Gastric Sleeve Surgery (Sleeve Gastrectomy)

In short: Gastric sleeve surgery, also known as sleeve gastrectomy, is a metabolic and bariatric procedure in which approximately 80% of the stomach is permanently removed. The remaining stomach forms a narrow, sleeve-shaped tube.

The procedure reduces the amount of food the stomach can hold and also affects hormones involved in hunger, satiety and metabolic control.

What Is Gastric Sleeve Surgery?

During sleeve gastrectomy, approximately 80% of the stomach is removed. The remaining stomach is shaped into a narrow tube or “sleeve”.

Unlike gastric bypass, the small intestine is not rerouted, and the normal pathway of food through the digestive tract is maintained.

The procedure works in two important ways:

• the smaller stomach limits the amount of food that can be eaten at one time;
• removal of much of the stomach fundus reduces the production of appetite-regulating hormones such as ghrelin, which may help reduce hunger and improve satiety.

Sleeve gastrectomy is irreversible, because the removed part of the stomach cannot be restored.

How Does Gastric Sleeve Compare with Other Weight-Loss Procedures?

Sleeve gastrectomy is one of the established surgical treatments for obesity and one of the most commonly performed forms of weight loss surgery.

It generally produces greater and more durable weight loss than non-surgical procedures such as an intragastric balloon.

For patients who are not suitable for surgery or who have a lower BMI, alternatives may include:

• medically supervised weight management;
• anti-obesity medications;
• an intragastric balloon;
• endoscopic sleeve gastroplasty.

The most appropriate treatment should be selected individually rather than according to BMI alone.

Who Is a Suitable Candidate for Gastric Sleeve Surgery?

Metabolic and bariatric surgery is generally recommended for adults with:

• a BMI of 35 kg/m² or higher, even without obesity-related medical conditions;
• a BMI of 30 kg/m² or higher with type 2 diabetes;
• a BMI between 30 and 34.9 kg/m² when substantial or durable weight loss has not been achieved with non-surgical treatment and obesity continues to affect health.

A suitable candidate must also be willing and able to follow long-term dietary recommendations, take prescribed vitamin and mineral supplements, attend medical follow-up and make lasting lifestyle changes.

Obesity-related conditions such as:

• type 2 diabetes;
• high blood pressure;
• obstructive sleep apnoea;
• abnormal cholesterol levels

may improve after successful bariatric surgery.

Who May Not Be a Suitable Candidate?

Gastric sleeve surgery is not automatically appropriate for everyone with obesity. The final decision should always follow an individual medical and surgical assessment.

Additional evaluation or an alternative procedure may be recommended in patients with:

• significant or poorly controlled gastro-oesophageal reflux disease;
• medical conditions that make general anaesthesia or major abdominal surgery unsafe;
• untreated alcohol or substance dependence;
• uncontrolled psychiatric conditions that may interfere with postoperative care;
• inability to follow the required nutritional programme and long-term medical follow-up;
• pregnancy or plans for pregnancy shortly after surgery.

Previous abdominal surgery, very high BMI or other complex medical conditions do not necessarily exclude bariatric surgery, but they may influence the choice of procedure and require additional specialist assessment.

What Are the Risks of Gastric Sleeve Surgery?

Sleeve gastrectomy is major abdominal surgery and, as with any operation, complications are possible.

Early complications can include: bleeding; infection; blood clots, including deep-vein thrombosis or pulmonary embolism; complications related to anaesthesia; leakage from the gastric staple line.

Long-term medical and nutritional follow-up is therefore an essential part of bariatric treatment.

How Much Weight Can I Expect to Lose After Gastric Sleeve Surgery?

Weight loss varies between patients and depends on: starting weight; eating habits; physical activity; metabolic factors; adherence to long-term follow-up.

As a general reference, patients may lose approximately 25–30% of their total body weight within two years following sleeve gastrectomy.

Individual results can be higher or lower.

It is therefore more accurate to discuss expected weight loss as a percentage of total body weight or excess body weight rather than promise a specific number of kilograms.

How to Choose a Bariatric Clinic and Surgeon

Bariatric surgery should ideally be performed by a surgeon with specific training and substantial experience in metabolic and bariatric surgery and within a medical facility capable of providing comprehensive perioperative and long-term care.

When comparing clinics, patients should ask about:

• the surgeon’s training and experience in bariatric surgery;
• how frequently the surgeon and centre perform sleeve gastrectomy;
• availability of anaesthesia, intensive care and emergency surgical support;
• preoperative medical assessment;
• nutritional guidance;
• postoperative follow-up;
• management of complications after discharge;

Meet our leading bariatric surgery expert, Jaroslav Tvaruzek, M.D., Chief Surgeon with extensive experience in minimally invasive and robotic surgery.

Gastric Sleeve Recovery and Long-Term Care

Hospital stay and recovery time depend on the individual patient, surgical technique and clinical course.

Patients normally begin with a staged postoperative diet and gradually progress from liquids to soft and then regular foods according to their medical team’s instructions.

Long-term success requires:

• smaller portions and appropriate nutrition;
• adequate protein and fluid intake;
• prescribed vitamin and mineral supplementation;
• regular physical activity;
• medical and nutritional follow-up.

Sleeve gastrectomy should be considered a long-term treatment for obesity rather than a stand-alone operation.