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Bariatric Surgery

Bariatric surgery is intended for people who are approximately 100 pounds or more overweight (with a Body Mass Index of 40 or greater) and who have not had success with other medical therapies such as diet, exercise, medications, etc. In some cases, a person with a Body Mass Index (BMI) of 35 or greater and one or more co-morbid conditions may be considered for bariatric surgery.

Sleeve Gastrectomy “Gastric Sleeve”

  • The sleeve gastrectomy is a bariatric procedure in which the surgeon divides the patient’s stomach into a slender vertical pouch. It’s currently the most common bariatric procedure worldwide.
  • The sleeve gastrectomy is a procedure that induces weight loss by restricting food intake
  • With this procedure, the surgeon removes approximately 80% of the stomach laparoscopically so that the stomach takes the shape of a tube or “sleeve”.
  • This procedure is not reversible. The stomach that remains is shaped like a thin banana and its capacity is about 3-5 ounces.
  • The nerves to the stomach and the outlet valve (pylorus) remain intact with the idea of preserving the functions of the stomach while reducing the volume.
  • This procedure can also be performed on super obese or high risk patients with the intention of performing another surgery at a later time. The second procedure can be the gastric bypass.
  • This procedure can be performed as a final or first step procedure.
  • The excess stomach is removed, not left in place. This greatly reduces Ghrelin-hormone production and helps reduce appetite and the hunger sensation. Five-year results from England and three-year results from the United States suggest that the Sleeve Gastrectomy has weight loss success similar to other procedures with lower risk of complication.
  • Expected weight loss for most patients can be 30-50% of their excess body weight over a 6-12 month period.
  • Of the procedures that are currently performed for the treatment of obesity, the sleeve is ideal for patients who have very high medical risks, high weight or BMI, complex surgical histories or those who are fearful of gastric bypass related complications. It is also ideal for lower BMI patients who wish to avoid a gastric bypass or the responsibility of vitamin or nutritional deficiencies secondary to procedures which cause decreased absorption.

Patients interested in the Adjustable Gastric Banding may also want to consider this procedure, since it avoids the foreign body issue of a band.

Sleeve Gastrectomy Advantages

  • The stomach volume is reduced, and it tends to function normally so most food items can be consumed in small amounts.
  • Eliminates the portion of the stomach that produces the hormones that stimulate hunger (Ghrelin).
  • No dumping syndrome because the pylorus is preserved.
  • Minimizes the chance of ulcers occurring.
  • By avoiding the gastric bypass, the chance of intestinal obstruction (blockage), anemia, osteoporosis, protein deficiency and vitamin deficiency are less.
  • Very effective as a first stage procedure for high BMI patients (BMI >55 kg/m2).
  • Comparable with gastric bypass in regard of weight loss after 3-5 years.
  • Appealing option for people with existing anemia, Crohn’s disease and numerous other conditions that make them too high risk for intestinal bypass procedures.
  • The anatomy is preserved.

Sleeve Gastrectomy Disadvantages

  • Higher BMI patients may need to have a second stage procedure later to help lose all of their excess weight. Two stages may ultimately be safer and more effective than one operation for high BMI patients. This is an active point of discussion for bariatric surgeons.
  • Soft calories from ice cream, milk shakes, etc., can be absorbed and may slow weight loss.
  • This procedure does involve stomach stapling and therefore leaks and other complications related to stapling may occur.
  • Because part of the stomach is removed, it is not reversible. It can be converted to almost any other weight loss procedure.

As with any surgery, there can be complications. Possible complications can include:

  • Deep vein thrombosis
  • Pulmonary embolism
  • Pneumonia
  • Spleen injury
  • Gastric leak and fistula
  • Postoperative bleeding
  • Small bowel obstruction
  • Gastroesophageal reflux (Long term)
  • Death

Currently overall complications rate is < 2%, making bariatric surgery safe as gallbladder or uterus removal.

What is a second stage operation?

In the stage approach, a multi-step operation like the gastric bypass is broken down into 2 operations. In the first stage, a sleeve gastrectomy is performed. This allows the patient to lose 80 to 100 pounds or more, which will make the second part of the operation substantially safer.

The second stage operation is usually performed 8 to 12 months after the first. The “sleeve” stomach is converted into a formal gastric bypass. This will permit additional weight loss and will provide a much more permanent result than sleeve gastrectomy alone.

Both stages of the surgery can be performed minimally invasively, giving the advantage of shorter recovery, shorter incision, and fewer incision-related problems and less pain.

Sleeve Gastrectomy Post-op Vitamin and Minerals Supplementation

For the first 1 month after Sleeve Gastrectomy surgery, all medications need to be CHEWABLE, CRUSHED or in LIQUID FORM.

Type of Vitamin/ Mineral Dosage
May take whole
Multivitamin with Iron daily
Calcium citrate with Vitamin D 500 mg three times a day for a total of
1200-1500 mg
Vitamin B 12 500 mcg sublingual pill/day OR
1 cc Injections monthly (Rx) OR
1 nasal spray (Rx)
Vitamin B Complex (with Thiamine) Thiamine should be in the dosage of:
75-100 mg/day
Iron to be taken with vitamin C
Do not take with Calcium
Iron = 45-60 mg/day
Vitamin C = 500 mg/day
Zinc
Biotin
Optional to minimized temporary hair thinning
15 mg/day
3000 micrograms/day
  • You need to take ALL of the vitamins for the first year after the Sleeve Gastrectomy. Then continue to take a multivitamin, B12, and calcium with vitamin D daily. Add the other vitamin (vitamin B complex with thiamine, and iron with vitamin C) as needed based on blood test results.