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Gastric Sleeve Surgery

What is gastric sleeve surgery?

Gastric sleeve surgery is a type of weight-loss surgery (bariatric surgery). This surgery is also known as sleeve gastrectomy or vertical sleeve gastrectomy). Gastric sleeve surgery restricts your food intake, which leads to weight loss. You may lose from 50 to 90 pounds, but each person's results will vary.

It’s often done as a laparoscopic surgery, with small incisions in the upper belly (abdomen). Most of the left part of the stomach is removed. The remaining stomach is formed into a narrow tube called a sleeve. Food empties out of the bottom of the stomach into the small intestine the same way that it did before surgery. The small intestine is not operated on or changed. After the surgery, less food will make you full when eating. 

Why might I need gastric sleeve surgery?

Gastric sleeve surgery is used to treat severe obesity. It’s advised for people who have tried other weight-loss methods without long-term success. Your healthcare provider may advise gastric sleeve surgery if you are severely obese with a body mass index (BMI) over 40. Your provider may also advise it if you have a BMI between 35 and 40 and a health condition from your obesity. This may include sleep apnea, high blood pressure, heart disease, or type 2 diabetes.

What are the risks of gastric sleeve surgery?

Bleeding, infection, heart problems, lung problems, pain, and blood clots in your legs are possible complications that may occur after any surgery. General anesthesia may also cause breathing problems or other reactions. There are also risks of a leak at the staple line. Also, too much weight loss can leave you with sagging skin. Both issues often need more surgery.

Over time, you may also have some trouble absorbing certain nutrients. Or you may develop a narrowing (stricture) in your stomach sleeve. Some people may have heartburn or reflux after the surgery. If you already have moderate to severe reflux, a gastric sleeve could make that worse. You may want to consider a gastric bypass surgery instead. That type of surgery can help or even stop reflux and heartburn.

You may have other risks based on your health. Make sure to talk with your healthcare team about any concerns before the surgery.

How do I get ready for gastric sleeve surgery?

Your healthcare team will need to make sure that gastric sleeve surgery is a good choice for you. Weight-loss surgery isn’t advised for people who abuse medicines or alcohol, or who can't commit to a lifelong change in diet and exercise habits.

Before having surgery, you’ll need to enroll in a bariatric surgery education program. This will help you get ready for surgery, and life after surgery. You’ll have nutritional counseling. And you may have a psychological evaluation. You’ll also need physical exams and tests, such as a chest X-ray, blood tests, and electrocardiogram. You may have imaging studies of your stomach, or have an upper endoscopy to better see your digestive system. 

If you smoke, you will need to stop several months before surgery. Your surgeon may ask you to lose some weight before surgery. This is important to reduce the risk of surgery related complications. You’ll need to stop taking aspirin, ibuprofen, and other blood-thinning medicines in the days before your surgery. Check with your healthcare providers about which medicines, herbs or supplements should be stopped (and when), and which should be continued at the time of your operation. Follow any directions you are given for not eating or drinking before your surgery.

What happens during gastric sleeve surgery?

You will have general anesthesia for your surgery. This will cause you to be deeply sedated through the surgery. Your surgeon will usually use the laparoscopic procedure to perform the surgery. They will make several small cuts (incisions) in your upper abdomen. The surgeon will then insert a thin tube (laparoscope) and put small surgery tools into these incisions. If the surgery can't be done safely with the laparoscope, then it may need to be completed with an open incision.

The anesthesiologist will then pass a small tube through your mouth down into the stomach. The surgeon will 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?

You’ll likely go home in 1 to 2 days after surgery. You will be on a liquid diet for the first week or two. Your surgery team will give you a schedule of types of meals over the next weeks. You’ll go from liquids to pureed foods, then soft foods, and then to regular food. Each meal needs to be very small. You should make sure to eat slowly and chew each bite well. Don’t move too quickly to regular food. This can cause pain and vomiting. Work with your healthcare team to figure out what’s best for you to eat. After your stomach heals, you'll need to change your eating habits. You’ll need to eat small meals for your small stomach. 

People who have weight-loss surgery may have trouble getting enough vitamins and minerals. This is because they take in less food, and may absorb fewer nutrients. You may need to take a daily multivitamin, plus a calcium-vitamin D supplement. You may need other nutrients, such as vitamin B-12 or iron. Your healthcare team will give you instructions.

You’ll need to have regular blood tests every few months in the year after surgery. This is 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 to take medicine to reduce stomach acid.

After losing weight, it’s possible to regain some of the weight that you lose. To prevent this, make sure to follow a healthy diet and get regular exercise. The sleeve may widen (dilate) over time. This will let you eat more. But keep in mind that if you eat all you can, you can regain weight. You may want to join a weight-loss surgery support group to help you stick with your new eating habits. Ask your healthcare provider for a list of reliable resources.

Next steps

Before you agree to the test or procedure make sure you know:

  • The name of the test or procedure

  • The reason you are having the test or procedure

  • What results to expect and what they mean

  • The risks and benefits of the test or procedure

  • What the possible side effects or complications are

  • When and where you are to have the test or procedure

  • Who will do the test or procedure and what that person’s qualifications are

  • What would happen if you did not have the test or procedure

  • Any alternative tests or procedures to think about

  • When and how you will get the results

  • Who to call after the test or procedure if you have questions or problems

  • How much you will have to pay for the test or procedure.

Medical Reviewers:

  • Marianne Fraser MSN RN
  • Raymond Kent Turley BSN MSN RN
  • Rita Sather RN
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