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August 16, 2023Gastric Sleeve Surgery
Something that can sometimes happen is that the patient experiences difficulties eating after gastric sleeve surgery.
On this occasion, we will separate the topic into two parts to explain in depth why this situation can occur:
1.- Causes related to the patient and his/her habits
2.- Causes related to the surgeon's technique
When a person finishes the postoperative gastric sleeve diet, follows their bariatric surgeon's instructions, and receives instructions from their nutritionist and psychologist on how to eat and interact with food, things should flow smoothly, so there should be no difficulty eating.
After completing the postoperative diet, which can vary from one bariatric center to another, but usually lasts 4-5 weeks, is the time when the patient resumes solid food intake, begins eating as usual, as you will do for the rest of your life and as you did before surgery (we are specifically referring to the consistency of the food, as many changes must be made after surgery for the long-term success of your surgery).
At this stage, it is essential for the patient gradually to try the different types of food, gradually integrating the different solids. At Obesity Free, we recommend leaving red meat, fibrous leafy vegetables (spinach, celery, lettuce, etc.), and flour in general as the last option. These foods are the most difficult to eat if started soon after finishing the postoperative diet.
We advise trying other solids and protein sources first such as fish, pork, chicken, fruits, vegetables and legumes. The recommendation is to try a specific type of food for 2 or 3 days with different presentations or recipes to ensure that said food is adequately tolerated by the patient. If so, we can consider that this food “gets along well with the gastric sleeve”. It may seem silly, but based on experience with patients, it seems that the gastric sleeve at certain times has its "mood", so there are times when without having changed any other factor, some food goes well and in others not so much.
We can say with almost complete certainty that after gastric sleeve surgery the vast majority of foods eventually become tolerated by patients. However, this does not mean that they should eat all kinds of food, especially those high in calories and liquid in consistency. I highlight the latter because it is likely that by this time the liquids will pass without any difficulty even in large quantities and it is common for patients to ingest high-calorie liquids excessively in order not to feel discomfort in the first days of a normal diet.
Another fundamental point to consider during this stage is that due to our lifestyle we are used to eating in a hurry without dedicating the necessary time to eating healthily.
Before the operation and in general, we usually chew very little each bite, if you analyze at how many times you chew each bite you will probably be surprised. The recommendation we give our patients is to plan in advance when they will eat, instead of letting the moment catch them off guard to avoid the following:
Speaking of the number of times that food should be chewed, we consider at least between chews 25 and 30 per bite. This helps in several main aspects:
Another point is the feeding technique, which could cause greater difficulty in eating food if implemented incorrectly. We recommend stopping drinking liquids when eating. The suggestion that we give to our patients is that they drink their liquids 30 minutes before starting their meal or 30 minutes after. The reason for this is simply not to "clean" or empty the stomach of the food that is sitting there, this will allow the feeling of satiety to last longer and in turn we eat less food, only what is necessary.
We often see how patients and their families are surprised by the "small" amounts of food that postoperative patients eat. But it's not so surprising when we consider how badly used we are to overeating. It is common to see that if we go to a restaurant and they serve us small portions, we consider that the restaurant is not highly recommended, and if we go to one where the portions are very large, it makes it more attractive and is a point in favor of returning in the future.
It should not be ruled out that there is a specific food that we will not tolerate after gastric sleeve surgery, at least initially. However, it is convenient that the type of food that patients generally do not tolerate are foods of little nutritional value such as flour, soft drinks, tortillas, etc.
In short, the difficulty in eating solid foods after gastric sleeve surgery goes hand in hand with poor communication and/or follow-up from your bariatric surgeon and her multidisciplinary group. That is why we consider it very important that you remain in close contact with your surgeon for a period of no less than one year.
During this period of time, your consultations with the different parties involved will prevent you from making mistakes due to ignorance or from correcting them if they are aware before they become a new habit or one that preceded surgery.
Regarding this point, I think that knowing specific technical details of gastric sleeve surgery is not very relevant for you as a patient. What you should definitely take into consideration is not choosing your bariatric surgeon based on factors such as the price of gastric sleeve surgery, proximity/comfort, or charisma/follwing on social networks. What you should consider is his training, what his practice and bariatric group offer you when you first consult with them.
What is relevant about this topic is that over the years the technique of said procedure has been modified and refined, however each surgeon has his own way of doing things and preventing complications. Much of what one as a surgeon does when operating is based on learning through his teachers and experience, after seeing in a significant number of cases what works best for an adequate and rapid recovery of the patient.
In our Obesity Free bariatric group, after more than 15 years of performing the same procedure, we have achieved a very refined technique and perfected the details of each of the steps of gastric sleeve surgery, which allows us to avoid situations such as difficulty to pass solid food due to poor surgical technique.
Poor surgical technique in gastric sleeve surgery can cause the stomach to become crooked instead of remaining as a uniform tube, which causes a considerable decrease in the internal diameter and, consequently, makes it difficult for food to pass through. In addition, if the stapling is placed too close to a curve of the stomach, it can cause a decrease in the internal diameter of the stomach, which makes it difficult for food to pass properly and freely.
What happens when there is a torsion or stenosis? Usually, the patient may begin to feel pain in the upper abdomen when transitioning from liquid to porridge/pureed food and from porridge to solids. These pains appear in the form of cramps or colic that are usually accompanied by nausea and vomiting of the ingested food, either in part or in its entirety. This situation can become recurring, occurring almost every day and after each food intake.
How to solve this problem is beyond the scope of the purpose of this article, but in summary, there are non-surgical and surgical invasive measures to treat it, and the decision of which is necessary will depend on each individual case.
We insist that the best medicine will always be prevention, and in this case, one way to prevent this complication that could require a reoperation is to carefully choose your surgeon, considering relevant factors such as their training, experience, credentials, and the evaluations they offer you before surgery.
If you have any questions related to this or any topic, do not hesitate to contact us.