Gastric Sleeve Surgery (Vertical Sleeve Gastrectomy or Vertical Gastrectomy)

Gastric sleeve surgery is used either by itself or as a first step in a two-step surgery. It has shown some very promising results as a stand-alone procedure, but some analysts remain skeptical.

• Could GS surgery be right for you?
• What’s the difference between GS and other bariatric surgery procedures?
• Results of Surgery including average weight lost and impact on co-morbidities
• Complications & Risks
• The Procedure (explanation and videos)
• Recovery
• Life after GS surgery
• Cost of Surgery
• Finding surgeons specialized in GS

Could Gastric Sleeve Surgery Be Right for You?

For patients with a body mass index over 50, the gastric sleeve (GS) is sometimes used as a “first step” to get the weight down before moving forward with a more complicated procedure such as the duodenal switch or gastric bypass surgery. It has been performed on patients ranging from 12 to 79 years of age.

Other patients receive it as a stand-alone surgery because the risks presented by other procedures are just too high.

And as a stand-alone procedure, gastric sleeve surgery has been impressive…

• It is less expensive and has fewer complications than other types of bariatric surgery
• It appears to have similar weight loss results
• It appears to have a comparable impact on obesity health problems

In addition, if you are on anticoagulation medication, compared with gastric bypass, gastric sleeve surgery is probably a better choice to reduce the risk of marginal ulcers.

So why doesn’t everyone try this bariatric surgery option first?

It has one big downside… there are limited long-term studies. As you’ll read further down the page, the short-term studies are numerous and extremely convincing. While there have been a few long-term studies to back them up, many surgeons and insurance companies still aren’t convinced.

The Difference between the Gastric Sleeve and Other Bariatric Surgery Procedures

As mentioned above, gastric sleeve surgery is much less complicated than many other types of bariatric surgery…

• Your digestive system is not rearranged, unlike the duodenal switch, gastric bypass, or mini gastric bypass surgery.
• Also unlike these other surgeries, is primarily restrictive in nature (works by making you feel full sooner).
• There are no foreign objects implanted in your body as with the lap band.

As a result, the gastric sleeve may have fewer complications, including…

• A reduced risk of malnutrition or vitamin deficiency
• Avoiding dumping syndrome, among other side effects, compared to the malabsorptive procedures
• A reduced risk of long-term gastroesophageal reflux disease (GERD) compared to other restrictive procedures.

In addition, since such a large part of the stomach is removed, following gastric sleeve surgery you may have less of the hormones that make you feel hungry (for more on this, see our Obesity and Genetics page).

Finally, gastric sleeve surgery is often used as second option if lap band surgery doesn’t work.

The gastric sleeve also has a couple of negatives compared to some of the other bariatric surgery types…

1. It is irreversible – once your stomach is shrunk there is no way to change it back to the original size (not necessarily a bad thing).
2. The operation to reduce your stomach size creates a relatively long staple line which presents an increased risk of staple line leaks and bleeding.

The following studies directly compared gastric sleeve surgery to other forms of weight loss surgery. In support of the information we have already reviewed above, the studies suggest that…

• Weight loss could be as good as or better than gastric bypass and the duodenal switch and gastric sleeve surgery could be less risky.
• The feeling of hunger may be lower after GS than with the gastric band (lap band) or gastric bypass.
• More long-term research is needed to confirm that GS is effective as a stand-alone procedure.
• Gastroesophageal Reflux Disease (GERD) may be worse after GS than after gastric banding in 1 year following surgery, but the reverse may be true after 3 years.

For further comparison of gastric sleeve surgery to other procedures, see our Types of Bariatric Surgery page.

Results of Surgery

The two sections above reviewed many of the benefits and drawbacks of the gastric sleeve.

In addition to benefits we’ve already covered (better weight loss and reduced risks), the gastric sleeve has a significant positive impact on health risks associated with obesity, especially…

• Diabetes
• Hypertension (high blood pressure)
• Hyperlipidemia (high levels of fat in the blood)

We will get into the exact amount of weight loss you can expect in a bit.

First, following are 7 studies that have shown the gastric sleeve to be effective. We discovered and included two studies that found similar results after 2 and 3 years, but more long-term research is needed (when reading below, remember that “laparoscopic sleeve gastrectomy” or LSG is another name for gastric sleeve surgery)…

So it appears that the gastric sleeve as a stand-alone procedure could be one of the bariatric surgery waves of the future. But exactly how much weight can you expect to lose?

Within the first year, patients in the following studies lost as little as 33% and as much as 70% of their excess weight. Over the longer term (up to 3 years), the excess weight lost was between 64% and 75%. The chart below covers the individual study results.

Complications & Risks of Gastric Sleeve Surgery

The relatively simple gastric sleeve procedure results in an extremely low mortality rate (0.19% on average)1. However, complications can arise especially in higher-risk patients.

