Sleeve gastrectomy

Overview

Sleeve gastrectomy is a type of weight-loss surgery. During this surgery, about 80% of the stomach is removed. The part that remains is shaped like a narrow tube about the size and shape of a banana.

Sleeve gastrectomy is usually done using a minimally invasive method called laparoscopy. This means the surgeon makes several small cuts, also called incisions, in the upper abdomen instead of one large cut. Small tools and a camera are used to perform the surgery.

Because the stomach is much smaller after surgery, you cannot eat as much food at one time. This helps reduce calorie intake. The surgery also changes hormones in the digestive system. These hormone changes can lessen hunger, help you feel full sooner and improve blood sugar management.

Sleeve gastrectomy is used to help people with obesity lose weight and improve serious health conditions linked to excess weight. These may include type 2 diabetes, high blood pressure, heart disease and sleep apnea.

Sleeve gastrectomy is a major surgery. It requires lifelong healthy eating habits, regular physical activity, and daily vitamin supplements to help prevent nutritional issues.

Why it's done

Sleeve gastrectomy is done to help people lose excess weight. It also can lower the risk of serious health conditions caused by obesity.

These health conditions may include:

• Type 2 diabetes.
• High blood pressure.
• Heart disease.
• High cholesterol.
• Obstructive sleep apnea.
• Stroke.
• Certain cancers linked to obesity.
• Infertility.

Losing weight after surgery can improve or even resolve some of these conditions. In some people, blood sugar levels get better quickly after surgery because of changes in gut hormones.

Sleeve gastrectomy is usually recommended only after you have tried to lose weight through diet, exercise and medical treatment without long-term success.

In general, sleeve gastrectomy may be an option if:

• Your body mass index (BMI) is 35 or higher, even if you do not have other health issues.
• Your BMI is 30 to 34.9 and you have a serious obesity-related condition, such as type 2 diabetes.

You also must be willing to make lifelong changes to your eating habits, physical activity and follow-up medical care. Long-term monitoring is important to help ensure safe weight loss and prevent complications.

Insurance coverage for weight-loss surgery varies. Check with your health insurance company to find out what your plan covers.

Risks

As with any major surgery, sleeve gastrectomy has risks. These risks can happen shortly after surgery or months to years later.

Risks associated with sleeve gastrectomy are similar to those of any abdominal surgery and can include:

• Bleeding.
• Infection.
• Bad reactions to anesthesia.
• Blood clots in the legs or lungs.
• Lung or breathing problems.
• Diarrhea.
• Leaks from the sleeved stomach.

Long-term risks and complications

Over time, some people may develop:

• Narrowing of the stomach, called a stricture.
• Gastroesophageal reflux disease (GERD) or worsening heartburn.
• Vitamin and mineral deficiencies.
• Low blood sugar, called hypoglycemia.
• Hernia.
• Bowel blockage, also called an obstruction.
• Ongoing nausea or vomiting.

Very rarely, complications of sleeve gastrectomy can be fatal.

Mental health considerations

Some people experience mood changes after weight-loss surgery. A small number of people may develop depression, alcohol misuse or other mental health concerns. Ongoing follow-up care and support are important.

How you prepare

Before sleeve gastrectomy, you go through a careful evaluation. This helps your healthcare team decide whether surgery is safe and right for you.

Your care team gives you detailed instructions. It is important to follow them closely. If you do not, your surgery may need to be done another time.

Medical evaluation

You may have:

• Blood tests.
• Heart and lung tests.
• A sleep study if sleep apnea is suspected.
• A review of your current medicines.

If you have conditions such as diabetes, high blood pressure or heart disease, they should be well managed before surgery.

Nutrition and lifestyle changes

You meet with a dietitian as part of your preparation for surgery. The dietitian explains the eating changes you make before and after the procedure.

Some programs require you to follow a medically supervised weight-loss plan before surgery. You may be asked to lose weight before your operation. Losing weight before surgery may help make surgery safer.

You may also be asked to begin or increase physical activity before surgery.

Stop smoking and limit alcohol

If you smoke, vape or use nicotine products, your care team will likely advise you to stop. Smoking increases the risk of serious complications, including infections and leaks. You also may be asked to avoid alcohol and recreational drugs.

Mental health evaluation

You may meet with a psychologist or other mental health professional. This helps make sure you are ready for the emotional and lifestyle changes that come with surgery.

What you can expect

Sleeve gastrectomy is done in the hospital. Depending on your recovery, your hospital stay may last 1 to 2 nights.

During the procedure

You receive a general anesthetic before surgery. This medicine keeps you asleep and comfortable during the procedure.

Most sleeve gastrectomies are done using a minimally invasive method called laparoscopy. The surgeon makes several small cuts in the upper abdomen. Small tools and a camera are placed through these openings.

During the surgery:

• The surgeon removes about 80% of the stomach, including the part that makes a hunger hormone.
• The remaining stomach is shaped into a narrow tube or sleeve. The rest of the digestive tract is not changed.

The surgery usually takes about 1 to 3 hours.

After the procedure

After surgery, you wake up in a recovery area. Your care team monitors you closely for any issues.

As you recover, you begin a staged diet. Your diet is slowly advanced over several weeks to allow your stomach to heal. You get detailed instructions from your care team about how to advance your diet safely.

Your diet progresses as follows:

• Clear liquids.
• Full liquids.
• Pureed foods.
• Soft foods.
• Regular diet.

You also take vitamin supplements for life.

As your body adjusts to rapid weight loss during the first six months, you may experience:

• Body aches.
• Feeling tired.
• Feeling cold.
• Dry skin.
• Hair thinning or hair loss.
• Mood changes.

These changes usually happen for a short time.

Results

Sleeve gastrectomy can lead to a lot of long-term weight loss. How much weight you lose depends on your eating habits, physical activity and follow-up care.

Most people lose about 25% to 30% of their total body weight within two years. Some people lose more, while others lose less.

Health improvements

In addition to helping with weight loss, sleeve gastrectomy may improve or resolve many weight-related health conditions, including:

• Type 2 diabetes.
• High blood pressure.
• High cholesterol.
• Obstructive sleep apnea.
• Heart disease.
• Stroke risk.
• Infertility related to obesity.

Some people see blood sugar levels get better within days to weeks after surgery because of hormone changes in the digestive system.

Many people also have improved quality of life after surgery.

When weight-loss surgery doesn't work as expected

Some people may not lose as much weight as expected after sleeve gastrectomy, or they may gain some weight again over time.

This weight gain can happen for several reasons. Lifestyle habits, such as eating high-calorie foods or not getting enough physical activity, can contribute. Biological factors and changes in metabolism also may play a role.

If weight loss slows or weight gain happens again, your healthcare team may recommend changes to your eating plan, increased physical activity, behavioral counseling or, sometimes, more treatment.

Long-term success after sleeve gastrectomy depends on lifelong healthy habits, regular follow-up and ongoing medical monitoring.