Gastric Sleeve Surgery (Gastrectomy)
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What is gastric sleeve surgery?
The gastric sleeve, also called sleeve gastrectomy, is a bariatric surgery operation to induce weight loss. It works by reducing the size of your stomach. The word “gastrectomy” means removal of part or all of your stomach. The gastric sleeve operation removes about 80% of your stomach, leaving behind a tubular “sleeve,” about the size and shape of a banana.
What does a gastric sleeve do?
Reducing the size of your stomach is a simple way to restrict the amount of food you can eat in one sitting, making you feel fuller faster. But it also serves another purpose: it reduces the amount of hunger hormones that your stomach can produce. This helps to decrease your appetite and cravings and may help to prevent the impulses that cause people to regain the weight they've lost.
How common is gastric sleeve surgery?
The gastric sleeve is the most commonly performed weight loss surgery in the U.S. and worldwide. More than half of bariatric surgeries performed in the U.S. each year are sleeve gastrectomies. The total number of gastric sleeve operations performed each year is about 150,000 in the U.S. and 380,000 worldwide. But, only 1% of people who could benefit and would qualify for the surgery actually get it.
What medical conditions does gastric sleeve surgery help treat?
Gastric sleeve surgery is a surgical treatment for obesity and medical conditions related to obesity. It’s only offered to qualified people who have serious medical conditions related to their obesity or are at high risk for developing them. Gastric sleeve surgery can improve and sometimes eliminate diseases, including:
- Insulin resistance and Type 2 diabetes.
- Hypertension and hypertensive heart disease.
- Hyperlipidemia (high cholesterol) and arterial disease.
- Nonalcoholic fatty liver disease and steatohepatitis.
- Obesity hypoventilation syndrome and obstructive sleep apnea.
- Joint pain and osteoarthritis.
Is the gastric sleeve safe?
The risks of gastric sleeve surgery are far less than the risks of having obesity and its related diseases. It also has lower complication rates than other common operations, including gallbladder removal and hip replacement. Most gastric sleeve procedures are performed by minimally invasive surgical techniques, which means less pain from incisions and faster recovery.
What qualifies you for gastric sleeve surgery?
To qualify, the general requirements are:
- That you have severe obesity (class III). This is determined by your BMI (body mass index), which is calculated by your weight and height, and your related health conditions. Class III obesity means a BMI of 40 or higher, or a BMI of at least 35 with at least one related disease.
- That you have tried to but not succeeded in losing weight prior to surgery. You may be required to spend three to six months on a medically supervised weight loss plan before your insurance company will approve and cover your surgery.
- That you are physically and mentally prepared for the surgery and recovery process. Before qualifying for weight loss surgery, you’ll meet with a team of dietitians, psychologists and other medical specialists for counseling and screening.
What happens before gastric sleeve surgery?
If you’ve passed your health screening and qualify for bariatric sleeve surgery, the next step will be a two-week liquid diet. Your surgeon will give you specific guidelines to follow. The purpose is to lose some of the fat in your abdomen and your liver to make the surgery safer.
You’ll be asked not to eat or drink anything for 12 hours before your operation. That’s to make sure your stomach is empty during the procedure. Having food or liquid left in your stomach during the surgery could cause unpleasant or even dangerous side effects.
How is gastric sleeve surgery performed?
Most of the time, a sleeve gastrectomy is done by laparoscopic or robotic surgery. That means that instead of making a large incision (or cut) to open your abdominal cavity to access your organs, your surgeon will perform the operation through small incisions. This makes for an easier recovery, but some people may be better served by open surgery, depending on their conditions.
What happens during gastric sleeve surgery?
- Your surgeon will give you general anesthesia, so you’ll be asleep during the procedure.
- Your surgeon will make a small cut in your abdomen (about 1/2 inch long) and insert a port. They’ll pump carbon dioxide gas through the port to expand your abdomen.
- Then they’ll place a small lighted video camera (laparoscope) through the port. The camera will project your insides onto a screen.
- Through one to three additional incisions, your surgeon will insert additional ports and complete the procedure using long, narrow tools.
- They will measure out the gastric sleeve, then divide and separate the remainder of your stomach using a surgical stapler.
- Your surgeon will remove the remainder of the stomach, then close your incisions.
How long does gastric sleeve surgery take?
