[AMA] I Had Weight Loss Surgery (Gastric Sleeve) 1 Month Ago. Ask Me Anything

I’ve recently has a surgery to remove 85% of my stomach. I did this at a private hospital in Sydney in Feb. If you have any questions, let me know, I’ll do my best to answer.


  • +2

    Username checks… (ok, I'll shutup)🤐

    Hope you're feeling better and the recovery journey is going well!

    • +2

      Haha it’s fine, pig doesn’t bother me :)

  • What was your weight before the surgery

    • +3

      Highest weight: 101kg
      Weight before the 2 week pre op diet: 99.7kg
      Weight day of surgery: 95kg
      Weight 1 month after surgery: 87kg
      Goal weight: 60kg

      • +14

        Getting surgery seems a bit extreme if you only weighed 100kg, but I guess it depends on your height. How tall are you? I thought this surgery was only for extremely obese people who weigh 200kg+

        • +1

          I’m 159cm. If you fall into a bmi close to 40+ you are allowed the surgery. It’s up to the surgeon as well.

          • +3

            @PropertyPig: I'm actually not much taller than you at 167cm and I've been that weight before too!
            That was about 15 years ago and it took me about a year of dieting at the time to drop by about 20kgs. I've been able to keep it off for this long. I sometimes look back at my old pictures and still laugh at myself! 🤣

            • +3

              @bobbified: I’m hoping I can look back at my old pictures and laugh too!

              • +4

                @PropertyPig: I'm sure you'll have no issue getting there.
                Surgery is no joke and the fact that you were willing to go through it says just how committed you are to this! Stay focused and look forward to achieving your goal!

                • +1

                  @bobbified: I need to lose about 40kg to be in the healthy BMI range. I'm about 35% of the way there!

      • +6

        Well-done @property pig & congrats on your recent surgery success! I'm coming up on 4yrs now since my own bariatric sleeve, original weight 122kgs down to 82kgs at lowest, 3 months post-op - I'm settled reasonably now at 88kgs.
        I'm hoping your procedure was uncomplicated, and that you continue to make great progress. It is, as you say, quite an ordeal & as you'll know well, there will be extensive follow up of your progress medically for the next 12 mths and beyond.
        I did have several issues, the worst of which was a seriously damaged intercostal nerve T10, during an enlargement of one of the small incisions used to perform the keyhole surgery. The pain from this has been intense & remains so - with nerve/neurogenic pain always being very difficult to treat, and largely unresponsive to even very strong pain medication. I mention these issues for others who may read your thread, not specifically to put them off, but to consider it for what it is, ie a very major and irreversible procedure, that can have complications.
        I still have no regrets, and have undergone surgery to cauterise/burn away the T10 nerve, but it was unsuccessful & has only amplified the pain. I am now awaiting a repeat of this surgery, to more extensively destroy this nerve & get some relief.
        Otherwise, and you may have mentioned this within the thread & my not seeing it…be mindful, if you are yet to experience what's known as 'dumping syndrome' - it will be brought on by drinking too soon after eating, and it can be a small snack, not necessarily a meal portion that does it. In brief, not allowing at least 30 minutes after the end of eating before drinking fluids, will result in feeling very unwell, nauseous & have the urgent need to lay down. The fluid has a flush through effect on the food within the stomach/sleeve, which causes the blood pressure to fall abruptly. Even as having been a Clinical Specialist Nurse of many years standing, and well aware of post-gastrectomy syndrome, aka dumping syndrome, didn't help me as I occasionally still forget & suffer the consequences.
        The dumping syndrome can also occur if persisting with eating when the sleeve/stomach is already at capacity, and aside from the mentioned stretching of the sleeve being a real possibility the awful feeling it brings on is definitely to be avoided.
        Although I don't drink alcohol, and haven't for some years, it's very cautionary to state the importance of minimising or stopping drinking….for calorific reasons alone post procedure…but also as alcohol (& most drugs) are exclusively absorbed by the stomach, your ability to metabolise the alcohol is greatly reduced, and taking that side of things more gently is the very least one should do.
        I'm sure, too, that you'll also make mention, if not already done, the immense vitamin & mineral regime we need to follow for the rest of our days.
        I won't go on too much here, I wanted to respond as it's such a great thread you've created on a topic that many will find fascinating and, quite possibly, relevant to their own thoughts of pursuing bariatric surgery.
        I will add to conclude, that my own reasons were life saving - as a diabetic since age 40 (I'm now almost 66) my weight ballooned due to my being in full insulin resistance. On 3 separate insulins twice a day, and taking care what I ate, I was heading toward the mortuary slab. The diabetes centre put my name forward as an urgent candidate for the surgery through the public system - at that time, this represented just 11% of bariatric surgeries annually, the vast majority were done privately.
        I would like to also finish by saying should there be anything at all you might like to ask me, since you're so early into your post bariatric journey, I would be only too happy to help you. I do have extensive medical knowledge additional to being a fellow sleeve recipient.
        Thank you for creating such an important thread that has already found a very eager & plentiful audience.🙂👍🏻❤

