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Sandra & Lindsey's Story

                 (Mother & Daughter)

These two women underwent Laparoscopic Gastric Sleeve 21 months ago. They tell their remarkable story in four brief videos. 

  • Part 1 - Why they chose weight loss surgery. 
  • Part 2 - Dietary & lifestyle changes.
  • Part 3 - Helpful advice for anyone considering weight loss surgery.  
  • Part 4 - Personal experience with MASTER CENTER®, Dr. Sewell and staff

Watch a Gastric Sleeve Surgery  

 

Obesity and Bariatric Surgery

Metabolic Syndrome and Obesity-Related Health Problems

The National Institutes of Health reports that morbid obesity reduces life expectancy and is associated with an increased risk of developing a variety of other health conditions such as:

  • Type 2 Diabetes
  • Hypertension (High Blood Pressure)
  • Back and Joint Problems
  • Sleep Apnea
  • Some Types of Cancer
  • Coronary Artery Disease
  • Respiratory Problems

Together these conditions are often referred to as Metabolic Syndrome. Obviously, each of these conditions is often treated as a separate problem, but if the underlying obesity can be successfully addressed, these secondary problems frequently improve dramatically, often eliminating the need for separate treatment. 


Obesity is an epidemic in America. It is estimated that approximately 2 out of every three Americans is over-weight and nearly 10% are morbidly obese. To be classified as morbidly obese a person generally must weigh at least 100 pounds more than his or her ideal weight. Typically this translates into a BMI of 40 kg/m2  or more. Body Mass Index (BMI) is a calculation used to assess relative obesity and is calculated by taking the person’s weight in kilograms, divided by their height in meters squared (kg/m2). It is much easier to just look it up on a BMI chart.  What’s your BMI?

Read Dr. Sewell's article "Is Weight Loss Surgery Right For You?"   

Weight Loss Options

There are many weight-loss options available to obese patient, including both surgical and non-surgical approaches. In general, any overweight individual should try non-surgical efforts first. Diets and exercise programs are easy to find, but sticking to them can be a bit more of a challenge. For the severely overweight person bariatric surgery may offer the best option. While the idea of surgery to promote weight loss may sound frightening, in recent years this option has become increasingly safe and effective. But, it's important to recognize that surgery alone may not solve the problem. For optimal results it is necessary to employ a comprehensive approach to bring about permanent lifestyle changes. This is what we offer our patients at the MASTER CENTER® Weight Management Program.  

Minimally Invasive Surgery Options

There are a number of surgical procedures that can aid patients in their weight loss efforts. For most patients looking to lose more thn 75 pounds, the Gastric Sleeve (also known as a Vertical Sleeve Gastrectomy) offers the best combination of safety and effectiveness. This procedure is routinely performed using laparoscopic surgical techniques, and typically require only an overnight hospital stay. Patients who come to the MASTER CENTER® Weight Management Program  undergo individual assessments by the surgeon, Robert Sewell, MD, FACS, our dietitian, Sandi Graham, LD, RD, and our certified fitness trainer, Staice Sauber to help them determine if the gastric sleeve procedure is the right option and to develop a long-range plan for success. While our program include a year long follow-up, many of our patients continue to come back year after year to help them stay on track.

Gastric Sleeve

The Gastric Sleeve, also known as the Verticle Sleeve Gastrectomy, is a weight loss operation that restricts the amount of food you can eat and significantly reduces hunger in most patients. It is a purely a restrictive procedure, meaning there is no rerouting of the GI tract that can interfere with the absorption of nutrients and, unlike the Adjustable Gastric Band, the Gastric Sleeve does not involve implanting any foreign object into the body. The procedure simply reduces the size of the stomach by removing approximately 3/4 of its volume.

Following the Gastric Sleeve procedure you will be unable to eat very much at a time, so to maintain appropriate nutrition, you must choose high quality foods, eat more slowly, take smaller bites, and chew everything very well. In other words, "stop living to eat" to start "eating to live."  Check out the After Surgery Do's and Don't's.

Watch Dr. Sewell Perform a Gastric Sleeve   viewed  >175,000 times 

Who is a Candidate?

If you need to lose anywhere from 75 to 250 pounds the Gastric Sleeve may provide a good option. If you have diabetes or high blood pressure or other obesity related health problems you may also be candidate even if you are not technically classified as morbidly obese.  Increasing clinical evidence suggests that weight loss procedures may provide significant benefit for diabetic patients even if they only need to lose 50 to 75 pounds. In these situations the Gastric Sleeve may offer considerable benefit with manageable risk. Patients who need to lose a very large amount of weight (more than 300 pounds) may still benefit from the Gastric Sleeve since it can be combined with other procedures later on to address persistent weight problems.  Do you know your BMI? 

