GASTRIC SLEEVE SURGERY - ALL YOU NEED TO KNOW

Reviewed by: John Rabkin, MD

Gastric sleeve surgery (vertical sleeve gastrectomy) removes about 80% of the stomach. As a result, patients:

  • Feel less hungry
  • Feel full sooner after eating
  • Lose up to 3/4 of their excess weight
  • Improve or cure their obesity-related health problems

Read and click the sections below for everything you need to know about the procedure.

01 How the Gastric Sleeve Works

How the Gastric Sleeve Works

Procedure reduces stomach size by 80% Patient feels full sooner while eating due to smaller stomach Patient feels less hungry because smaller stomach secretes fewer hunger-causing hormones

Procedure-tool-img
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1

Insert Instruments

4 to 6 small incisions made and laparoscopic instruments inserted

2

Remove Part of Stomach

80% of stomach of stomach is removed using a stapling device

3

Weight Loss

Smaller stomach causes patient to feel less hungry and full sooner while eating, leading to significant and rapid weight loss

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Why Gastric Sleeve Works

  • Reduced stomach size makes the patient feel full sooner after eating
  • Removed portion of the stomach means fewer hunger-causing hormones are secreted, causing patient to feel less hungry generally

Preparing for Surgery

Your surgeon will work closely with you during the weeks leading up to surgery, including:

  • Health assessment, including questions about your medical history, medications, and surgical history
  • Order certain tests like an ECG, x-ray, and blood tests
  • Establish a pre-surgery diet regimen, including:
    • 2 Weeks Before
      • No sugar
      • Lower carbs
      • Increased protein
      • Increased veggies
      • Plenty of fluids
    • 2 Days Before
      • Clear liquids, broth, one protein shake per day only
      • Talk with your surgeon about whether you should stop taking any medications
    • 12 Hours Before
      • No food or drink, no tobacco

Your other big goal before surgery: lose as much weight as possible.

Here’s why:

  • The more weight you lose pre-op, the more weight you will lose after surgery
  • The lower your pre-op weight, the lower your risk of complications
  • You will regain weight if you slip into old habits. The sooner you can establish good diet and exercise habits, the more likely you will be to maintain them after surgery

See our Preparing for Weight Loss Surgery page for more information.

How Gastric Sleeve Is Performed

How Gastric Sleeve was “Discovered”

Gastric sleeve started as the first step in the two-step duodenal switch (DS) procedure. DS surgeons saw impressive weight loss and health improvement before performing the second step. This caused them to test gastric sleeve as its own procedure.

Before surgery, you’ll perform the typical pre-surgery routine:

  1. Remove all clothes and jewelry
  2. Put on your hospital gown
  3. Meet with your nurse and anesthesiologist
  4. Start your IV
  5. Receive medication for relaxation and sleep

During surgery, your surgeon will remove about 80% of your stomach. This leaves a banana-shaped “sleeve” that connects the esophagus to the small intestines. [Some surgeons will then reinforce the staple line.]

Your much smaller stomach will cause you feel full sooner and result in long-term weight loss. It is done laparoscopically in one to two hours.

The gastric sleeve procedure is done for patients of all ages, from children to the elderly.

02 Weight Loss

Weight Loss

Up to 70% of excess weight within 1 year Click here to calculate your personal weight projections

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100%

Excess Weight Remains

Procedure Done

From Day 1, Feel Less Hungry & Full Sooner After Eating

Continued Weight Loss

Low Weight Reached Between Year 1 & Year 2

0 months

100%

Excess Weight Remains

Your Body Mass Index (BMI) is XXX.

Gastric sleeve is only available for patients with a BMI of 30 or higher.

However, you do qualify for other types of weight loss procedures.

Click here to learn your options.

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Weight loss happens fast after gastric sleeve surgery:

  • Month 3: About 1/3 of excess weight is gone
  • Month 6: About half of excess weight is gone
  • Month 12: Up to 70% of excess weight is gone

Most patients reach a plateau around the one to two year mark. Patients who eat and exercise right are usually able to keep the weight off or lose even more.

But many patients let their dedication slip and regain some weight. This is due to the stomach stretching over time, which is usually caused by overeating.

By 5 years after surgery, the average patient has kept off over half of their excess weight. Successful patients avoid weight regain by:

  • Working closely with their surgeon’s dietitian or nutritionist
  • Using a personal trainer
  • Attending in-person or online support groups at least twice per month
  • Keeping a food journal
  • Having the support of family and friends
  • Maintaining motivation and dedication

For more information about weight loss after gastric sleeve surgery, see our Gastric Sleeve Results page.

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03 Health Benefits

Health Benefits

Cures or improves diabetes, sleep apnea, hypertension, and at least 12 other conditions

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Gastric sleeve results in complete “resolution” (cure, as long as weight loss is maintained) of many obesity-related health problems, including those listed below.

Note that patients who have a strict follow-up schedule with their surgeon at 3-, 6-, and 12-months post-op see greater improvements in or remission of their diabetes, high blood pressure (hypertension), and high cholesterol than patients who skip these visits (1).

  • Diabetes
  • Sleep apnea
  • Hypertension
  • Joint problems
  • Asthma
  • Cholesterol problems
  • and at least 9 other conditions

Patients who aren’t cured usually experience a noticeable improvement.

For the full list of health issues cured or improved by gastric sleeve surgery, see the Health Benefits section of our Gastric Sleeve Results page.

04 Qualify

Qualify

30+ body mass index (BMI) required Click here to calculate your BMI

Enter your height & weight, then click the button:

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30+

GASTRIC SLEEVE
Required BMI

  • Below 18.5Underweight

  • 18.5 – 24.9Healthy Weight

  • 25.0 – 29.9Overweight

  • 30.0 – 34.9Obese

  • 35.0 – 39.9Severely Obese

  • 40.0 – 49.9Morbidly Obese

  • 50 or higherSuper Obese

Weight Loss Procedure Qualification Info

BMI's ranging from 30 to 34.9 may qualify for Gastric Balloon. This BMI range may also qualify for other procedures if the patient has poorly controlled diabetes or metabolic syndrome.

BMI's ranging from 35 to 40 may qualify for Gastric Balloon. This BMI range may also qualify for other procedures if the patient has poorly controlled type 2 diabetes, a higher risk of cardiovascular disease, or suffers from another weight-related health issue.

BMI's ranging from 40.1 to 45 may qualify for any weight loss procedure other than Gastric Balloon.

BMI's ranging from 45.1 to 55 may qualify for any weight loss procedure other than Gastric Balloon or vBloc Therapy.

BMI's above 55 may qualify for any weight loss procedure other than Gastric Balloon, vBloc Therapy, or AspireAssist.