  • Why 85%? Seems excessive🤷🏽‍♂️

    • +3

      With gastric sleeve, that’s just how much they cut out. They remove that part and staple it up and you get a new small stomach.

  • We’re you the fat guy dancing on the man shake commercial?

    • +4

      Nah I’m a women. I don’t remember dancing for a commercial.

  • Did you get the take the removed stomach home?

    • +4

      Unfortunately no, I did not. It would have looked great in a jar on the mantle, but I was completely unconscious when they did it so couldn’t ask for it.

      • I think they threw mine to some eagerly awaiting local dogs!! 😀

    • With MS Paint illustration?

  • +1

    Hows your appetite nowadays? What meal portion size do you eat now VS before surgery ?

    • +3

      My appetite is very small. I can probably eat about half a cup of soft food at maximum. I can only sip water.

      • Do your eyes salivate for your mouth now? I would miss all carbs and meat.

        • +1

          It’s hard going out and watching people eat. But I take a few bites and I’m full. Cravings still exist but are easily satisfied with a minuscule amount. We’re saving so much money on food!

  • +1

    What led you to decide on surgery?

    I'm sure you had a journey with battling your weight. What do you think prevented you from losing it and keeping it off with diet and exercise?

    • +1

      I had been battling with my weight for over 15 years. Tried a lot of different things. I did a whole year of gym and PT twice a week. I got vegan meals delivered. I barely lost anything (I did get stronger!) I was insulin resistant and with my mum and her mum both type 2 diabetic I decided that I didn’t want to be like this anymore or risk getting diabetes. My wife and I are expecting our baby in 7 weeks and I wanted to make sure I was fit and healthy to look after them.

      • +4

        Well you couldn't have asked for a better reason to make the change. Congratulations on the baby!

        What dietary changes did you attempt beforehand? Other than the vegan meals (I have those as well, but they either have the same or more calories than the non-vegan options). What method of calorie restriction did you employ?

        Exercise is fantastic, however the tendency is for people to increase their intake when they increase their activity. Prepared and delivered meals can make your time go further and help keep you on track, but like I said, aren't a promise that you are eating less than you are using. You mentioned willpower in another comment, how much do you think this let you down?

        Needing help (whether it is from a friend, a dietician, or surgeon) shouldn't be looked down upon, so my motivation in asking these questions is to learn about your experiences in a non-judgemental way. Hopefully make asking for help more welcoming, and maybe even challenge my own perspectives. I am hoping that intent is coming across.

        • +6

          I have tried calorie deficit, keto, vegan, mediterranean diet. Tracking in myfitnesspal, gym with a PT, joined a local soccer team. These things probably would work if I kept doing them and and finally broke through the willpower barrier and made it all a habit. After 15 years of trying, I decided to have the surgery. I was tired of being the fat one, and never feeling happy in my clothes, or being able to walk up stairs without puffing. Having to take a bunch of different medications and struggling with mental health.

          Its cool, I did the AMA because I figured other people want to know about it. It seems like "the easy way" but it comes with its own challenges. I HAVE to change my lifestyle now because i have been through this surgery and you can still put on weight if you stretch your new stomach.

          • @PropertyPig: I've read a lot of what you've been saying and will admit to being skeptical about anyone who says "I've tried everything".

            I myself lost 24Kg (93 down to 69) just after I turned 30 because I couldn't believe how I went from a slim and reasonably muscly guy to flab central in only 8 years. Well thinking back it was easy - I used to play a couple of hours of basketball a day and Tae Kwon Do 3 nights a week then stopped doing those and got an office job, but never adjusted what I used to eat PLUS the natural slowing of metabolism due to age.

