Gastric Sleeve / Vertical Sleeve Gastrectomy
As one of the newer standalone stapled weight loss procedures, the gastric sleeve has quickly become the most popular bariatric surgery in the United States. It is a straightforward procedure that removes 70-80% of the existing stomach pouch in a vertical manner, using restriction alone to achieve long-term results similar to the gastric bypass. The gastric sleeve does not alter the small intestine in any way.
How It Works
The gastric sleeve is a surgical weight loss procedure that permanently removes approximately 75-80% of the stomach. This laparoscopic procedure makes the sleeve long and tubular, resembling a “banana shape” allowing the stomach to remain intact with no part of the intestine modified or bypassed.
The sleeve benefits patients by removing the fundus of the stomach, which produces much of the “appetite hormone” ghrelin. As a result, patients receive additional help suppressing their hunger or appetite.
As with all surgical procedures, there is a degree of risk which may be exacerbated by poor health due to obesity.
Results of the Gastric Sleeve
Typical weight loss in the average patient may range from 50 to 75%, and many patients may see an improvement or elimination of type II diabetes, high cholesterol, high blood pressure and sleep apnea. While the gastric sleeve offers more modest weight loss rates versus the gastric bypass, long-term excess weight loss and maintenance is almost the same.
Potential Benefits of the Gastric Sleeve:
- Lower incidence of long-term complications compared to gastric bypass surgery
- Excess weight loss results are exceptional
- Obesity-related disease improvement rates are excellent
- No implants as with gastric banding
- Performed laparoscopically, and with robotic assist in some cases, which means less pain, less blood, generally fewer initial complications and a short hospital stay
- Less maintenance compared to the gastric band
After Gastric Sleeve Surgery
Typically, the sleeve requires an overnight stay, a day shorter than the gastric bypass and longer than gastric banding (an outpatient procedure). Once home, patients will limit strenuous activities according to their postoperative guidelines. Patients typically return to work within 2-3 weeks and normal activities within 6 weeks, with surgeon approval.
Gastric sleeve patients take a multi-vitamin supplement for the rest of their lives and follow a diet and exercise program that combines moderation and nutritional balance.
Our program’s approach is to re-educate the patient in order to adapt to the new post-surgery lifestyle. Food budgeting, exercise, vitamins, portion control, speed at which one eats, and behavior modifications will be important lessons and topics during your visits and support sessions.
Long considered the gold standard in bariatric surgery, the gastric bypass offers the greatest excess weight loss and obesity related disease resolution potential of any of the procedures we offer. The bypass works by both limiting the amount of food the patient can eat (restriction) and limiting the number of calories absorbed through the small intestine (malabsorption). It can be particularly useful for those suffering from uncontrolled type-2 diabetes or acid reflux.
About the Procedure
Gastric bypass is generally performed in a minimally invasive (laparoscopic) manner. This means that specially-made surgical tools, including a high definition camera, are passed through tiny incisions in the abdomen.
During surgery, your surgeon creates a small gastric pouch by dividing the stomach. This new pouch limits food intake (portion control). The surgeon then attaches a section of the small intestine (jejunum) directly to the new pouch. This allows food to bypass a portion of the small intestine (duodenum), which normally absorbs calories and nutrients. Having the smaller stomach pouch causes patients to feel full sooner and ultimately eat less food; bypassing a portion of the small intestine means the patient’s body absorbs fewer calories.
Unlike the gastric sleeve, the larger portion of the stomach is not removed from the abdomen. Rather, it remains, without accepting food, but continuing to produce digestive enzymes that are delivered to the intestine. As you eat less food and absorb fewer calories, your body may stop storing excess calories and start using its fat supply for energy.
Results of the Gastric Bypass
The gastric bypass is a very effective weight loss tool with potential excess body weight loss of typically upwards of 80%. The bypass is also effective in eliminating or improving many of the diseases associated with morbid obesity. The gastric bypass is particularly effective for those suffering from type-2 diabetes, which in many cases, will go into remission within days or weeks of surgery. The mechanism by which the gastric bypass improved diabetes so quickly, even without appreciable weight loss, was largely unknown. However, researchers now believe that the modifications to the small intestine may rebalance the patient’s gut bacteria.
Patients with severe and uncontrolled acid reflux may benefit as well.
Typical Benefits of the Gastric Bypass Include:
- Patients report an early sense of fullness and satisfaction that reduces the desire to eat.
- Patients generally lose more weight sooner than patients who undergo purely a restrictive procedure.
- Obesity related disease resolution rates are excellent.
- It can be performed laparoscopically, which means less pain, less blood loss, and shorter hospital stay.
- Built in negative feedback reinforcement with Dumping Syndrome, which produces rapid movement of food through the small intestine leaving the patient uncomfortable. This provides warnings signs that too much sugar and fat is being consumed, thus reinforcing healthy food choices.
