Gastric Sleeve Surgery: Understanding the Procedure

Gastric Sleeve Surgery

What is Gastric Sleeve Surgery?

Gastric sleeve surgery, also known as sleeve gastrectomy, is a weight loss surgery that has gained significant attention and popularity in the past few years. This procedure involves reducing the size of the stomach, thus limiting food intake and promoting a feeling of fullness with less consumption. But it's not just about size reduction; the operation also targets the "hunger hormone" ghrelin, typically produced in the part of the stomach removed during surgery, which contributes to diminished appetite post-procedure.

The Procedure: A Step-by-step Look

While it may sound daunting, gastric sleeve surgery is a straightforward process in the hands of skilled bariatric surgeons.

  1. Anesthesia and Preparation: The operation is performed under general anesthesia, which means you'll be asleep and won't feel a thing during surgery.

  2. Creating Access: The surgeon makes small incisions in the abdomen to insert a laparoscope – a tool with a camera that sends images to a monitor for a clear view of the stomach.

  3. Stomach Reduction: Around 75-80% of the stomach is removed, leaving a thin vertical "sleeve" about the size of a banana.

  4. Final Checks and Closure: The surgeon checks for leaks and then closes the incisions.

The entire procedure typically takes between one to two hours.

Gastric Sleeve Surgery Statistics

Understanding the data around gastric sleeve surgery can provide a clearer picture of the procedure's effectiveness and popularity. As of 2023, gastric sleeve surgery is one of the most common types of bariatric surgeries. Here are a few key statistics:

  • Success Rate: Studies reveal that patients typically lose 60% of their excess weight within the first year to 18 months post-surgery.

  • Popularity: Gastric sleeve procedures constitute around 60% of all bariatric surgeries, surpassing gastric bypass surgery in terms of popularity.

  • Complication Rates: Major complications are relatively rare, occurring in roughly 2-5% of patients.

Am I a Candidate for Gastric Sleeve Surgery?

Gastric Sleeve Surgery is typically recommended for people with severe obesity, especially those with a body mass index (BMI) over 35 or between 30 and 35 with a health condition such as sleep apnea, high blood pressure, heart disease, or type 2 diabetes. Candidates should also have tried and failed to lose weight through traditional methods such as diet and exercise. People looking into this procedure should also be committed to making lifestyle changes and following a strict post-surgery diet and exercise plan.
gastric sleeve surgery procedure image

The Road to Recovery + Risks and Benefits

The Approval Process and Preparing for Surgery

The approval process for gastric sleeve surgery can vary depending on factors such as insurance coverage and the requirements of the bariatric surgery program. Generally, it involves completing preoperative testing and evaluations, attending informational sessions, and meeting with a nutritionist or mental health professional. In some cases, the approval process can take several months.

The approval process may also involve working with an insurance company to determine coverage and out-of-pocket costs. It's important to work closely with your doctor and bariatric surgery program to ensure that you are completely prepared for the surgery and to understand the approval process timeline.

Preparing for Gastric Sleeve Surgery

Before having gastric sleeve surgery, you'll need to enroll in a bariatric surgery education program to help you get ready for surgery and life after surgery. This program may include nutritional counseling, a psychological evaluation, physical exams and tests, blood tests, and imaging studies of your stomach or an upper endoscopy. If you smoke, you will need to stop several months before surgery, and your surgeon may ask you to lose some weight before surgery to make your liver smaller and the surgery safer.

In the days before surgery, you'll need to stop taking aspirin, ibuprofen, and other blood-thinning medicines. You should not eat or drink anything after midnight before surgery.

What to Expect Post-Procedure

Your journey doesn't end when you leave the operating room; recovery is a huge part of the process, and understanding what to expect can make the transition smoother.

  1. Hospital Stay: Post-surgery, you'll typically stay in the hospital for one to two days for observation.

  2. Dietary Changes: A phased gastric sleeve food diet is introduced, starting with clear liquids, progressing to full liquids and pureed food, then soft foods, and eventually, after several weeks, to regular food. These stages help your "new stomach" adjust gradually.

  3. Physical Activity: Light activity, like walking, is encouraged soon after surgery, but strenuous activity should be avoided for around four to six weeks.

  4. Follow-Up Visits: Regular follow-up visits will be scheduled with your bariatric team to monitor your progress and address any concerns.

Remember, everyone's recovery journey is unique; some might bounce back quicker, while others may need a little extra time.

