Why Am I So Cold After Gastric Sleeve

Vertical sleeve gastrectomy

Vertical sleeve gastrectomy is surgery to help with weight loss. The surgeon removes a large portion of your stomach.

The new, smaller stomach is about the size of a banana. It limits the amount of food you can eat by making you feel full after eating small amounts of food.

Description

You will receive general anesthesia before this surgery. This is medicine that keeps you asleep and pain-free.

The surgery is usually done using a tiny camera that is placed in your belly. This type of surgery is called laparoscopy. The camera is called a laparoscope. It allows your surgeon to see inside your belly.

In this surgery:

  • Your surgeon makes 2 to 5 small cuts (incisions) in your belly.
  • The scope and instruments needed to perform the surgery are inserted through these cuts.
  • The camera is connected to a video monitor in the operating room. This allows the surgeon to view inside your belly while doing the operation.
  • A harmless gas is pumped into the belly to expand it. This gives the surgeon room to work.
  • Your surgeon removes most of your stomach.
  • The remaining portions of your stomach are joined together using surgical staples. This creates a long vertical tube or banana-shaped stomach.
  • The surgery does not involve cutting or changing the sphincter muscles that allow food to enter or leave the stomach.
  • The scope and other tools are removed. The cuts are stitched closed.

The surgery takes 60 to 90 minutes.

Weight-loss surgery may increase your risk for gallstones. Your surgeon may recommend having a cholecystectomy. This is surgery to remove the gallbladder. It may be done before the weight-loss surgery or at the same time.

Why the Procedure is Performed

Weight-loss surgery may be an option if you are very obese and have not been able to lose weight through diet and exercise.

Vertical sleeve gastrectomy is not a quick fix for obesity. It will greatly change your lifestyle. After this surgery, you must eat healthy foods, control portion sizes of what you eat, and exercise. If you do not follow these measures, you may have complications from the surgery and poor weight loss.

This procedure may be recommended if you have:

  • A body mass index (BMI) of 40 or more. Someone with a BMI of 40 or more is at least 100 pounds (45 kilograms) over their recommended weight. A normal BMI is between 18.5 and 25.
  • A BMI of 35 or more and a serious medical condition that might improve with weight loss. Some of these conditions are obstructive sleep apnea, type 2 diabetes, and heart disease.

Vertical sleeve gastrectomy has most often been done on people who are too heavy to safely have other types of weight-loss surgery. Some people may eventually need a second weight-loss surgery.

This procedure cannot be reversed once it has been done.

Risks for anesthesia and surgery in general are:

Risks for vertical sleeve gastrectomy are:

  • Gastritis (inflamed stomach lining), heartburn, or stomach ulcers
  • Injury to your stomach, intestines, or other organs during surgery
  • Leaking from the line where parts of the stomach have been stapled together
  • Poor nutrition, although much less than with gastric bypass surgery
  • Scarring inside your belly that could lead to a blockage in your bowel in the future
  • Vomiting from eating more than your stomach pouch can hold

Before the Procedure

Your surgeon will ask you to have tests and visits with your other health care providers before you have this surgery. Some of these are:

  • A complete physical exam.
  • Blood tests, ultrasound of your gallbladder, and other tests to make sure you are healthy enough to have surgery.
  • Visits with your doctor to make sure other medical problems you may have, such as diabetes, high blood pressure, and heart or lung problems, are under control.
  • Nutritional counseling.
  • Classes to help you learn what happens during the surgery, what you should expect afterward, and what risks or problems may occur afterward.
  • You may want to visit with a counselor to make sure you are emotionally ready for this surgery. You must be able to make major changes in your lifestyle after surgery.

If you smoke, you should stop several weeks before surgery and not start smoking again after surgery. Smoking slows recovery and increases the risk for problems. Ask your provider for help quitting.

Tell your provider:

  • If you are or might be pregnant
  • What medicines, vitamins, herbs, and other supplements you are taking, even ones you bought without a prescription

During the week before your surgery:

  • You may be asked to stop taking blood thinning medicines. These include aspirin, ibuprofen (Advil, Motrin), vitamin E, warfarin (Coumadin, Jantoven), and others.
  • Ask your doctor which drugs you should still take on the day of your surgery.

