GASTRIC SLEEVE SURGERY PATIENT GUIDE 2018
TABLE OF CONTENTS
- 1. Overview of Gastric Sleeve Surgery
- 2. How It Works
- 3. Step by Step Surgical Procedure
- 4. Health Benefits
- 5. Eligibility and Qualification
- 6. Insurance Coverage
- 7. Surgery Day
- 8. Diet and Life After
- 9. Pre-Op Diet
- 10. Post-Op Diet
- 11. Nutrition, Vitamins, and Supplements
- 12. Complications, Risks
- 13. Advantages and Disadvantages
- 14. Comparison to Other Bariatric Procedures
- 15. Weight Gain After Surgery
- 16. Can My Sleeve Stomach Stretch?
- 17. Long-Term Expected Results
- 18. Essential Tools for Long-Term Success
- 19. Gastric Sleeve with Hiatal Hernia
- 20. Exercise After Surgery
- 21. History of VSG
- 22. FAQs
Gastric Sleeve Surgery Overview
Gastric Sleeve Surgery is a bariatric procedure that removes up to 85% of the stomach creating restriction. Patients choose sleeve surgery now more than any other procedure because it is a less-invasive, clear-cut, and safe option resulting in effective long-term results. Gastric Sleeve Surgery, also known as Laparoscopic Vertical Sleeve Gastrectomy (VSG) is a restrictive procedure, in which the stomach is resected and almost 80% of it is removed along the greater curvature.
Rapid weight loss with gastric sleeve begins immediately after surgery. On average, patients can expect 65% excess weight loss (%EWL) after one year. Gastric sleeve surgery, or vertical sleeve gastrectomy (VSG), removes a significant portion of the stomach along the greater curvature where the hunger hormones called Ghrelin reside. The surgery makes neurohormonal changes within the brain and stomach, completely changing the quantity, hunger, and relationship with food.
Why Choose Gastric Sleeve?
1. Obesity Treatment: Our brain plays a major role in our weight management. The brain gets used to our body weight and considers it as a set-point. Trying to lower the body’s set-point (metabolic thermostat) with diet releases hormones to trigger metabolism decrease and hunger increase.
That is why dieting and exercise alone are not a long-term solution for weight loss. The gastric sleeve surgery procedure shrinks the stomach to create a long-term tool to aid in effective weight loss.
2. Bariatric Surgery for Effective Weight Loss: Bariatric surgery procedures, like vertical sleeve gastrectomy and gastric bypass, have grown exponentially around the world because of the low complication rate and high success rate.
Bariatric surgery, commonly known as weight loss surgery, changes a patient’s set-point and provides them a new outlook and chance in life.
3. Treatment for Obesity: Gastric sleeve surgery has proven to be a successful, long-term cure for obesity. With a low complication rate and high success rate, the sleeve is one of the most common bariatric procedures today.
How Gastric Sleeve Surgery Works
1. Gastric sleeve surgery works by reducing the size of the stomach by 85%.
2. The new stomach holds about 85% less food (and thus calories) and the patient feels full sooner and for longer periods of time.
3. The smaller stomach secretes fewer gut hormones that impact hunger, satiety, and blood sugar control.
The sleeve procedure is performed laparoscopically almost 100% of the time unless situations arise to dictate the need for open surgery.
Gastric sleeve surgery results in patients having a banana-shaped stomach “sleeve” connecting the esophagus to the small intestines. The new sleeve stomach size is reduced from 30-40 ounces in volume to 3-4 ounces. Eventually, the stomach size grows to 6-8 ounces in volume preserving "normal" healthy eating habits.
Unlike gastric bypass, gastric sleeve leaves the anatomy intact and the food already combined with digestive enzymes in the mouth gets mixed with the bile and pancreatic fluid from the liver and pancreas to completely get absorbed in the bowel.
There are three leak tests performed during and after surgery. Two leak tests take place during surgery with a blue dye and with air. The third leak test is performed with hydrosoluble contrast solution and X-rays. It is common to for the gastric sleeve surgeon to leave a drain in the abdominal cavity as a precaution for early detection of leak or bleeding.
Gastric Sleeve Procedure
- While the patient is lying on their back with the arms spread apart, general anesthesia is administered by inserting the breathing tube into the windpipe.
- First, the abdomen is inflated with CO2 in order to have room to comfortably work in the abdominal cavity.
