Gastric Sleeve Surgery

Sometimes, doctors recommend weight loss surgery (also known as bariatric surgery) for very overweight teens who have tried and failed to lose weight on normal diet and exercise plans.

There are several different types of weight loss surgeries. One type is gastric sleeve surgery, also known as sleeve gastrectomy.

What Is Gastric Sleeve Surgery?

In gastric sleeve surgery, a surgeon removes part of the stomach and makes a narrow tube or "sleeve" out of the rest. The new, banana-shaped stomach is much smaller than the original stomach. Part of the stomach that's removed makes hormones that increase appetite and help control insulin. So, after surgery a person's appetite decreases and their insulin resistance gets better.

The person will eat less, feel full sooner, and be less hungry. The gastric sleeve procedure is not reversible.

Who Gets Gastric Sleeve Surgery?

This surgery can help people who are very overweight and have serious health problems because of their weight. But it isn't a "fix it and forget it" kind of surgery.

To be considered for surgery, a person must commit to changing their eating and exercise habits over the long term. Not everyone who wants surgery will be eligible to get it.

Doctors consider many things when deciding if weight loss surgery is the right choice for teens. These include whether a teen:

• is healthy enough to handle surgery
• has a high body mass index (BMI) (of 40 or more) with serious medical problems caused by weight, like diabetes, heart disease, liver disease, or sleep apnea, or are 100 or more pounds over their ideal body weight
• has proved that he or she can stick to a healthy diet and get regular exercise
• has family members who will provide emotional and practical support (like driving to every doctor's visit or buying healthy food)

If you're worried about your weight or think weight loss surgery could help, talk to your doctor.

What Happens Before Gastric Sleeve Surgery?

Getting ready for this major operation takes months of work. Patients need to show that they can make big changes in their eating and exercise habits before the surgery.

The best place for teens to get gastric sleeve surgery is at a hospital with a bariatric surgery program whose team of specialists treats kids and teens. Members of the team will explain what's involved, help you prepare for your surgery, and care for you after it.

For several months before surgery, you'll work with the medical team to build the skills needed for success. Here are some of the people who work as a team to help teens prepare for gastric sleeve surgery:

Doctors and surgeons. Several months before your surgery, you'll meet with a medical doctor and surgeon. They will explain what happens during surgery, examine you, and talk about what to expect before and after surgery. They'll also let you know about some of the things that can go wrong (the possible "complications").

Psychologists. People go through lots of emotions before and after surgery. A psychologist can help you understand your feelings and help you prepare emotionally for surgery and the changes after it. Most people feel better about themselves after weight loss surgery. But some may still struggle, especially if they're dealing with depression or anxiety.

The psychologist will help you develop coping strategies as you learn to change your relationship with food. They'll also help you with things like worry, stress, or emotional eating. It's important to keep seeing the psychologist after surgery, especially if you feel overwhelmed, sad, or have other emotional concerns.

Dietitians. Because patients often depend on parents or other family members for meals, a dietitian will teach you and your family healthy eating basics like good nutrition, how to get regular meals, and healthy portion sizes.

Gastric sleeve surgery permanently decreases the size of the stomach. You will have to eat less than you did before. Your dietitian will explain what and how much you can eat after surgery, both right after the operation and for the rest of your life.

Exercise specialists. These experts help patients get more active. They'll work with you to develop an exercise program you'll like and workouts you can stick with. Exercising during the months before surgery helps patients get in better shape for the operation. This makes recovery easier. It also makes it easier after surgery to get back into working out. Many patients find that having a workout routine helps them feel better after surgery, but you will have to go slow. Talk to your doctor and exercise specialist about how to gradually get back into your exercise routine.

What Happens During Gastric Sleeve Surgery?

Gastric sleeve surgery is a major operation. Doctors will give you anesthesia so you sleep through the surgery. After you're asleep, the surgeon will take out three-quarters of your stomach. Your smaller banana-shaped stomach is called the gastric sleeve.

You'll probably stay in the hospital for a couple of nights so doctors and nurses can keep an eye on your recovery. They will give you medicine for pain or nausea (feeling sick), help you to get up and move around, and make sure you can drink liquids without throwing up.

Are There Any Risks With Gastric Sleeve Surgery?

Because it's major surgery, a gastric sleeve operation has some risks, including:

• bleeding
• leaking of stomach contents into the belly from where the surgeon cut the stomach
• a bad reaction to anesthesia
• blood clots
• infection
• gastroesophageal reflux
• vitamin and mineral deficiencies
• weight regain

What Happens After Gastric Sleeve Surgery?

People usually recover from gastric sleeve surgery in a week. But it will take several weeks before you can eat regular food again. Gastric sleeve surgery makes your stomach smaller — permanently. For the rest of your life, you'll always have to eat much smaller portions. You'll also feel full faster.

To ease into having a much smaller stomach, you'll need to follow a special diet that starts with liquids only. Your dietitian will give you an eating plan that gradually works up to solid foods. For example:

• For the first 2 to 3 weeks after surgery, you'll get all your nutrition from high-protein drinks.
• For the next 2 weeks or so, you'll eat puréed foods.
• Finally, you'll move on to soft foods for another couple of weeks before you can eat regular food.

Because you can't eat as much, the foods you choose to eat really matter. Your dietitian will teach you how to put together a healthy, balanced diet that includes fruits and vegetables and protein. Snacks like chips and candy are high in calories and don't have the nutrition you need, so try to avoid them. Your dietitian also will recommend vitamin and mineral supplements so you don't miss out on key nutrients.

What Else Should I Know?

Here are some things to be aware of in the weeks and months after gastric sleeve surgery:

• If you eat too much food or eat too fast, you might throw up, have diarrhea, or get acid reflux.
• Food might move too fast through your digestive system, causing nausea, cramps, and diarrhea (doctors call this "dumping syndrome").
• If you don't eat healthy and don't take your daily vitamin and mineral supplements, you won't get enough of important vitamins and minerals you need, like iron, vitamin B12, folate, and vitamin D.
• After you lose lots of weight, you may have loose skin.

If you have a lot of pain or bloating in your belly or you throw up a lot, call your doctor right away. It could be a sign there's a problem that needs medical care.

Looking Ahead

Gastric sleeve surgery makes a huge change to the way your body handles food. It can take a while to get used to your body's new normal. Besides eating a sensible diet, exercising is a key part of staying healthy and maintaining weight loss after surgery.

People who follow the recommended diet and exercise plan often lose a lot of weight in the months after gastric sleeve surgery. After that, weight begins to stabilize.

Your team of specialists will keep seeing you after surgery to monitor your diet and health, and to help you stay on track. It's very important to go to all return visits so you can maintain a healthy lifestyle and the bariatric team can watch for any problems.