Gastric sleeve surgery is a weight loss surgical procedure that permanently reduces the size of the stomach. A doctor may recommend it for people with obesity who have not found other weight loss strategies effective.
In gastric sleeve surgery, a surgeon removes about 80% of the stomach. This limits the amount of food an individual can eat and helps them lose weight in the long run.
Although this surgery can help people with obesity, it is a significant procedure that carries risks. Additionally, people can only maintain weight loss by following a sustainable diet and exercise plan.
This article explains how gastric sleeve surgery works and why experts recommend it. It also discusses the long-term changes people need to make for it to be successful.
Gastric sleeve surgery is one of several bariatric surgical procedures performed on people with clinically severe obesity. Doctors consider obesity to be clinically serious if the person has a body mass index (BMI) of 40 or greater. But people with a BMI of 35–39.9 are also eligible if they have at least one serious comorbidity.
Gastric sleeve surgery is the most common form of weight loss in the United States. It accounted for 59.4% of bariatric surgeries in 2019, according to the American Society for Metabolic and Bariatric Surgery (ASMBS).
The procedure permanently reduces the size of the stomach. After surgery, the stomach is about 20% of its original size.
This reduced size limits how much food and fluid a person can take in and helps them feel full faster. It also limits hunger signals over time because it removes the part of the stomach that produces the hunger hormone ghrelin.
A doctor may advise a person to have gastric sleeve surgery if they:
- have a BMI over 40
- have a BMI of 35-40 and an underlying medical condition such as sleep apnea, high blood pressure, or type 2 diabetes
- I have tried other weight loss methods and found them ineffective
Gastric sleeve surgery is an invasive procedure that requires mental and physical preparation. A person must also account for several weeks or months of recovery.
Before the operation
Prior to the procedure, candidates for surgery must enroll in a bariatric surgery training program. This helps them prepare for surgery and may help them lose weight, stop certain medications, and quit smoking if necessary.
Individuals also receive nutritional advice to help them stick to a balanced diet after surgery.
In addition to a psychological evaluation, a doctor will do blood tests, physical exams, and imaging tests of the person’s stomach. They may also do an upper endoscopy to check the gastrointestinal tract for abnormalities.
during the operation
A person needs general anesthesia for the operation. This will put them to sleep so they won’t remember the surgery.
During the procedure, a surgeon performs a laparoscopy by making several small incisions in the abdomen and inserting surgical tools and endoscopes. With these tools, the surgeon isolates the stomach and removes up to 80% of it with surgical staples. This leaves a narrow vertical “sleeve”.
The surgeon removes the rest of the stomach through one of the incisions.
After the operation
Usually people follow a liquid diet for 1-2 weeks. They will gradually introduce purees and then soft foods before finally introducing regular solid foods into the diet.
A medical team will work with the person to provide advice on diet and meal size while the stomach heals.
Meals after surgery are small and patients should focus on chewing their food thoroughly. They may also need to take supplements to ensure they are getting adequate vitamins and minerals as these are harder to obtain from smaller meals.
People may also need regular blood tests to check their iron, blood sugar, calcium, and vitamin D levels. Heartburn medication may sometimes be necessary to reduce stomach acid.
Learn more about nutrition after gastric sleeve surgery.
Gastric bypass is another common bariatric surgery. The stomach is divided into two sections. The smaller part of the stomach becomes the new stomach, and the larger part no longer stores or digests food. This helps people lose weight by reducing hunger, increasing feelings of fullness and reducing hunger hormones.
According to the ASMBS, the procedure is technically more complex than gastric sleeve and results in more vitamin and mineral deficiencies. In addition, recovery after the gastric sleeve procedure is faster and associated with a lower risk of complications. Because of this, it is generally a preferred option.
However, gastric bypass typically results in more significant and faster weight loss.
It can take 4-6 weeks to return to normal activities after weight loss surgery.
But even after a person has healed physically from surgery, they must adhere to certain recovery practices. A doctor or nutritionist will recommend long-term diet and lifestyle changes to maintain healthy weight loss.
Your recommendations may include:
- Diet: People should drink plenty of water, follow solid food return guidelines, and eat small portions. You should also avoid foods high in starches and sugars and opt for foods high in protein to avoid weakness and muscle wasting.
- vitamins: It will be necessary to take vitamin supplements for life. These typically include a multivitamin, vitamin B12, calcium, vitamin D, and iron.
- Exercise: A medical team will recommend daily moderate exercise of about 30 minutes. This can help the body recover faster and sustain weight loss.
- Smoking and alcohol: Doctors advise that people should continue to refrain from smoking after surgery. They will also likely recommend abstaining from alcohol after surgery as it can have serious consequences.
- Pregnancy: In general, women should avoid becoming pregnant 12-18 months after weight loss surgery.
Any weight loss surgery, including gastric sleeve surgery, is major surgery. However, the risks of serious complications and death are relatively rare. Research suggests the mortality rate is nearly 1 in 600.
Other risks and complications can include:
- blood clot: Surgery can increase the risk of blood clots in the lower legs or lungs.
- Infection: Wounds can become infected while healing, causing pain and swelling.
- Leakage: Food or liquid can sometimes leak from the stomach, which can lead to a serious infection.
- Blocked gut: Scars from surgery can cause the bowel to become blocked, causing vomiting and pain.
- malnutrition: A lack of vitamins and minerals can lead to malnutrition.
- Gallstones: Gallstones are common in the first 1–2 years after surgery.
Although weight loss surgery improves mental health in most people, it can have a negative impact on others. According to a 2019 systematic review, there is a small but significant increase in suicide and self-harm following surgery. Possible reasons for this are previously undiagnosed mental illnesses and the stress of an operation.
Because of this, doctors are urging people to undergo a psychiatric evaluation before deciding to have surgery.
In the United States, the average cost of weight loss surgery typically ranges from $17,000 to $26,000. Insurance companies will typically cover most of the cost, but the amount of coverage depends on a person’s plan, so they should contact their insurance provider to verify the details.
Many insurance companies require patients to participate in a weight loss program prior to surgery. This usually takes 2-3 weeks, but for some it can take up to 6 months.
Learn more about Medicare coverage for gastric sleeve surgery.
Gastric sleeve surgery is major weight loss surgery that removes up to 80% of the stomach. It is one of the most common forms of bariatric surgery in the US
Individuals undergoing the procedure must enroll in a program that may include counseling, weight loss, and nutrition education. Recovery can take up to 6 weeks, and sufferers must take certain medications and supplements for life.