Sleeve gastrectomy, often called gastric sleeve, is a bariatric operation that removes most of the stomach. This article explains who may be considered, how the operation is performed, what recovery looks like and which risks and long-term commitments to know about. For an overview of all techniques, see our other article on bariatric surgery for obesity.
What is a sleeve gastrectomy?
In this operation, the surgeon staples and removes most of the stomach. Mayo Clinic describes about 80% of the stomach being removed, leaving a narrow tube roughly the size of a banana. The intestines are not changed, so the operation limits how much you can eat rather than how much you absorb.
The sphincter muscles at the entry and exit of the stomach are not cut or changed. The operation cannot be reversed, and some people later have a gastric bypass instead, according to Alberta Health Services.
Who can have a gastric sleeve?
Criteria depend on the guidelines used. In France, the HAS retains a BMI of 40 or more, or 35 or more with at least one condition likely to improve after surgery, after 6 to 12 months of well-conducted medical care failed. More recent international guidelines are broader: ASMBS and IFSO (2022) recommend surgery from a BMI of 35 and suggest considering it from 30 with metabolic disease.
Mayo Clinic adds that candidates should be ready to make lifelong changes to eating, activity and follow-up. A psychological evaluation and a multidisciplinary review are part of the usual assessment. Only your medical team can say whether this operation suits you rather than another one.
How is the operation performed and what is the recovery?
The operation is usually done laparoscopically, under general anaesthesia, through 2 to 5 small incisions. It typically lasts 60 to 90 minutes, and up to three hours in some cases according to Mayo Clinic. The surgeon may remove the gallbladder at the same time, since rapid weight loss raises the risk of gallstones. Before the operation, some teams ask for a short liquid diet, and you must fast for about 12 hours, as Cleveland Clinic explains.
- Hospital stay: usually one to two days.
- Diet: clear liquids first, then pureed food by discharge, and a gradual return to regular food over several weeks, in small portions.
- Medicines: pain relief and an acid-reducing drug are usually prescribed at discharge.
- Return to normal life: allow about one month before feeling yourself or working at full capacity; many people return sooner to light activity.
Walk several times a day and increase activity gradually. Keep meals small so that the remaining stomach is not stretched.
What results can you expect, and what about hunger?
The part of the stomach that produces ghrelin, the hormone that stimulates hunger, is removed, and hunger tends to decrease as a result. Average weight loss is about 25% to 30% of total body weight within two years, although results vary, and weight loss may continue for up to 2 to 3 years.
Obesity-related conditions can improve, which is one reason the operation is considered in people with diabetes or hypertension, but any change to treatment must be decided with your doctor. Weight can also be regained if old habits return, with frequent snacking or high-calorie foods, or if the sleeve stretches over time.
What are the risks and long-term needs?
Early risks listed by Mayo Clinic include bleeding, infection, blood clots, breathing problems, reactions to anaesthesia and leaks from the stapled stomach. Longer-term risks include narrowing of the sleeve, hernia, low blood sugar, and vitamin and mineral deficiencies.
Acid reflux deserves special mention: existing reflux may worsen and new reflux may appear, and medication often helps. Gallstones can form during rapid weight loss. A small number of people also experience mood changes, depression or alcohol misuse, which is why mental health follow-up is part of care.
Because you eat much less, vitamin supplements are usually needed for life, with regular blood tests to detect deficiencies.
What follow-up is needed, and when should you seek advice?
Follow-up is not limited to the first months. It covers weight, associated conditions, nutrition and, when needed, mental health, and the HAS describes follow-up for life, shared between the team and your GP. If you may become pregnant, contraception is recommended until 12 to 18 months after surgery, and pregnancy should be planned with your team.
Contact your surgical team or emergency services without delay for severe abdominal pain, chest pain, difficulty breathing, fever, a fast heartbeat, confusion or persistent vomiting. If you are considering this operation, start with a consultation to review your history, your previous attempts and the alternatives.
Further reading at La Rose Clinic
Frequently asked questions
How much of the stomach is removed in a sleeve gastrectomy?
About 80% of the stomach is removed, according to Mayo Clinic and Cleveland Clinic. The remainder is a narrow tube about the size of a banana.
How long does the operation and hospital stay last?
The operation usually takes 60 to 90 minutes, and some sources mention up to three hours. The hospital stay is usually one to two days.
Does a gastric sleeve reduce hunger?
Yes, in general. The part of the stomach that produces ghrelin, the hunger hormone, is removed, so appetite tends to decrease.
Do I need vitamins after a gastric sleeve?
Yes, vitamin and mineral supplements are usually prescribed for life, with regular blood tests.
Can the sleeve cause acid reflux?
It can. Existing reflux may worsen and new reflux may appear. Medication often helps, and you should mention symptoms to your team.
References
- Sleeve gastrectomy – Mayo Clinic (mayoclinic.org)
- Vertical sleeve gastrectomy – MedlinePlus (medlineplus.gov)
- Gastric sleeve surgery – Cleveland Clinic (my.clevelandclinic.org)
- Sleeve gastrectomy – MyHealth.Alberta.ca (myhealth.alberta.ca)
- HAS – Chirurgie de l’obésité : information du médecin traitant (has-sante.fr)
- 2022 ASMBS/IFSO Indications for Metabolic and Bariatric Surgery (asmbs.org)
This article is for information only. It does not replace a medical consultation: if in doubt, talk to your doctor.