The most common serious complications include (see our Bariatric Surgery Complications page for more information about each)…

• Bleeding – 1.2% of patients
• Leaks – 2.2% of patients
• Stenosis/Strictures - 0.6% of patients1

Gastroesophageal reflux disease (GERD) is a common minor complication, with about 1 out of 5 patients experiencing it after 1 year. However, the prevalence of GERD plummets to about 3% after three years.2

Following are the mortality and complication rates from 7 separate studies (click here to skip past chart)…

In many cases, the patient is completely to blame for complications. Properly educating yourself and your family and following through on that education is key to lowering your risks after surgery.

See our Bariatric Surgery Complications page to learn what you need to do to succeed over the long run.

When deciding whether the complication and mortality risks associated with surgery are “worth it”, it’s smart to evaluate the risks associated with not having surgery. See our Life After Weight Loss Surgery, Obesity Health Problems and Cause and Effect of Obesity pages for more on this.

The Gastric Sleeve Surgery Procedure

The gastric sleeve surgery procedure is mainly restrictive in nature, meaning that it works by making you feel full sooner than before the surgery. It can usually be performed laparoscopically and takes between one and two hours on average.

To perform the operation, the bariatric surgeon will remove the fundus (the part of the stomach to the left and above the level of the opening of the esophagus3) along with most of the stomach. The 10-20% of the banana-shaped stomach that remains continues to connect the esophagus to the top of the small intestines exactly the way it did before surgery.

The average hospital stay following surgery is two to three days. The following is a computer animated explanation of the surgery followed by a video of the actual procedure being performed…

Computer Animated Video Explaining Gastric Sleeve Surgery

(click here to skip past video of actual procedure being performed)

Video of Actual Gastric Sleeve Surgery Being Performed

Recovery following Gastric Sleeve Surgery

Your doctors will run a number of checks before releasing you from the hospital, including a check to make sure there are no postoperative staple line leaks. They’ll also want to make sure that your wounds are healing properly and will want to get you started on your transitional diet as soon as possible.

Your new stomach will be sensitive, especially at first, so you’ll be on a liquid diet for a couple of weeks before slowly transitioning back to solid foods.

After you leave the hospital, you should have a follow up visit one week later then every few months thereafter to make sure everything is progressing the way it should. Malabsorption is much less likely than with other procedures, but your nutritionist or dietitian will still want to monitor you to make sure you’re getting the bariatric vitamins you need, especially B₁₂.

It may be possible to return to work within a couple of weeks, but you should plan on two to four weeks just to play it safe.

Life After Gastric Sleeve Surgery

As we’ve reviewed, the gastric sleeve is one of the least complex forms of bariatric surgery and has some of the lowest mortality and complication rates. 

You may experience a few of the same issues as you would after other weight loss surgeries such as diarrhea, constipation or difficulty swallowing. Since your stomach is bigger than the gastric bypass pouch and maintains the connection between the stomach and small intestine that is lost after the gastric bypass, these issues should be less prevalent.

Our Life after Weight Loss Surgery page explains the dramatic changes experienced after all types of bariatric surgery, and it will cover what you need to know about life after gastric sleeve surgery. However, do keep one caveat in mind:

Our Bariatric Diet section explores how and what you should eat following surgery along with long-term dietary changes.

Gastric Sleeve Surgery Cost

The cost of gastric sleeve surgery in the United States ranges anywhere from $7,000 to $20,000 or more, but the average is around $15,000.

Many insurance companies now include gastric sleeve surgery under their covered bariatric procedures, although there are a few that still do not.

See one of the following pages for more information about paying for surgery…

• Schedule a free consultation with a local qualified surgeon about direct payment or financing options (usually less expensive than other financing options)
• Financing bariatric surgery
• Bariatric surgery insurance ( including VBG, DS, gastric bypass, gastric sleeve and lap band insurance )
• Bariatric surgery in Mexico or abroad

Bariatric doctors specializing in Gastric Sleeve Surgery

Gastric sleeve surgery has become common enough to the point that a relatively high percentage of qualified surgeons now offer it as an option. As with any other procedure, confirm that the surgeon you are considering has ample experience before moving forward.

See our Bariatric Doctors page to learn how to interview and choose the best surgeon.

If you're ready to attend a free local seminar or schedule a free one-on-one consultation with a surgeon, click here to find a qualified surgeon in your area.

References

1. Varela JE, et al. Correlations between intra-abdominal pressure and obesity-related co-morbidities. Surgery for Obesity and Related Diseases 5 (2009) 524–528.
2. Himpens J, Dapri G, Cadiere GB. A Prospective Randomized Study Between Laparoscopic Gastric Banding and Laparoscopic Isolated Sleeve Gastrectomy: Results after 1 and 3 Years. Obesity Surgery Vol 16, No 11 / Nov 2006 pgs 1450-6.
3. Fundus definition from The Free Dictionary available at: http://thefreedictionarycom.ourtoolbar.com/.

[Last editorial review/modification of this page: 1/24/2012]