Patient feels full sooner while eating due to smaller stomach
Patient feels less hungry because smaller stomach secretes fewer hunger-causing hormones
During surgery, your surgeon will make between 1 and 5 small incisions in your abdomen (which minimizes gastric sleeve scars), insert various laparoscopic instruments, and 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.
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.
Cures or improves diabetes, sleep apnea, hypertension, and at least 12 other conditions
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).
and at least 10 other conditions
Patients who aren’t cured usually experience a noticeable improvement.
Gastric sleeve weight loss improves joint health. For every pound of weight lost, there is a 4 pound reduction in pressure on the knee (2). This improves mobility and reduces pain in the knees.
88,000 participants were involved in data collection on cancer research. Results state that patients who undergo weight loss surgery have 33% less risk of developing cancer (3).
Risk rates were even further reduced for obesity-related cancers, including (4):
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.
Average Patient Pays: $500 to $5,000 with insurance, $12,000 to $22,000 without insurance
Loan Payment: $445/month, on average
Discounts & Tax Savings: Usually available
According to our annual surgeon cost survey, the average total gastric sleeve cost without insurance is $19,000. However, cost range widely by state and surgeon. For example, our survey found that the highest average cost of gastric sleeve, $58,000, can be found in Alaska while the lowest average cost, $12,000, is available in Texas and South Dakota. See the full survey results by state and region in the interactive map below.
Many insurance plans cover gastric sleeve surgery, which will drop your out-of-pocket costs considerably. Patients with insurance that covers gastric sleeve can expect to pay an average of $3,500 for the procedure, although some plans will drop that amount well below $1,000.
If you don’t have insurance that covers the procedure, 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
Including Albany, Buffalo, New York City / Manhattan, Rochester, Watertown and Other Areas
Click your province in the map or select a cost tier below
HIGHEST COST STATES $20,500 - $58,000 range
If you do not have gastric sleeve insurance, the highlighted states above will be the most expensive. If you have insurance that covers gastric sleeve, your out of pocket costs will be about the same in all states.
AVERAGE COST STATES $17,450 - $20,500 range
If you do not have gastric sleeve insurance, the highlighted states above will have mid-level costs. If you have insurance that covers gastric sleeve, your out of pocket costs will be about the same in all states.
LOWEST COST STATES $12,400 - $17,450 range
If you do not have gastric sleeve insurance, the highlighted states above will be the least expensive. If you have insurance that covers gastric sleeve, your out of pocket costs will be about the same in all states.
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
Diet requirements by timeframe are summarized in the chart below.
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)
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
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:
Folate (folic acid)
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)
Exercise: 2.5 hours per week, spread out over 2 to 4 days
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 (5).
Working out regularly will also lead to quicker and better health improvement after surgery (6).
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.
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
Your Brain: Less Hungry, Careful About Food Addiction, New Mentality Will Change Behavior & Relationships
Ghrelin Hormone & Hunger
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.
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:
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.
Side effects may include digestion issues & sagging skin from rapid weight loss
Some weight regain possible
The relatively simple gastric sleeve procedure results in a very high survival rate (99.7%, or 319 out of 320 patients) (8).
But it does carry a risk of complications, side effects, and other challenges, some of which can be avoided.
The three most common serious gastric sleeve complications are:
Staple line leaks – 2.1% of patients on average (between 1.09% and 4.66%, depending on the study) experience staple line leaks (9) (10)
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.
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.
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.
The most common gastric sleeve side effects and challenges include: (13) (14) (15)
Potential digestive issues resulting from gastric sleeve surgery include: (16) (17)
Gastroesophageal reflux disease (GERD)
Intolerance to certain foods
Nausea and vomiting
Vitamin and mineral deficiency
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% (10).
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).
The other digestive issues listed above can often be addressed with diet and behavior changes.
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.
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 (18).
At 5 years, the average gastric sleeve patient regains at least 25% and possibly as much as 50% of the weight they lost (19).
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 (20).
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.
Newer procedures like gastric balloon, vBloc Therapy, and AspireAssist are becoming more popular, but they are still nowhere near as popular as the sleeve.
Gastric Sleeve Surgery Positives
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
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 syndrome – Dumping 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 Surgery Negatives
The gastric sleeve also has negatives compared to some of the other bariatric surgery types:
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.
Weight loss (on average) is usually lower than duodenal switch.
Health Improvement is generally not as good as gastric bypass or duodenal switch
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:
Port problems (since the sleeve does not use a port or any other implanted device)
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.
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.
5. 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.
6. Attend Support Groups Regularly
Regular support group participation leads to:
Reduce post-op recovery time
Lead to as much as 12% more long-term weight loss
Your surgeon will be able to recommend an in-person group near you.
7. 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.
*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.