What is Dumping Syndrome?

Dumping Syndrome is a collection of symptoms that occur after eating resulting from rapid delivery of stomach content into the small intestine. Symptoms can range from mild to severe. Normally there is a muscle sphincter (the pylorus) at the lower end of stomach that regulates the slow delivery of broken down food into the intestine. Therefore, dumping syndrome is very common in operations that bypass or remove the pylorus such as stomach cancer surgery and gastric bypass (85% of patients). Dumping syndrome is also seen in some patients having other stomach operations such as sleeve gastrectomy.

Dumping Syndrome and Sleeve Gastrectomy

The resection of around 85% of stomach in sleeve gastrectomy results in major changes in the anatomy and function of the stomach. Even though the pylorus valve is maintained, the new stomach tube has a very limited capacity (around 150 mL) resulting in rapid emptying of the stomach content into the intestine.
After sleeve gastrectomy very few patients experience true dumping syndrome, however, studies that used a glucose provocation test showed that around 25% of patients develop symptoms of dumping syndrome with glucose provocation. In general these symptoms are milder than those experienced by patients with gastric bypass. The symptoms tend to improve after the first year. 

What Brings About Dumping Syndrome After Sleeve Gastrectomy?

Wound Care

• Your wounds should heal nicely without special care. The skin has been stiched from the inside with a clear disolving suture. You also have steristrips (paper tapes) then a wound dressing. The wounds will feel lumpy for the first few months then they will soften and become smooth.
• The wounds do not need dressings for healing purposes. However, it is more comforatble to leave the dressings on for 5 days after going home. After that remove he dressings but leave the paper tapes if they remain attached until they start to come off by themselves.
• It is ok for the incisions to get wet in the shower. Simply dap the wound dry with a towel. Do not soak the wounds in a bath or a swimming pool until two weeks after your surgery.
• You may feel a pricking sensation at the corners of the wound. This is a end of the disolving suture sticking through the wound. It will disolve with time.
• Some patients notice a clear orange odourless drainage from one of the wounds within the first coupe of weeks. In the majority of patients this is normal and represent liquified fat if you are concerned then come and see Dr Zarrouk
• Some patients like to apply vitmain E ointment or apply silicon tapes on the wounds to reduce the scaring. There is no evidence that these make any differnece on scarring but they cause no harm either so you can use them if you like.

Medications

Discharge medications

The BN Multi is a chewable mutivitamin designed for patients following sleeve gastrectomy and gastric bypass. It has a nice slight tangy orange flavour making it easy to take.

We recently received a new shipment from the supplier. Now we give our new bariatric patients one bottle (60 tablets) at the time of booking of surgery. If you like the taste you can buy more from the supplier. Our patients can also buy directly from our clinic at the wholesale price. 

Sleeve Gastrectomy can rapidly change your life. Most patients see a 60% reduction in excess body weight within six months ¹* (* Results may vary from person to person). Weight-related conditions like diabetes, high blood pressure, asthma, and sleep apnoea significantly improve or disappear altogether. Everyday you'll feel lighter, be able to do more than you could before, and stay active for longer periods of time.

After six months that rapid weight loss slows as your body adjusts to your new caloric intake. By nine months it's almost stopped. That's why it's so important to act quickly and take advantage of the positive energy and momentum now.

What You Can Do to Maintain that Weight Loss Momentum?

Laparoscopic Sleeve Gastrectomy has become one of the most popular weight loss operations in recent years. You will be able to eat a normal diet and feel satisfied after a quarter of what you used to eat. The operation also reduce your hunger by removing the Ghrelin hormone.
Like all weight loss operation, the sleeve gastrectomy should be a viewed a tool that you need to use properly in order to maintain your weight loss long term. Adapting a new healthy lifestyle will ensure your long term success.
There are certain habits that you must avoid in order to achieve long term success.

1. Grazing

Constant grazing or snaking between meals is the worst thing you can do after sleeve gastrectomy. Eating chips or crackers slowly one after the other will defeat the tightest sleeve gastrectomy that I can perform. It leads to unnecessary calorie pileup and can impede weight loss. If required, choose healthy snacks such as fruits or proteins.

