What is a Sleeve Gastrectomy?
The Sleeve Gastrectomy procedure, commonly referred to as the Vertical Sleeve Gastrectomy, Vertical Gastrectomy or Gastric Sleeve, is a newer restrictive procedure where the majority of the stomach is removed, leaving a long tubular structure from the esophagus to the small intestine. The procedure is technically simpler than a gastric bypass because it does not bypass any of the intestinal tract. There is no foreign material left within the abdomen. The risk of nutritional deficiency is lower compared to operations that bypass part of the gastrointestinal tract.
The recovery time after sleeve gastrectomy surgery resembles that of the gastric bypass. Hospital stay is typically one night after surgery and most patients are able to go home the following day. Many patients who have sedentary jobs return to work within 2-4 weeks. Patients with jobs that require more physical effort may be out of work for 4-6 weeks.
Keep scrolling to see what you can expect from a typical gastric sleeve diet after surgery.
How to prepare for sleeve gastrectomy surgery
The following instructions are by no means exhaustive – please refer to the materials your doctor at Oregon Weight Loss Surgery has provided for full care instructions.
The week before bariatric surgery
- Avoid all non-steroidal anti-inflammatory (NSAIDS) medications 7 days prior to surgery because they can increase your risk of bleeding.
- NSAID examples: Aspirin, ibuprofen, Motrin, Advil, Aleve, Naproxen, as well as other medications that you may use for arthritis. Please ask if you are unsure. Tylenol is ok to use.
- Avoid all herbal medications 7 days prior to surgery. Many of these can increase your risk of bleeding and may interact with medications given in the hospital.
- Drink plenty of water in the days before surgery so urine is light in color. It is important you are well hydrated for surgery.
- Do not shave your abdomen as it may increase your risk of infection.
The night(s) before bariatric surgery
- Consume an all-liquid diet the day before your surgery. Examples of liquids include protein shakes, Propel, Gatorade, low-fat milk, juice, water, Jello and broth.
- Nothing to eat or drink after midnight before your surgery.
Your hospital stay
- Medications will be given to treat your pain and nausea as needed.
- Once awake, you will slowly start drinking liquids.
- You will be encouraged to get up and walk around once able which will help with any abdominal discomfort.
- Deep breathing exercises with your incentive spirometer will be important to keep your body well oxygenated.
- Most patients spend 1 night.
Sleeve Gastrectomy: Overview of post-surgery diet
You are about to begin a long process of changing your life and your lifestyle. Developing new eating and exercise habits cannot happen overnight. Taking small steps and working through one issue at a time is the best approach; we are here to help you through that process. Remember, a lifestyle change for weight loss needs to be permanent otherwise weight regain is likely, even with bariatric surgery.
After surgery, we request that you follow the guidelines closely. Your physicians at OWLS may need to modify these recommendations based on your specific needs. You are expected to schedule regular follow-up appointments to help keep you on track.
Phase I: Weeks 1 & 2 Post-Op
To help your stomach heal after a sleeve gastrectomy procedure, you need to introduce foods slowly. The goal is to heal and prevent dehydration and vomiting. You should have a follow up appointment with the surgeon and dietitian about 4 weeks after surgery. Please bring at least 3 days of food records to your appointments.
You may only have liquids for the first two weeks after the sleeve gastrectomy. Remember, the stomach can only hold a very small amount; you will need to sip fluids slowly throughout the day. You will start with just one ounce over 15 minutes and slowly increase to 8 ounces over 60 minutes.
Stay Hydrated with Plenty of Fluids
Your goal is to get at least 64 ounces per day total fluids (liquid protein shakes contribute to your total fluid goal). Sip fluids throughout the entire day. Your urine should be light yellow by mid-day. Avoid carbonated, caffeinated and high-sugar beverages. Temperature can often influence your tolerance. Some people find ice-cold beverages are better, while others might prefer warm or room temperature.
Pay close attention to your body’s sensations while drinking. If you feel fullness, as a discomfort at the breastbone, stop drinking at the first detection of this feeling. If ignored, vomiting or pain may follow.
Determine Protein Amounts You Need
To find your approximate needs, multiply your current body weight in pounds by 0.3. For example, a 300-pound person would need 90 grams of protein total every day (300*.3=90).
This amount of protein may be difficult to achieve in the first few weeks after the sleeve gastrectomy but you should work up to this goal. Your protein needs should be your focus when choosing liquids. You will need a liquid protein supplement for at least the first 6 weeks following surgery.
Avoid Solid Foods
In order to prevent blockages and allow for healing, it is important to avoid all solid foods. Also avoid:
- CHEWING GUM
- CAFFEINATED BEVERAGES
- HARD CANDIES
- NO LUMPS, SEEDS, OR CHUNKS
Pain medications and a high protein diet can often cause constipation. You should have some relief after you are done with the pain medications. If constipation continues, begin with 100mg Colace (3) times per day and (1) dose of milk of magnesia at night daily. Also make sure you are drinking enough water. Call the office if you are still concerned.