Health Risk: High

You are considered to be underweight, so you do not qualify for weight loss surgery.

You should take physician-approved steps to gain weight.

Health Risk: Low

Your weight is considered healthy, so you do not qualify for weight loss surgery.

Health Risk: Moderate

Your BMI is too low to qualify for weight loss surgery.

Your health risk increases to “High” if two or more of the following apply to you:

  • - You smoke cigarettes
  • - Family history of premature heart disease
  • - High blood glucose (blood sugar)
  • - High blood pressure (hypertension)
  • - Low HDL-cholesterol (“good” cholesterol)
  • - High LDL-cholesterol (“bad” cholesterol)
  • - High triglycerides

Your risk of health issues are even higher if your waist circumference is over 35 inches (88 cm) for women or 40 inches (102 cm) for men.

Health Risk: High

You have a high risk of obesity-related health problems.

Your risk is even higher if your waist circumference is over 35 inches (88 cm) for women or over 40 inches (102 cm) for men.

Your BMI indicates that you may be a good candidate for the gastric balloon procedure. You may also qualify for one of the other available weight loss procedures if you have uncontrolled diabetes or metabolic syndrome.

Health Risk: High

You have a high risk of obesity-related health problems.

Your risk is even higher if your waist circumference is over 35 inches (88 cm) for women or over 40 inches (102 cm) for men.

Your BMI indicates that you may qualify for any one of the available weight loss procedures, including gastric balloon.

Health Risk: Very High

You have a very high risk of obesity-related health problems.

Your risk is even higher if your waist circumference is over 35 inches (88 cm) for women or over 40 inches (102 cm) for men.

Your BMI indicates that you may qualify for any available weight loss procedure other than the gastric balloon (max BMI is 40).

Health Risk: Very High

You have a very high risk of obesity-related health problems.

Your BMI indicates that you may qualify for any available weight loss procedure other than the gastric balloon (max BMI is 40) or vBloc Therapy (max BMI is 45).

Health Risk: Very High

You have a very high risk of obesity-related health problems.

Your BMI indicates that you may qualify for any available weight loss procedure other than the gastric balloon (max BMI is 40), vBloc Therapy (max BMI is 45), or AspireAssist (max BMI is 55).

Click to Learn More

You could be a good candidate for gastric sleeve surgery if:

  • You have a body mass index (BMI) of 40 or more, OR
  • Your BMI is between 30 and 39.9 and you have a serious obesity-related health problem

Serious obesity-related health problems most commonly include:

  • High blood pressure
  • High cholesterol
  • Type 2 diabetes
  • Sleep apnea
  • Many others (see Health Benefits section below)

If you do not meet one of the above two BMI requirements, you still might qualify for one other less invasive procedure: the Gastric Balloon. See our Gastric Balloon Patient Guide for more information.

05 Insurance

Insurance

Gastric sleeve is covered if your insurance policy includes bariatric surgery Click here to check your insurance

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GASTRIC SLEEVE COST-AFTER-INSURANCE ESTIMATOR

Projected Out Of Pocket Costs After Insurance

Data is for illustrative purposes only. Please check with your insurance company for specific costs and benefit information.

GASTRIC SLEEVE INSURANCE TOOLS

Cost-After-Insurance Estimator

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This tool provides estimates only. Please contact your insurance company to verify your actual out of pocket costs.

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Gastric sleeve insurance coverage varies by country and insurance policy. Your insurance will cover gastric sleeve if your specific policy includes weight loss surgery and you have:

  • Completed a medically supervised diet program
  • A body mass index (BMI) over 35 with health problems or over 40 without health problems

Click here to use our Check My Insurance Tool.

In the U.S., gastric sleeve cost with insurance is about $2,000, depending on your policy. Scroll down this page to learn about the cost of gastric sleeve surgery without insurance.

See our Gastric Sleeve Insurance Guide for everything you need to know about getting insurance to pay for surgery.

06 Cost Without Insurance

Cost Without Insurance

Total Cost: $19,000, on average Loan Payment: $445/month, on average Discounts & Tax Savings: Usually available

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This tool provides estimates only. Please contact your insurance company to verify your actual loan estimator.

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about discounts:

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DISCOUNTS
6 Discounts to Ask Your Surgeon About

Talk with your surgeon about whether any of these discounts are available:

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The average total gastric sleeve cost without insurance is $19,000. That drops to around $2,000 with insurance (see the section above).

While surgery can be expensive, the good news is that:

  • Insurance may still cover some of your costs, such as pre-op testing, even if weight loss surgery is not an included benefit under your plan
  • Gastric sleeve patients save about $11,000 per year compared to the medical costs they would have incurred had they remained obese. In other words, gastric sleeve pays for itself in under two years.
  • Special discounts are usually offered to “self-pay” patients
  • Out-of-pocket costs may be tax deductible
  • Loans are available to make it more affordable

See our Gastric Sleeve Cost page for more information or click here to contact a top gastric sleeve surgeon to ask for a free cost quote.

07 Recovery

Recovery

Hospital Stay: 2 to 3 days Time Off Work: 1 to 3 weeks Full Recovery: 4 to 6 weeks Pain: Manageable – same as any laparoscopic surgery Diet & Activity: Slow transition back to normal

GASTRIC SLEEVE SURGERY RECOVERY

Hospital Stay: 2 to 3 Days

Most gastric sleeve patients stay in the hospital for 2 to 3 days to get through the initial healing process.

plan for a full 2 weeks off of work, and have family or friends available for daily help for at least the first week.

Full recovery typically takes 6 weeks.

Click to Learn More

Gastric sleeve surgery recovery includes:

  • Timeline: 4 to 6 weeks to full recovery
    • Hospital Stay: 2 to 3 days
    • Time Off Work: 1 to 3 weeks
  • Pain: Same as experienced after any laparoscopic surgery, managed with medication
  • Diet: Slow transition from clear liquids to solid foods
  • Activity: Slow transition back to regular activity and exercise
  • Challenges: Most side effects like nausea, digestive issues, and body changes go away over time or after adjusting diet/lifestyle habits
See our Gastric Sleeve Recovery page for an in-depth recovery timeline and details about each aspect of recovery.

08 Diet & Life After

Diet & Life After

Restricted diet with supplementation Regular exercise Less hungry than before surgery Personal relationships may change

FOOD & DRINK

Focus on eating proteins first, in solid form (not shakes). Get the majority of your calories from solid foods to avoid weight regain. Eat healthy "whole" foods (avoid processed foods). Drink 64+ oz (2+ liters) of liquids per day, but no drinking 30 minutes before or after meals.

VITAMINS & SUPPLEMENTS

Since you will be eating so much less, you will need to take daily vitamins and supplements to make up the difference. At a minimum, your surgeon will have you take a multivitamin and calcium supplements. Others may be needed as well.