On the day of your surgery:

  • Follow instructions about when to stop eating and drinking.
  • Take the drugs your doctor told you to take with a small sip of water.
  • Arrive at the hospital on time.

After the Procedure

You can probably go home 2 days after your surgery. You should be able to drink clear liquids on the day after surgery, and then go on a pureed diet by the time you go home.

When you go home, you will probably be given pain pills or liquids and a drug called a proton pump inhibitor.

When you eat after having this surgery, the small pouch will fill quickly. You will feel full after eating a very small amount of food.

The surgeon, nurse, or dietitian will recommend a diet for you. Meals should be small to avoid stretching the remaining stomach.

Outlook (Prognosis)

The final weight loss may not be as large as with gastric bypass. This may be enough for many people. Talk with your surgeon about which procedure is best for you.

The weight will usually come off more slowly than with gastric bypass. You should keep losing weight for up to 2 to 3 years.

Losing enough weight after surgery can improve many medical conditions you might also have. Conditions that may improve are asthma, type 2 diabetes, arthritis, high blood pressure, obstructive sleep apnea, high cholesterol, and gastroesophageal disease (GERD).

Weighing less should also make it much easier for you to move around and do your everyday activities.

This surgery alone is not a solution to losing weight. It can train you to eat less, but you still have to do much of the work. To lose weight and avoid complications from the procedure, you will need to follow the exercise and eating guidelines that your surgeon and dietitian give you.

Alternative Names

Gastrectomy – sleeve; Gastrectomy – greater curvature; Gastrectomy – parietal; Gastric reduction; Vertical gastroplasty

References

Buchwald H. Sleeve gastrectomy. In: Buchwald H, ed. Buchwald’s Atlas of Metabolic and Bariatric Surgical Techniques and Procedures. Philadelphia, PA: Elsevier Saunders; 2012:chap 10.

Richards WO. Morbid obesity. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 20th ed. Philadelphia, PA: Elsevier; 2017:chap 47.

Thompson CC, Morton JM. Surgical and endoscopic treatment of obesity. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran’s Gastrointestinal and Liver Disease. 10th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 8.

Post-Surgery Weight Regain: Sleeve Gastrectomy

Thursday, September 19, 2013

Continuing in my discussion of factors that can promote weight regain after bariatric surgery, discussed in our systematic review published in Obesity Surgery, I now turn to the technical or anatomical issues specific to sleeve gastrectomy.

As sleeve gastrectomies have only been performed as a stand-alone procedure for about 5 years, data on weight recidivism is rather limited.

However, there are studies and case reports to suggest that the remnant stomach or sleeve may expand over time and that the size of the gastric sleeve is related to weight loss and possibly weight regain.

How and why the sleeve expands and how exactly such expansion affects satiety and the mode of action of this type of surgery remains unclear and will require further study.

However, weight recidivism after sleeve gastrectomy should prompt appropriate investigations to rule out sleeve dilation (upper gastrointestinal endoscopy, radiographic upper gastrointestinal series) and a large remnant sleeve may require surgical correction or conversion of this procedure to a Roux-en-Y gastric bypass.

@DrSharma
Edmonton, AB

Karmali S, Brar B, Shi X, Sharma AM, de Gara C, & Birch DW (2013). Weight Recidivism Post-Bariatric Surgery: A Systematic Review. Obesity surgery PMID: 23996349

4 Comments

Thursday, September 19, 2013

After two years with the sleeve, I find I can eat a fairly “normal” amount of food. While it’s not nearly as much as my husband eats, it’s not so little as to draw the notice of anyone who doesn’t know that I had surgery. The first few months after surgery, I could literally eat only a few tablespoonfuls of food at one time. I find I have to eat very carefully and maintain a rigorous exercise schedule to keep the weight off.

