Procedure-SleeveGastrectomy

Procedure definition

A sleeve gastrectomy—also called a gastric sleeve—is a minimally invasive weight-loss surgery that removes roughly 75–80% of the stomach, leaving behind a slender, tube-shaped “sleeve.” This limits the amount of food you can eat and changes hunger hormones, leading to lasting weight reduction.

Surgeons perform the operation laparoscopically through 4–5 small incisions. Using a camera and surgical stapler, they divide and seal the stomach vertically, creating a narrow pouch while leaving the intestines untouched. The surgery typically takes 60–90 minutes.

The sleeve works through two mechanisms: (1) Restriction—the smaller stomach holds less food, and (2) Hormonal effect—removal of the upper portion of the stomach reduces levels of ghrelin, the hormone that triggers hunger.

Because the intestines remain intact, the sleeve avoids some nutritional issues seen in older bypass operations and is now the most common bariatric procedure worldwide.

Why it’s done

A sleeve gastrectomy is designed for people struggling with severe obesity (BMI ≥40, or ≥35 with obesity-related conditions such as type 2 diabetes, sleep apnea, or high blood pressure) who have not succeeded with diet, exercise, or medications.

It’s also used as a first-stage operation for very high-BMI patients before more complex procedures or as a standalone procedure when appropriate.

Weight loss after surgery averages 50–70% of excess body weight within 1–2 years. Many patients experience significant improvements or remission of diabetes, high cholesterol, sleep apnea, and joint pain. Long-term studies show improved life expectancy and quality of life when performed in accredited bariatric centers.

Risks & complications

Sleeve gastrectomy is a major operation, but when performed in high-volume centers, it’s very safe.

Overall major complication rate: 3–6%.
Mortality: ~0.1% (1 in 1,000), comparable to gallbladder surgery.

Specific risks include:
• Staple line leak: 0.3–2%.
• Bleeding: 1–2%.
• Stricture/narrowing: <1–2%.
• Infection or abscess: <1%.
• Venous blood clots (VTE): 0.2–0.5%.
• GERD (acid reflux): new or worsened symptoms in 10–30%.
• Nutritional deficiencies (iron, B12, folate): <5–10%, manageable with supplements.

Complication rates drop substantially when patients undergo careful preoperative screening and postoperative follow-up with a multidisciplinary bariatric team.

Recovery

Hospital stay: 1–2 nights for most patients; sometimes same-day discharge in select centers.

Pain & mobility: Mild to moderate soreness controlled with oral medications. Walking begins the same day to prevent clots.

Diet: A strict progression helps the new stomach heal safely:
• Days 1–14: clear liquids and protein shakes.
• Weeks 3–4: pureed or soft foods.
• Weeks 5–6: gradual reintroduction of solid foods.
Patients must sip fluids slowly to avoid nausea and dehydration.

Activity: Light work in 1–2 weeks; full activity in 4–6 weeks. Exercise is essential for maintaining long-term weight loss.

Follow-up: Lifelong vitamin supplementation (multivitamin with B12, calcium, vitamin D, iron). Regular visits with your surgical team and dietitian ensure healthy weight loss and monitor labs.

Surgeon types

Bariatric or Metabolic Surgeons perform this operation, usually at MBSAQIP-accredited (Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program) centers. These teams include dietitians, psychologists, and physical therapists for comprehensive care. Outcomes and safety are significantly better at accredited, high-volume hospitals.

Citations

1. American Society for Metabolic & Bariatric Surgery (ASMBS): “Sleeve Gastrectomy—Procedure and Outcomes.”
2. NIH MedlinePlus: “Bariatric Surgery.”
3. JAMA Surgery (2021): National readmission rate <5%; leak rate 0.6%.
4. Annals of Surgery (2020): Five-year weight-loss and diabetes remission data.
5. ASMBS Clinical Guidelines (2022): Safety and nutritional monitoring recommendations.