Gastric Sleeve Surgery: Complete Patient Guide

Gastric sleeve surgery, also called sleeve gastrectomy, is quickly emerging as the go-to procedure for many top surgeons and seems to have overtaken gastric bypass as the "gold standard" procedure for weight loss surgery.

This page will give you all the information you need to decide whether this is the right procedure for you...


Gastric Sleeve Surgery Overview: Weight Loss, Health Improvement, Risks

gastric sleeve surgery

Gastric sleeve surgery works by removing a large portion of the stomach, leaving a banana-shaped "sleeve" that connects the esophagus to the small intestines.

Unlike the more invasive gastric bypass and duodenal switch, gastric sleeve surgery does not rearrange the digestive system. This results in a lower complication rate, fewer malabsorption problems and a quicker recovery.

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.

"As a stand-alone procedure, gastric sleeve surgery has been impressive..."

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 has similar weight loss results
  • It has 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.

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Gastric Sleeve Vs. Other Types of Surgery

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Gastric sleeve surgery has skyrocketed in popularity.

In the United States, it now makes up over 60% of all weight loss surgery procedures performed, up from 24% in late 2011. During the same time frame, gastric bypass dropped from 62% to 37% of all procedures performed while gastric banding (e.g. Lap-Band) fell from 7.5% to 0.8% of all procedures performed.4

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

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. Unlike gastric banding, gastric sleeve surgery 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 (on average) is as good as or better than gastric bypass and much better (on average) than after lap band surgery. Duodenal switch patients typically experience more weight loss than any procedure.
  • The overall short-term risk of gastric sleeve is similar to that of gastric bypass, higher than lap band and lower than duodenal switch.
  • The overall long-term risk of gastric sleeve is lower than all other procedures.
  • The feeling of hunger may be lower after GS than with the gastric band (lap band) or gastric bypass.
  • 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.
Summary of Findings When Comparing Gastric Sleeve Surgery to Other Procedures Year of Study
References:  ABCDE, F, G, H, I, J, K, L
*For simplicity, all acronyms and procedure names have been changed to a common name (i.e. LAGB and Laparoscopic Adjustable Gastric Banding were changed to Lap Band Surgery).
Laparoscopic Gastric Bypass Surgery vs Gastric Sleeve
The data set is comprised of 3 retrospective clinical studies, 6 prospective clinical studies, and 2 randomized controlled trials (RCTs), which involved 429 patients in the gastric sleeve group and 428 patients in the gastric bypass group. In nonrandomized clinical studies, gastric sleeve displayed similar efficacy in remission of Type 2 Diabetes compared with the standard gastric bypass. In the RCTs, gastric sleeve had a lower effect than that of gastric bypass. No correlation was made between either or the procedures and Type 2 Diabetes remission, and percent weight loss was not observed for either procedure. Conclusions: Based on the current evidence, gastric sleeve has a similar effect on Type 2 Diabetes remission as gastric bypass.K 2015
The operation times of the gastric bypass patients were longer than those of both the gastric sleeve and mini gastric bypass patients. The gastric bypass and mini gastric bypass patients experienced higher major complication rate than the gastric sleeve patients. The weight loss of the gastric sleeve patient at 5 years was 28.3%, and the mean BMI was 27.1. The gastric bypass patients exhibited a 5-year weight loss similar to the gastric sleeve patients, and the mini gastric bypass patients exhibited greater weight loss than both of the other groups. Both the gastric bypass and mini gastric bypass patients exhibited significantly better glycemic control and lower blood lipids than the gastric sleeve patients, but the gastric sleeve patients exhibited a lesser micronutrient deficiency than the gastric bypass and mini gastric bypass groups. All three of the groups exhibited improved quality of life at 5 years after surgery, and there was no significant between-group difference in this measure.
