Post-Gastrectomy - Dietary Advice

We have selected the following expert medical opinion based on its clarity, reliability and accuracy. Credits: Sourced from The University of Pittsburgh Medical Centre (UPMC) (see below). Please refer to your own medical practitioner for a final perspective, assessment or evaluation.

What is plastic sleeve surgery?

Restrictive operations like gastric sleeve surgery make the stomach smaller and help people lose weight. With a smaller stomach, you will feel full a lot quicker than you are used to. This means that you will need to make big lifelong changes in how you eat—including smaller portion sizes and different foods—in order to lose weight.

This surgery can be done by making a large incision in the abdomen (an open procedure) or by making several small incisions and using small instruments and a camera to guide the surgery (laparoscopic approach). More than half of your stomach is removed, leaving a thin vertical sleeve, or tube, that is about the size of a banana. Surgical staples keep your new stomach closed. Because part of your stomach has been removed, this is not reversible.

Sometimes this surgery is part of a larger approach to weight loss done in several steps. If you need to lose a lot of weight before you have duodenal switch surgery, gastric sleeve surgery may help you.

What To Expect

Recovery from surgery

You will have some belly pain and may need pain medicine for the first week or so after surgery. The cut that the doctor makes (incision) may be tender and sore.

Because the surgery makes your stomach smaller, you will get full more quickly when you eat. Food also may empty into the small intestine too quickly. This is called dumping syndrome. It can cause diarrhea and make you feel faint, shaky, and nauseated. It also can make it hard for your body to get enough nutrition.

Depending on how the surgery was done (open or laparoscopic) you'll have to watch your activity during recovery. If you had open surgery, it is important to avoid heavy lifting or strenuous exercise while you are recovering so that your belly can heal. In this case, you will probably be able to return to work or your normal routine in 4 to 6 weeks. The surgery is most commonly done as a laparoscopic procedure, which means the recovery time is faster.

Eating after surgery

Your doctor will give you specific instructions about what to eat after the surgery. For about the first month after surgery, your stomach can only handle small amounts of soft foods and liquids while you are healing. It is important to try to sip water throughout the day to avoid becoming dehydrated. You may notice that your bowel movements are not regular right after your surgery. This is common. Try to avoid constipation and straining with bowel movements.

Bit by bit, you will be able to add solid foods back into your diet. You must be careful to chew food well and to stop eating when you feel full. This can take some getting used to, because you will feel full after eating much less food than you are used to eating. If you do not chew your food well or do not stop eating soon enough, you may feel discomfort or nausea and may sometimes vomit. If you drink a lot of high-calorie liquid such as soda or fruit juice, you may not lose weight. If you continually overeat, the stomach may stretch. If your stomach stretches, you will not benefit from your surgery.

Your doctor will probably recommend that you work with a dietitian to plan healthy meals that give you enough protein, vitamins, and minerals while you are losing weight. Even with a healthy diet, you probably will need to take vitamin and mineral supplements for the rest of your life.

Why It Is Done

Weight-loss surgery is suitable for people who are severely overweight and who have not been able to lose weight with diet, exercise, or medicine.

Surgery is generally considered when your body mass index (BMI) is 40 or higher. Surgery may also be an option when your BMI is 35 or higher and you have a life-threatening or disabling problem that is related to your weight.

It is important to think of this surgery as a tool to help you lose weight. It is not an instant fix. You will still need to eat a healthy diet and get regular exercise. This will help you reach your weight goal and avoid regaining the weight you lose.

How Well It Works

Research has shown that people who have had a sleeve gastrectomy on average lose more than half of their excess weight. Success is higher for people who are realistic about how much weight will be lost and who keep appointments with the medical team, follow the recommended eating plan, and are physically active.

Risks

Over time, you may have problems from poor nutrition. Some vitamin and minerals may not be well absorbed, because a large portion of your stomach has been removed. You should expect to work with your doctor over a long period of time to prevent problems.

Risks common to all surgeries for weight loss include an infection in the incision, a leak from the stomach into the abdominal cavity (resulting in an infection called peritonitis), and a blood clot in the lung (pulmonary embolism). Some people develop gallstones or a nutritional deficiency condition such as anemia or osteoporosis.

What To Think About

Weight-loss surgery does not remove fatty tissue. It is not cosmetic surgery.

Some studies show that people who have weight-loss surgery are less likely to die from heart problems, diabetes, or cancer compared to obese people who did not have the surgery.

About the source

UPMC

The University of Pittsburgh Medical Centre (UPMC) is an integrated global non-profit health enterprise that is closely affiliated with its academic partner, the University of Pittsburgh. It is considered a leading American healthcare provider, as its flagship facilities have ranked in US News & World Report "Honour Roll" of the approximately 15 to 20 best hospitals in America for over 15 years.

References

1. Brethauer SA, et al. (2009). Systematic review of sleeve gastrectomy as staging and primary bariatric procedure. Surgery for Obesity and Related Diseases, 5: 469–475. 
2. Heber D, et al. (2010). Endocrine and nutritional management of the post-bariatric surgery patient: An Endocrine Society clinical practice guideline. Journal of Clinical Endocrinology and Metabolism, 95(11): 4823–4843. Available online: http://www.endo-society.org/guidelines/final/upload/FINAL-Standalone-Post-Bariatric-Surgery-Guideline-Color.pdf.
3. Adams TD, et al. (2007). Long-term mortality after gastric bypass surgery. New England Journal of Medicine, 357(8): 753–761. 
4. Brethauer SA, et al. (2009). Systematic review of sleeve gastrectomy as staging and primary bariatric procedure. Surgery for Obesity and Related Diseases, 5: 469–475.
5. Colquitt JL, et al. (2009) Surgery for Obesity. Cochrane Database of Systematic Reviews (2).

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