- The surgeon will make between 1 (single-incision) to 5 small incisions in your abdomen and insert trocars to be able to get various laparoscopic instruments into the stomach cavity.
- The liver is lifted out of the way with a retractor.
- The greater curvature is released by longitudinal resection of the stomach starting from the antrum to about two inches from the pylorus.
- A bougie is inserted through the mouth as a guide for cutting the stomach.
- Then, the majority of the stomach is removed by cutting and stapling at the same time alongside the bougie by a special instrument. Three lines of titanium staples (Johnson & Johnson or Covidien brand) seals the newer smaller stomach pouch.
- Some surgeons will then reinforce the staple line with prolene suture, called inverted sleeve.
- The surgeon also repairs hiatal hernia if present.
Trocars are inserted in incisions
New stomach is cut/stapled
Sleeve stomach is closed with sutures
Drain is inserted into incision
The New Stomach Size
The bougie is the device inserted within the mouth that goes down the esophagus to form an outline for your new stomach sleeve. This outline is cut and stapled by the bariatric surgeon laparoscopically.
The bougie size is important as it guides the shape of the stomach to be cut properly. As a surgeon, technique matters because it depends how close they cut the bougie to the stomach. This impacts the sleeve size of the patient's new stomach and the new stomachs holding capacity. Some surgeons are known to cut/staple along the bougie loosely, and some surgeons do it tightly.
Below are diameters of bougie/ "guides" in inches (as you see is very little difference in diameter).
- 32F = .40"
- 34F = .425"
- 36F = .45"
- 38F = .476"
Health Benefits of Gastric Sleeve Surgery
There are many advantages shown through major health benefits of gastric sleeve surgery. Beside rapid and long-term weight loss, the sleeve procedure increases the quality of life and improves overall health. Here is a list of health benefits patients can expect:
Health Concerns Caused by Obesity
- Obstructive Sleep Apnea
- High Blood Pressure
- High Cholesterol
- Type 2 Diabetes
- Stress Urinary Incontinence
- Metabolic Syndrome
- Cardiovascular Disease
- Polycystic Ovarian Syndrome (PCOS)*
- Dyslipidemia hypercholesterolemia
- Venous Stasis Disease
- Soft Tissue Infections
Health Risks of Belly Fat
Abdominal fat (waistline) is one of the predictors of a health risk as well. If the waist circumference (measured at the belly button) is greater than 35 inches for women or greater than 40 inches for men, the risk is higher for heart disease and type 2 diabetes. Waist-To-Hip Ratio (WHR) should be also considered for abdominal obesity; women > 0.85 and men > 0.9.
Quality of Life Benefits
- Romantic Interests
- Self Confidence
- Stamina and Energy
- Reduced Disability
- Reduced Anxiety
Non-Scale Victories (NSV)
Bariatric surgery is not a cosmetic procedure. While you will lose weight and typically look better and healthier, the success of bariatric surgery, like gastric sleeve surgery, should be based on a reduction of co-morbidities, improved longevity, and an improved quality of life, not numbers on a scale.
Are you happier, healthier and going to live longer? Let’s take a look at some non-scale victories:
- Be able to ride in a sports car
- No need for an extender belt on an airplane
- Shave your legs easily without a mirror
- Make it up the stairs without the struggle
- Not embarrassed to be in pictures
- Fit in one leg of your old pants
- Wear old rings that you once grew out of
- Not having to walk around with constant pain
- Wear the clothes you couldn't fit in
- Be able to cross your legs
- Not the biggest person in the room
- Be able to wrap a bath towel around your body
- Don’t have to shop at plus size stores
- Go out wearing a nice bathing suit
- Be able to walk outside without feeling bad
- Going to a wedding and looking great
Eligibility, Qualifications, & Requirements
Health Concerns/Medical Problems
Commitment to Life Change
Qualifying Requires Age: 15 to 65 years with
BMI (Body Mass Index) of 30+ or 100 lbs Overweight
BMI Under 30: Obesity-Related Health Problem; Diabetes, High Blood Pressure, Sleep Apnea, etc.
Unable to Achieve a Healthy Weight for a Period of Time Despite Weight Loss Efforts
Failed Diets, Nutrition Plans, or Weight Loss Attempts
Gastric Sleeve Insurance Coverage
Obese individuals spend $395 more on medical care per year than non-obese individuals - 36% more on health care services and 77% more on medications. Even though the obesity costs the U.S. alone $117 billion for healthcare costs and lost productivity, getting approval from the insurance companies is like jumping through hoops.