Wednesday, December 18, 2013

I am curious as to any advice. It has been 2 years since my gastric sleeve. I lost a total of 50 lbs before the surgery on my own (using the specialists advice of 3 cups of food, in total, per day). After the surgery I lost a total of 40 lbs. I too could only eat a table spoon of food at a time. Now I can maybe consume a half a cup to 3/4 cup of food in one sitting. I still throw up alot, and there are so many foods I cannot eat, like rice or quinoia. I had a recent reconstruction surgery (unrelated to the sleeve). After which I had a severe allergic reaction to a pain killer. The Doctors put me on quite a bit of steroids to combat the reaction. After that, with in a week to two weeks I gained 30 lbs. I have been working very diligently to lose the weight, adding more excersize and adding more power foods like kale, ginger etc. I cannot lose any weight. I just entered menopause as well and am struggling greatly. I do not consume anymore than 775 to, at most, 900 calories per day. Does anyone have any advice as to what my next step is?

Wednesday, March 2, 2016

I had a VSG in 2009 and have been vigilent with my diet – almost to the point of anorexia – and I still have weight gain. I was 50 when I had the surgery and have gone through menopause and from the 45 pounds I lost, I have regained 11 and am struggling to not gain more. I cannot seem to lose. Protein is my mainstay and I drink cold pressed green juices for my veggies. I have had trainers tell me I have set my metabolism so low that when I do eat, it sticks. I don’t think I can eat less every day (about 500 calories) and I walk about 3 – 5 miles a day, and pilates 3 times a week. Is there any good news for me? When it is recommended I eat 1200 calories a day, I cringe – and I have tried, but I rarely can reach it.
Your thoughts please. If it is to eat 1200 to reset my metabolish, I can try (yes hypothyroid, 5’0″ and 131lbs at present. When I say, I might as well enjoy my food if I am going to gain weight, I put on a few pounds overnight that takes weeks to get off…but most of it has not come off.

Thursday, March 3, 2016

Apologies, but I cannot give personal medical advice on this site.

Gastric Sleeve Surgery Post Op Diet

Your commitment to a planned gastric sleeve post op diet is the most important part of the weight loss surgery treatment. The gastric sleeve diet you follow will determine your ability to control your weight for the rest of your life.

For this reason, it is critical that you understand how to progress through the 4 different stages over the course of the next few months. You will start with clear liquids and gradually transition to solid foods.

With Jet Medical Tourism by your side at each stage, you will increase your chances of safe and successful weight loss.

4 Stage Gastric Sleeve Post Op Diet

Stage 1: Clear Liquid Diet (Days 1-3) After Gastric Sleeve

Your goal for days 1-3 after gastric sleeve surgery is to stay hydrated and to allow your stomach to heal. Clear liquids must be plain or sugar-free. In general, clear liquids are liquids that you can see through.

Avoid: Alcohol, caffeine, carbonated and sugary beverages.

Fluid Type: Calorie-free, sugar-free, non-caffeinated, non-carbonated liquids.

Fluid Goal: 2 oz per hour.

Cold Liquids: Water, smart water, crystal light, green tea, sugar-free Jell-O, sugar-free juices (apple juice, white grape juice, cranberry juice and strained lemonade).

Hot Liquids: Low-sodium chicken, vegetable or beef broth (fat-free or low-fat) bouillon, or consomme.

Tip: Sip slowly, stop sipping as soon as you feel full and do not use straws because they introduce air into your system.

Stage 2: Full Liquid Diet (Days 4-10) After Gastric Sleeve

Continue with the Stage 1 diet, but focus more on your protein intake. Start by having high-protein, low-sugar shakes for most of your meals. Add water or skim milk to your shake mix.

Diet Plan: Consume only full liquids.

Instructions: Please record the amount of protein shakes and clear liquid fluids that you drink daily.

Vitamins: Start taking your daily multivitamins and calcium supplements.

Avoid: Alcohol, caffeine, carbonated and sugary beverages.

Protein Goal: 60-80 grams per day (about 5-6 protein shakes containing 8 oz each).

Protein Shakes: Try to drink an 8 oz protein shake every 2.5 hours starting at 8:00 AM.

Fluid Goal: At minimum 6-8 cups (48-64 oz) per day of sugar-free, calorie-free, non-caffeinated, non-carbonated liquid. Your protein shakes are not included in this fluid count.

Frozen Liquids: Sugar-free gelatin or sugar-free popsicles.

Cold Liquids: Water, smart water, crystal light, green tea, sugar-free juices (apple juice, white grape juice, cranberry juice and strained lemonade).