YOUR BRAIN

After surgery you will feel less hungry, but that won't fix food addiction. Food addiction issues should be addressed before surgery. Rapid weight loss will also affect relationships with family, friends, coworkers, and strangers - both positively and negatively.

EXERCISE

Exercise is almost as important as diet for long-term success. Plan to exercise 2.5 hours per week spread out over 3 or 4 days. Patients who do so lose more weight and report a much higher quality of life.

FOOD & DRINK
VITAMINS & SUPPLEMENTS
YOUR BRAIN
EXERCISE
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Weight loss after gastric sleeve surgery often takes center stage for new patients. It’s also important to consider what day-to-day life will be like.

Your surgery is only a tool. Long-term success requires diligence and sometimes difficult change in other areas.

The following sections give you an idea about what to expect before and after surgery. Every surgeon is different, and every patient is different. Please talk with your surgeon before acting on any of the following advice.

Food & Drink : Your Diet Transition Schedule

Review diet requirements by timeframe in the chart below. For detailed information about each stage, including foods to eat and avoid, see our Gastric Sleeve Diet page.

Timeframe Range
2+ Weeks Before Surgery
2 Weeks Before Surgery
1 Week Before Surgery
2 Days Before Surgery
Midnight Before Surgery to 7 Days After Surgery (Varies by Surgeon)
In Hospital (Varies by Surgeon)
Day 1 to Week 2 After Surgery (Varies by Surgeon)
Day 2 to Week 3 After Surgery (Varies by Surgeon)
Day 3 to Weeks 4+ After Surgery (Varies by Surgeon)
Diet Requirements
Timeframe(Varies Widely By Surgeon) – Diet Requirements
Practice your post-sleeve diet
2+ Weeks Before Surgery – Practice your post-sleeve diet
High protein, low sugar, low carbs
2 Weeks Before Surgery – High protein, low sugar, low carbs
Stop or change some medications
1 Week Before Surgery – Stop or change some medications
Clear liquids only
2 Days Before Surgery – Clear liquids only
Nothing to eat or drink
Midnight Before Surgery – Nothing to eat or drink
Clear liquids only
In Hospital to 7 Days After Surgery (Varies by Surgeon) Clear liquids only
Add thicker drinks & smooth foods (no chunks)
Week 2 After Surgery – Add thicker drinks & smooth foods (no chunks)
Slowly test pureed & soft solid foods
Week 3 After Surgery – Slowly test pureed & soft solid foods
Slowly test solid foods
Day 3 to Weeks 4+ After Surgery (Varies by Surgeon) Slowly test solid foods

Again, see our Gastric Sleeve Diet page for details about each stage.

Vitamins & Supplements : 5 Lifelong Supplements

You will start taking a vitamin regime for the rest of your life after gastric sleeve surgery. This will help you make up for any nutrients you might not be getting in your daily diet. Here is a list of the vitamins your doctor may ask you to take:

Vitamins
Multivitamin
Calcium
Folate (folic acid)
Iron
Vitamin D
Purpose
Vitamins – Purpose
Prevents general nutrition problems & vitamin deficiency
Multivitamin – Entire body
Keeps your bones strong
Calcium – Keeps your bones strong
Reduces risk of anemia
Folate (folic acid) – Reduces risk of anemia
Prevents stroke, heart attack, or other blood-related issues
Iron – Prevents stroke, heart attack, or other blood-related issues
Prevents rickets (weakening of bones, muscles, and teeth)
Vitamin D – Prevents rickets (weakening of bones, muscles, and teeth)

For detailed information about each vitamin, see our Gastric Sleeve Vitamins & Supplements section.

Exercise: 2.5 hours per week, spread out over 2 to 4 days

gastric sleeve surgery

Exercise is almost as important as your diet when it comes to long-term success:

  • Patients who exercise regularly lose more weight over the long-term
  • Physical and mental health benefits are incredible

How much exercise do you need to for noticeable results?

One study of gastric bypass patients found that 2.5 hours per week resulted in 5.7% greater excess weight loss(2).

Working out regularly will also lead to quicker and better health improvement after surgery (3).

To help you stay on track, block out time to exercise at the same times on the same days of the week.

Also, spread your 2.5 hours per week out over 3 or 4 days (in other words, 30 to 45 minutes 3 or 4 days per week). This will make it less intimidating to get started each day and will help you build endurance.

Exercise Types

There should be 3 main goals of your exercise routine:

  • Endurance – walking, stationary bike, and especially swimming
  • Flexibility – a good stretching routine. Yoga is best since it incorporates proper breathing and uses your own body weight to build strength
  • Strength – exercise balls, weights, and yoga

Learn more about exercise after weight loss surgery.

Your Brain: Less Hungry, Careful About Food Addiction, New Mentality Will Change Behavior & Relationships

Ghrelin Hormone & Hunger

gastric sleeve surgery

You may feel less hungry following surgery.

When your stomach is empty, it secretes a hormone called ghrelin into your bloodstream. This causes your brain to generate hunger impulses.

After you eat, the amount of secreted ghrelin drops then slowly rises until your next meal. Since your stomach will be so much smaller after gastric sleeve surgery, the amount of ghrelin it secretes may also go down.

Less ghrelin in your system means you will feel less hungry than you did before surgery.

See our page about Obesity & Genetics for more information.

Food Addiction

Our bodies secrete certain hormones (like ghrelin) that tell us when we’re hungry. Junk food may override those hormone signals by overstimulating our reward centers. This is just like the way our bodies and brains react to an addictive drug.

You may have food addiction if your desire for food takes priority over other important parts of your life, such as:

  • Personal health
  • Family
  • Friends
  • Work
  • Your appearance
  • Avoiding obesity related health issues like hypertension, sleep apnea, or diabetes

If left unchecked, food addiction can lead to obesity. If not addressed before surgery, it can also lead to weight regain.

To find out if you may be suffering from food addiction, take our Food Addiction Quiz.

Relationships After Weight Loss

gastric sleeve surgery

Being thin again, or being thin for the first time, may be a shocking experience. Many patients express amazement at:

  • No more obesity discrimination. For example, strangers tend to be nicer to thin people.
  • Being treated with more respect
  • Getting more romantic interest from others
  • Building deeper relationships by being able to physically keep up with kids and more physically fit friends
  • Getting more compliments from others
  • Increased self-confidence and the effect that has on others

But there may be negatives to being thin as well.

People who you’ve known for a long time will not be used to the way you look and may not know how to act around you. For example:

  • How will overweight friends or family members feel when you’re losing weight but they are not?
  • Will your new healthier diet and smaller portion sizes make meals with others awkward?
  • Could intimacy with your spouse or partner be affected?
  • Could your spouse or partner become jealous now that others are noticing you more?
  • How will your coworkers react? Should you even tell them you are having surgery?
  • Will your friends or family make it difficult for you to stay on track by making bad diet choices?
  • Could your new self-confidence create conflict with people who are used the “old” you?