The Gastric Band has emerged as a popular weight loss operation during the late nineties and early 2000s, however, over the last 10 years or so its popularity has decreased due to high failure rates, food intolerance and late complications associated with the procedure.
Quite often, the patient is blamed for failing to lose weight or maintain the weight loss. The patient's friends, family and even doctors believe that the patient has stopped following the recommended diet resulting in inadequate weight loss or even weight gain. Even many patients start to drown themselves in self-blame. In my view, this is incorrect.
The gastric band works by creating an area of fixed narrowing in the upper part of the stomach that limits food intake. Because of this area of obstruction, healthy food items such as red meat, chicken, and fruit and vegetables tend to get stuck resulting in frequent vomiting and regurgitation of food. Vomiting or bring up of food becomes part of the patients' daily routine that patients do not even report to their doctors. On top of this, the band does not address the hunger most patients experience with eating less and for losing weight. After few trials patients quickly change their diet from the healthy food that get stuck to diet consisting mostly of smooth, sloppy, calorie-dense food such as smoothies, ice cream and chocolate. These food items go through the band without restriction and without discomfort. In effect the band punishes patient for eating healthy food and rewards patients for cheating.
We cannot blame the patient for failing the band. It is the gastric band itself that fails the patient.

A sleeve gastrectomy will transform your body however, on its own, it is not enough. Working to improve both your body and your mind before the operation will help you achieve the best outcome and long term success. The following point will help you prepare for surgery and the recovery period.

• Start practicing healthy eating habits before the surgery. Keep a journal or mentally keep track of the foods you eat and your corresponding moods.
• Begin the habit of eating and drinking slowly. Chew food thoroughly with small bites.
• Stop smoking 6 weeks before surgery, and decide to quit indefinitely after surgery.

One of the challenges some patients face after weight loss surgery is a condition described as the hibernation syndrome. This is a group of symptoms that include feeling fatigued, depressed and lack of motivation to do any physical activity. Patients often feel upset and become plagued by thoughts that the surgery was as mistake.. This can be quite alarming to patients recovering from the surgery and recognizing the signs assist in getting over this stage in recovery.

Hibernation syndrome is common in the first few weeks after the surgery. It is caused by the low number of calories being consumed and the reduced activity associated with this time of healing. The body perceives that it is starving and triggers an evolutionary response that has helped humans survive famines. The main aim of the response is to slow us down to conserve energy and thus resulting in; tiredness, need for sleep, lack of motivation and depression. It is important to understand that these symptoms are normal and will pass with time.

Most patients notice improvement in their symptoms around 4-6 weeks after the operation and the improvement is brought by increasing protein in the diet, taking the multivitamin tablets, increasing the metabolic rate with exercise and return to work and the encouragement patients get as they shed the extra weight. A supportive family member or friend is a great help during this time.

Is there an age requirement to have the sleeve gastrectomy?

It is recommended that you be between the ages of 18 and 65 to undergo weight loss surgery including the Sleeve Gastrectomy. 

What medical problems will be improved by sleeve gastrectomy?

Most illnesses that are related to obesity can be improved or even cured by weight loss surgery. These include: sleep apnoea, diabetes, high cholesterol, hypertension, stress incontinence, depression, acid reflux, joint pain, as well as osteoarthritis. Losing weight for obese patients also means greater outcomes from pregnancy, increased fertility, and a lower risk of cancer. The surgery increases life expectancy, on the whole.

Are there specific vitamins I need to be taking?

Surgery patients should take a complex multivitamin as well as 1200 mg of calcium daily. Look for a calcium supplement that also has vitamin D. A vitamin B12 supplement is very beneficial, as well. Take two of your multivitamins daily. In the first few weeks after surgery it is preferable to use soluble or chewable multivitamins. Our dietitian will recommend few brands for you.

Is weight loss surgery considered a cure for obesity?

The surgery is considered a "tool" to help patients to lose weight, but not a cure. The patient must utilize the effects of the surgery to adopt a healthy lifestyle of eating properly and exercising to lose weight and reverse their obesity.