after the sleeve gastrectomy

After the Sleeve Gastrectomy, Now What? Expected Results After 1 Year

October 18, 2021

Sleeve gastrectomy (VSG) is the most common procedure performed worldwide. It remains popular with surgeons and patients due to its reproducibility and safety profile. Despite being the new kid on the block (it has been around for about 20 years as a stand-alone procedure) it has been proclaimed by multiple studies as a highly effective method for weight loss and resolution of obesity-related comorbidities.

After the Sleeve Gastrectomy (VSG)

The sleeve gastrectomy is a procedure where a surgical stapling device removes about 80% of the stomach. The way this works is that the new stomach, which is shaped like a banana, can only hold a small amount of food leading to fewer calories consumed.

Since a majority of the stomach is removed, there is less Ghrelin (a hunger hormone) production and thus decreased appetite. The advantages of the sleeve gastrectomy are:

  1. It is technically simple and easier to do
  2. Less risk of complications than the Gastric Bypass
  3. Can be performed in patients who are sicker
  4. Can be converted to other bariatric procedures such as Gastric Bypass or SADI
  5. Has good 1-year weight loss and resolution of obesity-related problems such as hypertension, diabetes, or sleep apnea

After the Sleeve Gastrectomy (VSG): Weight Loss

At 6 months after sleeve gastrectomy, you can expect to lose about 45% of your excess body weight (meaning if you are 100 pounds overweight you should lose 45 pounds).

At 1 year you're looking at 70% excess body weight loss. Of course, you can lose more or less depending on how much exercise you do and how well you eat. At the 1 year mark, you should be close to your goal weight.

The honeymoon period for any bariatric surgery is in the first year where you have the most rapid and sustained weight loss. You can still lose weight after the first year but it won’t be as easy.

After the Sleeve Gastrectomy (VSG): Complications

A common problem in the first year after surgery is hair loss. This is usually caused by the decreased intake of iron, vitamins, and protein. A way to prevent this is to make sure you take in the appropriate amount of protein as well as supplement with a multivitamin and biotin.

After the Sleeve Gastrectomy (VSG): Nutritional Deficiencies

Some common nutritional deficiencies after a Sleeve gastrectomy are low Iron, Vitamin B12, folate, calcium, and zinc. That is because these vitamins are absorbed in the stomach and with the surgery, you are removing the majority of the stomach.

The symptoms of vitamin deficiency are fatigue, hair loss, weakened immune system, and dumping syndrome. That's why your bariatric surgeon will make sure you take a daily multivitamin and check your vitamin and iron levels 6 months and 1 year after surgery.

After the Sleeve Gastrectomy (VSG): Personality Changes

A subjective change you can see in some people who have had a sleeve gastrectomy is that they feel more “self-confident” and “less of a pushover.”

In a recent interview, about 50% of respondents who had a sleeve gastrectomy noticed a personality change. They characterized these changes as good overall. This may be a combination of the psychiatry and counseling sessions pre and post-op as well as the improved body image with weight loss.

After the Sleeve Gastrectomy (VSG): Diabetes

Due to the prevalence of obesity in America, the incidence of Type 2 diabetes has increased. According to the World Health Organization, the number of people with diabetes from 1980 to 2014 went from 108 million to 422 million!

In the USA the number is 34.2 million or 10.5% of the population! Diabetes leads to decreased quality of life, high healthcare costs, and early mortality.

Bariatric surgery has been shown to be an effective treatment for diabetes and multiple randomized controlled studies have demonstrated the superiority of bariatric surgery to medical weight loss for diabetes resolution.

The improved glycemic control after a sleeve gastrectomy is partly explained by the weight loss but we also see improvements in blood sugar the first day after surgery! This is likely due to the hormonal changes brought about by surgery. In a meta-analysis of multiple studies, the 1-year remission of diabetes after a sleeve gastrectomy (meaning a normal HbA1c) is 47-55%.

After the Sleeve Gastrectomy (VSG): High Blood Pressure, High Cholesterol, and Obstructive Sleep Apnea

Now how does the sleeve gastrectomy fare against other obesity comorbidities besides diabetes? These include hypertension (high blood pressure), hyperlipidemia (high cholesterol), and obstructive sleep apnea as well as joint disease such as osteoarthritis.

There was a study that compared sleeve gastrectomy versus gastric bypass for the resolution of these problems. The study found that the sleeve gastrectomy “markedly improves most obesity-related complications.”The sleeve gastrectomy fared just as well as the gastric bypass in resolving these comorbidities. After 1 year about 86% of sleeve gastrectomy patients had one or more comorbidities in remission compared to 83% in the gastric bypass group. 

After the Sleeve Gastrectomy (VSG): Diet

After 1 year from your gastric sleeve, you should be near your goal weight and settled into a routine. There are no food restrictions at this time. You may start experiencing food cravings which you probably did not have until now.

The bariatric meal plan consists of healthy food options with meals centering around protein. The goal of the bariatric diet is to help you lose weight after surgery, however, after the 1st year, the goal is to maintain your weight and avoid weight regain. The weight comes off pretty easily after surgery due to the decreased appetite and being limited to eating a small volume of food.

After the Sleeve Gastrectomy (VSG)

After the 1st year, it is common for your hunger to return as well as cravings for sugary and salty foods. You will also likely notice you can eat larger volumes of food than before. This is why it is so important to utilize the bariatric diet as a lifelong eating plan.

The sleeve gastrectomy is just a tool to maintain your successful weight loss. A key path to success is the close follow-up with your surgeon and dietician which will help you keep on track to success and keep the weight off.

Studies have shown that close follow-up with your surgeon and dietician will help avoid weight regain after surgery, especially after the first year.

In conclusion, sleeve gastrectomy is a safe and effective bariatric surgery and results in excellent weight loss and resolution of your medical problems.

after the sleeve gastrectomy
Pascal BortzDr. Pascal Bortz is a Board Certified Surgeon at Olde Del Mar Surgical and has advanced skills in laparoscopic, robotic and bariatric surgery. He earned his Bachelor of Science at the University of California San Diego and received medical school training at Saba University School of Medicine. Most recently, his project on local anesthetic to improve post-operative pain in bariatric surgery was presented at the SAGES national meeting. Read more articles by Dr. Bortz!