And what about the new “skinny lens” you see the world through? For example:

  • Would this person be treating me the same way if I hadn’t lost all this weight?
  • How do I handle obesity discrimination now that I’m on the “other side”?

Be prepared for both the good and the challenging “shocks” of dramatic weight loss following surgery.

For real life experiences and advice from other patients, see our Relationships After Weight Loss surgery page.

09 Downsides

Downsides

Moderate risk of non-serious complications Side effects may include digestion issues & sagging skin from rapid weight loss Some weight regain possible

Complications
  • Very high survival rate (99.7%)
  • General anesthesia risks exist, as with any procedure
  • 3 most common are relatively rare and usually caught/treated while still in hospital: Staple line leaks (2 % of patients), bleeding (1% of patients), and stenosis/strictures (<1% of patients)
Side Effects
  • Gastroesophageal reflux disease (GERD) experienced by 20% of patients during the first year. Drops to 3% after 3 years.
  • Intolerance to certain foods may cause nausea, vomiting or indigestion. Fixed by changing diet or eating habits
  • Vitamin and mineral deficiency possible if don’t take prescribed supplements
  • Gallstone formation occurs in about half of all patients as a result of rapid weight loss
  • Sagging skin as a result of rapid weight loss
  • Weight regain possible if don’t change diet & lifestyle after balloon removal
Click to Learn More

The relatively simple gastric sleeve procedure results in a very high survival rate (99.7%, or 319 out of 320 patients)(4).

But it does carry a risk of complications, side effects, and other challenges, some of which can be prevented. Click below to learn more.

Preventing Gastric Sleeve Complications

gastric sleeve surgery

The patient is often to blame for complications as a result of not following their doctor’s instructions.

Behaviors that will dramatically reduce your risk of gastric sleeve complications:

  • Pick a good surgeon
  • Follow your surgical team’s advice to the letter
  • Educate yourself
  • Educate your family
  • Lose as much weight as possible prior to surgery
  • Eat a healthy diet in the months leading up to surgery
  • Get tested for sleep apnea syndrome several weeks before surgery (and address the issue if it exists before moving forward)
  • Plan for at least 2 weeks of recovery time
  • Exercise right away after surgery, but take it easy at first.
    1. Compression stockings
    2. Pneumatic compression devices
    3. Blood thinners after surgery
  • Have an effective support system of friends, family, and weight loss surgery support groups

See our Bariatric Surgery Complications page for more information about each of these points.

Serious Gastric Sleeve Complications

The three most common serious complications associated with gastric sleeve surgery are:

  • Staple line leaks – 2.1% of patients on average (between 1.09% and 4.66%, depending on the study) experience staple line leaks (5) (6)
    Occur when sealed or sutured (stitched) openings leak digestive contents into the abdomen. This can cause infection and abscess. Gastrointestinal leaks occur in as many as 5% of patients and can be repaired as long as it is caught early. Symptoms include fever, severe pain and a high heart rate. In order to prevent leaks, your surgeon should check the surgical connections a number of different ways, including (1) blowing air into the connection and observing whether any gets through and (2) using a dye to check for a leak. Leaks not discovered right away are usually treated by resting the stomach (being fed through an IV), but sometimes surgery is required to fix them.
  • Bleeding – 1.2% of patients (7)
    A copious discharge of blood from the blood vessels. One study showed that out of 1,700 laparoscopic bariatric surgery patients only 3 had hemorrhagic complications, none of which needed to be converted to open operations or needed reoperations. However, other studies have shown internal bleeding to be as high as 4% following Roux-en-Y gastric bypass surgery. After the surgeon determines the type and severity of internal bleeding, it can be resolved in a number of ways: on its own, replenishing bodily fluids, stopping the use of all anticoagulation drugs and (rarely) by transfusion or reoperation.
  • Stenosis/Strictures – 0.6% of patients (8)
    A narrowing or constriction of the diameter of a bodily passage or orifice. This is most common in procedures that rearrange your digestive system such as gastric bypass surgery (up to 8% of patients) and duodenal switch surgery and results from a build-up of scar tissue between your intestine and your reduced stomach or at an intestine-to-intestine connection (anastomosis).

The staple line leak rate studies were done with less effective surgical techniques. Newer techniques may result in lower risks.

Blood clots are a concern with any surgery. Your surgeon will take steps to reduce the risk, including blood thinners and the use of compression stockings after surgery. They will also have you up and moving as soon as possible after surgery.

For more information about serious complications, visit our complications page.

Gastric Sleeve Side Effects: Digestion & Sagging Skin

Digestion Issues

About 1 in every 5 patients experience Gastroesophageal reflux disease (GERD) in the first 12 months. The good news is that this tends to be a shorter-term issue. After 3 years, the GERD rate drops to around 3% (9).

GERD is a highly variable chronic condition that is characterized by periodic episodes of gastroesophageal reflux and usually accompanied by heartburn. It may result in histopathologic changes (change in the microscopic structure) in the esophagus. It also often leads to esophagitis. GERD increases the risk of some bariatric surgery complications such as dumping syndrome and sepsis, but the condition is also improved for many following bariatric surgery.

Several at-home treatments are effective for GERD, including avoiding certain foods and drinks (alcohol, citrus juice, tomato-based food, and chocolate), waiting 3 hours before lying down after a meal, eating smaller meals and elevating your head 8 inches when you lay down. If these don’t work, your doctor may recommend/prescribe antacids, H2 blockers or even Proton Pump Inhibitors (PPI).

Other potential gastric sleeve side effects include (10) (11):

  • Indigestion (Dyspepsia)
  • Gallstones
  • Intolerance to certain foods
  • Nausea and vomiting
  • Vitamin and mineral deficiency

Sagging Skin

For most obese patients, the skin has been stretched out for so long to accommodate the extra weight that it has lost its elasticity. Gastric sleeve surgery causes most patients to lose a lot of weight very quickly, and your skin simply can’t keep up.

The extra skin may be embarrassing. It can also cause several issues ranging from minor to severe, including:

  • Difficulty getting dressed
  • Difficulty exercising, which may impact long-term weight maintenance and health
  • Skin fold rashes or breakdown of skin
  • Skin fold infections

In some cases, patients manage sagging skin with body-contouring undergarments. In more serious cases, patients have plastic surgery to remove the excess skin. Surgery to remove excess skin is often covered by insurance.

See our Plastic Surgery After Weight Loss page for more information.

