Frequently Asked Questions About Sleeve Gastrectomy
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.
Is sleeve gastrectomy reversible?
Gastric sleeve is not reversible. Part of the stomach is permanently removed. It is important to understand that reversing any weight loss operation (such as gastric band or gastric bypass) will result in weight regain back to original weight. You should not have any weight loss operation if you intend to ever reverse it. Though gastric sleeve is not reversible, it can be changed to gastric bypass if there was any need.
Will the staples in the stomach set off metal detectors or be unsafe for MRIs?
Stapling devices are used in almost all operations on the intestine or stomach. The tiny staples that are used in the surgery are made of titanium, and therefore will not be a trigger metal detectors or cause a problem for the MRI scanner.
Is it possible to regain the weight that I lose after sleeve gastrectomy?
Yes, it is possible to regain the weight that you lose from any weight loss operation. It's important to remain vigilant about diet and exercise for the rest of your life. It helps to reach out and gain support from your dietitian, as well as on-line support groups, to help maintain your focus and new habits. A behavioral health specialist can also be a tremendous resource for keeping you on track.
Is sleeve gastrectomy covered by my health fund?
All health funds cover most of the expenses of sleeve gastrectomy. You need to speak with your health fund to check if your particular policy covers you for the sleeve gastrectomy. The MBS item number for the sleeve gastrectomy is 31575. There will be out of pocket cost as described in the fees section.
Is the sleeve gastrectomy available in public hospitals in NSW?
Unfortunately there is a very limited funding for obesity surgery in NSW.
Before the Sleeve Gastrectomy
What medical problems will be improved by weight loss surgery?
Most illnesses that are related to obesity can be improved or even cured by weight loss surgery. These include: sleep apnea, diabetes, high cholesterol, hypertension, stress incontinence, depression, acid reflux, joint pain, as well as osteoarthritits. 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.
What is the purpose of the pre-op liquid diet?
A: Following a liquid protein diet 14 days before your surgery is highly important, because it significantly helps to reduce complications during your procedure. The purpose of the diet is to reduce the size of your liver, which makes it much easier to perform surgery on your stomach.
Must I quit smoking before weight loss surgery?
Without question. All potential risks of surgery are exasperated by smoking, including death. Tobacco can lead to dangerous blood clotting in the legs, otherwise known as deep venous thrombosis. Smoking also leads to poor tissue healing that causes leak and infection, as well as complications with anesthesia that lead to acute respiratory distress and pneumonia. Smoking can also cause gastric ulcers and erosions in your new stomach. You should stop smoking for at least 6 weeks before your operation. We encourage you to never start smoking again after surgery.
Do I need to take a bowel preparation before sleeve gastrectomy?
No. It is not required that you take a bowel cleanser before sleeve gastrectomy. Because you have been on a liquid diet for two weeks, there's no buildup in the colon to necessitate a laxative.
Are there any medications I should avoid before the sleeve gastrectomy?
Any medication that thins the blood is not allowed. These include NSAIDS like Nurofen, Mobic, Advil, Ibuprofen, and Feldene, as well as Aspirin, Warfarin, and Plavix. All steroids prevent healing and must be avoided. Any medications that can lead to blood clots, such as hormones and birth control, must be avoided as well.
The Surgery and Beyond
Will there be a tube in my nose, a urine catheter or a drain when I wake up from surgery?
No you will not have a tube in the nose when you wake up. We also do not routinely place a urine catheter or an abdominal drain. However, in difficult or long operations a urine catheter or a drain may be placed on individual basis.
How long will it take before I'm able to walk?
There is never a restriction on walking. You will be able to get up and walk on the day of your surgery, and from there you are encouraged to walk 30 minutes daily to prevent blood clots from forming in the legs. The risk of clotting can last for up to 6 weeks post-surgery, and that's why walking each and every day is so important.
How long will I be kept in the hospital?
Gastric sleeve patients generally stay in hospital for 2-3 days, on average.
What will my diet be like post-op?
There will be a number of phases to the diet: Phase 1 is a liquid diet that will last for 1 week after the procedure. Phase II is comprised of puree food, and this will last for 2 weeks. Phase III is the soft food diet and last for 3 weeks. After that you will be on normal diet that is high in protein, and low in carbs and simple sugars, and this is the diet you will maintain for life.
Are there medications I should avoid after surgery?
For the first three months you must still avoid the NSAIDS mentioned previously, as they cause stomach ulcerations and prevent healing of the staple line. Oral steroids such as Prednisone must still be avoided as well.
After surgery, am I able to attend social events where food is involved?
Yes! Patients are encouraged to get out and be social. After gastric sleeve, patients find that with a little preparation and change of habit, they can enjoy all social events and restaurants while still maintaining their diet.
Do I need to exercise?
Absolutely. Patients are highly encouraged to exercise to achieve the maximum long-term success at weight loss. Increased physical fitness leads to a whole host of health benefits.
Will I be able to fly on a plane after surgery?
Yes you can fly 6 weeks after the surgery but it's recommended that you get an aisle seat so as to be able to get up and walk frequently, preventing harmful blood clots. We also encourage you to wear your elastic stockings during travel.
How soon can I resume sexual activity?
Just as soon as you no longer feel pain. Once the pain has passed it means that your stomach has healed, and sexual activity is then perfectly safe.
Will I lose hair after sleeve gastrectomy, and if so, is it permanent?
