2025-03-01 · surgical, sleeve-gastrectomy, bariatric
Sleeve Gastrectomy
Overview
Sleeve gastrectomy, often called “the sleeve,” is a bariatric procedure that removes about 70–80% of the stomach, leaving a narrow, tube-shaped stomach. The smaller stomach limits portion sizes and reduces the production of hunger hormones such as ghrelin. Because it does not reroute the intestines, it preserves normal digestion while still supporting significant weight loss. The procedure is now one of the most commonly performed bariatric surgeries worldwide.
How it works
By reducing the stomach’s size, sleeve gastrectomy limits how much food can be eaten at one time. The removal of the stomach fundus also changes hormonal signals, often decreasing appetite and improving satiety. Food follows the same digestive pathway, which makes the sleeve simpler than gastric bypass in terms of anatomy. However, the smaller stomach still requires major lifestyle adjustments and careful nutrition.
Who is a good candidate
The sleeve is often recommended for people with a BMI over 40, or over 35 with obesity-related conditions such as diabetes or sleep apnea. It can be a good choice for patients who want strong weight loss results without the intestinal rerouting of bypass. People with severe reflux may need additional evaluation, as sleeve gastrectomy can worsen GERD in some patients.
Benefits and expected outcomes
Many patients lose 50–70% of excess weight in the first 12–18 months. Improvements in blood pressure, blood sugar, joint pain, and mobility are common. Because the procedure is less complex than bypass, it often has a shorter operative time and lower risk of some complications. Still, long-term success depends on consistent follow-up, nutrition, and activity.
Risks and side effects
Risks include bleeding, infection, and blood clots, which are risks common to most surgeries. Specific risks include leaks along the staple line, new or worsening acid reflux, and nutrient deficiencies due to lower intake. Some people experience nausea or food intolerance if they eat too quickly or do not chew well. Regular lab monitoring helps detect and address deficiencies early.
Life after surgery
The post-operative diet begins with liquids and progresses to pureed foods, soft foods, and eventually small portions of solid foods. Protein and hydration are top priorities, and patients are advised to avoid sugary drinks and carbonated beverages. Vitamins and minerals are typically required for life. Many programs recommend support groups or counseling to help with emotional eating and lifestyle change.
Frequently asked questions
How much of the stomach is removed? Surgeons remove about three-quarters of the stomach, leaving a sleeve-shaped tube. The exact size can vary based on technique and patient anatomy.
Will I still feel hungry? Most people feel significantly less hungry in the months after surgery due to hormonal changes. Hunger can return over time, which is why establishing healthy eating habits is critical.
Is the sleeve reversible? No. Because part of the stomach is removed, the procedure is permanent. Some patients may consider revision if there are complications or inadequate weight loss.
Can the sleeve cause reflux? Yes. Sleeve gastrectomy can worsen or trigger reflux in some people. Your surgical team will evaluate reflux history and discuss whether another procedure may be better.
How long is the hospital stay? Many patients stay one night and go home the next day. Recovery timelines vary, but light activity often resumes within days.
What does a typical meal look like afterward? Meals are small and protein-focused, often 2–4 ounces at a time. Patients eat slowly, chew well, and stop at the first sign of fullness.
Do I need to count calories? Some programs encourage tracking, while others focus on protein goals and portion sizes. The key is consistent, nutrient-dense choices and avoiding grazing.
Will I lose muscle? Muscle loss can occur if protein intake and strength training are inadequate. Your care team can help you build a plan that protects lean mass.
How soon can I return to work? Many people return to desk jobs within two weeks. Jobs with heavy lifting may require four to six weeks of recovery.
What if I stop losing weight too soon? Weight loss plateaus are common. Reviewing meal patterns, hydration, sleep, and activity levels with your care team can help restart progress.
Planning your next steps
Start by clarifying your goals beyond the scale. Think about improvements you want in energy, mobility, labs, or symptoms, and share those priorities with your care team. Review your medical history, current medications, and prior weight loss attempts so you can discuss how this approach fits into your overall health plan. A clear baseline helps you and your clinician measure progress objectively.
Build support systems that make the plan realistic. That might include meal planning, activity routines, sleep habits, stress management, and accountability check-ins. Tracking simple metrics such as hunger, energy, and adherence can reveal whether the approach is sustainable. Focus on small, consistent actions instead of perfection so the changes are easier to maintain.
Consider access, cost, and follow-up requirements. Ask about insurance coverage, out-of-pocket expenses, supplies, and the timeline for reassessment. Understanding how often you will be monitored and what adjustments are possible can reduce surprises later. A good plan includes checkpoints to evaluate safety, effectiveness, and quality of life.
Extra questions to consider
How do I know if this option fits my lifestyle? Look at your daily schedule, food preferences, travel routines, and stress levels. The best approach is one you can follow most days without constant friction. If an option feels overly restrictive or hard to sustain, discuss alternatives with your care team.
What should I track to know it is working? Track weight trends, measurements, and how you feel in daily life. Some people also monitor lab values, appetite, sleep quality, or exercise capacity. Choosing a few meaningful metrics helps you see progress even when the scale moves slowly.