            It was hard work. Really hard work. I used to do quite high intensity Aerobic work out every day for 1-2 hours and I started eating normal portions and watching my kj intake.

            It took a good couple of years to get it down and stabilised.

            These days I work out up to an hour on weekdays and do Karate 3 times a week, and eat normal portions and keep the kj low during the weekdays.

            On the weekends I let loose and do whatever I want.

            My weight has stabilized now. It is usually 75-76 during the week, then temporarliy can blow up to 77-78 on weekends or when I'm on holiday.

            So yeah maintaining is a lot easier then losing. being strict on yourself during the week but giving yourself weekends off works for me to keep the weight off.

            Getting back to your point though - I truly DO believe weight can be lost naturally in practically all circumstances, but I know from experience it is STUPID hard work, and if you're a busy person and can't make the time I get it.

            So I've upvoted this particular comment because you seem to agree that it is all about willpower and habit, which can be devastatingly hard to break, but at least you've made the steps to live a healthier life as you mention you are now forced to.

            In short - I'm skeptical of anyone who says they can't do it by themselves, but acknowledge if you can't taking this step still takes a lot of courage so I absolutely envy you for that.

            • +1

              @Ramrunner: I agree, its totally possible to do. Lots of people do and they're lives are better. I would consider myself someone who likes to achieve things. I have in pretty much every other aspect of my life. It was just weight loss that I kept failing at. Once we started trying for a kid, I knew that I didn't want to be overweight and unhealthy. I acknowledge that I wasn't going to win on sheer willpower. I wanted to make sure that I would teach my kid how to be healthy. To do that, I needed to do it myself. The surgery was just a tool to force me to do it.

  • +1

    Are you a property investor?

  • +1


    • +2

      Yep tried it. Initially worked for me but saw a stall. I also didn’t have the will power and kept putting it back on.

  • Do you reccomend any particular private insurer? I have heard its best to talk to the surgeon before and see which provider they prefer?
    Also how was your recovery?

    • +3

      I personally went with Ahm, as I was with them already. The waiting period is 12 months. You can talk to a few surgeons, I spoke to 2. Their gap prices differ.

      My recovery is going well. No leaks or complications which I’m very very thankful for. I had to go through the stages of food (liquid only, puréed food, soft food) and it’s getting better.

  • What does a typical day of food/eating look like for you?

    • +2

      A typical day now looks like this:

      Morning: 1 shot of coffee with a splash of protein milk and a small scoop of tasteless protein powder.
      Breakfast: 1 tablespoon of cooked oats, splash of protein milk, 1 pinch of high fibre cereal
      Lunch: Soup of some kind
      Dinner: Last night i had a half cup of cauliflower gratin.
      Dessert: Sometimes I have some plain yogurt with a few berries, or a tablespoon of no sugar jelly.
      Water: about 1.5L a day is all I can manage.

      • Is there worry about dehydration or pressure on kidneys if you don't manage to drink enough water for a period of time?

        • +1

          Yes, dehydration is common right after surgery. They don't release you from hospital if you cant drink 1L of water a day. I know people who have had to go back into emergency as be put on a drip. The problem is, after the surgery, water feels "heavy". A lot of people opt for ice chips, fiji water, protein water or other things to try keep their hydration up. I still struggle with plain water.

      • +1

        Oh wow - that’s genuinely at tiny amount of food. Is it expected that you’ll eat more a bit further down the track? Do you feel mentally hungry or tired?

        Does your wife eat regular amounts of food?

        • +2

          Its a very very small amount. You can eventually eat more but you. have to be careful not to get into bad habits as you will stretch your new stomach by overeating.

          Yes, mentally I struggle with what I wish i could eat vs what I can eat. I do get tired, which is why I need to get as much protein in me as possible.

          She does eat regular food, but right now shes 30 weeks pregnant so she cant eat much without getting full!

          • +2

            @PropertyPig: Exciting times ahead for you both! All the best with your ongoing recovery, weight loss and arrival of the little one.

  • How has it impacted your diet in what you can eat? Things like processed food/sugar vs unprocessed, deep fried food and so forth? In recovery did you have a lot of trouble moving?

    I'm having some of my stomach removed (plus heaps more) so it's good to know other people's experiences.