Considerations and Risks of the Gastric Bypass
The Gastric Bypass is still a major surgery and comes with a degree of surgical risk which may be exacerbated by a patient’s poor health due to obesity.
- If any staple line begins to leak, the results could be bleeding or infection in the abdomen, which requires emergency care and surgery.
- The Gastric Bypass is treated as a permanent approach and is not adjustable. However, the procedure can be revised if it does not produce the desired results.
- There will be a hospital stay with this procedure.
- There are potential risks of anastomotic leaks; fistulas; intestinal irritation and ulcers; Dumping Syndrome; vitamin and mineral deficiencies such as iron, chronic anemia, vitamin B12 and calcium. This will require lifelong vitamin supplementation. It may also present lifelong difficulty in visualizing the lower stomach and segments of the small intestine when using endoscopy.
After Gastric Bypass Surgery
The typical hospital recovery time after a gastric bypass requires one to two days. Once home, patients will practice appropriate wound care and limit strenuous activities according to their postoperative guidelines. Most patients return to work within 2 weeks and normal activities can be resumed within 6 weeks, with surgeon approval.
Like other bariatric surgeries, gastric bypass patients will take a multi-vitamin supplement for the rest of their lives. Patients will likely take additional supplements because of the limited absorption of nutrients in the small intestine. These may include Vitamin D, Calcium, Vitamin B12, Iron and more. Periodic blood tests will ensure that any nutritional deficiencies are found and addressed appropriately. As with any bariatric post-op program, patients will follow a diet and exercise program that combines moderation and nutritional balance.
Our program’s approach to food budgeting, exercise, vitamins, portion control, speed at which one eats, and behavior modification such as refraining from drinking while eating is exactly the same regardless which procedure is chosen.
The latest weight loss device to be approved by the FDA, the gastric balloon uses an endoscopically-placed, saline-filled balloon to take up stomach space and increase fullness. This 6-month implant, paired with a one-year medical weight loss program, has proven results for those who may be concerned about surgery and for whom traditional diet and exercise has failed.
How It Works
The patient is sedated and an endoscopic procedure places the balloon-like device in the stomach. Once placed appropriately in the stomach, your surgeon will fill the balloon with sterile saline. The balloon will be roughly the size of a grapefruit.
The entire procedure only requires 20-30 minutes and it is performed in an outpatient setting for maximum comfort and convenience.
After six months the balloon is removed. For most patients, the six month implant will be sufficient to lose a significant amount of weight, assuming they continue with their medical weight loss program and lifestyle change. The medical weight loss program will continue for another half-year.
To remove the gastric balloon, the surgeon will puncture it and allow the saline to pass through the GI tract. Then the balloon is removed endoscopically.
Expectations and Results
The gastric balloon procedure is relatively safe and results have been proven with over 220,000 balloons placed around the world. Clinical data from the manufacturer show over 3 times more weight lost than by diet and exercise alone. As with any weight loss program, results will vary and patients must maintain a new and improved lifestyle including appropriate diet and exercise.
Do You Qualify?
Patients suffering from obesity who do not qualify for, or do not wish to undergo, surgery may find the gastric balloon to be a good alternative for their particular circumstance. There are, however, qualification criteria set by the FDA which include:
- You must be over 18
- You must have a BMI of 30-40
- You must participate in a medically supervised weight loss program
Benefits of the Gastric Balloon
- The device is a non-permanent implant
- Up to 3 times more weight loss than diet and exercise alone
- Continued support for up to a year
- “Day procedure” / outpatient
Risks and Considerations of the Gastric Balloon
Typically patients will not lose as much weight as with a weight loss surgery procedure
- As with any weight loss program, lifestyle improvements through diet and regular exercise are required for success
- There is a chance that the balloon may deflate before the full course of treatment, requiring removal of the deflated balloon
- Most insurance companies do not cover this procedure
- Many patients may feel nauseous or vomit for up to 2 weeks after the procedure. In these cases we may be able to help with medications
As is possible with any surgical procedure, bariatric surgery does not always turn out as planned. While complication and mortality rates have steadily decreased over the years, on average, it is important to remember that these procedures are complex and serious, and for one reason or another, may fail at some point in the future.
When a patient expresses to us that they are unsatisfied with the results of their past bariatric procedure, we begin by analyzing their diet and exercise regimen. Post-surgery lifestyle changes are a key component of success after bariatric surgery and some patients may not have been ready to undertake critical lifestyle changes such as modified eating and improved workout habits. If this is the case, then revision surgery will not be performed. Rather, we will work with the patient to analyze possible problem areas and develop a comprehensive plan to address them.