Health insurance plans, including Medicare and most Medicaid plans, have coverage for bariatric surgery. However, their coverage & criteria vary and it is important to examine what insurance plans cover bariatric surgery.
- Around 25% of individuals looking to get bariatric surgery coverage are denied 3 times before getting their approval.
- Patients are required to complete a six-month medical weight loss program prior to being accepted. Around 60% of patients report their health worsened during this waiting period.
If you don’t see your plan here, please contact us as terms change frequently. For more information on bariatric surgery insurance coverage for gastric sleeve surgery, visit http://obesityreporter.com/weight-loss-surgery-insurance-costs/
How to Find Out if You're Covered
Acquire a copy of the Medical Policy statement of bariatric surgery for your insurance coverage. Some policies require a medically supervised weight loss program. These are additional questions you to ask your insurance company for gastric sleeve coverage:
- Do they cover bariatric surgery under your plan?
- What are the covered bariatric surgery options?
- What criteria is needed for coverage?
- Do they have a pre-existing clause?
- What is the co-pay amount?
- How much is left to meet your annual deductible and when does it renew?
- Medical Policy
Insurers need to know that it takes at least 3 months from attending an orientation seminar to get to the operating room. To take advantage of the end of the year deductible and get surgery by the new calendar year, people should start the process early enough to give themselves enough time.
Is Pre-Approval Necessary?
Pre-approval is sometimes required for weight loss surgery. It is a way to make sure the procedure is covered by your Bariatric Surgery Insurance policy. Typically, our surgeon’s office will submit the required information to your insurance provider to gain pre-approval.
Insurance Questions and Answers
What are some of the most common bariatric insurance coverage requirements?
Some of the most common bariatric insurance coverage requirements include:
- Body mass index (BMI) greater than 40 or BMI greater than 35 with co-morbidities (diabetes, high blood pressure, etc.). To see if you meet these requirements, you can calculate your BMI using our calculator.
- 18 years of age or older.
- Diagnosis of morbid obesity.
- A few insurance plans require participation in a physician-supervised weight loss program for extended time periods (this can vary from 3 to 12 consecutive months, depending on your insurance plan).
- Psychological evaluation prior to surgery. Our bariatric clinic will either provide this service or refer you to a psychologist.
- Documentation of failed diet and exercise plans.
What if my insurance provider denies the coverage?
The surgeon’s office will be notified of the denial of coverage and will assist you the appeal process if you choose to appeal.
Standard insurance requirements include;
- Body Mass Index (BMI) of 40
- or a Body Mass Index (BMI) of 35 with one or more of the following co-morbidities:
- Type 2 Diabetes
- Heart Disease
- Obstructive Sleep Apnea
- High Cholesterol
- Or other health-related issues.
- Must have:
- six-month medically-supervised diet program.
- private consultation with a bariatric surgeon.
- Must get a medical clearance from your primary care physician (PCP).
- Must seek out a psychological consultation and get clearance.
- Must schedule nutritional evaluations with a Registered Dietician (RD).
Basic Guidelines and Rules
- Stop smoking as soon as possible
- Avoid NSAIDs such as ibuprofen (Advil, Motrin)
- Lose as much weight as possible
- Begin to exercise so your body is ready to be active
- If you’re a woman and take birth control pills, try an alternative contraception
Medical Tourism to Mexico
Mexico is the largest destination in the medical tourism industry for bariatric surgery. Medical tourism to Mexico offers extremely affordable, yet competitive pricing for safe and high-success rate weight loss procedures.
Mexico Bariatric Center has been a part of the medical tourism industry for a decade with over 10,000 bariatric surgeries performed among our surgeons. We offer all-inclusive packages at the best price for top-quality, certified bariatric surgeons. Gastric sleeve surgery is extremely popular and growing fast as an effective treatment for obesity, with similar results to gastric bypass surgery.
What To Bring for Bariatric Surgery
Surgery Day - What to bring with you:
- Your CPAP machine
- A comfortable robe and slippers
- Personal toiletries, chapstick
- Computer, iPad, phone, iPod
- Paper and pen
- A book, puzzle or a game
- Your post-op instructions
- Photo ID and insurance card
If you are nervous, please let your nurse know and they will have the anesthesiologist give you some medication that can help you relax. When you wake up you feel a little pain, but medication should help. You can have ice chips after surgery. Gas-X strips help you deal with the gas. 25% of patients have nausea for the first 24 hours after surgery for which medication will be given for.