Minimally Invasive Surgical Options

It was a positive experience, from beginning to end. 
                           ~Linda K.

The Gastric Sleeve is performed under general anesthesia, and most patients spend only one night in the hospital.  The operation is performed using laparoscopic techniques, which means quicker recovery and minimal pain in most cases. (Watch a video of the Gastric Sleeve procedure) Following the procedure, you will be on a liquid diet for the first couple of weeks or so with solid foods gradually reintroduced back into your diet over the first month following surgery. Eventually Gastric Sleeve patients are able to eat most foods they chose without much difficulty.

Results & Risks

Perhaps the biggest benefit of the Gastric Sleeve is a significant reduction in your sense of hunger. Most patients tell me they just aren't hungry. When they do get a little hungry they eat a couple of bites and are satified. By physically removing a large part of the stomach there are fewer signals being sent to the brain, which create that feeling of hunger. While the sleeve is a great tool, and most patient lose weight fairly quickly, to maximize success it should be combined with a comprehensive weight management program, including regular follow-up visits with the surgeon and dietitian along with regular exercise.

The risk of the Gastric Sleeve is relatively low, but cannot be ignored. Part of the stomach is removed using a stapling device which seals-off both sides of the stomach with overlapping rows of staples then cuts the tissue between the rows of staples. It is possible for a leak to occur through the staple line, which could be a serious problem requiring additional surgery to repair. Deaths have been reported due to infections resulting from staple-line leaks. To help reduce this risk, Gastric Sleeve patients are maintained on a liquid diet for the first couple of weeks to minimize the stress on the staple-line. After that the risk of a leak is very small.

Dilation of the Gastric Sleeve can occur over time due to persistent over-eating. This could result in gradual weight gain if you return to your old eating habits. This is why it is important to combine weight loss surgery with dietary counseling, behavior modification and regular exercise to achieve optimal long-term success.

 

 

 

What Our Patients Say


Watch these VIDEOS

It is extremely important for any potential patient to recognize that obesity is a complex disease and the Gastric Sleeve alone will not cure this problem. The procedure should be viewed as a tool that is most effective when combined with a comprehensive weight management program. Only by combining weight loss surgery with dietary counseling, behavior modification training and regular exercise is it possible to achieve optimal success. 

 

Gastric Banding

When it Comes to the Lap Band® Dr. Sewell Wrote THE Book 

Dr. Sewell's book includes everything you need to know to make an informed decision about Lap Band or any other weight loss surgery. It contains more than 20 patient stories, both those who were successful and those who were not. It is written in easy to understand language that speaks directly to patients. Check out what others have to say about this valuable resource at Amazon.com.

 

   

The Adjustable Gastric Band

The Adjustable Gastric Band (AGB), also known as the Lap Band® promotes weight loss by restricting the amount of food you can eat. When the band is properly adjusted the upper stomach pouch will only hold only a couple of ounces of food. If you continues to eat, food will back up into the esophagus making you very uncomfortable followed by regurgitating or spitting up. For patients to be successful with the band you must choose good quality, nutritious foods, high in protein and learn to eat more slowly, taking small bites, and chewing everything very well. You also need to avoid drinking with your meals. This sounds easy enough, but changing a lifetime of eating habits requires commitment and perseverance, as well as regular follow-up by a team of trained professionals.

Who is a Candidate?

Patients who need to lose anywhere from 75 to 100 pounds may be good candidates for the AGB. Others who havediabetes or high blood pressure may also be candidates even if they are not technically classified as morbidly obese.  Increasing clinical evidence suggests that weight loss procedures may provide significant benefit for diabetic patients who only need to lose 50 to 75 pounds. In these situations the AGB may offer significant benefit with high risk. But patients who need to lose a very large amount of weight (more than 100 pounds) may be better served with a different procedure, such as the Gastric Sleeve.  Find your BMI here.

The AGB operation is performed under general anesthesia, and most patients spend only one night in the hospital.  It is routinely performed using laparoscopic techniques, which means quick recovery and minimal pain in most cases. When first placed, the band is relatively loose around the top of the stomach, so it the needs to be tightened by adding saline into a small injection port under the skin. The adjustment process is typically started about 6 weeks after the surgery, and normally it takes several adjustments over the first few months to customize the tightness of the band to meet the individual patient’s specific needs.

Results & Risks

Sustained weight loss requires regular exercise and a new overall healthier lifestyle.  Repeated adjustments to the tightness of the band are not a substitute for making those difficult lifestyle changes. 
Dr. Sewell is one of the nicest, kindest, most reassuring and pleasant doctors I have ever known.  I have the utmost confidence in him and his abilities. ~Rosemary L.