Weight Regain

After two years, about 1 out of 20 gastric sleeve patients have gained back some weight from their low point. That number increases to 3 out of every 4 patients after 6 years (12).

At 5 years, the average gastric sleeve patient regains at least 25% and possibly as much as 50% of the weight they lost (13).

Just as bad, the more weight you gain back, the more likely your health problems are to return. For example, one gastric sleeve study found this difference in Type 2 diabetes remission:

  • Year 1: 56% of patients
  • Year 5: 20% of patients

This return of Type 2 diabetes happened for patients who gained back weight (55).

The reason for weight regain?

Most patients who regain weight do so for one of the following reasons:

  • They consume calories in liquid form, such as protein shakes, pureed foods, smoothies, etc. As reviewed in the Diet section above, your new sleeve stomach works by making you feel full sooner. Since liquids don’t make you feel as full as solid foods, you’ll eat more and gain weight if you get your calories from liquids instead of solids.
  • They “slip” in their dedication and start to overeat or eat the wrong things. This can stretch out their smaller stomachs.
  • Even if you stick with the correct diet program, there’s still a risk of weight regain. Over time, the stomach may still stretch and lead to weight regain.

Remember, gastric sleeve is one of the best tools for weight loss, but it is only a tool. To avoid weight regain, eat the right foods and make the right lifestyle choices.

See our Weight Gain After Gastric Sleeve Surgery page for more weight maintenance advice.

For surgical options to address weight regain, see our Gastric Sleeve Revision Surgery page.

10 Gastric Sleeve Vs. 6 Other Weight Loss Procedures

Gastric Sleeve Vs. 6 Other Weight Loss Procedures

One of the best for weight loss & health improvement 1 of 3 procedures that makes patient feel less hungry Lower risk than other procedures that result in large amounts of weight loss 1 of 3 procedures that is not reversible

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BMI Needed to Qualify

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Avg Total Cost With Insurance (U.S.)

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Procedure Type

Year of Peer-Reviewed Research

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Procedure Time (Approx)

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Difficulty Swallowing?

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Diet Risks

Food Cravings Decreased

Lifelong Vitamins Required

Qualified Surgeons

Patient Guides

The average gastric sleeve patient loses between 65% and 75% of their excess weight within 2 years and has kept most of the weight off after 5 years.
Gastric sleeve surgery improves or cures at least 15 obesity-related health problems, including diabetes, hypertension, sleep apnea, and many others.
35 - 39.9 with health problems; 40+ without
For policies that cover weight loss surgery, gastric sleeve is included
Gastric sleeve financing is available, subject to credit approval

$2,000

Actual out of pocket costs depend on your insurance plan.

$19,000

Costs vary by surgeon and hospital.
Most gastric sleeve procedures are performed laparoscopically.
Gastric sleeve surgery is backed by a significant amout of long-term research.
No external device is used (other than materials for "sealing" the smaller stomach).
Not usually reversed
not applicable (gastric sleeve is not usually reversed)
The path of digestion remains the same after gastric sleeve (although part of the stomach is removed).
Gastric sleeve surgery usually takes about 2 hours to perform.
Non-severe complications are much more common than severe complications. Learn Risks & How to Minimize
Gastric sleeve mortality risk is equal to that of any other routine surgical procedure.
Most gastric sleeve patients remain in the hospital for 2 to 3 days.
Most gastric sleeve patients are able to return to work within 2 weeks.
Can be caused by eating too quickly, too much or not chewing food enough and can usually be fixed by avoiding these issues.
GERD (reflux) in ~1 out of 5 patients after 1 year, drops to 1~ out of 33 patients after 3 year. Some patients experience diarrhea.
Potential problem foods: Dairy
Food cravings may be reduced after gastric sleeve surgery due to fewer hunger-causing hormones being released by the smaller stomach.
Lifelong vitamins will need to be taken to compensate for patients eating less food as a result of a smaller stomach.
The gastric balloon is a temporary procedure. Depending on the balloon type you choose, it must be removed 3 months, 6 months, or 1 year after insertion.
Gastric balloon patients are more likely to see health improvements than people of similar weight who do not have the procedure.
Between 30 & 40 in U.S. (above 27 elsewhere)
Gastric balloon is not usually covered by insurance
Gastric balloon financing is available, subject to credit approval

$8,150

Gastric balloon is usually not covered by insurance.

$8,150

Costs vary by surgeon and hospital.
Gastric balloon requires no incisions.
The gastric balloon is a relatively new procedure so long-term studies are limited.
An inflated silicon balloon remains in the stomach for 6 months.
The balloon must be removed after 6 months (Orbera and ReShape balloons).
The balloon must be removed after 6 months (Orbera and ReShape balloons).
The path of digestion is unchanged with the gastric balloon.
Gastric balloon usually takes about 30 minutes to perform.
Non-severe complications are much more common than severe complications. Learn Risks & How to Minimize
Gastric balloon survival rate is very high since the procedure requires no incisions and since complication risks are very low.
Most balloon patients leave the hospital the same day as the procedure.
Most balloon patients are able to return to work within a few days.
Can be caused by eating too quickly, too much or not chewing food enough and can usually be fixed by avoiding these issues.
Vomiting possible (but often avoidable with proper habits). “Feeling bloated” reported by some patients.
Potential Problem Foods: Pasta and other foods that might stick to balloon in stomach.
Food cravings will remain the same with the gastric balloon.
The balloon must be removed after 6 months (Orbera and ReShape balloons), so lifelong vitamins are not required.
The average gastric bypass patient loses between 65% and 75% of their excess weight within 2 years and has kept most of the weight off after 5 years.
Gastric bypass surgery improves or cures at least 15 obesity-related health problems, including diabetes, hypertension, sleep apnea, and many others.
35 - 39.9 with health problems; 40+ without
For policies that cover weight loss surgery, gastric bypass is included
Gastric bypass financing is available, subject to credit approval

$2,000

Actual out of pocket costs depend on your insurance plan.