    • +1

      At the moment I can only have soft foods. But no soft bread. (Sits heavy in stomach).

      It’s hard at the start as you have to eat very slowly. I started with yogurts and puréed food. Most of that was from the supermarket so it’s processed. My partner did make me soup which was from scratch.

      Now we can eat a bit better with unprocessed foods (I had salmon and some sweet potato the other night). I try to avoid deep fried food because it makes me feel nauseous.

      I was walking the day after surgery. They put gas in you to have more visibility during surgery. So you feel super gassy afterwards. Just gotta walk it off! I came home and slept but I could walk up and down stairs and around the house find.

      • That's good to know. So I guess something sweet like chocolate is easy to digest than say an apple? Simply because chocolate is processed?

        I'm not having this due to weight but it'll certainly be like it.

        • +1

          It’s less about the food and more about the texture. Chocolate would go down easier as it would melt and become like liquid. Apple would too if you chewed it enough! I’ve had apple sauce and it’s great.

          • @PropertyPig: Ah that's interesting. Sounds like a nightmare.

            • +2

              @Clear: Yeah it can be. My diet will return to "normal" soon, but with much smaller portions.

  • Can the surgery be reversed once you reach your goal weight and maintain it for some time?

    • +2

      Specifically gastric sleeve cannot be reversed. However your new stomach can stretch. I believe that a gastric bypass can be reversed, but I'm not too sure on that. Some people have issues with losing more than the goal weight, and have to increase their calories.

      • Yes I was wondering how your body will know when it is time to stop losing weight and there could be a danger of not being able to consume enough calories to survive! But obviously there must be a lot of research and data and they wouldn't be doing it if that was likely.

        • +3

          By the time you lose the weight you want it, its usually anywhere between 8 months to 2 years after surgery (depends on how much you had to lose). Your body adapts and then kinda knows when to stop. Losing more than the goal weight is pretty rareI think. But it does happen.

  • Did they tell you that part of the stomach is vital for far soluble vitamin absorption and in 3-5 years, despite taking oral supplements, you will be vitamin deficient?
    They always seem to forget that part, the "2 year" studies look great, there is a reason they don't show you the 10 year data :/

    • +4

      Yes they did. I have a strict vitamin regiment and I take a special bariatric vitamin. I also have ongoing blood tests with my surgeon for the next 5 years to make sure that I am getting the vitamins I need.

  • Male or female?

  • What's recovery been like?

    • +3

      Exciting to see the weight slide off and my body get smaller. Frustrating to not be able to eat normally. Physically I’m recovering really well. It was keyhole so I only had a few small incisions. At the start, eating anything to much or too quickly causes nausea and (a few times for me) vomiting. Have to be careful not to eat foods that aren’t soft as it can cause a leak with the staples in your stomach.

  • Are you sharing this on social media or documenting it

  • Are you noticing any loose skin? Drastic weight loss in a short period of time can cause result in saggy skin.

    • +2

      Yes a bit on my arms. Not too much anywhere else. I’m cleared for the gym next week so doing some strength training should help with the loose skin.

  • Have you noticed any hair loss/thinning? I know someone else who has had the same procedure, and they say they noticed their hair thinning. Can't say I noticed the same, but then I don't look that closely at their hair and they normally have a short hair cut.

    • +2

      I haven’t had any hair loss from the surgery, but I also have alopecia, so i was losing hair before it. So if im losing it from the surgery, I can’t tell. It’s not too bad. Some people lose a lot. Getting enough protein helps with not losing hair.

  • Do you have to pay for it yourself? If so how much is it? Are you happy you did it? Did you have to do a lot to get ready for it? How long after, before you were back and going again? Has your hunger/hunger pains stopped now when you eat less food?
    Thanks for answering all these questions!

    • +6

      Did I have to pay for it myself?

      Yes and no. I have private health insurance which covered the hospital and some of the fees for the surgeon. Surgeons have their own prices so it varies. For me:

      Initial surgeon consult: $200
      Pre op diet shakes: $80
      Blood tests (not covered by Medicare) $60
      Hospital excess: $750
      Anaesthesiologist fee: $1900
      Surgeon fee: $5600 (this includes all follow ups and dietician meetings)
      Vitamins:$60 (6 months worth)

      Am I happy I did it?