The AGB is widely recognized as the weight loss operation with the lowest surgical risk, but there are problems that may occur weeks, months or even years after the surgery. If the band is adjusted too tightly, over time the result may be a stretching of the esophagus, which can cause chest pain, trouble swallowing and even regurgitation of food or fluid into the lungs. The band can also "slip" down on the stomach due to excessive retching and vomiting, or persistent overeating. The symptoms of a slipped band include:
  • heartburn
  • chest pain
  • regurgitation
  • failure to lose weight

It is also possible for the band to erode through the wall of the stomach causing an infection of the band and the surrounding area. The diagnosis of an eroded band is confirmed either by an upper GI X-ray or an endoscopic examination of the inside of the stomach. If an erosion occurs it is mandatory that the band be removed.

In rare cases the patient may simply be intolerant of the restriction the band creates, which may necessitate removal of the Lap Band® with conversion to a Gastric Sleeve. SEE REVISIONS & CONVERSION
 

Revisions and Conversions

Problems can arise months or even years after an Adjustable Gastric Band (AGB) or Lap-Band®. It may be possible to reposition or replace the band, and in some cases the appropriate option may be to simply remove the band. But for many patients the best way to manage problems with a Lap-Band® is to convert to an entirely different weight loss procedure. Watch a BAND TO SLEEVE CONVERSION VIDEO 

These procedures can usually be performed with the same laparoscopic techniques used to place the band initially. For many Lap Band patients the conversion to a sleeve can offer the best alternative to eliminate the continued struggles with the band.

Who is a Candidate?

If you have developed a complication or intolerance to the Lap-Band® you may be a candidate for a conversion procedure. One common complication is known as a slipped band. If the band slides down on the stomach it creates a larger than normal upper pouch. This can occur even though the band was sutured in place. Symptoms may include heartburn, weight gain, frequent regurgitation and chest pain. 

Watch this video as Grace shares her experience with conversion from Band to Sleeve.

 
The best way to show the actual position of the band before determining the best course of action is an Upper GI X-ray. The band can be repositioned, but it may slip again in the future, so in most cases it is preferable to remove the band and convert to an entirely different procedure, such as the Gastric Sleeve. 

Top notch!  Dr. Sewell is the best.  

                            ~ Dale A.

For other patients their AGB seems to work very well up to a point, then they just seem to stop losing weight. The reason for this plateau effect is unknown, but on average it occurs when the patient has lost about half of their excess body weight. This may be very acceptable for someone who only needed to lose 75 to 100 pounds, but for those who started out 150 to 200 pounds or more overweight this 50% loss is generally not an adequate result. Band patients who have reached a plateau and are still morbidly obese often seek another solution. Removal of the band with conversion to another weight loss procedure such as the Gastric Sleeve may be exactly what it takes to get them started losing weight again.

Results & Risks

For many patients a revision or conversion of their Gastric Band can provide a new start toward achieving their ultimate goal. However, one thing must be made very clear: if the underlying problem is a failure to change long-standing behaviors, it will not matter what procedure is done. So any revision procedure should include a comprehensive weight management program to help ensure the best possible result.

In general, revision procedures carry a higher risk for complications than the original surgery. This is particularly true for revisions of the Gastric Band. The dissection and identification of the stomach and surrounding organs is more difficult because of the scar tissue that invariably surrounds the band. So, if revision surgery is required, there is no substitute for an experienced laparoscopic surgeon and a team of dedicated support personnel.

Nutrition Corner

Sandi Graham is a Licensed and Registered Dietitian who works closely with all our bariatric surgery patients. She has extensive experience in not only helping patients lose weight, but also provides important nutritional guidance that ensures patients maintain a healthy diet.

A major part of the MASTER CENTER® Weight Management Program is getting our patients actively involved in setting their own realistic goals and creating strategies to acheive them. Sandi works with each patient to help keep them on track and focused on restoring their health through good nutrition.

Exercise Corner

Getting regular exercise is an extremely part of any weight loss program and we are excited to have Stacie Sauber on our team.

Stacie Sauber is an exercise and fitness expert who performs an initial assessment of each patient's physical fitness prior to surgery, She then offes support all along the way.providing our patients with helpful tips for creating their own exercise routine that will keep them moving toward their healthier lifestyle goals. Stacie offers individual and small group work-out sessions at her small private facility in Southlake, Purely for Fitness.

Stacie participates in our Monthly Forum where she offers a variety of ideas that help keep exercise both fun and productive. She has suggested the resources below to assist each patient in assessing their ability to participate in regular exercise routines.

1. The American College of Sports Medicine Risk Stratification Categories will help you determine where to start.

2. Check out How to Determine Your Heart Rate Max based on your age.

3. Learn about the Groups of Cardiorespiratory Endurance Activities.

Weight Loss Surgery Extras

30 Days - 30 Ways handout                                January's book was Michael Pollan's "Food Rules"

New Diet Do's and Don't's

Smoothie Recipes

Vitamins and Minerals