Conclusions: Gastric sleeve appears to be an ideal bariatric surgery, and the efficacy of this surgery is not inferior to that of gastric bypass.J
2015
A total of 21 studies involving 18,766 morbidly obese patients were eventually selected according to the inclusion criteria. No significant difference was found in % excess weight lost during 0.5 to 1.5-year follow-up, but after that, gastric bypass achieved higher % excess weight loss than LSG. Except for type 2 diabetes mellitus (gastric bypass had higher resolution or improvement rates), the difference between these two procedures in the resolution or improvement rate of other comorbidities did not reach a statistical significance. There were more adverse events (complications) in gastric bypass compared with gastric sleeve. In conclusion, gastric bypass is superior to gastric sleeve in efficacy but inferior to gastric sleeve in safety.I 2014
Compared with gastric sleeve, gastric bypass had significantly better effect in resolving type 2 diabetes mellitus, hypertension, hypercholesterolemia, gastroesophageal reflux disease, and arthritis. However, gastric bypass had higher incidence of complications and reoperation, and longer operation time than gastric sleeve.G 2014
Overall complication rates among patients undergoing gastric sleeve (SG) (6.3%) were significantly lower than for gastric bypass (RYGB) (10.0%, P < 0.0001). Serious complication rates were similar for SG (2.4%) and RYGB (2.5%, P = 0.736). Excess body weight loss at 1 year was 13% lower for SG (60%) than for RYGB (69%, P < 0.0001). SG was closer to RYGB than lap band (LAGB) with regard to remission of obesity-related comorbidities.H 2013
PYY levels increased similarly after either procedure. The markedly reduced ghrelin levels in addition to increased PYY levels after gastric sleeve, are associated with greater appetite suppression and excess weight loss compared with gastric bypass surgery.A
(Editors’s note: both ghrelin and peptide YY effect appetite. See our Obesity and Genetics page for more details)
2008
Lap Band Surgery vs Gastric Sleeve
Bariatric surgery is an effective treatment strategy in morbidly obese adolescents who have failed medical management. Gastric sleeve results in greater short term weight and BMI loss when compared to gastric banding (e.g. Lap-Band). Longer follow up with more patients will be required to confirm the long term safety and efficacy of gastric sleeve in adolescent patients.L 2015
Weight loss and loss of feeling of hunger after 1 year and 3 years are better after gastric sleeve than lap band surgery. Gastroesophageal Reflux Disease (GERD) is more frequent at 1 year after gastric sleeve and at 3 years after lap band surgery. The number of re-operations is important in both groups, but the severity of complications appears higher in gastric sleeve.B 2006
Weight loss and loss of feeling of hunger after 1 year and 3 years are better after gastric sleeve than lap band. GERD is more frequent at 1 year after gastric sleeve and at 3 years after lap band. The number of re-operations is important in both groups, but the severity of complications appears higher in gastric sleeve.C 2006
Gastric sleeve may become the ideal operation for staging in patients with body mass index (BMI) >55, for treating morbidly obese patients with severe medical conditions, as an excellent alternative to adjustable bands in lower BMI patients, or for conversion of lap band patients.D 2005
Multiple Procedures vs Gastric Sleeve
The gastric sleeve operation is able to achieve significant weight loss comparable to the gastric bypass and duodenal switch operations but with the low morbidity profile similar to that of lap band placement.E 2007
Gastric sleeve has been highly effective for weight reduction for morbid obesity even as the sole bariatric operation. Gastric dilatation was found in only 1 patient in this short-term follow-up. Weight regain following gastric sleeve may require conversion to gastric bypass or duodenal switch. Follow-up will be necessary to evaluate long-term results.F 2006

