Table of Content
What is a sleeve gastrectomy?
A sleeve gastrectomy is a life-changing operation. It is used to help people to lose weight and improve their health. Losing weight lowers the risk of developing medical problems associated with obesity, such as heart attack, high blood pressure, diabetes mellitus, arthritis, obstructive sleep apnea, fatty liver, back pain, knee pain and ankle pain.
A sleeve gastrectomy makes your stomach smaller and should change the amount you can eat at your meals which will help you to lose weight. It is not a reversible procedure. This is the most common type of bariatric surgery performed in the world and Singapore currently.
How does it work?
The operation involves removing approximately 70% – 80% of your stomach, leaving behind a narrow tube (sleeve) that becomes your new stomach. After the surgery, food will follow the normal route into the smaller stomach and then into the small intestine.
The operation also alters some of the hormone signals from the stomach and intestine to parts of the brain that control body weight: many patients report that following this operation they feel less like eating and feel fuller sooner and for longer after a meal.
As the size of your stomach has been reduced, the size of your meals will need to be reduced to be appropriate for your new small stomach. Your reduced meal portion size, combined with low fat and low sugar choices, will help you lose weight and maintain weight loss.
The surgery is done laparoscopically, commonly known as “keyhole” surgery. This means that you will be up and about soon after surgery and should make a speedy recovery.
How much weight can you expect to lose?
You can lose up to 40% – 80% of your excess weight (EWL) or 20-30% of your total weight (TWL) in the first 12–18 months following surgery. However, an excess weight loss of 100% or more is not uncommon in patients who do intensive exercising. The amount of weight you can lose and keep off after surgery will also depend on the lifestyle changes you make, such as increasing the amount of exercise you take and eating a healthy diet.
- Bleeding, blood in stools
- Constipation
- Diarrhoea
- Change in bowel habit
What are the risks of a Sleeve Gastrectomy?
- Previous history of colorectal polyps
- If you have a family history of colorectal cancer. Patients with family members who had colorectal cancer are at high risk of developing colorectal cancer.
- If you are 50 years old and above, consider going for Colorectal screening.
Recovery
What should you expect after the procedure?
Hospital Stay
The first few hours after the operation
You will wake up in a recovery room where nursing staff will monitor you for any complications. You will have a drip and also be wearing stockings and have a pumping device on your legs to prevent blood clots.
As soon as you are fully awake and comfortable, you will be transferred to either the surgical ward, high dependency or the intensive care unit where your relatives can visit you. You will be able to have sips of water and some painkillers to control any pain.
You are encouraged to get out of bed as soon as possible after surgery. This helps to reduce the chance of post-operative complications, such as blood clots in the legs or chest infections.
The day after the operation
You may be scheduled for a swallow test by Dr Tan. After which you will be able to have some fluids. Your drip will be removed when you are drinking enough to keep you hydrated.
The following few days after the operation
You should start to feel better very quickly after the operation and will be able to move around on your own. You will need to drink an average of 1.5L to 2.5L of fluids daily. We will have a dietician to guide your post-operative diet. 2-3 days after surgery you will be able to go home.
At Discharge
Pain and Medications
You will be given oral pain medications to go home. You will also be given anti-acid medications. If you have been taking medication to control your blood pressure or diabetes, these will be reviewed before your discharge. In most cases, these can be reduced or sometimes stopped altogether. Please make sure you are clear about this before you leave the hospital.
Wounds
The small incisions made for your surgery may be covered with small plasters upon discharge. Dr Tan will review the wounds when you see him in the clinic.
Eating and Drinking after the operation
You will be given a diet information sheet. Our dietician will help guide you along for your post-operative diet.
Activities
You will be able to walk straight after surgery. Try to go for a walk every day, gradually increasing the distance as you feel able. You will be given hospitalization leave. It is advisable to avoid heavy lifting for at least 1 month after abdominal surgery.
Women of childbearing age must not become pregnant for at least one year following bariatric surgery.