- Walk, Walk, Walk! Walking helps fast recovery, prevent blood clots in calves & pulmonary embolism, and fewer gas problems.
- Sip, Sip, Sip! Get used to sip after surgery.
- Breathe, Breathe, Breathe! Use barometer breathing machine to open up your air-sacs (alveoli).
Drains are installed for the first 2 days to help detect a possible leak. 24 hours after surgery, fluoroscopy is performed to make sure there is no leak or obstruction. Patients can shower after 24 hours. Staying hydrated is very important as swallowing is hard during the recovery period. Make sure you sip fluid. Larger pills than M & M needs to be crushed and mixed with applesauce.
The No-Nos for Patients
No driving, no sex, no climbing ladder, no swimming and no lifting heavy objects (more than 25 lbs) for at least 2 - 4 weeks after surgery.
Diet and Life After Gastric Sleeve Surgery
The gastric sleeve gives patients a renewed life and a new beginning. Life after sleeve surgery is a process and needs to be followed up with good aftercare and lifestyle changes for long-term success. Recovery is important to stay healthy and achieving your weight loss goals.
In the weeks after sleeve gastrectomy surgery, there are instructions to follow for nutrition and activity. Post-op diet needs to go from liquid to soft or pureed foods, and eventually to solid or regular food. It is important to get enough fluid and stay hydrated (64 oz per day).
Patients can start exercise 3 to 6 months after surgery. Increasing muscle mass and using it moves your set-point lower, and as a result, your hunger goes down and metabolism increases. Follow the pre-op and post-op diet within our gastric sleeve bible for the best success.
Each patient will be placed on a gastric sleeve pre-op diet prior to surgery. The instruction and length of time that sleeve patients need to be on the pre-op diet is based on BMI:
BMI less than 32: 2 days clear liquids
BMI 33-39: 1 week (including 2 days clear liquids)
BMI 40-45: 2 weeks (including 2 days clear liquids)
BMI 46-49: 3 weeks (including 2 days clear liquids)
BMI 50-59: 6 weeks (including 2 days clear liquids)
BMI 60+: 8 weeks (including 2 days clear liquids)
Each patient with a BMI 33 and above will be placed on a meal plan consisting of 2-3 protein shakes a day and two meals with 4-7 ounces of lean protein and unlimited non-starchy vegetables.
- Protein shake needs to have 20g or more of protein and less than 5g sugar.
- Protein needs to be considered lean and/or has very little visible fat.
- Avoid starchy vegetables such as potatoes, corn, and peas.
- Approved to have up to ½ cup berries or ½ banana a day. No additional fruit.
- 64oz Water or sugar-free drinks only.
- No additional snacks, grains, or desserts.
- Must wean off coffee, caffeine, and carbonated beverages.
The Liquid-Only Diet (2 Days)
Every patient will have to do two full days of clear liquids just prior to surgery. During these two days the patient will be instructed to only have:
- Sugar-free beverages such as crystal light, propel, vitamin zero water, Powerade zero
- Apple, cranberry, or white grape juice is approved if it is diluted 50/50 with water
- Sugar-free Jello
- Sugar-free popsicles
Every patient is also instructed to have 2 greek yogurts per day during the Clear Liquids Phase ONLY. This is only a requirement if the patient is not taking a probiotic.
Start taking a probiotic with a minimum of 50 billion CFU as soon as possible before surgery. This will help create a healthy balance of bacteria and will help with digestion.
Vitamins need to begin 7-10 days after surgery.
Each patient will transition through four phases of post-op diet after gastric sleeve surgery:
Phase 1: Begins the day of surgery, lasts 5-7 days
Clear Liquids: Just as advised two days before surgery.
