Gastric Sleeve Surgery (Gastrectomy)

Gastric sleeve surgery, also called sleeve gastrectomy, is a bariatric surgery procedure. It removes a large portion of your stomach, leaving behind a narrow “sleeve.” Reducing your stomach helps restrict calories and reduce hunger signals. This surgery is offered to help people with clinically severe obesity achieve effective weight loss.

What is gastric sleeve surgery? The gastric sleeve, also called sleeve gastrectomy, is a bariatric surgery operation to induce weight loss. It works by reducing the size of your stomach. The word “gastrectomy” means removal of part or all of your stomach. The gastric sleeve operation removes about 80% of your stomach, leaving behind a tubular “sleeve,” about the size and shape of a banana.

What does a gastric sleeve do? Reducing the size of your stomach is a simple way to restrict the amount of food you can eat in one sitting, making you feel fuller faster. But it also serves another purpose: it reduces the amount of hunger hormones that your stomach can produce. This helps to decrease your appetite and cravings and may help to prevent the impulses that cause people to regain the weight they've lost.

How common is gastric sleeve surgery?

The gastric sleeve is the most commonly performed weight loss surgery in the U.S. and worldwide. More than half of bariatric surgeries performed in the U.S. each year are sleeve gastrectomies. The total number of gastric sleeve operations performed each year is about 150,000 in the U.S. and 380,000 worldwide. But, only 1% of people who could benefit and would qualify for the surgery actually get it.

What medical conditions does gastric sleeve surgery help treat?

Gastric sleeve surgery is a surgical treatment for obesity and medical conditions related to obesity. It’s only offered to qualified people who have serious medical conditions related to their obesity or are at high risk for developing them. Gastric sleeve surgery can improve and sometimes eliminate diseases, including:

Insulin resistance and Type 2 diabetes.

Hypertension and hypertensive heart disease.

Hyperlipidemia (high cholesterol) and arterial disease.

Nonalcoholic fatty liver disease and steatohepatitis.

Obesity hypoventilation syndrome and obstructive sleep apnea.

Joint pain and osteoarthritis.

Is the gastric sleeve safe?

The risks of gastric sleeve surgery are far less than the risks of having obesity and its related diseases. It also has lower complication rates than other common operations, including gallbladder removal and hip replacement. Most gastric sleeve procedures are performed by minimally invasive surgical techniques, which means less pain from incisions and faster recovery.

What qualifies you for gastric sleeve surgery?

To qualify, the general requirements are:

That you have severe obesity (class III). This is determined by your BMI (body mass index), which is calculated by your weight and height, and your related health conditions. Class III obesity means a BMI of 40 or higher, or a BMI of at least 35 with at least one related disease.

That you have tried to but not succeeded in losing weight prior to surgery. You may be required to spend three to six months on a medically supervised weight loss plan before your insurance company will approve and cover your surgery.

That you are physically and mentally prepared for the surgery and recovery process. Before qualifying for weight loss surgery, you’ll meet with a team of dietitians, psychologists and other medical specialists for counseling and screening.

What happens before gastric sleeve surgery?

If you’ve passed your health screening and qualify for bariatric sleeve surgery, the next step will be a two-week liquid diet. Your surgeon will give you specific guidelines to follow. The purpose is to lose some of the fat in your abdomen and your liver to make the surgery safer.

You’ll be asked not to eat or drink anything for 12 hours before your operation. That’s to make sure your stomach is empty during the procedure. Having food or liquid left in your stomach during the surgery could cause unpleasant or even dangerous side effects.

How is gastric sleeve surgery performed?

Most of the time, a sleeve gastrectomy is done by laparoscopic or robotic surgery. That means that instead of making a large incision (or cut) to open your abdominal cavity to access your organs, your surgeon will perform the operation through small incisions. This makes for an easier recovery, but some people may be better served by open surgery, depending on their conditions.

What happens during gastric sleeve surgery?

Your surgeon will give you general anesthesia, so you’ll be asleep during the procedure.

Your surgeon will make a small cut in your abdomen (about 1/2 inch long) and insert a port. They’ll pump carbon dioxide gas through the port to expand your abdomen.

Then they’ll place a small lighted video camera (laparoscope) through the port. The camera will project your insides onto a screen.

Through one to three additional incisions, your surgeon will insert additional ports and complete the procedure using long, narrow tools.

They will measure out the gastric sleeve, then divide and separate the remainder of your stomach using a surgical stapler.

Your surgeon will remove the remainder of the stomach, then close your incisions.

How long does gastric sleeve surgery take?

Compared to other weight loss surgery procedures, a sleeve gastrectomy is a relatively short and simple operation. It takes about 60 to 90 minutes. Your surgeon may still want you to stay in the hospital for one to two days afterward. This way, they can help manage your pain and any temporary side effects of surgery, such as nausea.

What happens after gastric sleeve surgery?

You’ll have frequent check-ups with your healthcare provider in the following weeks and months. They’ll monitor your weight loss progress, your related health conditions and any side effects of the surgery. They’ll also want to know if you’re taking good care of yourself and following the necessary lifestyle guidelines to maintain your health and weight loss.

Will I have to follow a diet after gastric sleeve surgery?

In the short term, you will have to follow strict dietary guidelines to make sure your stomach heals well. After a few months, you may begin to eat a more normal diet, but you’ll still have to choose your foods wisely. Because you won’t be able to eat as much as before, you’ll have to make sure that what you do eat is nutritious enough to sustain your energy needs. You’ll begin taking vitamins shortly after surgery and will need to continue taking them permanently.