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Gastric Sleeve

Also known as sleeve gastrectomy, gastric sleeve surgery is a bariatric procedure whose purpose is to remove a significant portion of your stomach, which will result in a sleeve-like organ. During gastric sleeve surgery, approximately 85% of your stomach will be resected so as to make you feel full faster after you eat, as well as to prevent you from ingesting large amounts of food at once. Furthermore, the surgeon will remove the portion of your stomach responsible for producing hormones, which boost your appetite. Therefore, your food cravings will also lower in intensity.

The procedure is most suitable for people with a body mass index (BMI) over 40, as well as for those whose weight is too high for undergoing gastric bypass surgery. It is also important to note that gastric sleeve surgery is permanent and irreversible. Sleeve gastrectomy is minimally invasive, as it is performed with the aid of a laparoscope. The surgery will not alter the normal functioning of your stomach, so there will be no food restrictions afterward. This bariatric surgery has been gaining more and more in popularity in the U.S. since 2010 when its cost began being covered by United Healthcare.

To determine whether you are a good candidate for gastric sleeve surgery, the healthcare team at Cedars-Sinai Marina del Rey Hospital will ask you to undergo some or all of the following tests and medical examinations:

• physical examination
• blood tests such as basic serum electrolytes
• EKG
• upper endoscopy
• pH monitoring studies
• chest X-ray
• stress test
• pulmonary function tests
• urine work
• sleep studies to ascertain whether you suffer from obstructive sleep apnea

If you are deemed suitable for gastric sleeve surgery, you will have to follow a 2-week diet prior to the actual procedure in order to lower your risks of postoperative complications. The diet consists in increasing your protein consumption by eating lean meats, lowering your carbohydrate intake by avoiding foods such as bread, pasta, and rice, and finally, eliminating sugar. The aim of these eating habits is also to decrease the size of your liver. Furthermore, two days before gastric sleeve surgery, you will have to give up caffeine and carbonated drinks. Adhering to a clear liquid diet during this period is highly advised.

On the day of your surgery, you will be put under general anesthesia and your vital signs will constantly be monitored by a team of well-trained bariatric nurses. After making several incisions in your abdomen, the surgeon will remove a large portion of your stomach longitudinally with the aid of a laparoscope – a fiberoptic instrument. The remaining part of your stomach will be carefully stitched to form a banana-shaped pouch (the sleeve). During the final step, the incisions in your abdomen will also be tightly closed with sutures and covered with sterile dressings to prevent infection. The surgery takes between one and two hours to complete.

There is also a new technique, namely SILS (Single Incision Laparoscopic Surgery), with the help of which our bariatric surgeons can perform sleeve gastrectomy. As the name suggests, it entails a single incision in your abdomen through which the surgery is carried out, also with the aid of a laparoscope. This kind of sleeve gastrectomy implies even fewer postoperative risks. However, it will not be suitable for all patients who need gastric sleeve surgery.

Unlike gastric bypass surgery, sleeve gastrectomy is significantly easier to perform a bariatric procedure which implies fewer risks for the patient. There are numerous advantages for the person who undergoes it, including:

• a short recovery time
• low risk of postoperative complications
• reduced chances of suffering from vitamin deficiencies
• a beneficial loss in appetite, as the surgery removes the portion of the stomach which releases the Ghrelin hormone
• normal functioning of your stomach
• non-existent risk of experiencing dumping syndrome, which often occurs after gastric bypass
• no need for adjustments, as opposed to lap band surgery
• relatively rapid weight loss (usually, within 18 months)
• improvement or disappearance of conditions related to obesity, such as high blood pressure and orthopedic problems
• increased life quality and expectancy

Depending on your particular situation, you may have to spend 1 to 3 days in the hospital or, on the contrary, be allowed to leave the same day. Shortly after the effects of the anesthetic wear off, you will receive pain relievers to alleviate postoperative sleeve gastrectomy discomfort. You will be encouraged to move and walk within the first 5 hours after you wake up to prevent blood clots. It is completely normal to experience pain, nausea, vomiting, and constipation after the procedure. Some of the risks and complications of gastric sleeve surgery are:

• infection
• leaking of stomach contents into the abdomen, which affects 1 in 100 patients
• blood clots
• internal bleeding, which occurs in 1 out of 200 people
• pneumonia
• damage to adjacent organs during surgery

Nevertheless, while the risks of sleeve gastrectomy are minimal, the aspect you should pay close attention to following the procedure is your diet. Accordingly, during the first week, you are allowed to drink only sugar-free, clear liquids such as broth, water, Jell-O, decaffeinated tea and coffee, sugar-free beverages which are not carbonated, etc. When the second week comes, you can add the following to your previous diet:

• soup with soft noodles
• sugar-free pudding
• very thin creamed soups
• non-fat yogurt
• very watery hot oatmeal
• thinned applesauce
• sugar-free sorbet

During the third week following your gastric sleeve surgery, it is recommended to include foods, which are more solid in your diet, but still, limit your sugar and fat intake. These foods should be gradually introduced into your diet, as the procedure you have undergone was quite radical. You should thoroughly chew every bite and eat slowly. Some ideas of foods you can enjoy within this period of time are:

• low-fat cottage cheese
• ground chicken or beef
• scrambled eggs
• canned tuna and salmon, to which you can add low-fat mayo
• mashed fruit such as avocados and bananas
• almond milk
• hummus
• soft vegetables (boiled or steamed)

At the same time, you should not consume food, which contains starch, like pasta and bread, fibrous vegetables such as broccoli or celery, as well as smoothies with high sugar content.

Finally, a month after your surgery, you can start introducing solid food in your diet, but should still be cautious, as your new stomach is still healing. Thus, you need to avoid carbonated drinks, foods high in carbohydrates, dessert, whole dairy foods, nuts, and fried foods. Instead, the following foods are highly recommended during the fourth week, provided you remember to eat slowly and chew every bite thoroughly:

• fish
• mashed and baked potatoes
• cereal
• fruits and vegetables
• caffeine (in moderate amounts)
• chicken and beef

In addition to the 3 meals you should have every day, you can also include snacks in your diet, such as hard-boiled eggs, fresh fruit, hummus, and oatmeal. After the fifth week, you can begin introducing any food you like in your diet, but do not forget to do this slowly and pay attention to how your body reacts after each meal, as it might not tolerate certain foods anymore.

If you experience the following symptoms after your gastric sleeve surgery, seek medical attention immediately:

• persisting or worsening pain
• fever over 101.5
• redness, warmth, or pus draining from the incision sites
• nausea
• inability to swallow

Walking is strongly encouraged during the recovery process. Within the first 3 weeks after surgery, you should avoid lifting anything heavy, as well as bating. Full recovery is typically achieved in 2 to 3 months after surgery. You can return to work within 2 to 4 weeks following the procedure, depending on what your job requires in terms of physical effort.