$24,000

Costs vary by surgeon and hospital.
Most gastric bypass procedures are performed laparoscopically.
Gastric bypass surgery is backed by a significant amout of long-term research.
No external device is used (other than materials for "sealing" the smaller stomach pouch and establishing the new intenstinal route).
Not usually reversed
not applicable (gastric bypass is not usually reversed)
Part of the small intestines are bypassed after gastric bypass surgery.
Gastric bypass surgery usually takes about 4 hours to perform.
Non-severe complications are much more common than severe complications. Learn Risks & How to Minimize
Gastric bypass mortality risk is equal to that of any other routine surgical procedure.
Most gastric bypass patients remain in the hospital for 2 to 3 days.
Most gastric bypass patients are able to return to work within 2 weeks.
Can be caused by eating too quickly, too much or not chewing food enough and can usually be fixed by avoiding these issues.
Dumping syndrome occurs in ~80% of patients who eat sugar, refined fats, or carbs.
Potential problem foods: Sugars, Refined fats, Carbs, Dairy. Malabsorption will require life-long vitamin supplementation.
Food cravings may be reduced after gastric bypass surgery due to fewer hunger-causing hormones being released by the smaller stomach pouch.
Lifelong vitamins will need to be taken to compensate for patients eating less food as a result of a smaller stomach and for the lack of absorption resulting from the rerouted intestine.
The average duodenal switch patient loses between 65% and 90% of their excess weight within 2 years and has kept most of the weight off after 5 years.
Duodenal switch surgery improves or cures at least 15 obesity-related health problems, including diabetes, hypertension, sleep apnea, and many others.
35 - 39.9 with health problems; 40+ without (but more common for 50+)
For policies that cover weight loss surgery, duodenal switch is included
Duodenal switch financing is available, subject to credit approval

$2,000

Actual out of pocket costs depend on your insurance plan.

$27,000

Costs vary by surgeon and hospital.
Most duodenal switch procedures are performed laparoscopically.
Duodenal switch surgery is backed by a significant amout of long-term research.
No external device is used (other than materials for "sealing" the smaller stomach and establishing the new intestinal route).
Not usually reversed
not applicable (duodenal switch is not usually reversed)
Part of the small intestines are bypassed after duodenal switch surgery.
Duodenal switch surgery usually takes about 4 hours to perform.
Non-severe complications are much more common than severe complications Learn Risks & How to Minimize
Survival rate may be lower than other procedures because DS surgery tends to be performed on heavier patients who have higher risk.
Most DS patients remain in the hospital for 2 to 3 days.
Most duodenal switch patients are able to return to work within 2 weeks.
Can be caused by eating too quickly, too much or not chewing food enough and can usually be fixed by avoiding these issues.
Might be significant, including frequency, diarrhea, and/or foul-smelling stools/flatulence.
Malabsorption will require life-long vitamin supplementation.
Food cravings may be reduced after duodenal switch surgery due to fewer hunger-causing hormones being released by the smaller stomach.
Lifelong vitamins will need to be taken to compensate for patients eating less food as a result of a smaller stomach and for the lack of absorption resulting from the rerouted intestine.
Gastric Band surgery has highly variable results, with excess weight loss after 2 years ranging from 45% to 70%.
Gastric Band surgery improves or cures at least 15 obesity-related health problems, including diabetes, hypertension, sleep apnea, and many others.
35 - 39.9 with health problems; 40+ without
For policies that cover weight loss surgery, Gastric Band is included
Gastric Band financing is available, subject to credit approval

$2,000

Actual out of pocket costs depend on your insurance plan.

$15,000

Costs vary by surgeon and hospital.
Most Gastric Band procedures are performed laparoscopically.
Gastric Band surgery is backed by a significant amout of long-term research.
A silicone and silastic band is left around the top of the stomach, and a balloon around the inside of the band connects to a tube that leads to a round half-dollar-sized port just below the skin.
The Gastric Band can be removed.
Gastric Band removal is not required unless the patient develops a device-related complication.
The path of digestion is unchanged with the Gastric Band.
Gastric Band surgery usually takes about 1 hour to perform.
Non-severe complications are much more common than severe complications Learn Risks & How to Minimize
Gastric Band mortality risk is equal to that of any other routine surgical procedure.
Most Gastric Band patients leave the hospital the same day or the day after the procedure.
Most Gastric Band patients are able to return to work within 2 weeks.
Can be caused by eating too quickly, too much or not chewing food enough and can usually be fixed by avoiding these issues.
Reflux and vomiting common if band too tight (can be adjusted). Some patients experience constipation.
Potential problem foods: Dairy. Should not drink anything within 30 minutes before or after eating
Food cravings will remain the same after Gastric Band surgery.
Lifelong vitamins will need to be taken to compensate for patients eating less food as a result of the smaller stomach pouch created by the band.
The average vBloc patient loses 25% of their excess weight within 1 year. Longer-term studies are not yet available.
While studies are limited, vBloc Therapy has been found to improve hypertension, diabetes, and several obesity-related health factors.
35 - 39.9 with health problems; 40 - 45 without (none over 45)
vBloc Therapy is not usually covered by insurance
vBloc Therapy financing is available, subject to credit approval

$18,500

vBloc Therapy is not usually covered by insurance.

$18,500

Costs vary by surgeon and hospital.
Most vBloc procedures are performed laparoscopically.
vBloc Therapy is a relatively new procedure so long-term studies are limited.
The vBloc Therapy device is placed below the rib cage just under the skin. Leads (wires) connect the device to the vagal nerve, just above the stomach.
The vBloc Device can be removed.
vBloc device removal is not required unless the patient develops a device-related complication.
The path of digestion is unchanged with vBloc Therapy.
vBloc implant usually takes less than 90 minutes to perform.
Non-severe complications are much more common than severe complications Learn Risks & How to Minimize
vBloc mortality risk is equal to that of any other routine surgical procedure.
Most vBloc patients leave the hospital the same day as the procedure.
Most vBloc patients are able to return to work within a few days.
Most vBloc patients do not have any issue with swallowing.
Most vBloc patients do not experience digestion or bowel movement problems.
No medical risks, but healthier eating recommended for better results.
The vBloc device was specifically designed to control how often hunger impulses reach the brain.
vBloc device settings should be such that enough food will be eaten to provide the right amount of vitamins and minerals. Your doctor should monitor your vitamin levels.
AspireAssist studies are currently limited, but one study showed 31.5% excess weight loss after 4 years.
Early AspireAssist studies indicate a positive impact on diabetes, hypertension, and hyperlipidemia, but more reasearch is needed to confirm.
35 - 55, regardless of health problems
AspireAssist is not usually covered by insurance
AspireAssist financing is available, subject to credit approval

$10,500

AspireAssist is not usually covered by insurance.

$10,500

Costs vary by surgeon and hospital.
The AspireAssist procedure passes a tube through the mouth and down into the stomach. The tube is then pulled through the abdominal wall through a small incision.
AspireAssist is a relatively new procedure so long-term studies are limited.
A silicone “A-tube” connects the stomach to the Skin-Port™ located on the outside of your abdomen. The Skin-Port™ is the opening between your external device and the tube leading to your stomach. An Emergency Clamp component prevents any leakage of stomach contents if the A-tube and Skin-Port become disconnected.
The AspireAssist device can be removed.
AspireAssist removal is not required unless the patient develops a device-related complication.
The path of digestion is unchanged with AspireAssist (although some food is routed out of the body directly from the stomach).
The AspireAssist procedure usually takes about 15 minutes to perform.
Non-severe complications are much more common than severe complications. Learn Risks & How to Minimize
Available studies to date have shown zero deaths as a result of having the AspireAssist procedure.
Most AspireAssist patients leave the hospital the same day as the procedure.
Most AspireAssist patients are able to return to work within a few days.
Most AspireAssist patients do not have any issue with swallowing.
Low risk of vomiting (17% of patients), constipation (4.5% of patients), or diarrhea (4.5% of patients)
Potential malabsorption will require some monitoring and may result in a vitamin regimen
Food cravings will remain the same with the AspireAssist device.
Whether vitamins are required depends on each patient and how they are using the device. Your doctor should monitor your vitamin levels.
Click to See More

Gastric sleeve surgery is the most popular surgical weight loss procedure by far.