Compared to other weight loss surgery procedures, a sleeve gastrectomy is a relatively short and simple operation. It takes about 60 to 90 minutes. Your surgeon may still want you to stay in the hospital for one to two days afterward. This way, they can help manage your pain and any temporary side effects of surgery, such as nausea.
What happens after gastric sleeve surgery?
You’ll have frequent check-ups with your healthcare provider in the following weeks and months. They’ll monitor your weight loss progress, your related health conditions and any side effects of the surgery. They’ll also want to know if you’re taking good care of yourself and following the necessary lifestyle guidelines to maintain your health and weight loss.
Will I have to follow a diet after gastric sleeve surgery?
In the short term, you will have to follow strict dietary guidelines to make sure your stomach heals well. After a few months, you may begin to eat a more normal diet, but you’ll still have to choose your foods wisely. Because you won’t be able to eat as much as before, you’ll have to make sure that what you do eat is nutritious enough to sustain your energy needs. You’ll begin taking vitamins shortly after surgery and will need to continue taking them permanently.
Risks / Benefits
What are the advantages of this procedure?
Compared to other bariatric surgery operations, the gastric sleeve is simpler, quicker and safer. People with health conditions that might not be suited for a longer procedure can often tolerate a sleeve gastrectomy. Because the surgery doesn’t rearrange your intestines, it’s also much less likely to cause long-term complications related to nutrition.
While the average weight loss with gastric sleeve is slightly less than with more complex weight loss surgeries, it still offers excellent weight loss and health benefits. This operation began as the first step in a two-step bariatric surgery called the duodenal switch. Surgeons started offering it as a standalone procedure after many people found that they didn’t need to complete the second part.
What are the possible risks or complications of gastric sleeve surgery?
All surgeries have some risk of complications. With sleeve gastrectomy, they occur in less than 1% of operations. Surgical complications include:
- Reactions to anesthesia.
- Leaking from the staple line.
After recovering, some people develop long-term complications from the surgery. These are usually easy to treat when they occur. They can include:
- Scar tissue after the operation can cause your stomach to be narrow, which can slow or block food from moving through your stomach causing nausea, vomiting, and difficulty eating.
- Nutritional deficiencies. It’s harder to get enough nutrients when you’re eating much less. People who have bariatric surgery are usually prescribed daily nutritional supplements for life.
- Gastroesophageal reflux. Some people who had acid reflux before the operation feel that it gets worse afterward, and some people who didn’t have it before seem to get it. This can often be treated with medication.
- Gallstones. Rapid weight loss can make gallstones more likely. It causes more fat to process through your liver, which can then build up in your gallbladder as cholesterol stones and cause pain after eating. You may need another surgery to remove your gallbladder called a cholecystectomy.
Recovery and Outlook
What is the recovery time from gastric sleeve surgery?
You should give yourself a good month before you expect to feel quite like yourself or return to work at full capacity. During this time, many people feel fatigued or tired as their bodies work to recover while adjusting to limited calories. In the early weeks, you’ll only be able to tolerate a liquid diet. Over time, you’ll gradually progress to a soft diet, and finally, solid foods.
How much weight will you lose with the gastric sleeve?
The average weight loss is 25% to 30 % of your body weight in the first one to two years. That means if you weighed 300 lbs before surgery, you’d lose 100 lbs. You might lose more or less, depending on the lifestyle habits you adopt after surgery. Some people also regain some weight, but the overall average weight loss of 25% to 30% of your body weight is consistent over five years.
What if it doesn’t work?
While it isn’t common, some people do regain the weight they lose. They might go back to old habits, or their stomach may stretch out again over time. If this happens to you, you might consider gastric sleeve revision surgery. Your surgeon may repair the original gastric sleeve or convert it to another type of weight loss operation with stronger results, such as a gastric bypass or duodenal switch.
A note from Cleveland Clinic
A sleeve gastrectomy is a simple and safe procedure that can produce great weight loss results. It’s also an irreversible change to your stomach that will require lifelong changes from you. You’ll have to be very intentional about what and how you eat after surgery, and for the rest of your life, to protect your stomach and meet your nutritional needs.
But if you’re committed to change and weight loss, surgery can help you be healthier. It doesn’t just limit what you can eat, but it also helps reduce hunger and regulate your blood sugar, so fewer calories feel more natural. Many obesity-related health conditions can improve and even resolve after gastric sleeve surgery.
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