In some cases, the primary procedure may have failed due to gastrointestinal anatomical problems or a case where the surgery was not appropriate for that particular patient. In situations like these, the most important next step is to figure out why the procedure failed. Upon learning the underlying reason, and then approving a patient for revision surgery, we must then evaluate the options available to them.
When to Call Us
Just as in a patient’s pre-bariatric lifestyle, weight will fluctuate. These fluctuations may be caused by temporary dietary changes, menstrual cycles and a multitude of other factors. However, when the ups and downs become rapid and significant, this may warrant a call to our office. We suggest that all our patients keep a journal of their diet and exercise regimens. Another useful factor to journal is mood. Stress, anxiety, sadness and even happiness can all contribute to weight gain, as we often use food both to medicate and celebrate. The bottom line? Discuss your challenges in a support group or call our office if you believe something is not right. We’re here to help.
The Most Common Bariatric Surgery Revisions
Gastric bypass revisions are most often employed to correct stretching of the gastric pouch or stoma. This can happen slowly over time as the stomach is a very adaptable organ. There are several remedies to address this issue that can include minimally invasive and endoscopic (no incision) procedures. Patients should be aware that after they reach their goal weight, they may gain back 5-10% of their excess body weight loss – this is natural and does not require a revision.
The sleeve gastrectomy, or gastric sleeve, removes a significant portion of the stomach pouch, but can be revised by converting into a gastric bypass. In doing so, we add a malabsorptive (restriction of the absorption of nutrients in the intestine) component to the sleeve. This combination can offer the jump-start a patient needs to get back on track.
The gastric band can be revised to virtually any other procedure, assuming that the patient qualifies. Remember, some patients can qualify for a Lap-Band with a BMI of as low as 30 – it is important to remember that these patients may not qualify for a stapled procedure. Since the band does not permanently alter any part of the digestive tract, the original band can be replaced or the band can be removed and a stapled procedure such as a gastric bypass or gastric sleeve can be performed.
Revision surgery should not be taken lightly. These surgical procedures are still major surgery and come with all the risks associated with any other bariatric procedure. In fact, the risks of the revision procedure are actually heightened due to the fact that the patient will have already had abdominal surgery. Risks of complications may also be greater. While we do not encourage patients to revise their primary bariatric procedure in every case, we do understand that it is important and necessary in some. We will help you determine if your case qualifies for a revisional bariatric procedure and discuss solutions according to your specific need.
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What non-surgical options are available to help with weight loss?
Bariatric surgery is a very personal decision. While the benefits of losing weight through a surgical solution are real, it typically isn’t anyone’s first choice. That’s why we offer options to help you manage your weight before seeking surgery, regardless of your BMI, lifestyle or any health issues related to your weight.
Through nutrition counseling, we help you gain the confidence to make healthier dietary choices with a nutrition plan and prepackaged food options tailored to you under the guidance of our registered dietitian, medical bariatrician and surgeon. Find the structure, coaching and accountability you need to meet your goals for weight loss and improved health.
If diet alone doesn’t bring the desired result, medication management with a prescription weight-loss drug approved for long-term use may be another option. Any medication administered takes place with the support of our medical bariatrician and surgeon and is designed to help you control/curb your appetite for effective, sustained weight loss.
Is bariatric surgery safe?
Bariatric surgery, like any other surgery, does have risks and should be discussed with your primary physician and our surgeon. However, there are times when the surgical risk of bariatric surgery is lower than the risk of living with obesity and its related co-morbidities. That’s when surgery is ideal. Complication and mortality rates have been dropping over the past decade and laparoscopic techniques have further reduced the incidence of surgery-related complications.
How do I qualify?
Qualification criteria include weight vs. height (BMI), the presence of health conditions, age and surgical risk, among other factors. We will perform a full evaluation of your condition after your consultation and let you know if you qualify under our guidelines and, if applicable, under those of your insurance company. Find out now.
How can I pay for surgery?
For patients who have insurance, the first and most important requirement is to know if your insurance plan covers bariatric surgery. You will also want to find out what requirements your insurance company has in order to pre-approve you for the specific procedure in which you are interested. Insurance companies generally have strict qualification standards and knowing these standards beforehand can be very helpful in ensuring a smooth insurance process.
Our program offers flat rates for bariatric surgical services in order to reduce your total-out-of pocket expense. Cash pay patients should speak to our patient coordinator for the specific contracted rates. We strive to offer any guidance that we can, however we do suggest that you consult with your financial professional, in order, to fully understand your options and the impact to you.
If you need to explore payment options please call 469-698-1622.
Will my insurance cover surgery?
This depends on the insurance provider, your specific plan and its exclusions, as well as the procedure being performed. Many insurance plans cover bariatrics however the specifics of your plan are outlined on your plans website or through employer Human Resources departments. If you have questions please consult your insurance company or reach out to us for general questions.