In the United States, it now makes up over 60% of all weight loss surgery procedures performed. This is up from 24% in 2011.

During the same time frame:

Newer procedures like gastric balloon and vBloc Therapy are becoming more popular. But they are still nowhere near as popular as the sleeve.

Gastric Sleeve Positives

gastric sleeve surgery

Gastric sleeve has earned its place as the most popular procedure for several reasons:

  • Weight loss is as good or better than gastric bypass. It is much better than after lap band surgery, gastric balloon, and vBloc Therapy.
  • Health Improvement is better than every procedure other than duodenal switch.
  • Reduced hunger – only gastric sleeve, duodenal switch, and vBloc Therapy make you feel less hungry.
  • Short-term risk of gastric sleeve is similar to gastric bypass and lower than duodenal switch.
  • Long-term risk of gastric sleeve is lower than gastric bypass, duodenal switch, and lap band surgery.
  • No external device – There is no external device left inside the body after gastric sleeve surgery as there is with Lap-Band, gastric balloon, vBloc Therapy, and AspireAssist, so there is no risk of device-related complications. While the risk of device-related complications is relatively low for vBloc Therapy, gastric balloon, and AspireAssist, it is a concern and should be considered for Lap Band.
  • Compared to gastric bypass and duodenal switch (DS):
    • Comparable improvement in obesity-related health problems
    • Quicker recovery than bypass or DS
    • Complication rates are lower than bypass or DS
    • Risk of vitamin deficiency is lower than bypass or DS
    • Little to no risk of dumping syndrome (unlike gastric bypass)
    • Side effects like nausea, vomiting, or diarrhea should be less likely than bypass or DS. If present, they are usually less severe than after gastric bypass.
    • Less expensive overall than bypass or DS. Similar cost if you have insurance that covers weight loss surgery.
    • If you are on anticoagulation medication (blood thinners), gastric sleeve surgery is probably a better choice than gastric bypass to reduce the risk of marginal ulcers.
  • Compared to Lap-Band surgery:
    • Risk of long-term gastroesophageal reflux disease (GERD) is lower with gastric sleeve
    • Risk of esophageal dilation, pouch dilation, and food trapping is much lower with gastric sleeve
    • No risk of external-device-related issues like lap band erosion, band slippage, or port problems with Lap-Band surgery
    • Much lower risk of long-term complications than Lap-Band surgery
    • Fewer follow up doctor visits required than after Lap-Band surgery
    • More expensive overall than Lap-Band surgery. Similar cost if you have insurance that covers weight loss surgery.
  • No dumping syndromeDumping syndrome is experienced by up to 7 out of 10 gastric bypass patients, although many patients report this being a “good thing” since it helps them keep their diet on track. Dumping syndrome is uncommon after gastric sleeve surgery.
  • Cost With Insurance – The cost of gastric sleeve is tied for the lowest with gastric bypass, duodenal switch, and Lap-Band surgery (gastric balloon and vBloc Therapy usually are not covered by insurance).

Gastric Sleeve Negatives

The gastric sleeve also has negatives compared to some of the other bariatric surgery types:

Gastric sleeve also has negatives:

  1. Not reversible – Unlike lap band, gastric balloon, vBloc Therapy, and AspireAssist, gastric sleeve surgery is irreversible. You cannot change back your smaller stomach. This is not necessarily a “negative”, but it is worth noting. More on this below.
  2. Weight loss (on average) is usually lower than duodenal switch.
  3. Health Improvement is generally not as good as gastric bypass or duodenal switch
  4. Short-term risk is higher than lap band, gastric balloon, vBloc Therapy, and AspireAssist.

Is Being Irreversible a Bad Thing?

The fact that gastric sleeve (vertical sleeve gastrectomy) is not reversible may not be a bad thing.

For example, any nausea, diarrhea, or vomiting are usually short-term issues. About 1 out of 5 sleeve patients have Gastroesophageal reflux disease (GERD) which also improves over time. The GERD rate drops to about 3% after three years.

Patients’ bodies also tend to tolerate the sleeve better than procedures like lap band or gastric bypass. For example, gastric sleeve carries a much lower risk of the following compared to lap band:

  • Esophageal dilation
  • Pouch dilation
  • Food trapping
  • Port problems (since the sleeve does not use a port or any other implanted device)

Click here for studies that compare gastric sleeve surgery to other surgery types.

Click here for studies that compare gastric sleeve surgery to other surgery types.

Summary of Findings When Comparing Gastric Sleeve Surgery to Other Procedures
Summary of Findings When Comparing Gastric Sleeve Surgery to Other Procedures
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
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
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
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
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
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
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
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
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
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
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)
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)
Lap Band Surgery vs Gastric Sleeve
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
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
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
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
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
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
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
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
Multiple Procedures vs Gastric Sleeve
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
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
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
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
Summary of Findings When Comparing Gastric Sleeve Surgery to Other Procedures
Year of Study
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 a more-detailed comparison, see our Types of Bariatric Surgery page.

11 Start to Finish

Start to Finish

7 steps to long-term weight loss

01

Start Working with a
Top Surgeon As Soon
as Possible

Top surgeons will help you effectively navigate the various procedure choices, pre-surgery steps, financing, and insurance options:

  1. Many surgeons offer a free initial consultation, free local seminar, or free webinar. These will give you a better idea of what to expect and allow you to ask questions.
  2. Many also provide a free insurance check. They will also help you appeal any denials or find financing.
  3. Most insurance companies need proof of a medically supervised diet program. Your surgeon will set this up for you if you haven’t done so already.
  4. Your surgeon will push you towards new habits that will be essential to success after surgery. Many surgeons will recommend support group meetings for feedback from actual patients.

02

Two Weeks Out: Prepare for Surgery

You will have completed your pre-op tests, physical, and any other required steps. You should have insurance approval by this point.
You should also be well on your way towards developing your diet and lifestyle habits.

In the week or two leading up to surgery, you’ll go to the hospital pre-surgery department. They will perform an EKG, blood work, and any last minute tasks or other pre-op tests.
You’ll meet with the surgeon one more time to wrap up final tests and forms. The night before surgery, do not eat or drink anything starting at midnight.

