Post Surgery Gastric Sleeve Diet Tips


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Pinwheel flaps for cancers on scalp

Besides lap bands, sleeve gastrectomy, gastric bypass and other forms of weight loss surgery, Dr. Ken Wong also performs a lot of skin cancer surgery. The photos below show an elderly man who had a large skin cancer on the top of his scalp. This was cut out and skin was rotated like a Swastika to cover the defect. Flaps always give better results than skin grafts.

About a million stitches were put in!

The next photo show how it looks 4 weeks later after stitches have been taken out.

You can imagine how shocked his hairdresser was.

Finally, a photo at 6 months later, showing the chrome dome back to all its shiny glory.

As you can see, there are no dents, divets and funny coloured skin from the flap as you would expect from skin grafting.

These cases are an interesting diversion from sleeve gastrectomies, lap bands, gastric bypass and other abdominal surgeries which form a major portion of Dr. Ken Wong’s practice.

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Top Reasons to Take GORD Seriously

Gastro-esophageal reflux disease (GORD)

GORD (also known as GERD) is a condition of the gastro-intestinal system which affects up to 1 in 5 people in the Western world. It refers to a constellation of problems which people experience such as the burning sensations just under the ribs, acid taste in mouth, chest pain, regurgitation of food in the mouth and coughing / wheezing. It can affect anyone of any age: from infants to elderly. Men and women are equally affected.

Weight Loss and Exercise

Generally, when food is digested, acid is produced in the stomach. This acid with the digested food, proceeds downstream into the bowels.

However, in people afflicted with GORD, this acid does not go downstream. Instead, refluxes back upstream through the gullet/esophagus towards the lungs and mouth thereby causing the various symptoms of GORD.

5 Symptoms of GORD

June is National GORD Awareness Month

This is thought to be related to a weak, malfunctioning muscle at the top of the stomach – called the esopahgeal sphincter – which usually prevents the upstream passage of the acid.

Risk factors

The risk factors for GORD include obesity, asthma, autoimmune conditions, Western populations, presence of a hiatus hernia and after weight loss surgery, especially sleeve gastrectomy.

Why take GORD seriously?

Whilst most people are mildly troubled by GORD, there can be serious consequences of prolonged GORD.

Prolonged exposure of the esophagus to acid can lead to a pre-cancerous condition called Barrett’s esophagitis, which if unchecked or undetected ed, can progress to full blown cancer of the esophagus. Furthermore, long term acid exposures can lead to narrowing of the esophagus which can require repeated surgeries to correct.

How to diagnose GORD?

GORD is often diagnosed with taking a history from the patient. They will often tell you that various foods and eating positions will make it worse. To confirm the diagnosis, the doctors can perform various investigations, including endoscopy (camera down the mouth into the stomach) to look for acid related changes in the lining of the esophagus and various measurements of acid levels in the esophagus and stomach.

Treatment for GORD

GORD can be treated by various means.  Firstly, lifestyle and dietary modifications are advised. Sufferers often feel better if they avoid certain foods, lose weight and stop smoking. Often if they eat earlier before they sleep, they may experience less symptoms. Medications are commonly used to treat GORD. These medications act to neutralise stomach acid or to minimise the production of stomach acid. Finally, if during various investigations, anatomical anomaly of the stomach and esopahagus is found, then surgery may be useful.

This is often the case if we find that the stomach is sitting up in the chest (hiatus hernia) , then surgery may be useful to help correct the hiatus hernia by bringing the stomach back down to its rightful position in the abdomen and GORD symptoms may be improved.

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Weight gain after gastric sleeve surgery




A common scenario: 39-year-old woman is obese. She had gastric sleeve surgery about three years ago. She has regained most of her weight from before surgery. She no longer feels full and all her hunger cravings have returned. What to do?

Team of Weight loss surgeonsThis is a problem that our clinic sees a lot. Everyone regains weight over time after gastric sleeve surgery. Some regain a little. Some a lot.

Firstly, we must address the diet and exercise. Is the person eating more than 1200 calories a day? Usually this is the main problem.

Secondly how big is the stomach now. Has the stomach stretched back to normal size. We can investigate this by means of barium meal xray and a gastroscopy.

If the stomach has stretched, the patient may be suitable for re-sleeving. This is done in a similar fashion to the original gastric sleeve. Reflux may be worsened and there is a higher gastric staple line leak rate from revisional surgery.

If the stomach has not stretched , then revisional surgery will mean a gastric bypass. This is not a friendly operation to live and can carry permanent short and long term effects. Many patients will need further operations.

Before committing to revisional surgery, it is best to talk to an experienced bariatric surgeon about all the risks and side effects. Again, even with further surgery, weight may not stay off if a strict diet and exercise program is not adhered to.

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Pinwheel flaps and scalp skin cancer – part two

This photo shows the flap being constructed and sewn together with nylon stitches.


Six weeks after the operation, there is some non-healing at the confluence of the flaps, causing a lot of consternation to the patient.

Ten weeks after the operation. The patient has shaved some hair to facilitate wound care.

Finally about four months after the operation, a good result for the pinwheel flap.

With any wounds there can be delayed healing. But a good cosmetic result was accomplished in the end.

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