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Sleeve Gastrectomy Procedure Guide

• Pre-Op
• Living with Sleeve Gastrectomy
• Weight Loss

Choosing weight-loss surgery is an important decision. You should be informed on what to expect. Although our staff will review guidelines during each phase, we provide this overview to get you started.

Pre-Op

It’s very important to us that you are completely informed from the beginning. Well before your procedure, you’ll talk in detail with our physicians and staff and get all of your questions answered. We may also want you to meet with other experts who can greatly influence your success, such as dieticians, physiotherapists and psychologists. Depending on your age and medical history we may also require specific pre-operative tests, such as a cardiac workup, blood work, sleep study and psychological evaluation.

Pre-Op Diet

The pre-op diet is vital to your success. It gets you into the proper nutritional state for your surgery, reduces fat in and around your spleen and liver to reduce potential bleeding during and after the operation, and shrinks the liver itself. If the pre-op diet is not followed properly, your surgery may have to be postponed. Here are the guidelines you should follow:

If your weight exceeds 300 pounds, a strict liquid protein diet should be started ten days before surgery. Three to four protein shakes may be consumed per day in place of meals, with one cup of fresh vegetables allowed in the evening. Recommended shakes include Atkins Advantage, Carbs For Life, and Slim-Fast Low Carb.

If you weigh less than 300 pounds, immediately cease your consumption of fatty meats, fried foods, sugary foods, carbonated drinks, butter, whole milk, breads and other carbohydrates. Please follow the following diet:

Living with Sleeve Gastrectomy

The first rule in living and thriving with the Sleeve Gastrectomy is to remember that weight loss will be gradual - one to two pounds per week is considered successful. However, this success depends on your making real lifestyle changes. Here are our recommendations regarding diet, lifestyle and exercise.

Post-Op Diet

Eating Guidelines for Life

• Eat at least three well-balanced meals per day
• Concentrate on solid foods, which will make you feel full faster and for longer periods of time
• Avoid snacking
• Eat small amounts
• Eat slowly. A meal should last 30 to 45 minutes
• Do not gulp foods or fluids
• Chew all foods to a paste consistency. Swallowing chunks of food may obstruct the pouch outlet
• Use a small fork or spoon to control portion size
• Put utensils down between bites and wait one minute between bites
• Stop eating as soon as you feel full. Signs of fullness may include nausea, pain in the upper chest, or pressure below the rib cage
• Avoid foods high in sugar and fat
• Drink plenty of non-caloric liquids between meals

Fluids

Fluid intake is very important to prevent dehydration and constipation, but it is important not to drink with meals or close to meals, which may cause bloating, nausea or vomiting. Drinking near meals also quickly washes food through, which induces hunger and excess eating. The guideline is to avoid liquids 30-45 minutes before and 40-60 minutes after meals.

Follow these simple guidelines:

• Sip water all day
• Do not use a straw, which can fill your stomach with air
• Avoid regular soft drinks and adding sugar to beverages
• Avoid all carbonated drinks after surgery to prevent bloating
• Avoid high-calorie liquids, which impart calories without making you feel full. Most fluids should be non-caloric such as water, Crystal Light, sugar-free Kool-Aid, coffee and unsweetened tea
• Avoid alcoholic beverages

Fiber

Constipation may occur after surgery and is typically caused by decreased intake of food, fiber and fluid. To prevent constipation it is important to eat high-fiber foods and drink plenty of fluids - we recommend a daily minimum of 64 ounces. It also may be helpful to have baby prunes or unsweetened prune juice.

High-fiber foods have the added benefit of slowing the emptying of your stomach.

Problem Foods

Red meat such as steak, roast beef, and pork is high in muscle fiber, which is difficult to break down even with a great deal of chewing. Other problem foods include:

• Dry meat
• Shrimp
• Un-toasted bread
• Doughy bread
• Pasta
• Rice
• Peanut butter
• Membrane of citrus fruits
• Seeds and skins of fruits and vegetables
• Dried fruit
• Fibrous vegetables such as corn, asparagus, and celery
• Nuts
• Coconut
• Popcorn
• Greasy or fried foods

Behavior Modification Techniques

• Do not eat in front of the TV
• Do not read while eating
• Pre-portion your food and put the box or package away
• Keep tempting foods out of the house
• Do not go to the grocery store hungry
• Make a shopping list and stick to it
• Use smaller plates and bowls
• Keep healthy foods readily available
• Focus on activities other than eating
• Brush your teeth after meals or if feeling the desire to eat
• Do not eat standing up at parties or buffets
• Do not stand at the food table at parties
• Offer to bring a healthy food item to parties
• Park you car a good walk from your destination
• Take the stairs instead of the elevator
• Keep a food and exercise diary

Exercise

Creating a daily exercise habit is absolutely critical to your long-term success, even more than diet compliance. You must exercise at least 30-minutes a day, every day. Any activity that increases the heart rate for an extended period is acceptable, including walking, running, swimming, aerobics and hiking. The key is to find activities that you enjoy and make them part of your daily routine.

Weight Loss

The amount of post-surgery weight loss varies from patient to patient depending on several factors such as age, starting weight, exercise level, metabolism and eating habits. But the most important factor is your overall commitment to a new lifestyle. The goal isn't just to lose weight, but to gain life. Your new lifestyle will perpetuate itself - you lose weight, you feel better, your life improves, you lose more weight.

Remember, good health is the objective, which is why the weight loss must be gradual. While obesity carries serious health risks, so does weight loss that occurs too rapidly. Losing one to two pounds a week in the first year is possible with one pound a week more likely. On average, patients lose about 45-60% of their initial weight in the first 12 to 18 months.