- Sugar-free beverages such as crystal light, propel, vitamin zero water, Powerade zero
- Apple, cranberry, or white grape juice is approved if it is diluted 50/50 with water
- Sugar-free Jello
- Sugar-free popsicles
Phase 2: Begins 5-7 days after surgery, lasts a minimum of 5 days
- Protein shakes
- Pureed soups
- Apple Sauce
- Pureed fruits and vegetables
- Thinned oatmeal or cream of wheat
- Thinned Greek yogurt
- Milk (Dairy or non-dairy such as almond milk)
Phase 3: Begins 10-21 days after surgery
Soft Solids (anything that can be mashed with a fork):
- Cottage Cheese
- String Cheese
- Well-cooked vegetables
- Tuna mixed with mayo
- Mashed potato or sweet potato
- Peanut or Almond butter
Phase 4: Begins 21 days or later following surgery (depending on the individual)
Solid Foods (Creating a healthy meal plan that lasts forever)
- Lean meats (red meat may take longer to be able to digest)
- Vegetables (raw may take longer to be able to digest)
- Healthy fats (avocado, nut butter, oil, butter)
- Whole grains (oats, quinoa, Ezekiel bread)
- Berries and other fruits in moderation
Nutrition, Vitamins, and Supplements
What Vitamins Should I Take After Gastric Sleeve Surgery?
- Calcium with vitamin D
- Iron (in some cases)
- Vitamin B12 supplement
Make sure you take chewable or liquid bariatric multivitamins that meet American Society of Metabolic and Bariatric Surgeons (ASMBS) guidelines.
It is advised:
- Take in 60 to 100g protein daily in several servings of 230g each
- Eat primarily whole foods (whole grains)
- Avoid fibrous, starchy, and greasy foods
- Eat fruits and vegetable
- Limit processed and high-fat foods
Potential Complications and Risks
Gastric sleeve surgery complications are separated into two key categories; immediate complications and long-term complications:
- Hemorrhage - The risk of postoperative hemorrhage or bleeding is at 4%* (1% to 6%)**.
- Sleeve Leaking - Sleeve leak, the most serious complication, occurs in up to 2.8%*** of patients.
- Abscess - Fistula formation after the gastric sleeve is about 3% to 7% of patients****.
Possible Long-Term Complications:
- Blood clots (happens 1% of the time)
- Wound infections - Surgical site infections occur in about 10-15% of post-op patients.
- Stomach Strictures - Symptomatic stenosis occurs 3.5% of post-op patients.
- Aversion to food and nausea
- Damage to the vagus nerve which will cause constant nausea
- Gastroparesis, with a delay in moving food from the stomach to the small intestine
- Esophageal spasm/pain
- Gastroesophageal Reflux Disease (GERD)
- Hair Thinning
- Dumping Syndrome
- Stomach Stretching
- Nutrient Deficiency 12%
The surgeon can accidentally inflict a cut (laceration) to the stomach that goes unnoticed and does not get repaired prior to closing. The proper pre-op diet is crucial for patients to follow in order to shrink the liver for easier surgery.
According to ASMBS, the mortality rate for weight loss surgery is about 0.1 percent, however, it can increase the life expectancy by up to 89 percent.
Risks & Downsides
Hair loss after surgery is a concern among patients. It starts as early 3 months out, peaks at 6 months, and resolves around 9 to 12 months. It is more of an issue among females and depends on the amount of hair they have and how thin it is. An Iron deficiency can cause hair loss; less common is a zinc deficiency. Biotin (10 mg per day) can help prevent hair loss as well as taking adequate protein (especially first 3 months).
Advantages & Disadvantages
Advantages of Gastric Sleeve Surgery
- Induces rapid and significant weight loss (>50%) similar to that of the gastric bypass
- Requires no foreign objects, like Adjustable Gastric Band (AGB)
- No bypass or re-routing of the intestine and the food stream, like RYGB
- No malabsorption
- Relatively short hospital stay (2 days)
- Causes favorable changes in gut hormones that suppress hunger, reduce appetite and improve satiety
Disadvantages of Gastric Sleeve Surgery
- Is a non-reversible procedure
- The potential for long-term vitamin deficiencies
- Higher early post-op complication rate than the AGB
- gastric sleeve surgery side effects
Loose, Excess Skin After Surgery
Patients may experience loose, sagging skin due to rapid weight loss. The excess skin is common with weight loss more than 100 lbs. It is not so bad in so many individuals and depends on factors like:
- Skin elasticity
This can be fixed with plastic surgery if it becomes too much of an issue; it is a personal choice.
Comparison to Other Weight Loss Procedures
Gastric sleeve surgery is becoming the fastest growing bariatric procedure because of it's high expected weight loss and the low complication rate because of it is "less-invasive". It results in comparable excess weight loss (5% less than bypass) and success rate (~80% of patients are successful with long-term weight loss).