Most patients will lose some hair between months 3 and 6 post-surgery. This is not a permanent loss, and the hair will certainly grown back. Do not worry, you will not go bald. To slow the speed of the hair loss, be sure to up your protein intake and take your multivitamin daily. The supplement Biotin may also help.
When is it safe to drive after sleeve gastrectomy?
Once you've stopped your pain medication for 24-48 hours, are not experiencing any pain, and are able to rotate the upper portion of your body without hindrance, then you're safe to drive. This commonly takes about 1-2 weeks to achieve.
How soon can I stop using the CPAP machine after the sleeve gastrectomy?
Once your Obstructive Sleep Apnea is resolved, you'll be able to discontinue using the CPAP machine. It is generally advised for those with sleep apnea to use the mask for at least 6 months after surgery. Upon reaching that mark, it's important to have another sleep study to confirm that the condition is cleared up. If it is not, most likely your CPAP device will be re-titrated to produce less air pressure during the night.
How much fluid should I drink throughout the day after going home?
It's crucial that you stay hydrated after surgery, and the goal is to consume 1.5 Liters of fluid each day. Remember to sip sip sip.
How much protein should I eat daily?
It's important to consume approximately 60-70 grams of protein each day. Plant based proteins are a fantastic source, so stock-up on lentils, beans, and soy. Also incorporate chicken, fish, and very lean meats.
Will I be able to tolerate milk products?
It's common for gastric sleeve patients to develop lactose intolerance post-surgery. Lactose-free dairy products are highly recommended. Make sure that anything you choose is low in fat.
Will I be able to consume alcohol after surgery?
Alcohol provides liquid calories that are not conducive to weight loss and your long term goals. Eliminating it from your diet will save you a tremendous amount of excess calories that cause weight gain. If you choose to drink, wait at least one year after your surgery before you have a drink. And then, it must be kept to a minimum. You may notice that you feel the effect of alcohol earlier and stronger than before due to the rapid emptying of the stomach into the intestine.
Will I be able to have spicy food sleeve gastrectomy?
Yes. However, we recommend that you do not have spicy food until you are tolerating a normal diet (6 weeks after the sleeve). Begin to slowly introduce spicy dishes after this waiting period.
Do I need to crush my pills after the sleeve gastrectomy?
In the first 6 weeks after the operation it may be difficult to swallow large tablets. Liquid preparations and breaking big tablets will make it easier in the first 6 weeks. Coated or slow release tablets should not be crushed or broken. After the first six weeks you should be able to comfortably swallow any tablet.
Are revision surgeries risky?
It can be complicated to revise a previous weight loss surgery, and that is why the risks are higher than the first surgery. Not all patients can qualify for this procedure if their health is not in good shape.
Can I increase my metabolism?
Yes. Exercising daily is a fantastic way to boost your metabolism, and interval training in particular is great for adding variety and burning even more calories. Eating breakfast is the tried-and-true method for waking up your metabolism in the morning. A healthy diet of protein and vegetables will naturally give you a boost, as well as drinking plenty of fluids, and getting sufficient rest of at least 8 hours a night.
What can I do about constipation?
It is essential that you're getting enough fiber in your diet. Supplementing with Benefiber or Metamucil can be very helpful. Make sure that you're drinking your 1.6 Liters of fluid each day, and exercising consistently to help with bowel emptying. When these measures don't provide relief, try Coloxyl and Senna tablets or Movicol
How soon after sleeve gastrectomy is it safe to get pregnant?
You should wait at least 18 months after the sleeve to get pregnant.
Will I need to have plastic surgery after weigh loss surgery?
It is usually not necessary. If you find that the excess skin is uncomfortable, first try the new cloth body contour devices on the market before any kind of surgery. If you do end up with excess skin that is a problem for you then plastic surgery may be needed.
If I'm tolerating foods well in my current phase of diet, can I jump ahead?
Unfortunately, no. The diet phases are specially designed to allow your stomach to heal and encourage the correct speed of weight loss. Jumping ahead, without being advised to do so by your dietitian or surgeon can stress the staple line and lead to serious complications.
How many calories should I be consuming daily?
There is no standard amount of calories that you should have daily, and keeping track of protein is far more important than counting caloric units. It's typical for long-term patients (a year or more after surgery) to consume just about 1,000 to 1,200 calories daily. Those who engage in more vigorous athletic training will need more. Consult our dietitian to better understand what your requirements might be.
How do I look after my incisions ( wounds) ?
Remove the wound dressings 5 days after surgery if they are still on. Leave the Steri-strips tapes in place. They will curl and fall off in about 10 days. If they are still in place two weeks after the surgery then you can remove them in the shower. The incisions may itch while healing and this is normal. Remember to apply sunscreen on the incision sites if you go to the beach as the new scars are sensitive to sunlight.
When can I shower or bathe after the operation?
Your dressings are water proof and you may shower from the first day after the operation. Pat the incisions dry after showering. You can continue showering after removal of the dressings as well. Do not rub the wounds hard. Do not take a bath or swim for two weeks after the operation.
When should I come for urgent review?
If you have any of the following then come for urgent review
1. Increasing redness , swelling, heat or pain at any incision
2. Drainage from an incision
3. Fever greater than 38.5
4. Abdominal or shoulder pain
5. Frequent vomiting
6. Shortness of breath
7. Leg swelling
8. Not able to drink enough
9. Generally not feeling or doing well.