Gastric Sleeve Surgery: Overview

Weight loss surgery, illustration

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In This Article

Gastric sleeve surgery—also known as sleeve gastrectomy—is a type of bariatric (weight loss) surgery, just like gastric bypass surgery. The gastric sleeve surgery involves reducing the size of your stomach, so you feel full after eating only a small amount of food. While this operation is an effective means of losing weight, it's not a permanent solution. Patients must be willing and able to commit to lifelong healthy eating and exercise habits.

According to the American Society for Metabolic and Bariatric Surgery, gastric sleeve surgery is the most commonly performed bariatric procedure in the United States.

What Is Gastric Sleeve Surgery?

Gastric sleeve surgery is performed by a bariatric surgeon in a hospital or surgical center under general anesthesia. This scheduled, one to two-hour surgery may be performed in adults as well as adolescents.

With gastric sleeve surgery, the surgeon removes about 80% of the stomach in order to create a smaller stomach. The new stomach is tubular in shape and about the size of a banana. With a much smaller stomach, patients feel full for several hours after eating just a little amount of food.

Besides making a smaller stomach, gastric sleeve surgery removes the stomach cells that normally produce the hunger hormone ghrelin. With this decrease in hormone production, patients often experience a decrease in appetite, which can further contribute to weight loss.

Various Surgical Techniques

The gastric sleeve procedure is usually done laparoscopically, using minimally invasive techniques. Less commonly, the surgery is open, which means that the surgeon makes a large incision in the patient's abdomen to access the stomach.

When compared to gastric bypass surgery (another popular type of weight loss surgery), gastric sleeve surgery is associated with lower risks and is technically easier to perform. Gastric sleeve surgery is also not considered as extreme by patients, as it's only a restrictive procedure and does not involve reducing nutrient absorption in the small intestines.

Criteria and Contraindications

The indications for undergoing weight loss surgery, including gastric sleeve surgery, are patients with:

Interesting Aside

Due to a higher prevalence of abdominal obesity, weight loss surgery may also be considered for Asian patients with uncontrolled type 2 diabetes and a BMI as low as 27.5.

Absolute contraindication to undergoing gastric sleeve surgery include patients who:

Relative contraindications to undergoing gastric sleeve surgery include patients with Barrett's esophagus, gastroesophageal reflux disease (GERD), and a large hiatal hernia.

Potential Risks

While the gastric sleeve is less risky than other bariatric surgeries, there are potential side effects and complications that can happen in the days or even years after surgery.

In addition to the known risks of anesthesia, and the general risks of surgery, gastric sleeve surgery is associated with these specific risks:

  • Bleeding, usually of the staple line (where the stomach has been divided)
  • Stricture formation (a narrowing) within the new tubular stomach that can make it difficult for food and fluids to pass through
  • Gastric leak—when stomach contents leak into the abdominal cavity
  • An abdominal abscess (collection of pus)
  • Wound infection
  • Nutritional deficiency due to a decrease in food consumed
  • Gastroesophageal reflux disease (GERD)

Purpose of Gastric Sleeve Surgery

The purpose of gastric sleeve surgery is weight loss—in addition to reversing or improving health conditions that may be associated with obesity.

Examples of obesity-related conditions include:

How to Prepare

After making the decision to move forward with gastric sleeve surgery, your surgical team will set you up for a psychological evaluation. This is to ensure that you are mentally ready to undergo a surgery that will ultimately require major lifestyle changes.

In order to receive insurance coverage, you may also have to participate in a bariatric presurgical lifestyle program starting up to six months before your operation date.

Your surgical team will also provide you with various instructions to help prepare you for your surgery.

These instructions may include:

What to Expect on the Day of Surgery

On the day of your gastric sleeve surgery, you can expect the following steps:

  • Upon arrival at the hospital, you will go to a pre-operative room where you will change into a hospital gown.
  • A nurse will place a small tube (an IV catheter) in a vein in your arm.
  • You will be taken into an operating room and given anesthesia medication to put you to sleep.
  • The surgeon will make at five or six tiny incisions in the abdomen through which a camera and long, thin surgical instruments will be inserted.
  • Using these instruments, the surgeon will remove the majority of the stomach through one of the incisions. This will leave a portion of the stomach that connects the esophagus to the first part of the intestine called the duodenum.
  • The incision line where the stomach was removed will then be closed with staples. The suture line will be carefully checked to make sure that it is not leaking.
  • The surgeon will then remove the instruments, and close the rest of the incision sites with absorbable sutures and sterile tape. 
  • Anesthesia will be stopped, and you will be taken to a recovery room where you will wake up.

Recovery

Once you wake up in the recovery room, it's normal to feel groggy and experience some nausea, vomiting, and pain. Rest assured that a nurse can give you pain and anti-nausea medications to help ease your symptoms.

Usually, after a few hours, you will be moved from the recovery room to a hospital room where you can expect to stay for one to two nights.

In the hospital, you will be closely monitored for complications like bleeding and infection. You will also be encouraged to start walking as soon as possible to avoid developing blood clots in your leg.

Once you are tolerating a clear liquid diet well (which usually begins the morning after surgery), and you have no signs of complications, you will likely be discharged home.

At home, your surgeon will provide you with various instructions to follow.

Some of these instructions may include:

  • Seeing your nutritionist regularly—you will slowly advance your diet over a period of several weeks from liquids to puréed foods to soft foods to solids.
  • Drinking water regularly to stay hydrated.
  • Returning to work one to two weeks after surgery (if involves mild activity)
  • Taking any medications as directed (all medications will need to be crushed, or taken in liquid form for the first two weeks after surgery).
  • Keeping your incision sites clean and dry
  • Avoiding strenuous activity for three to six weeks after surgery .

Long-Term Care

The vast majority of patients lose a significant amount of weight after gastric sleeve surgery. The key is keeping the weight off. Fortunately, research has found that by five years after the surgery, the average patient has lost about 60% of their excess body weight.

Still, gastric sleeve surgery is not a quick fix for losing weight. Patients must strictly adhere to a diet and exercise regimen after surgery.

This regimen includes:

  • Adhering to a healthy diet that is rich in protein, fruits, and vegetables
  • Limiting processed foods, snacks, and desserts
  • Exercising regularly
  • Daily tracking of food intake using an online diary or food journal
  • Taking various vitamins (complete multivitamin, calcium, Vitamin D, iron, Vitamin C, and Vitamin B12).

Keep in mind as well—there are significant emotional issues that can accompany any type of weight loss procedure. For people who use eating as a coping mechanism, finding a new way to adapt and manage stress without food can be challenging.

It's important to find healthy outlets for stress, such as exercise or making quality time for yourself. Open and clear communication with friends and family can also be useful, as can a bariatric support group.

A Word From Verywell

In the end, long term success from gastric sleeve surgery will depend entirely on a person's willingness to create new habits and stop behaviors that lead to obesity. The most successful individuals create a system of accountability in their lives by working closely with friends, relatives, and even professional healthcare providers to maintain good habits from day to day.

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