Patients are also able to get bariatric revision surgery if they are not successful with gastric sleeve. The most popular revisions are gastric bypass and duodenal switch in case their surgery is not successful whereas patients with gastric bypass have limited options for revisional surgery.
Not Losing Weight After Gastric Sleeve Surgery
Although hard, patients can stall or plateau after gastric sleeve surgery. If patients form unhealthy habits, weight regain is possible. There are many possible factors involved such as:
- Binge, emotional, impulse eating
- Stress, Depression
- Lack of activity, mobility
- Sugary foods
- Alcoholic beverages
- Hormones in Meat
- Lack of sleep
- Yo-yo dieting
- Pregnancy or Menopause
- Poor meal planning
Preventing Weight Gain
Preventing weight regain is about eating lots of high quality and nutrient food rather than starving yourself! If you ate 3 lbs of spinach (low-glycemic food) every day, you do not gain weight but lose weight. Also, staying active is a huge part of weight loss after surgery. Exercise with intensity rather than focusing on low-intensity long-duration movements.
Stretching the Sleeve Stomach
Can it be Stretched?
When patients get concerned about their stomach stretching, they need to know the following facts. In general, the stomach stretches to hold food and contracts once it empties. Repeated expansion beyond the normal size gradually can lead to permanent over-stretching of the stomach. With gastric sleeve surgery patients, there is a progressive increase in the capacity for food. There is also a shift in the way that the brain and stomach & intestine interact as time goes by. It is more than anatomy and the size of the stomach, there is a hormonal impact of the surgery and metabolic mechanism involved.
Sleeve Size Growth
The stomach will not grow to the original volume after surgery. Do not worry about your stomach stretching, worry about falling into the same traps that made you get surgery in the first place. We will work closely with you to learn good eating habits and portion sizes to optimize your outcome and enhance the long-term result.
Long-Term Weight Loss
Long-term (3+ years) weight loss depends more on diet and environment and the following clinical predictors:
- Food Intake
- Level of Physical Activity
The weight you lose after gastric sleeve surgery does not bring you happiness. Success is reached once you develop good eating habits and lifestyle change. Here is a sleeve weight loss timeline to see expected results.
Tools For Long-Term Success
- Join Online Forums
- Join Facebook Support Groups (Closed groups)
- Join Local Support Groups
- Use a Bariatric App
- Document Your Progress
It can be common to not always lose weight, in fact, sometimes weight can be regained periodically. Following the gastric sleeve post-op diet and changing your lifestyle will ensure the best chance of staying healthy. Some patients also experience digestive issues which often resolve on their own with time or by altering the diet.
Food journaling is very useful to keep track of snacking, meal planning, and calorie intake. Journaling helps patients to document their calories, carbs, and proteins to set the best goals for their weight loss journey. While food journaling, there are very useful apps to log the types of meals and snacks you eat to determine everything you need to stay on top of your diet.
Obesity kills a lot of people every year. Surgery is not the easy way out but it gets you started. You will lose a significant amount of weight that you cannot do it on your own. It gives you hope and feel like there is light at the end of the tunnel. So, if you're thinking about weight loss, make contact with our specialized and dedicated coordinating staff and surgeon liaison at Mexico Bariatric Center. You can get your questions answered by MBC staff. Also, you can join the Facebook closed support group for Mexico Bariatric Center and look at what people are going through.
Hiatal Hernia Repair
Most gastric sleeve patients don’t realize they have a hiatal hernia until they are in surgery. Past studies have shown that hiatal hernia is common in around 42% of bariatric patients.
A hiatal hernia occurs when the stomach moves to a different area of the chest where it should not be. The stomach then pushes through a section of the muscle creating a bulge. Typically, small hernias go unnoticed. The larger they grow, the more problems they create. Hiatal hernias are typically removed when laparoscopic sleeve gastrectomy is performed.
Types of Hiatal Hernia
There are two types of hiatal hernia; a paraesophageal hernia, known as PEH hernia, and the sliding hernia. The PEH hernia is rare, occurring in only 5% of hiatal hernia patients. A paraesophageal hernia is when the hiatus pushes through the muscle lining of the upper stomach. A sliding hernia is more common, occurring in 95% of hiatal hernia patients. This type of hernia occurs when a portion of the stomach slides through the muscle into the chest cavity.