03

Surgery Day

You’ll arrive at the hospital at least two hours before surgery to allow for prep time. The gastric sleeve procedure itself will take about 2 hours to perform. Immediately after surgery, you’ll have a dedicated nurse to manage your pain and check your vitals.

Click here for more about what to expect in the hospital.

04

Recovery

Most gastric sleeve patients are in the hospital for 2 or 3 days. You can't eat or drink anything for at least 24 hours after surgery. And your your surgeon will want you to get up and walk around as soon as possible to start the healing process.

You’ll leave as soon as your surgeon is confident that you are well on the road to full recovery. You’ll need someone to drive you home from the hospital and care for you for at least a few days following surgery. Full recovery generally happens within 2 to 4 weeks.

Click here for more about the recovery process.

05

Adjust to Your New
Post-Surgery Diet &
Lifestyle

For the first 4 to 5 weeks after surgery, you will go from a clear liquid diet to your “new normal” gastric sleeve diet. You should also continue your transition into a more active lifestyle. You will feel full sooner, less hungry, and start to experience weight loss within a couple weeks.

Your surgeon’s dietitian or nutritionist will help you determine an appropriate diet. See the Diet & Life After section of this page for more information.

06

Attend Support
Groups Regularly

Regular support group participation leads to:

  1. Reduce post-op recovery time
  2. Lead to as much as 12% more long-term weight loss

Your surgeon will be able to recommend an in-person group near you. You can also sign up and attend free online moderated support groups through BariGroups.

07

Ongoing Doctor Visits

Your surgeon will schedule a follow up visit within 2 weeks to ensure you are recovering well and to answer any questions. Later visits will be scheduled as-needed.

12 TEST YOUR KNOWLEDGE

TEST YOUR KNOWLEDGE

Click here to take the gastric sleeve quiz

GASTRIC SLEVE: TEST YOUR KNOWLEDGE

Well-educated patients are more likely to be successful over the long-term. Test your knowledge to ensure that you're ready to take the next step!

12

QUESTIONS
Try to answer at least 11 out of 12 questions correctly

29

QUESTIONS
Try to answer at least 25 out of 29 questions correctly

13 Help & Support

Help & Support

Ask the expert Patient experiences

Patient Experiences

Ask the Expert & Patient Experiences*

We would love to hear your experiences with gastric sleeve surgery. Your insights are invaluable to making sure other people have the tools to meet their goals.

We would also be happy to answer any questions you may have about gastric sleeve surgery.

Please use the form below to share your experience or ask a question.

Click for Form & Visitor Submissions

Ask the
Expert

Ask the Expert & Patient Experiences*

We would love to hear your experiences with gastric sleeve surgery. Your insights are invaluable to making sure other people have the tools to meet their goals.

We would also be happy to answer any questions you may have about gastric sleeve surgery.

Please use the form below to share your experience or ask a question.

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Questions From Other Visitors*

Click below to see contributions from other visitors to this page…

My Experience After Gastric Sleeve Surgery*

I am 3 years post gastric sleeve surgery. I lost 62 kilos (137 lbs) in the first 10 months (weighed 124 kilos - 273 lbs - prior to surgery). I…


6 Mo. After Gastric Sleeve: Warnings & Successes*

I had some pretty major complications after my gastric sleeve surgery (I blew out some staples in my stomach, probably from rushing my solid food choices) and was very ill…


Sleep Apnea, GERD and Gastric Sleeve Surgery*

Why are people with sleep apnea and GERD at high risk during gastric sleeve bypass surgery? And what are the associated deaths 3 to 5 years following surgery?My husband is…


Happy Life with Challenges 4 Years After Gastric Sleeve*

Having a VSG (gastric sleeve) is the best thing I could ever have done for myself. It has changed my life in so many ways. I was 28 years old…


Hunger Pains & Stomach Growling 5 Days After Gastric Sleeve Surgery*

I had the gastric sleeve done 9/8/15 and the second day post op I started getting hungry. The hunger pains I'm experiencing are some of the worst I've ever experienced.…


Gastric Sleeve Effect on Lazy Bowel Syndrome*

I have "lazy bowel" syndrome. How would the gastric sleeve procedure effect me?


Weight Loss Surgery for Patient with Ulcerative Colitis*

Is it safe to have weight loss surgery (gastric sleeve in my case) if I have ulcerative colitis?I just had AAA repair surgery one month ago for colon ischemia.Is it…


Lap Band Revision to Gastric Sleeve with Low BMI*

I had my lap band for 7 years, Starting weight 222 ending weight 129 I'm 5'4". In July of 2014 I had to have it removed due to slippage and…


Pre-Op Concerns for Gastric Sleeve Patient*

I am scheduled to have gastric sleeve surgery. I have great confidence in my surgeon and that he will make the procedure as safe as he can. However, I am…


Taking Appetite Suppressants Before Bariatric Surgery*

Can I take a prescription or over the counter appetite suppressant before bariatric surgery?I'm scheduled to have gastric sleeve surgery in 10 days and want to make sure that it's…


Can I get a gastric sleeve procedure after I've had a Fundlipication ?*

My BMI is >40 and considering bariatric surgery . My surgeon's nurse (that did the Fundlipication) said it was possible. Was she correct? Is there a certain procedure better?


Worried About Excess Skin After Gastric Sleeve*

I'm 18 years old, weigh between 250-260 pounds, and am 5'4 1/2 (BMI of 44). I'm so scared the I will have severe excess skin and still feel ugly even…


How Fast Will I Lose Weight After Gastric Sleeve Surgery?*

Hi! I have my gastric sleeve surgery coming up in a couple weeks and am trying to prepare for how fast I will be losing weight after my procedure. I…


Is Gastric Sleeve The Best Weight Loss Surgery For Pregnancy?*

Dear Bariatric Surgery Source, I have been enjoying your site so far, thank you for all the info (it really helps!). But, I was hoping to find a little more…


Weight Regain After Gastric Sleeve Surgery. Help!*

Hi, I had the gastric sleeve surgery 2 years ago this March. First year, dropped weight like a rock. It was fantastic. I kept to the diet and exercise instructions…


14 Find a Top Gastric Sleeve Surgeon

Find a Top Gastric Sleeve Surgeon

Ask for a free insurance check or cost quote Attend a free seminar or webinar Schedule a phone or in-person consultation (both often free)

Search the gastric sleeve surgeon directory below to find a top surgeon by country and region:

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[ Last editorial review/modification of this page : 03/20/2017 ]

* Disclaimer: The information contained in this website is provided for general information purposes and your specific results may vary depending on a variety of circumstances. 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