Gastric Sleeve / Sleeve Gastrectomy
Updated for 2022!
The gastric sleeve, also known as the sleeve gastrectomy or vertical sleeve gastrectomy, is currently the most popular weight loss surgery procedure in the United States. There’s a good reason for this.
The procedure involves simply cutting away 70-80% of the stomach and does not require rerouting or bypassing the intestine. This makes it a straightforward procedure for the surgeon and reduces some inherent risks associated with a malabsorptive approach.
Initially, the gastric sleeve was conceived as the first part of a two-part procedure known as the duodenal switch, discussed here on this website. As time went on, bariatric surgeons realized that the gastric sleeve alone offered significant weight loss benefits, eventually becoming a standalone procedure.
How The Gastric Sleeve Is Performed
The video below is an animated illustration of the gastric sleeve procedure:
As with all of the procedures we perform at MASJax, the sleeve gastrectomy is almost always performed in a minimally invasive or robotic manner. Minimally invasive surgery requires only 5 small incisions in the abdomen versus the single large incision necessary for traditional open surgery. The result is a shorter recovery with fewer complications including less pain and blood loss, a shorter hospital stay, a lower risk of incisional hernias and reduced risk of infection. Robotically assisted surgery is also an excellent option for patients that qualify.
During the sleeve surgery, the bariatric surgeon creates a small, sleeve-shaped, vertically oriented stomach that is only 20% of the size of the original stomach. This is achieved by cutting along the greater curvature (outer portion) of the stomach. The portion of stomach that is cut away is then removed from the abdomen entirely. The remaining pouch is larger than that created during gastric bypass: about the size and shape of a banana or sleeve – hence the name.
Unlike the gastric bypass, which modifies both the stomach pouch and the small intestine lower down, the gastric bypass simply reduces the size of the stomach, which reduces the likelihood of dumping syndrome and minimizes vitamin and mineral deficiencies after surgery.
Who Qualifies for Gastric Sleeve
Sleeve gastrectomy requires a BMI of 35 or over with at least one obesity-related comorbidity (such as hypertension, diabetes, sleep apnea, hyperlipidemia, etc.), or a BMI of 40 or over regardless of comorbidities.
The procedure takes approximately 35-50 minutes and patients remain in the hospital overnight for observation. Patients are usually back to work within 3 weeks with reduced physical exertion. Full recovery requires approximately 6 weeks.
The sleeve may also be appropriate for some patients who have not achieved their expected results after a gastric band. Bands can be converted to a sleeve by removing the band and performing a standard gastric sleeve during a single anesthesia event. Conversions and revisions come with somewhat higher surgical risk that will be discussed during consultation.
Life After Gastric Sleeve
The gastric sleeve has shown excess body weight loss potential and disease improvement / resolution rates similar to that of the gastric bypass, while avoiding many of the risks. Because the pyloric sphincter is kept intact during the surgery, it is less likely for patients to suffer from dumping syndrome, for example.
Patients who are diligent with their postoperative care can expect excess body weight loss greater than 65% and an improvement or resolution of most of their obesity-related conditions. One notable exception is that some patients who undergo a gastric sleeve will develop or worsen their acid reflux. This is often mitigated by repairing a hiatal hernia during surgery, if present.
Most patients will experience an added hormonal benefit of the gastric sleeve in the form of fewer hunger pangs after surgery. This is because the excised portion of the stomach includes the fundus, the main production center of ghrelin, a hunger hormone, which is removed from the body as well. However, it is worth knowing that ghrelin production may increase in the years after bariatric surgery. This means patients must develop and reinforce their healthy eating habits while they still receive this hormonal benefit.
Potential Risks and Concerns of Gastric Sleeve
- Much like gastric bypass patients, gastric sleeve patients will have to supplement their diet with a multivitamin, and other vitamins as necessary. The risk of nutritional deficiencies however is much lower than with a combination restrictive and malabsorptive procedure
- The most severe, but fortunately uncommon, risk is that of a leak along the staple line made during surgery. Our surgeons have a great deal of experience with this complication and take steps both during and after surgery to help ensure a leak does not occur
- As with any surgical procedure there are inherent risks including infection, blood loss and pain. Please speak to your surgeon about these and other risks.