Reza Keshavarzi, MD, FACS, FASMBS

Hi Clementine,

Thank you for your thoughtful question — and congratulations on taking such an important step toward your health with your recent vertical sleeve gastrectomy (VSG)!

You’re right that post-operative diet plans can vary a lot from surgeon to surgeon. The reason for the difference is that not all programs are built the same — and not all surgeons have the same training, experience, or philosophy when it comes to patient care and recovery.

In my practice, I’ve spent years developing a very specific and carefully designed diet protocol for my patients, based on my advanced fellowship training in bariatric surgery, my background in culinary arts and nutrition during my undergraduate years, and my hands-on experience caring for thousands of patients. My approach is both cautious and progressive because I want to give my patients the safest healing process and set them up for long-term success — not just short-term recovery.

I can’t speak for what other doctors do, but I base everything I recommend on the best available medical evidence, my surgical training, and my real-world experience seeing what helps patients truly thrive after surgery. My patients consistently do very well because the plan is structured, clear, and tailored for true healing.

As for your concern: eating puréed foods too early could potentially stress the newly healing stomach, which is still swollen and sensitive after surgery. That’s why some programs — like mine — are more conservative early on, focusing on clear liquids and then slowly advancing to full liquids and eventually purées. Giving the stomach the proper time to heal lowers the risk of complications like leaks, strictures, or prolonged inflammation.

I know this phase can feel frustrating, but it’s temporary — and protecting your healing now sets you up for amazing long-term results.

Hang in there — you're doing great, and asking these questions shows you are taking your recovery seriously!

Wishing you strength and a smooth journey ahead,
Dr. Keshavarzi

Hi Vertedo,

Thank you for your great question — it’s very smart to be thinking ahead as you prepare for your vertical sleeve gastrectomy (VSG), also known as gastric sleeve surgery.

Yes, it’s true that the chance of developing gallstones after gastric sleeve surgery can increase, especially during the period of rapid weight loss. In our practice, we see about 5% of patients develop gallbladder issues after surgery. This happens because rapid weight loss can cause changes in the bile, making it easier for stones to form.

The good news is that when gallbladder problems do occur, they are typically very easy to resolve, often with a simple outpatient gallbladder removal surgery.

If you are concerned about gallstones, you may request a medication called Ursodiol, and we can have a conversation together to see if it’s a good fit for you and your concerns. Ursodiol can be very effective in helping prevent gallstone formation during the rapid weight loss phase.

Most importantly, the health benefits of gastric sleeve surgery — including improved heart health, better blood sugar control, reduced joint pain, and increased energy — far outweigh the small potential risk of developing gallbladder issues. You are making a powerful investment in your long-term health.

Wishing you the very best as you move forward — you’re taking a truly exciting step!

Dr. Keshavarzi

Hi Myrna867,

Thank you for your question and for sharing a bit of your journey — you’ve clearly been through a lot, and it’s inspiring to see you taking steps toward better health.

The good news is that a gastric sleeve procedure is often an option for patients with a history of breast cancer, especially if you have been in remission and are not currently undergoing active cancer treatment. Generally, most bariatric programs — including ours at Miami VIP Surgery — like to see that patients are at least one to two years out from completing active cancer therapy before considering surgery. Since your last chemotherapy ended in early 2018, and you completed Herceptin by late 2018, you are well beyond that window.

You do not have to wait five years to be eligible for surgery in most cases. However, we do usually require a clearance letter from your oncologist stating that you are in remission and that they feel you are medically stable for elective surgery. This is part of ensuring your safety and the best possible outcome.

At Miami VIP Surgery, we work closely with your other healthcare providers to create a safe, personalized plan for your weight loss journey. If you’d like to learn more about our program or take the next steps, feel free to visit us.

You’ve already shown incredible strength — and I’m excited for all the good that’s ahead for you.

Wishing you health and happiness,

Dr. Keshavarzi

Hi Gregarious460892,

Thank you for reaching out and sharing your story. It’s clear you’ve been through a lot, and I want to first acknowledge your strength in seeking answers and pushing forward with your health journey.

After bariatric surgery, such as a gastric sleeve or gastric bypass, medication absorption does change. Because the anatomy of the digestive system is altered, certain medications may absorb differently — sometimes more slowly, sometimes less predictably. This can mean that some people need dosage adjustments after surgery, and in some cases, medications may actually work better once inflammation decreases, weight is lost, and overall metabolism improves.

For conditions like depression and anxiety, many patients do find that after weight loss surgery, improved sleep, reduced inflammation, and positive changes in energy levels and self-esteem can help support better mental health outcomes. However, it’s important to work closely with your psychiatrist and surgical team after surgery to monitor how your medications are working and adjust them as needed.

At Miami VIP Surgery, we specialize in personalized care before and after gastric sleeve and gastric bypass procedures. We’re proud to offer comprehensive coaching and support throughout your journey. If you’d like to learn more about what to expect after surgery, feel free to visit our website.

Please know you’re not alone in this. Many people with Crohn's disease, depression, and anxiety have gone on to feel significantly better after surgery — physically and mentally. It can be the start of a powerful new chapter. We’re rooting for you every step of the way.

Wishing you strength and healing ahead,

Dr. Keshavarzi

100% ghrelin removal isn't possible. Ghrelin (the hunger hormone) is made in several parts of the body, not just the stomach. A sleeve gastrectomy does lower ghrelin levels significantly, but complete removal cannot be achieved through surgery.

80–90% stomach removal is typical in a first-time sleeve gastrectomy. If your original surgery removed only about 65% of your stomach, a re-sleeve could potentially remove more. However, the benefits must be weighed carefully against the risks — especially with a BMI as low as 25.

Important to know:
Since your BMI is already in a normal range, and you have other health factors like an autoimmune condition, a second surgery might not be the best choice. It’s important to have a full evaluation with a bariatric specialist to explore whether a re-sleeve is necessary or if non-surgical options would be safer and more effective.