- Severe or persistent heartburn: Usually becomes aware if your body shifts position (ex. leaning, stretching, or straining the body)
- Chest pain when breathing, coughing, or swallowing
- Regurgitation or belching
Repair and Treatment
In some cases, a hiatal hernia is not serious enough to need repair. These mild hernia cases can generally be resolved by diet, nutrition, or lifestyle changes. In more serious cases, hiatal hernia repair through a surgical procedure is needed.
Exercise & Physical Activity
- We recommend that the only type of exercise for the first 8 weeks post-op is walking. It takes about 8 weeks for your body to fully heal after gastric sleeve surgery.
- Remember, if you exercise too much, you can slow down weight loss. Finding the perfect exercise balance between staying active but not over-exerting yourself.
- After 8 weeks post-op, start exercising a few days a week for 30 minutes per day. As you progress, build up to longer or more frequent physical activity.
- The amount of exercise you get depends on your diet. The goal is to eat between 1,000 to 1,200 calories per day. This amount should not negatively affect your exercise habits.
Types of Exercise for Sleeve Patients
- Low, moderate intensity cardiovascular - walking, elliptical, stationary bike
- Weight training - free weights, machines, calisthenics, yoga
- Interval training - boot camp, CrossFit
History of Gastric Sleeve Surgery
Obesity, defined as having elevated levels of excess body fat, has become an epidemic worldwide. Clinically, obesity is measured with a 2-digit number, Body Mass Index (BMI = weight / height2). A body-mass index (BMI) of greater than 25 is considered overweight and over 30 is considered obese.
The overweight rate in the U.S. is 70% whereas this rate is 30% for rest of the world. As the BMI goes up, so does the risk of early death due to obesity-related comorbidities. Obesity is a metabolic disease and the health consequences of obesity are devastating. It is associated with multiple comorbidities such as:
Factors Contributing to Obesity
- Environment Exposure
- Genetic Predisposition
- Behavioral Factors
There is also a strong association between self-reported abuse in childhood (sexual, verbal, fear of physical abuse and physical) and severe obesity - a study conducted jointly by Kaiser-Permanente and The Centers for Disease Control and Prevention (CDC).
Why Get Weight Loss Surgery
Do not wait any longer. Do not just keep putting it off. Life is very short. Make a decision sooner so that you can get started on the healthy journey sooner. You need to be mentally happy with yourself. This isn't going to cure that, but it can improve a lot of things for you. Just know that you're not alone and no matter what you choose you are a beautiful person inside!
Why Mexico Bariatric Center
At Mexico Bariatric Center, we have been in the bariatric surgery industry for over a decade, with over 10,000 surgeries combined. We have a higher success rate than the United States for gastric sleeve, with a lower complication rate. We have the top, board-certified surgeons at the most affordable price. Contact us today.
FAQs: Frequently Asked Question
What are advantages of gastric sleeve surgery versus other weight loss procedures?
At Mexico Bariatric Center, we have seen weight loss occur quicker for sleeve patients versus other bariatric procedures. Also, with all bariatric surgeries, there are food intolerances that occur in patients. With VSG, patients often see fewer food intolerances than other procedures. While expected weight loss is up there with the top bariatric procedures, like gastric bypass and duodenal switch. The sleeve has a lower risk than bypass and duodenal switch and is minimally invasive.
Is it reversible?
No, gastric sleeve surgery is not reversible. It involves removing up to 80% of the stomach, meaning the stomach will stay small, although it can slightly stretch over time.
Who qualifies for gastric sleeve surgery?
To qualify for Vertical Sleeve Gastrectomy at Mexico Bariatric Center, patients must have over a 30 BMI. The only candidates under 30 BMI typically need one or more comorbidities or health concerns. Sleeve patients should have tried other weight loss methods, like diet, exercise, etc., although it is not required.
Is gastric sleeve surgery expensive?
In Mexico, the sleeve is affordable and inexpensive. At Mexico Bariatric Center, VSG procedure starts at only $4,195, depending on the surgeon. In the United States and Canada, it can cost upwards of $20,000 to $30,000.
What are the risks and complications?
Obviously, with any surgery, there are risks and complications that can arise. Sleeve complications include blood clots, gastritis (erosion or irritation in the stomach lining), vomiting, bowel blockage, and infection within lungs, kidney, or bladder. Some risks include heart attack, stroke, and death, although rare.
