Gastric Sleeve Surgery: Long-Term Care

Gastric sleeve surgery, also known as “sleeve gastrectomy,” is a procedure, in which 75 to 80% of the stomach is removed to facilitate weight loss. This widely performed bariatric procedure is highly effective in combating obesity, as well as a range of often-related conditions, such as high blood pressure (hypertension), type 2 diabetes, and sleep apnea, among others.

But the surgery, itself, doesn’t take off the weight; the real work happens afterward. While the smaller size of the postoperative stomach will reduce the amount of food you can eat and overall appetite, it will be the lifestyle and dietary changes you make that actually cause weight loss. Critical to success, then, is an understanding of long-term care after this procedure.

Benefits of Surgery

The most impactful benefit of gastric sleeve surgery is a significant reduction in weight. Within a year after the procedure, you’re expected to lose 60 to 70% of excess weight, and that alone can yield numerous benefits. Largely, too, patients that have tried and failed to shed pounds in the past see sustainable success with this procedure.

In addition, the procedure helps with a range of other conditions, including:

• Type 2 diabetes: Obesity and being overweight are closely linked to this difficult to manage disease, with many stopping insulin.
• High blood pressure: Reduction in weight also leads to healthier blood pressure and heart function.
• Sleep apnea: Getting to a healthy weight can also stop excessive snoring without using a CPAP machine.
• Joint pain: Excessive weight impacts the joints, which can lead to numerous problems.
• Depression: Many obese individuals experience depression or other mood disorders associated with their weight.
• Pregnancy: Obese and overweight people often have a harder time getting pregnant, so losing weight can help with fertility.
• Other diseases: Losing weight can also help with other conditions, like metabolic syndrome, gallbladder disease, and certain complications of pregnancy.

And what can you do to maintain these benefits? Here are some quick tips:

• Keep up with appointments: Especially in the earlier going, there will be a number of follow-up appointments; these are necessary to ensure everything is progressing well. This is essentially a life-long process, after a busy first year post-surgery, you’ll need to come back in once a year for testing and counseling. Make sure to listen carefully to your healthcare provider’s orders and never hesitate to ask any questions you have.
• Nutrition guidance: Your diet will need to be severely restricted in the first two to six months after surgery as you learn to eat with your new stomach. Even afterward, it’ll be essential that you keep up a healthy diet. Oftentimes, your healthcare provider will recommend that you work with a nutritionist to learn about good practices you can incorporate.
• Food journaling: As you’ll see, a big part of ensuring successful weight loss outcomes involves carefully looking at and regulating what you eat. Your healthcare provider will advise that you keep a daily food journal tracking your intake.
• Mental health counseling: The emotional toll of going through a surgery like gastric sleeve can be intense. Mental health assessment and counseling are part and parcel of the weight loss surgery process throughout and can be critical afterward. Post-operative patients are prone to a number of psychiatric and mood disorders as they adjust to a changing body and a new lifestyle. Individual or group counseling can help during this time.

Perhaps the most important thing you can do after gastric sleeve surgery is to keep your healthcare provider and medical staff informed, especially if anything seems off. If you're struggling with any aspect of recovery, don't be afraid to call for help.

Possible Future Surgeries

While gastric sleeve surgery is often a standalone procedure to promote weight loss, other treatments may be necessary to ensure success. Most commonly, patients who have rapidly lost weight may have excess and loose skin on their bodies. This being the case, plastic surgery procedures are not uncommon once the weight is lost.

