Gastric Sleeve Surgery: Understanding the Process and What to Expect

What is gastric sleeve surgery?

Gastric sleeve surgery, also known as vertical sleeve gastrectomy (VSG), is a type of weight-loss or bariatric surgery. It involves removing approximately 80% of the stomach, leaving a small pouch about the size of a banana. The remaining stomach forms a narrow tube or "sleeve." Unlike other bariatric surgeries, the small intestine is not operated on or changed. A smaller stomach means that you take in less food, absorb fewer calories and nutrients, and may experience a decrease in appetite due to changes in hunger signals to your brain.

How does gastric sleeve surgery work?

Gastric sleeve surgery works by limiting the amount of food you can eat and reducing your calorie and nutrient intake. The surgery is typically performed using a minimally invasive laparoscope and small incisions.

Am I a candidate for gastric sleeve surgery?

Bariatric surgery is typically recommended for people with severe obesity, especially those with a body mass index (BMI) over 40 or between 35 and 40 with a health condition such as sleep apnea, high blood pressure, heart disease, or type 2 diabetes. Candidates should also be committed to making lifestyle changes and following a strict post-surgery diet and exercise plan.

What are the benefits of gastric sleeve surgery?

Gastric sleeve surgery can lead to improvements in obesity-related conditions such as:

• Type 2 diabetes
• Sleep apnea
• High blood pressure
• Fatty liver disease
• Osteoarthritis

It typically has fewer side effects than more complicated gastric bypass surgery and does not require a foreign object in the body, as gastric banding does. Patients who undergo bariatric surgery, including gastric sleeve surgery, generally have higher life expectancy, better health, and a higher quality of life than similar people who do not have the surgery. Additionally, it is generally safe to use anti-inflammatory drugs (NSAIDs) after gastric sleeve surgery.

What are the risks of gastric sleeve surgery?

Like any surgery, gastric sleeve surgery carries risks such as bleeding, infection, and blood clots in your legs. General anesthesia may also cause breathing problems or other reactions. Over time, you may also experience trouble absorbing certain nutrients or develop a narrowing (stricture) in your stomach sleeve. Some people may also experience heartburn or reflux after the surgery, and if you already have moderate to severe reflux, a gastric sleeve could make it worse.

Complications can include:

• Excessive bleeding
• Infections
• Hernias
• Leaking from the staple line
• New or worse acid reflux
• A few patients develop dumping syndrome, which can lead to nausea, vomiting, and diarrhea
• Feeling cold after surgery often

It's important to note that the surgery is not reversible, and you must take vitamin and mineral supplements and follow dietary guidelines for life.

How long is the approval process for gastric sleeve surgery?

The approval process for gastric sleeve surgery can vary depending on factors such as insurance coverage and the requirements of the bariatric surgery program. Generally, it involves completing preoperative testing and evaluations, attending informational sessions, and meeting with a nutritionist or mental health professional. In some cases, the approval process can take several months.

The preoperative evaluations and testing may include blood tests, imaging studies of the stomach, and a psychological evaluation to ensure that the candidate is mentally prepared for the surgery and the lifestyle changes that come with it. The approval process may also involve working with an insurance company to determine coverage and out-of-pocket costs. It's essential to work closely with your doctor and bariatric surgery program to ensure that you are adequately prepared for the surgery and to understand the approval process timeline.

What are the costs of gastric sleeve surgery?

The cost of gastric sleeve surgery can vary widely depending on factors such as the surgeon's fees, hospital fees, and any preoperative testing or evaluations. Insurance coverage for the surgery may also vary depending on the individual's plan and coverage. It's important to check with your insurance provider to determine whether gastric sleeve surgery is covered under your plan and what your out-of-pocket costs may be.

How do I prepare for gastric sleeve surgery?

Before having gastric sleeve surgery, you'll need to enroll in a bariatric surgery education program to help you get ready for surgery and life after surgery. This program may include nutritional counseling, a psychological evaluation, physical exams and tests, blood tests, and imaging studies of your stomach or an upper endoscopy. If you smoke, you will need to stop several months before surgery, and your surgeon may ask you to lose some weight before surgery to make your liver smaller and the surgery safer.

In the days before surgery, you'll need to stop taking aspirin, ibuprofen, and other blood-thinning medicines. You should not eat or drink anything after midnight before surgery.

What happens during gastric sleeve surgery?

Gastric sleeve surgery is performed under general anesthesia, which will cause you to sleep through the surgery. Your surgeon will use a laparoscope and make several small incisions in your upper abdomen. The surgeon will then insert the laparoscope and small surgical tools into these incisions. They will pass a sizing tube through your mouth down into the stomach and then use a laparoscopic stapler to divide the stomach, leaving a narrowed vertical sleeve. The part of the stomach that was removed is then taken out of the abdomen through an incision. Your surgeon may then test for any leaks in the sleeve using a dye study or an upper endoscopy.

What happens after gastric sleeve surgery?

After sleeve gastrectomy, you'll begin with a liquid diet for the first week, then progress to pureed foods for three weeks, and finally to regular foods about four weeks after surgery. You'll be required to take a multivitamin twice a day, a calcium supplement once a day, and a vitamin B-12 injection once a month for life.

You'll have frequent medical checkups to monitor your health in the first several months after weight-loss surgery. You may need laboratory testing, bloodwork, and various exams. You may experience changes as your body reacts to the rapid weight loss in the first three to six months after sleeve gastrectomy, including body aches, feeling tired, feeling cold, dry skin, hair thinning and hair loss, and mood changes. You may also have trouble getting enough vitamins and minerals, so you'll need to take a daily multivitamin and calcium-vitamin D supplement, and you may need additional nutrients such as vitamin B-12 or iron. You'll need to have regular blood tests every few months in the year after surgery to make sure you don’t have low blood iron (anemia), high blood glucose, or low calcium or vitamin D levels. If you have heartburn, you may need medicine to reduce stomach acid.


It's important to remember that gastric sleeve surgery is just one tool in the weight-loss journey, and the sleeve may widen (dilate) over time. This will allow you to eat more, but if you eat too much, you may regain weight. Joining a weight-loss surgery support group can help you stick with your new eating habits and maintain long-term weight loss.

In conclusion, gastric sleeve surgery can be a life-changing procedure for individuals struggling with severe obesity. However, it is a major decision that requires careful consideration and planning. By understanding the process, risks, benefits, and what to expect before and after the surgery, you can make an informed decision about whether gastric sleeve surgery is right for you. It's also crucial to work closely with your bariatric surgeon and follow their instructions for postoperative care to ensure a successful recovery and long-term weight loss.