Will insurance cover it?
VSG is very expensive in the United States unless insurance covers it. There are many insurance companies that cover weight loss surgery, although the coverage can be tricky. In fact, if patients have health-related problems that continue to be future problems, insurance companies are more likely to cover bariatric surgery. Most doctors or surgeons can communicate directly with your insurance company to determine if you are covered for bariatric surgery. Insurance coverage is typically a strict process, patients have to document and display:
- Previous and recent weight loss effects
- Attend meetings up to 6 months before receiving acceptance or surgery date
- Speak with a nutritionist and try out different diets
- Speak with a psychologist for their approval
- Must stay on pre-op diet and document for 2 to 8 weeks
What tests do I need before surgery?
Depending on certain patients, different precautionary tests may need to be done before surgery. Either physical, psychological, or blood tests are needed depending if patients are going through insurance or not. If not, the only testing needed is if the surgeon requires it. This is usually rare or voluntary, and in very few cases mandatory. For gastric sleeve to be covered by insurance, there are generally many tests needed for approval and during pre-op. Dietary assessments may also be needed for some patients, mainly those insured. Some testing includes but not limited to EKG, psychological evaluation, standard tests, blood test, gallbladder test, urine test, sleep study, ultrasound or pregnancy test, pulmonary function, or cardiology evaluation.
Will my taste in food and diet change after surgery?
In our experience, many patients have a change in taste-buds after surgery. Many times, old favorite foods aren’t as tasty as they used to be. Foods like ice cream, candy, and snacks don’t taste the same as they used to. By eating less food with small portions and eliminating certain foods - like carbonated drinks, sugary foods, and unhealthy fats patients see more weight loss. By going on the pre-op diet before gastric sleeve surgery, patients start building healthy eating habits and a diet routine that will be critical to emphasize after surgery.
Will I need plastic surgery after surgery?
With a lot of excessive, rapid weight loss, patients may need to get plastic surgery to compensate their new body. Depending on age and length of time being obese, excess skin may build up in areas like the arms and stomach. Arm lift surgery, body lift surgery, and skin removal surgery are often sought for VSG patients. Obviously, your new body brings new happiness, but also more areas of improvement. Patients need to understand bariatric surgery is not a “fix-all” procedure and many patients don’t need plastic surgery after. We recommend waiting for at least one to two years after surgery to guarantee you won’t get skin removal surgery before all major weight loss has happened.
How long is the procedure and hospital stay length?
Gastric Sleeve Surgery takes between 30 minutes and an hour depending on surgeon experience and patient anatomy. Although, single incision gastric sleeve surgery is more difficult and takes up to two hours. The hospital stays in the United States is generally one day, as they try to get as many patients in as possible. At Mexico Bariatric Center, we keep our patients for 2-3 days, to make sure the procedure went well even as they begin healing. We also do our post-op tests within those days following surgery while still in the hospital.
How much weight will I lose?
Gastric sleeve surgery is very effective while not changing patients anatomies, like gastric bypass and duodenal switch. Losing weight after sleeve surgery usually starts when the post-op diet begins. In fact, VSG patients shouldn’t expect rapid weight loss until four to eight weeks after surgery. On average, patients should expect to lose 65% of excess body weight after 12-18 months post-op.
What follow-up care should I expect after gastric sleeve surgery?
After sleeve surgery, patients generally need to follow up with their surgeon, doctor, and dietician or nutritionist. In order to check all your results, surgeons should perform certain tests after sleeve procedure. Following the surgery, patients should continue checking in with their primary physician at certain points, generally a few months after and at the one year mark. Follow-up care with a dietician or nutritionist is needed to ensure their diet works for patients.
Will I lose my hair after surgery?
Usually not. Although some patients lose a very little amount of hair just after surgery, it does not persist long term. As the stomach is reduced, the amount of protein that is usually absorbed in the body also reduces. The malnourishment of protein may cause some hair loss until the body evens itself out. A fix for hair loss is taking protein supplements after gastric sleeve surgery.
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- *** https://www.sages.org/meetings/annual-meeting/abstracts-archive/meta-analysis-of-leak-after-laparoscopic-sleeve-gastrectomy-for-morbid-obesity/
- **** http://www.soard.org/article/S1550-7289(14)00221-4/abstract