      Yes, 100%. There I times I get frustrated but I’m already feeling lighter and better.

      Did I have to do a lot to get ready for it?

      There is a 2 week pre op diet. It’s hard. It 2 weeks of only 3 optifast shakes a day and 2 cups of vegetables. I wrote a lot down about why I was doing this.

      How long til I got going again?

      Day after surgery I was walking up and down the halls to get rid of some of the gas pains. I went home after 2 nights. I took a week off work but I was fine. I work from home so it wasn’t hard to get back to work. I did initially get tired in the day but that’s better now I take protein.

      How are my hunger pangs/pains?

      I barely feel hungry. Sometimes I do if I don’t eat something filling, but then I can eat something small and get full. To give you an idea, I can drink a glass of water over 15 mins and I will feel full. I have to remind myself to eat.

      • +3

        Thanks for all this information, I really appreciate it!

    • +9

      Surgery isn’t an easy decision. It’s also true that people who have gastric sleeve can put weight back on afterwards if they continue eating bad food and stretching their new smaller stomach. But it is hard to do because you cannot overeat without severe heartburn, and vomiting. Along with the surgery I have a dietician, a personal trainer and a therapist all to deal with issues that caused obesity in the first place. It’s still going to take a lot of work, learning how to eat proper food, proper exercise, vitamins for the rest of my life as well as confronting mental/emotional issues that caused overeating. Also, I will never again be able to eat the way I use to. That’s gone and something I have to deal with. Also alcohol is out. So I wouldn’t consider this an easy way.

      • Did you try and just eat less? You have to eat less now and can't have alcohol etc, so why not just do that without the surgery?

        • +3

          I sure did try eat less. I went on a 1200 calorie diet with exercise which was monitored by my GP. I had some serious insulin resistance as well. I don't really care about drinking alcohol so that wasn't a problem for me. I mentioned above that I did try a lot of different things. You can't get the surgery if you haven't tried these things before.

  • +1

    Thanks for doing the AMA
    1) Did you try any weight loss medications before deciding to go with surgery?
    2) What was your diet like pre-surgery?

  • +2

    Yes years ago I did try duromine. Worked great for 2 weeks but I was incredibly jittery and could not sleep. Gave me heart palpitations so I stopped.

    Pre surgery I was on a 2 week optifast diet. The point of it is to shrink your liver so that it’s safe for the surgery to go ahead. It was incredibly hard. It consisted of 3 x optifast shakes a day and 2 cups of vegetables a day. And lots of water. I’m glad that is over.

    • Thanks
      Sorry i meant your usual diet pre surgery.

      Just curious if you feel as though youll miss out on being able to enjoy food post surgery

      • +4

        Ohhh well it was a mixed bag. My partner liked to cook and we did cook a lot from scratch, but I always had big portions. Pasta, rice, noodles, burgers, hot chips etc. I loved savoury stuff, bread, cereals. I can’t have any of that now. Eventually I can reintroduce them in very small amounts but if I’m use to not having them, I may as well continue the fish, veges, lean meats, salad etc.

  • I know of 3 people who have had it done, worked great for 12-18 months, They are now bigger than before.

    You can't outrun (surgery) bad habits or lack of intestinal fortitude. I hope you prove me wrong.

    • I know only one people who did it and she's been doing great after 3-4 years now. She probably was in similar size and shape to OP but she seems to inherit the gene on her mum's family with very similar body shape, her other siblings are skinny but she struggled ever since. But to be fair her mum side seemed to have the bad eating habits that exacerbate the problem (typically aussie diet with passionate hatress for good stuff like seafood and vegetables). She was the only one having the will to break the cycle. I bet if we could get metabolic measurements done like we do our blood pressure then we can tell.
      to OP, wish you all the best. Having surgery is not an easy journey with associated behavioural changes you have to commit to and keep up the will power.

    • +3

      I'm part of a lot of groups full of people who have has this and similar surgeries. Majority of the people have kept the weight off and have changed their lives. There are some people who have gained the weight back. It's unfortunate but it happens. That's why they recommend having not only your dietician and surgeon, but also getting a personal trainer and a psychologist who specialises in weight loss, eating disorders or bariatric surgery.