After one year: if you are planning a pregnancy, please inform Dr Tan and he will guide you accordingly.
Follow up schedule
You will be given an appointment to see Dr Tan in his clinic for follow up. Initially after the surgery, there will be closer follow up, after which the periods for follow up will then be further spaced out.
Complications that can occur after surgery
- Wound infection: this can usually be treated with a course of antibiotics and does not require hospital admission.
- Bleeding: You will be monitored carefully for signs of bleeding. If occurs, it can be often managed conservatively and occasionally it may require transfusions. Exceptionally the Dr Tan will need to perform surgery to stop the bleeding.
- Blood clots in the legs or the lungs (DVT/PE): To prevent blood clots from forming you will be given an injection just before the operation to thin the blood. During and immediately after your operation, you will wear special stockings to prevent clots from occurring. You will be asked to ambulate early to minimize the risk of such clots.
- Smoking significantly increases the risk of clotting. If you are a smoker, you will be advised to stop smoking before surgery.
- Leaks from staple lines: This postoperative problem is rare but serious and may require emergency surgery. A leak is usually caused by a failure of the natural healing process as all staple lines are checked at the end of the operation. If this happens, your hospital stay will be longer. Sometimes this will heal without further surgery. In the worst-case scenario, Dr Tan may decide to take you back to operating theatre to control the leak and perform additional measure to help with your recovery.
Possible long term complications after surgery
- Narrowing (stricture) of the sleeve which can make eating and drinking more difficult. This may require treatment with an endoscopy, or conversion to a bypass.
- Reflux symptoms. Some patients may experience heartburn symptoms after sleeve gastrectomy. Some may settle with medications. For severe reflux symptoms, there may be a need to do further investigations to find the cause. Rare occasions may include the need to convert to a Roux-en-Y gastric bypass. (RYGB)
- Hair loss or thinning in the first six months. This is a temporary side effect of the rapid weight loss and it will improve with time.
- Gallstones. Gallstone formation can be found in up to 30% of post bariatric surgery patients. Discuss your options with Dr Tan.
- Port site hernias of the abdominal wall
- Nutritional deficiencies. You may be advised to take multi-vitamin supplements after surgery during your routine follow up with Dr Tan and dietician in the multi-disciplinary team. If there are vitamin insufficiencies, you will be advised accordingly.
Keyhole Surgery Expertise
A sleeve gastrectomy is carried out through a minimally invasive way known as laparoscopic, or keyhole, surgery. Whereas an open surgery requires long incisions made in the abdomen, laparoscopic surgery only requires small incisions and is carried out with the use of specialised keyhole instruments.
Because the procedure is less invasive, keyhole surgery offers the advantage of promoting less post-operative pain, shorter hospital stay and a quicker recovery period. At Surgicare, Dr Tan specialises in providing keyhole surgery when surgical repair is needed and where applicable.
Dr Tan Chun Hai (陈俊海医生)
Upper Gastrointestinal, Bariatric & General Surgeon
Endoscopy & Minimally-Invasive Surgery Specialist
Dr. Tan Chun Hai is a dual fellowship-trained specialist in laparoscopic (keyhole) stomach cancer surgery and Bariatric & Metabolic surgery. His clinical expertise includes the use of minimally invasive surgical techniques for stomach-related disorders, Gallstones, Appendicitis and Gastroesophageal Reflux Disease.
Dr. Tan also specialises in performing endoscopies/gastroscopies and colonoscopies. When applicable, Dr. Tan provides same-day treatment within a few hours of diagnosis. Dr. Tan subscribes to a less invasive practice, promoting less postoperative pain and shorter hospital stays.
Have a concern?
Send us your enquiry or give us a call at 6250 5610
For emergencies after hours, send us a text via WhatsApp > head to Gleneagles Urgent Care Centre and request for Dr. Tan Chun Hai
Our Clinic: 6A Napier Road, Gleneagles Hospital Annexe Block, #05-36A, Singapore 258500
