being 70-75% of excess body weight one year after surgery. So, if you are 100 pounds overweight, you can expect to lose 70-75 lbs the first year. The long-term weight loss is typically in the 65% range. Some people will lose more and some a little less depending on their metabolism, activity level, and compliance with the diet. Accountability is the key to long-term success. We have shown that patients who participate in our comprehensive Aftercare Program lose the most weight and have the best long-term weight loss.

Dramatic weight loss obviously helps you feel better and improves your quality of life. It can also prolong survival by eliminating the diseases that are a direct result of the obesity like diabetes, high blood pressure, high cholesterol, and sleep apnea. With gastric sleeve surgery, patients can expect resolution of these medical problems in greater than 75% of cases. So, in addition to weight loss, patients are also dramatically changing their overall health.

If you would like to see how these surgeries are changing people’s lives, please take the time to read the stories of our patients, look at their before and after pictures, and really get an idea of just how much the gastric sleeve could change your life.


Contact Nashville Weight Loss Solutions for more information on the gastric sleeve

Are you trying to diet and exercise on your own, but still not getting the results you want? Nashville Weight Loss Solutions offers a comprehensive range of proven weight loss programs to help you reach your goals, whether you need to lose 20 pounds or 200. Contact our office today to schedule a consultation!

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