bariatric sleeve

Question
Hello Karla,

I am booked for the sleeve in the next few weeks and am trying to research as much as possible, pros & cons.  i have 40 kilos to loose and have young children. I do suffer from depression and the weight is really making me miserable...

I need to know the honest and realisitic pros & cons.  My husband is concerned, as this is an irreversible procedure, does the weight keep coming off after you have met your goal weight?  How has your life changed?

I appreciate your response and honesty.

Daena

Answer
Hi Daena:

I think that with only 40 kg to lose, you could be very successful with the sleeve.  In general, people lose about 60% of their excess weight with the sleeve.  The closest thing we have to five year data on the Sleeve is the Magenstrasse & Mill operation.  Patients who underwent the M&M (which is like a VSG, only the remnant stomach is not removed) lost 60% of their excess weight and kept it off for five years.  So, I think it's realistic to expect similar results with the sleeve--especially as most of the data is showing a similar weight loss.  Of course, some lose it all.  Some lose less.  I've known a few people who have lost 15-20 kg and haven't lost anymore.  I've yet to meet anybody whose had a problem with losing too much.  

There is roughly a 1% chance of a leak with the Sleeve operation.  Your risk of a leak goes down considerably every day you are out of surgery--with most surgeons saying that you're no longer at risk at around 6 weeks post-op.  Your surgeon will give you a leak test in the hospital (usually a gastrograffin swallow) to check for leaks.  Following your surgeon's post-op diet will help your stomach heal and reduce your risk of leaks as well.

You can face long-term risks of vitamin issues--mainly B12 deficiency, but iron, folate, and calcium are also possibilities.  Because of this, you will need to supplement for life.  You will also need to have regular bloodwork done.  Most people take a sublingual B12 supplement daily.  Because the portion of your stomach that produces most of the intrinsic factor necessary for B12 absorption is removed, normal oral supplements will not be effective.  I've known two VSG patients who have needed B12 shots.  Other supplements usually include a multivitamin, iron if necessary, Vitamin D (1000 IU), and calcium citrate.  

Another risk is dehydration--especially as an early post-op.  Some people find they cannot drink as quickly as they did as a pre-op.  For others, they can consume ample fluids early on.  Regardless, you will need to be very vigilant in making sure you get roughly 8 glasses of water/fluids in each day.

Dietary wise, most people tolerate most foods--which is great. You may have increased acid production, which will necessitate a Proton-Pump Inhibitor like Nexium or Prilosec.  Many people discontinue these after 6 months, although some do need them for life.

You will also experience reduced hunger--especially in the first year.  That's a blessing and a curse, because you may actually have to remind yourself to eat.  Protein is key... you need to ensure that you get 60-70 grams/day.  You may need to supplement with protein shakes early on.

As this is surgery, there is also the very real risk of death.  The risk of death with the VSG is comparable to the Lap-Band operation.  Still, it's a very real risk and this can be rather sobering... especially if you have young children.  I know that when I had surgery, I wrote out a will, as well as letters to each of my kids.  It was difficult to do, but it also reemphasized just how serious my morbid obesity was.  

I hope this helps.  It's a tough decision--especially for loved ones.  I think it's rare for somebody to regret the surgery.  You may not lose 100% of the weight you need to, but you will end up healthier.  

Good luck,
Karla

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