Gastric Sleeve FAQ

Gastric Sleeve

• What to Expect

  The Sleeve Gastrectomy usually requires only a 24 hour hospital stay.  The procedure itself takes approximately an hour to an hour and a half and results in very little post-operative pain.  In fact, most patients who undergo the sleeve gastrectomy do not need to take prescription pain medicine - Tylenol or Advil usually is enough.
  
  The process begins with an informational seminar and a pre-operative visit with your surgeon.  To see a list of our upcoming seminars, click here.  At the seminar, you will receive more information about the process and have a chance to ask the surgeon any questions that you may have.  The pre-operative visit is a one-on-one opportunity to meet with the doctor to review your medical history and again ask any questions that you may have.
  
  The major determinant of the time until surgery can be scheduled is your method of payment.  Most insurance companies require an extensive pre-operative evaluation before they will authorize the surgery.  This evaluation frequently includes a medically supervised diet for 6-12 months, a cardiology evaluation and a psychological assessment.  The necessary steps vary from insurance to insurance and can only be determined by contacting your carrier directly.
  
  Any patient with a history of significant heart disease would clearly require a cardiology appointment before undergoing lap band surgery, but those without any history of heart disease or any symptoms of heart disease would not require this evaluation.
  
  After your surgery is scheduled, you will be given instructions on a pre-operative diet.  This diet is designed to shrink your liver to decrease the risks of this very safe surgery even further.  The length and extent of the diet depends on your pre-operative weight.
  
  All operations are performed at Harper University Hospital in Detroit, Michigan.  We recommend a follow up visit approximately one week after surgery.  This provides an opportunity to review your diet and go over strategies of the successful patient.

• How the Sleeve Gastrectomy Works

  This procedure generates weight loss by reducing the stomach volume. The stomach is restricted by stapling and dividing it vertically and removing more than 85% of it. The stomach that remains is very slim like a banana and measures about 1-5 ounces. The nerves to the stomach and the outlet valve remain intact with the idea of preserving the functions of the stomach while drastically reducing its volume.

  Advantages

  1. Reduces the stomach capacity but tents to allow the stomach to function normally so most food items can be consumed, but in small amounts.
  2. The procedure eliminates the portion of the stomach that produces the hormone that stimulates hunger (Ghrelin).
  3. Dumping syndrome is avoided or minimized because the pylorus is preserved.
  4. Chances of an ulcer occurring are minimized
  5. The intestines are left intact, therefore no reconnecting or rerouting is required which will almost eliminate the chance of intestinal blockage, marginal ulcers, anemia, osteoporosis, protein deficiency and vitamin deficiency.
  6. Very effective as a first stage procedure for higher BMI patients (>60)

  Disadvantages

  1. Potential for inadequate weight loss or weight regain. While this is true for all procedures, it is theoretically more possible with procedures that do not have an intestinal bypass.
  2. Higher BMI patients will most likely need to have a second stage procedure later to help lose the rest of the weight.
  3. Soft calories such as ice cream, milk shakes, etc. can be absorbed and may slow weight loss.
  4. The procedure requires stapling, therefore there is a risk for leaks and other complications related to stapling

  The procedure is not reversible.

• Risk of Surgery

  Surgery should not be considered until you and your doctor have evaluated all other options. As with all surgeries, there are risks associated with these procedures.  Harper Bariatric Medicine Institute bariatric surgeons have an excellent track record for safety with complication rates that are well below the national average.  Nevertheless, it is important that you are aware of the following risks of the sleeve gastrectomy:

  • Deep Vein Thrombosis and Pulmonary Embolus: This is a rare but dangerous complication. A blood clot could form in your leg or in your pelvic veins and could travel to your lungs, endangering your life.
  • Heart Problems: Severe cardiac problems can occur, however we will make every effort to assess your cardiac condition prior to the surgical procedure.
  • Lung Problems: Respiratory insufficiency or problems may occur after the surgery necessitating the use of a ventilator. This potentially would lengthen your hospital stay and your recovery.
  • Injuries to other Intra-abdominal organs: As with all surgical procedures, injuries to other intra-abdominal organs can occur. Your surgeon will attend to them as needed. *Removal of the spleen is necessary in about 0.3% of patients to control operative bleeding.
  • Bleeding: Bleeding may occur during the procedure or in the early post-operative period. You may require the transfusion of blood products as needed. Your surgeon has explained the risks of such transfusions.
  • Complications due to anesthesia and medications.
  • Infections: either at incision sites or within the abdominal cavity could require further procedures or possible need for another operation.
  • Hair Loss: Some patients report some form of temporary hair loss, which is believed to be due to a reduced and insufficient post-operative intake of protein. Again, patients need to follow post-operative instructions meticulously.

