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Sleeve gastrectomy, also called vertical sleeve gastrectomy, is a surgical weight-loss procedure. This procedure is usually performed laparoscopically, which involves inserting tiny instruments through multiple small incisions in the upper abdomen. During a gastric sleeve procedure, approximately 80% of the stomach is removed leaving a portion of it that looks like a tube and is the size and shape of a banana.

Reducing the size of the stomach limits the amount of food a person can consume. Furthermore, the procedure induces hormonal changes that aid weight loss. These same hormonal changes also help relieve conditions associated with being overweight, such as high blood pressure or heart disease.

Why is this done

Sleeve gastrectomy is done to help you lose excess weight and reduce the risk of potentially life-threatening weight-related health problems, including:

• heart disease
• Hypertension
• high cholesterol
• Obstructive sleep apnea
• Type 2 diabetes
• Apoplexy
• cancer
• infertility

A gastric sleeve will usually not be done until you’ve tried to lose weight by improving your diet and exercise habits.

In general, gastric sleeve surgery may be an option for you if:

• If your BMI is 40 or more (obese).
• If your BMI is 35 to 39.9 (obese), and you also have a serious weight-related health problem; Such as type 2 diabetes, arterial hypertension, or severe sleep apnea. In some cases, you may be eligible for certain types of weight-loss surgery if your BMI is between 30 and 34 and you have serious weight-related health problems.

You should also be willing to make lasting changes to lead a healthier lifestyle. You may be required to participate in long-term follow-up plans that include monitoring your diet, lifestyle, behavior and health.

Check with your health insurance plan or visit your local Medicare or Medicaid services office to see if your plan covers weight-loss surgery.

Risks

As with any major surgery, sleeve gastrectomy carries potential health risks, both in the short and long term.

The risks associated with gastric sleeve surgery can include the following:

• severe bleeding
• infection
• Adverse reaction to anesthesia
• blood clots
• Lung or breathing problems
• Leaks from the edge of the cut stomach

Long-term risks and complications associated with gastric sleeve surgery can include the following:

• gastrointestinal obstruction
• hernia cases
• gastroesophageal reflux disease
• lack of blood sugar
• Malnutrition
• vomiting

Fatal complications of gastric sleeve surgery are very rare.

How to prepare

In the weeks before surgery, you may be asked to start a program of physical activity and to completely quit using tobacco products.

Just before the surgical procedure, there may be some restrictions on eating and drinking and the medications you can take.

It would be a good idea to start planning in advance for the postoperative recovery phase. For example, make arrangements to get help at home if you think you will need help.

What you can expect

Sleeve gastrectomy is performed in a hospital. Depending on how well you recover, your hospital stay may last from one to two nights.

During the operation

The specifics of the surgery depend on your personal situation and the practices followed in the hospital or by your doctor. Some sleeve gastrectomy operations are performed by making traditional large incisions in the abdomen. However, sleeve gastrectomy can usually be done laparoscopically, which involves inserting small instruments through multiple small incisions in the upper abdomen.

You will receive general anesthesia before the surgery begins. General anesthesia is medication that keeps you asleep without any pain during surgery.

To perform a gastric sleeve, the surgeon creates what looks like a tight sleeve by stapling the stomach vertically and removing the largest curved portion of the stomach.

This surgery usually takes one to two hours. After the surgery, you are recovered in the recovery room where the medical staff monitors your condition for any complications.

After the operation

After gastric sleeve surgery, your diet begins with non-carbonated, sugar-free liquids for the first seven days, progresses to pureed food for three weeks, and eventually to regular food about four weeks after surgery. You’ll need to take a twice-daily multivitamin, a calcium supplement once a day, and a once-monthly injection of vitamin B-12 for life.

You will undergo frequent medical examinations to monitor your health for the first several months after weight loss surgery. You may need a lab test, a blood test and multiple tests.

You may experience changes as your body reacts to rapid weight loss in the first three to six months after gastric sleeve surgery, including:

• body aches
• Feeling tired, as if you had the flu
• feeling cold
• dry skin
• Hair thinning and loss
• Mood changes

Results

Sleeve gastrectomy can lead to long-term weight loss. The amount of weight you’ll lose depends on the changes you’ll make in your lifestyle habits. It is possible to lose about 60% or more of your excess weight within two years.

In addition to weight loss, gastric sleeve surgery may improve or treat conditions often associated with being overweight, including:

• heart disease
• Hypertension
• high cholesterol
• Obstructive sleep apnea
• Type 2 diabetes
• brain attack
• infertility

Sleeve gastrectomy can improve your ability to perform routine daily activities and can help improve your quality of life.

When weight loss surgery doesn’t work

You may not lose enough weight after weight-loss surgery, and you may even gain weight back. And this weight gain can happen if you don’t follow the recommended lifestyle changes. For example, if you are constantly eating high-calorie snacks, you will not lose weight adequately. To help avoid regaining weight, you should make permanent healthy changes in your diet and get regular physical activities.

It’s important to keep all of your scheduled follow-up appointments after weight-loss surgery so your doctor can monitor your improvement. If you notice that you are not losing weight, or if you develop complications after surgery, you should see your doctor immediately.