Risks and Complications

Complications, Risks, and Side Effects from gastric sleeve surgery

While gastric sleeve surgery has a high success rate, like any surgical procedure, it isn't without potential risks and complications. Common risks include:

  • Nutrient deficiencies: Due to reduced food intake and alterations in digestion, some patients may struggle with nutrient deficiencies, particularly of vitamins and minerals. This is because the operation alters the structure of the digestive system, potentially impacting nutrient absorption. Deficiencies can lead to various health problems if not properly managed, including anemia, osteoporosis, and neurological issues. Post-surgery, patients are usually advised to take a daily bariatric multivitamin and additional supplements as needed, such as iron, calcium, vitamin B12, and others, to ensure they get the nutrients they need.

  • Gastroesophageal reflux disease (GERD): Some patients may experience increased heartburn or GERD. This is because the surgery changes the stomach's size and shape, which can potentially affect how food and stomach acid travel through the digestive tract, leading to an increase in acid reflux symptoms. GERD can usually be managed with medications and dietary changes, but in severe cases, additional surgery may be necessary.

  • Leakage: There's a small risk of leakage from the area where the stomach is stapled. This occurs when the newly created stomach sleeve leaks fluid into the abdominal cavity, which can lead to infection or abscess. If leakage occurs, it is considered a serious complication and needs immediate medical attention. Symptoms can include rapid heart rate, fever, abdominal pain, and shortness of breath. Fortunately, with advances in surgical techniques, the risk of leakage is relatively low, but it's essential to be aware of the signs.

Other potential risks and complications can include nausea and vomiting (often due to eating too quickly or too much), gallstones, and surgical complications like bleeding or infection. In rare cases, a second surgery (revision surgery) may be necessary to correct complications.

Benefits Beyond Weight Loss

Gastric sleeve surgery is about more than just shedding excess pounds; it's about enhancing overall health and quality of life. Here are some notable benefits:

  • Improvement in comorbid conditions: Many patients experience significant improvements in obesity-related conditions such as type 2 diabetes, hypertension, and sleep apnea post-surgery.

  • Boost in self-esteem and quality of life: The weight loss often results in increased confidence, better mobility, and an overall improved sense of well-being.

  • Appetite and craving control: By removing the portion of the stomach that produces hunger-inducing hormones, patients often find their appetite and cravings easier to manage.


It's important to remember that gastric sleeve surgery is just one tool in the weight-loss journey, and the sleeve may widen (dilate) over time. This will allow you to eat more, but if you eat too much, you may regain weight. Joining a weight-loss surgery support group can help you stick with your new eating habits and maintain long-term weight loss.

If you are considering gastric sleeve surgery, it can be helpful to hear from others who have undergone the procedure. Here's a personal perspective on the physical and emotional journey from one of our friends: 5 Years Post-Op Gastric Sleeve: This is My Story

Frequently Asked Questions

How much weight can I expect to lose after gastric sleeve surgery?

Typically, patients lose about 60% of their excess weight within the first 18 months post-surgery. However, weight loss varies between individuals and depends on factors such as diet, physical activity, and commitment to lifestyle changes post-surgery.

Will I experience a lot of pain after surgery?

While some discomfort is expected after any surgical procedure, pain levels can vary from person to person. Most patients report that pain is manageable with medication.

How long will I have to stay in the hospital after the surgery?

Most patients stay in the hospital for one to two days post-surgery. 

Will I need to take vitamins and supplements after the surgery?

Yes, due to altered food intake and digestion post-surgery, you will likely need to take vitamins and supplements to prevent nutrient deficiencies.

Can I get pregnant after gastric sleeve surgery?

Yes, you can get pregnant after having gastric sleeve surgery. However, it's generally recommended to wait at least 18 months post-surgery before becoming pregnant. This waiting period allows your body to stabilize post-weight loss, and for you to adjust to your new lifestyle and eating habits.

Author: Allison

Allison, a certified nutritionist and research author, brings over 15 years of experience in the health and weight loss industry. Allison's influence extends through her authorship of multiple health and wellness journals, where she shares her expertise and research on medical weight loss and bariatric medicine.

Reviewed By: Dr. K. Huffman

Dr. Kevin D. Huffman, D.O., is a board-certified bariatric physician renowned for his expertise in treating obesity. With over 10,000 patients and a reputation as a national leader in bariatric medicine, he has trained hundreds of healthcare providers. As the founder of American Bariatric Consultants, Dr. Huffman develops protocols and training materials sought after by medical societies, pharmaceutical companies, patients, and hospitals.