Who is on the care team?
Your care team at the Texas Health Rockwall Bariatric Center will consist of the following skilled specialists:
Weight Loss Surgeon
Typically, your weight loss surgeon specializes in minimally invasive bariatric surgery and minimally invasive general surgery and has received advanced training through the American Society for Metabolic and Bariatric Surgery (FASMBS). Your surgeon typically has experience performing gastric bypass, gastric sleeve (sleeve gastrectomy), gastric ballooning, gastric band and revisional weight loss surgery procedures. They place a priority on lowering your risk of life-threatening health problems through an effective and tailored weight loss solution.
You and your surgeon will meet at least once prior to surgery to determine the best path to achieve your unique goals for weight loss. This is a great time for you to get your questions answered, including about your surgeon’s focus area(s), how may patients they have supported through weight loss journeys and how those patients are doing now.
This physician specialist is unique to our program. She is here to help you optimize your health through a medically supervised weight loss plan, nutritional education, and a combination of traditional and integrative therapies for weight loss and lifestyle changes. Her highly personalized approach to medication management ensures that you get the benefit of her full attention as well as the precise advice and treatment you need to help curb your appetite, deal with the hormone fluctuations associated with weight gain and more.
Bariatric Center Program Director
Think of our program director as the liaison between you and your surgeon. She will help get your questions about surgery answered and will support you and your family with education to get you on the right path for your needs. Our program director is also available to help connect you to support groups, if desired. As a former weight-loss surgery patient herself, our program director can bring unique insight to what to expect on your weight-loss journey.
Our clinical reviewer focuses on providing you with the utmost in program quality based on compliance to program standards established by a national bariatric organization. Think of her as a quality assurance detective.
You will meet our patient coordinator during your consultation with the surgeon and communicate with her quite often up until surgery, should you choose that path. The role of our patient coordinator is to facilitate obtaining approval for your bariatric surgery. She will coordinate the scheduling of any necessary pre-op testing, complete all required orders and pre-op clearances, help you navigate insurance coverage by requesting approvals and ultimately schedule your surgery.
You will be greeted by our super-friendly admitting representative when you first arrive at the center. She will be happy to assist if you should need something during your appointment or need to schedule a follow-up visit.
Why do I need a psychological test?
Psychological tests are not performed to determine mental health issues, but to ensure that you are prepared for the lifestyle changes you will have to make after surgery. Your body and mind will be going through many changes as you lose weight, and we must be sure that you are ready and willing to embark on this new journey.
What will I be able to eat?
Immediately after surgery you will be on a liquid diet for approximately 2 weeks, then soft solid for 2 weeks and then move on to solid texture, healthy foods. You will not be able to eat what you did before, nor the same amount, as the restriction that the procedures provide will force you to eat less at each meal. Most likely, however, you will be able to eat a wide variety of foods.
What can’t I eat and drink?
There are many foods that will be off the table after surgery. Foods and drinks high in calories, sugars and bad fats are big no-nos. Carbonated drinks, alcoholic beverages and caffeine should also be avoided. To get a better idea of the changes in store after your procedure, you will have the opportunity to see a sample meal plan before you undergo surgery. In the end, the bulk of your diet will consist of healthy fruits, vegetables and proteins – and plenty of water.
How long will I be in the hospital?
Generally speaking, the average patient will leave the hospital on the same day for gastric banding procedures and the next day for gastric sleeve procedures. Of course, every case is unique.
What support is available after my procedure?
The more you surround yourself with support, you are, statistically, more likely to achieve a better outcome. Support can come from many sources including organized groups, family and friends and exercise classes. The most important thing is to find the support that you need and fits into your life. Our bariatric center feel so strongly about support that we offer programs that can meet a variety of your needs.
Texas Health Rockwall offers a virtual support group to its post-surgical patients. In support group, we are surrounded, encouraged and learn from others who have struggled with weight. Adopting a new lifestyle, while exciting, can still bring challenges so taking time to share with others is particularly beneficial to your success. Perhaps one of the greatest benefits is to know that you are not alone in your journey.
Will I lose hair?
Some patients do experience some hair thinning or hair loss after surgery because of the restriction of calories and nutrients. This is most often temporary and the hair should grow back once the patient’s diet stabilizes in protein consumption. Consult your dietitian to see how you can minimize the chances of hair loss after surgery.
Is bariatric surgery right for me?
In the end, you along with your surgeon will be able to answer that question. Every case is different and while some patients enjoy great success after surgery, there are many potential patients on whom we never operate because they are not ideal candidates. Your particular health situation, your willingness to work hard to lose weight, and the results of your testing will let us know if surgery is right for you.
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