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

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Gastric Sleeve Surgery Cost

The cost of gastric sleeve surgery in ranges anywhere from $13,000 to $30,000 or more, but the average is around $19,000. Our Gastric Sleeve Cost page provides a breakdown by region.

Most 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…

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Gastric Sleeve Results

YOUR Weight Loss Journey

Help visitors like you by sharing your advice related to this page or other topics...

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

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)

Before getting into the details of expected weight loss (on average, patients lose between 64% and 75% of their excess weight)...

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)…

Summary of Findings Year
References:  GHZ, AB, AD, AE
*For simplicity, all acronyms and procedure names have been changed to a common name (i.e. Laparoscopic Sleeve Gastrectomy or LSG was changed to gastric sleeve).
After 15 years, laparoscopic sleeve gastrectomy (gastric sleeve) has a firm position as a stand-alone procedure to effectively treat morbid obesity. Low morbidity and mortality have been advocated as advantages over more complex procedures such as laparoscopic Roux-en-Y gastric bypass and biliopancreatic diversion with duodenal switch or other restrictive procedures like the laparoscopic adjustable gastric banding that can have serious anatomical complications in the mid- to long-term follow-up. It also avoids intestinal surgery with associated complications such as internal herniation, small bowel obstruction, micronutrient deficiencies, and malnutrition. It has also been argued that the follow-up is less demanding than for the aforementioned procedures. Since long-term reports are starting to appear, some of these facts are now supported in the literature. These are some of the reasons that have made gastric sleeve a technique that is growing in popularity and is offered by most bariatric centers. 2015
This study reports the longest follow-up of LSG patients thus far [after 6 to 8 years] and supports the effectiveness, safety, and durability of laparoscopic sleeve gastrectomy as a definitive therapeutic option for severe obesity, even in high-risk, high-BMI patients.AD 2012
In this long-term report of laparoscopic sleeve gastrectomy, it appears that after 6+ years the mean excess weight loss exceeds 50%. However, weight regain and de novo gastroesophageal reflux symptoms appear between the third and the sixth postoperative year. This unfavorable evolution might have been prevented in some patients by continued follow-up office visits beyond the third year. Patient acceptance remains good after 6+ years.AB 2010
From the current evidence, including 36 studies and 2570 patients, LSG is an effective weight loss procedure that can be performed safely as a first stage or primary procedure. From this large volume of case series data, a matched cohort analysis, and 2 randomized trials, LSG results in excellent weight loss and co-morbidity reduction that exceeds, or is comparable to, that of other accepted bariatric procedures. The postoperative major complication rates and mortality rates have been acceptably low. Long-term data are limited, but the 3- and 5-year follow-up data have demonstrated the durability of the SG procedure.Z 2009
Our data have shown that gastric sleeve is a highly effective and safe procedure for achieving weight loss, improving co-morbidities, and improving the quality of life in patients with type 2 diabetes mellitus and morbid obesity during a long-term period.G 2009
Gastric sleeve is reproducible and seems to be an effective treatment to achieve significant weight loss after 12 months follow-up. Gastric sleeve can be used as a standalone operation to obtain weight reduction. Management of postoperative gastric fistula remains a major issue.H 2009

So 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.

Hear It Straight from the Source... For Free

Most surgeons offer free seminars that teach you about your options and their office's specific results. The seminars also allow you to get to know the surgeon prior to a one-on-one consultation (usually free as well).

Click here to find and schedule a free in-person seminar or one-on-one consultation with a qualified weight loss surgeon in your area.

Otherwise, continue below for the rest of the gastric sleeve details, including risks, details about the procedure, recovery, life after surgery and cost.

Studies # of GS Patients in Study Weight Loss
(% of Excess Weight Lost at...)
Year
References:  NOPQ, RZ, AB, AC, AD, AF
Study AF 140 1 year - 70.5%
2 years - 65.2%
3 years - 60.2%
4 years - 53.2%
5 years - 57.2%
2015
Study AD 74 6 years - 52%
7 years - 43%
8 years - 46%
2012
Study AC 20 1 year - 73% (range 13–105%)
2 years - 78% (range 22–98%)
3 years - 73% (range 28–90%)
8 to 9 years - 68% (range 18–85%)
2012
Study AB 41 6 Years - 57.3% 2010
Study R 26 5 Years - 55% 2010
Study Z 1,749 Ranging from 3 months to 3 years - 60.4% 2009
Study N 23 3 Years – 74.58% 2009
Study O 135 6 months – 38.6%

1 Year – 49.4%
2009
Study P 16 6 months – 55.5%

1 Year – 69.7%
2008
Study Q 130 3 months – 33.1%

6 months – 50.8%

1 Year – 62.2%

18 months – 64.4%

2 Years – 67.9%
2008
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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.

See our Gastric Sleeve Complications & Side Effects page for all the details.

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The Gastric Sleeve Surgery Procedure & Recovery

The gastric sleeve procedure is typically done laparoscopically in about 2 hours and is a relatively simple operation compared to the more complicated gastric bypass and duodenal switch.

Hospital stays typically last two or three days.

For a complete explanation and videos of the procedure and what to expect during recovery, see our Gastric Sleeve Surgery Procedure & Recovery page.

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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. 

YOUR Weight Loss Journey

Help visitors like you by sharing your advice related to this page or other topics...

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.

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Bariatric Surgeons 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.

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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/.
  4. Laparoscopic sleeve gastrectomy leads the U.S. utilization of bariatric surgery at academic medical centers. J. Esteban Varela, M.D., F.A.C.S., F.A.S.M.B.S., Ninh T. Nguyen, M.D., F.A.C.S., F.A.S.M.B.S., Department of Surgery, Irvine Medical Center of University of California, Orange, California
    Received 9 October 2014, Accepted 8 February 2015, Available online 12 February 2015

[ Last editorial review/modification of this page : 6/2/2015]

Disclaimer: The information contained in this web site is provided for general informational purposes only. It is not intended as nor should be relied upon as medical advice. Rather, it is designed to support, not replace, the relationship that exists between a patient/site visitor and his/her existing physician(s). Before you use any of the information provided in the site, you should seek the advice of a qualified medical, dietary, fitness or other appropriate professional. Read More