  Staple line leak:  One of the most feared complications is a leak at the staples section of the stomach.  The incidence of this complication is considered to be around 1% nationally.  In some instances you may have to undergo an additional surgical procedure(s) to correct this problem.

• Do I Qualify

  Harper University Hospital uses the following criteria to determine whether or not you qualify for the sleeve gastrectomy:

  1. Age greater than 18 years
  2. BMI greater than 35 (usually 50 or more pounds overweight)
  3. Well motivated and well informed about the significant lifestyle changes necessary
  4. No active substance abuse problems within the last year
  5. Are medically healthy enough to tolerate the procedure

  Unfortunately, most insurance companies use a different set of criteria to determine whether or not they will authorize the procedure.  Each insurance company is different and therefore you must speak with your carrier to find out what criteria they require.

  Our highly qualified staff will work with you and your insurance carrier to determine whether or not you meet the necessary qualifications.

• The Hospital Stay

  Patients are admitted the same day of their procedure. The procedure itself takes approximately one hour.  The hospital stay is considered a "23 hour admission", meaning that patients will stay overnight in a hospital room for observation.  Most patients are able to walk the halls quite comfortably immediately after the surgery.  You will be started on a "clear liquid" diet as soon as you are awake enough to drink.
  
  During your hospital stay you will meet with a nutritionist for detailed information regarding your post operative dietary restrictions.  Additionally, your surgeon will counsel you on the next steps after the operation and answer any questions you may have.  Most patients are discharged by 11 am the following day.  You will also be provided a detailed handout with post operative information to make your recovery a smooth and comfortable experience.
  
  Most patients are sent home with only a prescription for pain medicine.  Less than half of our patients need to fill this prescription since Tylenol or Advil usually suffices for pain control.  Those patients who travel more than two hours will also be given a prescription for a blood thinner to prevent blood clots from forming while they travel.

• Life After Surgery

  Going Back to Work 
  Your ability to resume pre-surgery levels of activity will vary according to your physical condition, the nature of the activity and the type of weight loss surgery you had. Many patients return to full pre-surgery levels of activity within six weeks of their procedure. Patients who have had a minimally invasive laparoscopic procedure may be able to return to these activities within two to three weeks.
  
  Birth Control & Pregnancy 
  It is strongly advised that women of childbearing age use the most effective forms of birth control during the first 12 to 18 months after weight loss surgery. The added demands pregnancy places on your body and the potential for fetal damage make this a most important requirement.
  
  Support Groups
  The widespread use of support groups has provided weight loss surgery patients an excellent opportunity to discuss their various personal and professional issues. Most learn, for example, that weight loss surgery will not immediately resolve existing emotional issues or heal the years of damage that morbid obesity might have inflicted on their emotional well-being.  Harper Bariatric Medicine Institute's bariatric surgeons have support groups in place to assist you with short-term and long-term questions and needs. Ongoing post-surgical support helps produce the greatest level of success.

• Post-Operative Diet

  Pre-operatively, our patients are placed on a low calorie diet for 1-2 weeks before surgery.  The purpose of this pre-operative diet is to decrease the size of the liver which will make the surgery safer.  The length and restrictions of the diet are based on your BMI and gender since these are the major determinants of the size of the liver.  The details of the pre-operative diet are spelled out in our Knowledge Center.  
  
  The post operative diet has been created to help reduce the chances of having any complication in the early post operative period. By slowly advancing your diet you are allowing your body time to heal. 
  
  The stepwise advancement of diet may initially seem to be an eternity, but do not worry. The goal is to advance you to a "normal" diet by the 4th week after surgery. Be mindful that as you progress through the different stages you may notice that you get full quicker or even have a little discomfort after you eat. This is normal and is referred to as "the learning curve" after undergoing band placement. Over time you will learn how quickly you can drink, how much you need to chew and what items you just can't tolerate no matter what you do. No two patients have the same finger prints, and no two patients can tolerate every food item the same.
  
  The details of the post-operative diet are spelled out in our Knowledge Center.

• Insurance and other Payment Options

  Currently, only a limited number of insurance policies will cover the sleeve gastrectomy. The first step to determining whether or not your insurance carrier will cover the procedure is to call the phone number on the back of your insurance card and ask whether or not your policy will cover the sleeve gastrectomy and find out what their qualifying requirements are.
  
  Those patients who elect the insurance payment option will need to undergo the evaluations that are required by their insurance carrier (like a psychiatric evaluation).
  
  Self Pay

  ---

  There are self pay / cash packages available to patients whose insurance policy does not cover the surgery. You should speak with a coordinator in your surgeons office regarding these options.