These procedures, called “post-bariatric body contouring,” include:

• Arm lift (brachioplasty): Following surgery, and as weight loss progresses, excess skin can build up on the underarms. In this procedure, surgeons open up the underside of the arm and trim away excess skin and tissue.
• Breast lift (mastopexy): In cases where a person's breasts droop excessively following surgery, this surgery, which involves removing excess tissue above the breast. This procedure may be augmented further with the addition of implants to make up for lost fat.
• Stomach lift (abdominoplasty): Perhaps the most common post-surgical complaint patients have is the presence of excess skin hanging from the abdomen over the pubic region. Not only is this considered unsightly, but it can lead to rashes and discomfort. Stomach lift techniques vary, but they typically involve re-contouring the waist, back, and flanks by removing excess skin, and, sometimes, incorporating liposuction (in which fat is directly removed from the body). 
• Lower body lift: This involves trimming excess skin and tissues from the buttocks and thighs and can be paired with liposuction. In both cases, the end goal here is to tighten the skin in these areas by re-draping the remaining skin.

It’s also important to note that, in some cases, gastric sleeve surgery will be employed alongside other weight loss procedures, like gastric bypass, to achieve results.

In these cases, treatment is staged—that is broken up into multiple surgeries—and only progresses if previous work has been successful. Throughout your consultation process, you’ll have a chance to learn about and consider your options.

Surgeons vary on how long they want people to wait between procedures when waiting is an option. Most healthcare providers will recommend waiting six to 12 weeks between surgeries. Longer wait times are advised for surgeries involving significant blood loss, an extensive time under anesthesia, or the disruption or removal of major organs or tissues.

Lifestyle Adjustments

As noted above, gastric sleeve surgery, itself, doesn’t perform the weight loss; results occur due to reduced post-operative digestive capacity working with changes you make in diet and lifestyle. Ultimately, these adjustments need to become permanent fixtures in your life. What changes need to be made? Here’s a quick breakdown.

Mindful Eating

As you’ll be counseled, significant changes will likely need to be made in regard to both how and what you eat. With a smaller stomach, for instance, you should work on slowing down eating; this way, you’ll be more likely to stop once you’re full.

That said, don’t overdo it; aim for mealtimes of at least 20 but no more than 30 minutes for a meal. As you eat, focus on the flavors and remain mindful of how you’re feeling; stop once you feel satiated, and don’t overdo it.

Emphasize Proteins and Vitamins

Further, healthcare providers will lay out a dietary plan with you that ensures you get the recommended 60 grams (g) of protein a day, as well as plenty of necessary vitamins and minerals.

As you move towards eating solid foods, you’ll need to make sure your body is getting enough in terms of appropriate and healthy nutrition. You may also be advised to get into the habit of taking multivitamins and other supplements.

Get Plenty of the Right Kind of Fluids

Ensuring that you’re getting enough fluids is another important aspect of post-surgical living. Healthcare providers recommend that you get about 40 ounces (oz) of liquid, such as water or clear juices, a day.

You’ll have to steer clear of coffee or tea for the first two months following surgery, and you should abstain from alcohol for at least a year. Make sure to separate eating from drinking; recommendations may vary based on progress, but typically you should wait at least one hour before drinking fluids after a meal.

Fitness Work

Alongside dietary changes, important changes in workout frequency and routine also need to be made. In the earlier going, as you’re recovering from surgery, you’ll need to aim for at least three sessions of light activity (such as walking) a week, for about 30 minutes each.

Over time, and with your healthcare provider’s OK, you should be scaling up to daily activity, as well as the addition of other kinds of exercise. As important as dietary changes, getting more exercise is absolutely crucial for weight loss success.

Throughout the process of losing weight, it’s a good idea to focus on the positives that are emerging. The aim of gastric sleeve surgery should not be a specific weight goal or body shape, but rather a feeling of wellbeing and health.

A Word from Verywell

While there is much that goes into long-term recovery from gastric sleeve surgery, it’s important to note that the process is completely manageable. As mentioned, this procedure has a very high success rate—approximately 80 to 90%—and most are entirely satisfied with how they look and feel after this operation.

The journey to a new body, however, shouldn’t be undertaken alone. Remember: alongside your healthcare provider and medical staff, loved ones, family, friends, and even others undergoing weight loss surgery in online communities are all there to offer assistance and help.

As an engaged part of your own transformation process, and alongside your support network, there’s no doubt you’ll find positive outcomes with this procedure.