    • Its good that you've slightly redeemed yourself with this comment…..its never the way to go to make such sweeping assumptions.
      Whilst I'm sure it's true that you know of 3 unsuccessful surgeries, the vast majority will have had great success to varying degrees. Its not, in any way, nor should it be viewed as 'an easy way out'. I often get such attitudes, and always from people who both know nothing of my issues nor those from my having it done.
      There are always multi-factorial reasons, not only for this, but for many medical interventions.
      My own was life-saving, and it's all too easy for people to suggest I had placed myself in the position to ever need the surgery. Simply not so.
      Its also not, in any way, a walk in the park, and does have ongoing responsibilities to keep on the Right pathways.
      Despite extremely careful screening, some candidates invariably slip through the net as not truly good candidates that will go on to do well with this surgery. It's pretty bad luck statistically that you know 3 of these who have sabotaged their 2nd chances at a better future…unless, of course, you know of other reasons for the failure not directly of their own doing.

  • +1

    i don't understand why people have this surgery.

    the purpose of the surgery isn't like liposuction - where you literally lose weight.

    it is basically enforced food intake reduction by removing ~80% of the the stomach.

    if someone sticks to the post op diet - but with out having the surgery - then the results would be the same.

    • +2

      a lot of people lack the willpower to stick to diets, it's why it's such a profitable industry. how many different diets are these days? probably thousands. keto, carnivore, vegan, mediterranean.. the list goes on

    • +7

      You are right. Many people can stick to a diet and they get results. But a lot of those people gain it back. I tried many many times. I thought long and hard about this surgery. For over 2 years. Ultimately I decided to do it and use it as a tool to change my life. It forces you to confront your food choices and change your life. For me, if that was the way to finally get healthy, I was going to do it.

      My GP supported me, and so did my family and friends. I know in the long run it reduces my chances of diabetes, cardiovascular disease, cancers and extends my life. Actually, it improves my quality of life. This is why people have this surgery.

      To me, if someone told me - hey don't smoke and you probably won't get lung cancer. Great, I don't have a problem with smoking, so its easy for me not to smoke. But telling that to someone who smokes a pack a day and has an addiction, it's not that simple. They've probably tried quitting. They know that its causing harm to their body. Its causing issues to their loved ones. They know they have an addiction, they understand what they are doing is not good, but they do it anyway. They have friends or family that are smokers. It's a problem that is a lot deeper than you think. Eventually the person has to make the decision to stop.

      For me I made that decision to stop and change my life, I just used a more drastic tool to do it. It may work, it may not. But it will require a lot of changes in my life to have it be successful. If I reduce my intake of food and I lose weight, thats great, but I have to change what food goes into my mouth now. I have to change my attitude towards eating. I have to move my body more. It'll now be easier as I will be carrying less weight and its less strenuous on my bones.

      This turned into a long reply, sorry. I get what you are saying. Eat less + move more = weight loss. However, there's a whole psychological thing that goes along with it that some people just can't handle until they are forced to.

      • +4

        That is a great way to explain it, with smoking. People who don't have issues with eating (or thyroid problems) can't understand, they think you can just not eat. Just like non-smokers can't understand the pull of cigarettes. You having the gastric sleeve surgery is like if a smoker could get a device implanted that made them vomit when their lips touched a cigarette as well as patches to remove the cravings.

        If it was as easy as just not eating as much, there would be no obese people in the world. Same as there would be no smokers if it was as easy as just not smoking.

        I had been thinking about some kind of surgery but the list of side effects is eye-watering. At the moment I am on weight watchers and down 11kg since December. Have about 50kg to lose altogether. Hopefully that continues and I won't have to do any surgery, but it is great to hear that it is working in case I do!

    • +1

      They have it done as it works very successfully in most cases, when they have tried all of the less invasive things. It is never a first line thing, nor should it be, but it is extremely successful & life transforming if one follows the correct way forward post-operatively.

  • +5

    You made the right decision in getting the surgery. It is life changing. There is little risk from it & very high success in long term weight loss. You've improved your life drastically. Ignore all the haters who say you've taken the easy option, or that they think its wrong somehow - you saw an opportunity to improve your life and you took it - well done!

    • +1

      Thanks so much adam!

  • Is this what James Packer had?

    • +2

      I believe he had gastric bypass which is a different surgery. I had the sleeve. Gastric sleeve cuts the stomach and staples it together to form a smaller stomach. Bypass is a bit more invasive and moves things around so your stomach is bypassed.

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