Supplements after bariatric surgery
Start taking a chewable multivitamin supplement once daily.
Phase 2: Weeks 3 & 4 Post-Op
At three weeks after the sleeve gastrectomy, if you have been tolerating liquids without problems, then you may begin to introduce pureed foods. Pureed foods should be smooth and very moist. Continue to aim for 64 ounces of liquid per day. As you introduce pureed foods separate your fluids from solids. Wait 15-30 minutes both BEFORE and AFTER each meal before sipping liquids.
Continue drinking a liquid protein supplement during Phase 2 to best meet your protein goals. Start with primarily protein based foods and once meeting protein needs you can gradually add soft cooked, pureed vegetables.
It is important to continue to avoid all solid foods. Also avoid:
- CHEWING GUM
- HARD CANDIES
- NO LUMPS, SEEDS, OR CHUNKS
Pay Attention to Fullness
Your meals should begin with 1-2 tablespoons and increase to 3-5 tablespoons towards the end of the first 4 weeks. Pay close attention as you are eating and stop eating at the first sign of fullness. It is OK if you cannot eat the amount of foods described here. You are encouraged to aim for feeling just satisfied and avoid feeling “full”.
Eat slowly and chew your food well. It is important to take very small bites (dime size or less), chew 20 times before swallowing and wait a full minute between bites. Each meal should take on average 30 minutes to complete.
Continue taking a chewable multivitamin supplement once daily.
Phase 3: Weeks 5 & 6 Post-Op
The basis of your diet at this stage should be soft, moist foods. Your goal is to slowly introduce solid texture foods during these weeks after the sleeve gastrectomy. High protein foods should be first at each meal.
Continue to aim for 64 ounces of liquid per day. Wait 15-30 minutes both BEFORE and AFTER each meal before sipping liquids again. If you are drinking enough fluid throughout the day, you should not be thirsty at meal times.
Continue Protein Intake
Continue drinking a liquid protein supplement during Phase 3 to best meet your protein goals. Keep track of your protein intake and decrease your liquid protein supplement, protein from solid foods increases. (example, if your protein needs are 80 grams/day and are able to eat 60 grams protein/day from solid foods, decrease liquid protein supplement to 1/day).
Foods to Avoid
- DRY MEAT
- RAW VEGETABLES
- FRUITS WITH SKINS
- FRUIT JUICE
As you introduce more textures make sure to chew foods well and go slowly. Take 1 minute between each bite. Each meal should take about 30 minutes to complete.
Phase 4: Ongoing Dietary Guidelines after Sleeve Gastrectomy
If you have been tolerating foods well to this point, you can start returning to a normal consistency diet. Food = Fuel and healthy protein choices should always be a priority. The goal is to continue to focus on getting what you NEED, not what you desire.
It is not necessary to eat excessive amounts of protein, just ensure that you are getting an adequate amount. Choose a healthy source of protein with each meal. Total daily protein needs in grams = your weight in pounds x 0.3 or no less than 60 grams protein per day.
Foods to Continue to Avoid
- DRY MEAT
- FRUIT JUICE
- HIGH CALORIE DRINKS
Introduce Foods Individually
If one food is not tolerated (causing vomiting or pain), return to Phase 1 or Phase 2 for a couple of meals until your stomach feels calm again. If you are unable to swallow or keep down food after returning to Phase 1, call the office for intervention.
Pay Attention to Fullness
Listen to your body. Most people can eat ½ cup to 1 cup of food at one meal. The amount tolerated can vary and will depend on the consistency of the food. It is still a good idea to occasionally measure your food to increase your awareness of the amounts you are able to eat at one time. This will help to keep your food portions in check.
Continue to chew food well, take very small bites and go slowly. Spend 20-30 minutes eating each meal. Stop when you feel satisfied, not full. Pay attention to when and why you are eating. It is a crucial time to understand physical hunger versus emotional hunger. If you are having difficulty refraining from emotional eating, it may be beneficial to seek help from a mental health professional or attend a support group.
Keep Meals Consistent
It is important to have established mealtimes that are separate from other activities. If you are hungry between meals, a planned, healthy snack is okay. Avoid snacking frequently throughout the day (also known as grazing) as this can lead to weight gain over the long term.
Skipping meals or going too long without eating often causes people to eat more quickly which may lead to problems tolerating foods or overeating. Do not delay or skip meals. Aim for 4 small meals daily total. Use a liquid protein supplement as meal replacement for up to two of these meals.
Limit Fat Intake and Liquid Calories
Some fat is good, especially it if is monounsaturated or polyunsaturated fat. Be aware that eating high fat foods can be high in calories. Watch out for added fats in cheese, dairy products, salad dressings, sauces and gravies. Be careful with the amount of calories you consume from liquids, drink primarily water and other calorie-free drinks. Watch out for calories in alcohol, sweetened coffee drinks and juice.
Gastric sleeve diet after surgery
Ready to change your life for the better? Contact OWLS today to learn how a sleeve gastrectomy can help you reach your weight loss goals and keep the weight off.