Hot Liquids: Low-sodium chicken, vegetable or beef broth (fat-free or low-fat) bouillon, or consomme.

Tip: Sip slowly, stop sipping as soon as you feel full and do not use straws because they introduce air into your system.

Stage 3: Soft Food Diet (Days 11-30) After Gastric Sleeve

Stage 3 of the gastric sleeve post op diet gradually re-introduces soft food to your digestive system. Generally, we recommend that you prepare one new solid food per meal (i.e., turkey meatloaf, steamed carrots, etc). Work on eating as much protein as you can while staying hydrated.

Diet Plan: Focus on preparing soft foods high in protein.

Instructions: Continue to record your food consumption to ensure adequate protein and fluid intake.

Vitamins: Continue to take your daily multivitamins and calcium supplements.

Avoid: Alcohol, caffeine, carbonated and sugary beverages

Protein Goal: 60-80 grams per day from soft food combinations.

Fluid Goal: 64 oz (8 cups) per day of sugar-free, calorie-free, non-caffeinated, non-carbonated liquid.

Tip: Focus on eating as much protein as you can. Do not force yourself to eat if you feel full. Continue to chew food slowly and thoroughly. Your digestive system might still be sensitive to spicy foods or dairy products. If you’d like to eat these foods during Stage 3, add them into your diet slowly and in small amounts.

Soft food can include:

  • Soup
  • Canned chicken, tuna and salmon mixed with light mayo
  • Cottage cheese, low fat
  • Diced tuna or chicken
  • Turkey meatloaf and turkey chili
  • Scrambled eggs
  • Steamed carrots, mashed potato
  • Fat-free plain Greek yogurt
  • Oatmeal
  • You can now blend your protein with yogurt and nonfat milk

To puree your foods, choose solid foods that will blend well:

  • Lean ground meats
  • Beans
  • Fish
  • Egg whites
  • Fat-free or fat-free light yogurt
  • Puree fruits and vegetables
  • Low-fat cottage cheese
  • Part-skim ricotta cheese

Blend the solid food with a liquid:

  • Water
  • Fat-free milk
  • Juice with no sugar added
  • Broth
  • Fat-free gravy

Avoid these foods during Gastric Sleeve Post Op Diet Stage 3:

  • Sugary beverages such as juice
  • Starch foods such as bread, pasta, rice, and raw fruits
  • Ground beef, lobster, scallops, shrimp, or steak
  • Fibrous vegetables such as asparagus, broccoli, celery, or raw leafy greens

Stage 4: Solid Foods Diet (Day 31 and Beyond)

Stage 4 of your gastric sleeve diet re-introduces solid food to your system. It is important that you eat slowly and chew food well because your stomach is still sensitive. Remember, your body must get the protein it needs from Stage 4 so plan your meals carefully.

Instructions: Continue to record your food consumption to ensure adequate protein and fluid intake.

Vitamins: Continue to take your daily multivitamins and calcium supplements.

Calorie Goal: 1,000-1,400 calories per day.

Protein Goal: 60-80 grams per day from different combinations of soft food.

Fluid Goal: 64 oz (8 cups) per day of sugar-free, calorie-free, non-caffeinated, non-carbonated liquid.

Important information for gastric sleeve post op diet patients:

  • Stick to a “schedule” of eating.
  • Do your best to eat as much protein as you can.
  • Take your time eating.
  • Chew food slowly and thoroughly.
  • Do not over eat and never force food down.
  • Protein shakes – continue to have them with one of your meals (ex, lunch or nighttime snack).
  • Chicken or beef – make sure it is cooked, moist and grounded or finally deiced.
  • Fish – you can eat any type, but be careful with bones.
  • Vegetables – make sure they are cooked soft and chew them thoroughly.
  • Sweet potatoes are full of nutrients and a smart choice.

Avoid these foods as they may cause GI problems:

  • Breads
  • Desserts
  • Dried fruits
  • Fast foods
  • Fried foods
  • Granola
  • Nuts
  • Popcorn
  • Seeds
  • Sodas and carbonated beverages
  • Stringy or fibrous vegetables, such as celery, broccoli, corn or cabbage
  • Tough meats or meats with gristle

Patient Guide to Gastric Sleeve Surgery

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