Gastric Sleeve (Sleeve Gastrectomy)


Gastric sleeve or sleeve gastrectomy surgery is a type of weight loss surgery. It may be appropriate for you if you have a BMI of 35 or more. It is a more significant operation than having a gastric band fitted, however it is not considered as invasive as a gastric bypass since it involves fewer changes to your body’s digestive system.

Sleeve gastrectomy can be performed on its own, however it is occasionally performed as the first part of a two stage procedure. For patients considered too high risk for gastric bypass for example, the gastric bypass can be performed sometime after the gastric sleeve surgery once the patient has lost some weight.

About the gastric sleeve operation

The gastric sleeve procedure involves reducing the size of your stomach. During the operation up to ¾ of the stomach is removed by dividing it, with the new stomach taking the shape of a narrow tube or sleeve. This effectively restricts the stomach capacity without affecting its function, so that the amount of food that can be eaten at one time is restricted.

Gastric sleeve surgery can be performed either as “keyhole” surgery or through an incision in your abdomen during an open operation, and usually takes one to two hours. It is performed under general anaesthetic, which means you will be asleep during the procedure. You will normally need to stay in hospital for one to three days so we can look after you and make sure we are happy with everything before you go home.

How does the gastric sleeve differ from other weight loss operations?

Gastric sleeve surgery reduces the size of your stomach, unlike the gastric bypass procedure which also affects the way food is absorbed. Compared with a bypass operation there are also fewer restrictions on the types of food that can be eaten following the surgery.  Following gastric sleeve surgery patients often experience a reduction in appetite as the area of the stomach that has been removed plays a role in the amount of the hunger hormone your stomach releases and you may initially lose weight more rapidly than with a gastric band.

The gastric sleeve operation also differs from the gastric band procedure since it is a permanent reduction in the size of your stomach, and is not reversible.


Frequently asked questions about gastric sleeve

How much weight will I lose?
Weight loss results following sleeve gastrectomy vary. The national average weight loss is 65% of the excess body weight over an 18-24 month period. 

Will I lose weight quickly?
Weight loss commences when the liver reducing diet is started prior to surgery. Post operative weight loss can be quite rapid in the first six to eight weeks but then should settle into a steady monthly reduction. The national average weight loss is 65% of excess weight over a 12 -18 month period, but success is related directly to motivation, commitment and following the guidelines provided.

How long will I have to stay in hospital after surgery?
You are normally expected to stay one to two nights for this type of procedure, however, if it is clinically necessary for you to stay in longer then this will be explained to you by our clinical team. 

How long will I have to take off work?

Most people are able to return to work after 2 – 3 weeks depending on the kind of work you do. If you work in heavy manual labour you may require a little longer.

Will I have to take any medication after surgery?
Yes. All sleeve gastrectomy patients will need to take medication to protect the stomach for a short period after surgery (six weeks). B12 and folic acid will be given at six weeks post operatively at the hospital and continued by your GP. There is no evidence to suggest that nutritional supplements are required but many patients choose to take a good quality multivitamin for the first few weeks after surgery. If you are eating a small, varied and healthy diet you should remain nutritionally stable in the long term.

Should I exercise after surgery?
You will be encouraged to exercise following surgery, gradually increasing your activity over two week. Exercise is an important part of your recovery – it will help relieve the symptoms of ‘trapped wind’, reduce the risk of blood clots in the legs (DVT), help increase weight loss by increasing metabolism, and help reduce blood pressure and cholesterol levels. Exercise will also help support your joints and to improve your final physique.

Exercise such as walking in the first two weeks can be increased gradually until you are exercising for 30 minutes three or four times a week. 

How long before I can drive after surgery?
You should not drive for 10 days post operatively (DVLA policy). You can drive after that time if you can safely carry out an emergency stop. Ask your insurance company for advice if you have any doubts.

How will my diet change after surgery?
In the first few weeks after surgery your diet will be restricted but it is important to protect against nutritional deficiencies. You could take a good quality multivitamin when fully recovered; however consuming a small but healthy diet should provide you with adequate vitamins and minerals so supplements would not typically be prescribed. An anti-acid tablet may be provided (depending on past medical history) as this will help reduce stomach acid and prevent the formation of ulcers. The aim of any treatment is to help individuals change eating habits and lifestyle to improve health and quality of life in the long-term. It is important to take this opportunity to make changes, as reverting to a grazing or poor quality food choices may result in regaining weight or a less successful weight loss.   

Will my current medical problems/conditions affect my weight loss surgery?
Many people with pre-existing medical conditions undergo treatment/surgery. Some medical conditions associated with increased body weight, such as type 2 diabetes, obstructive sleep apnoea, hyperlipidaemia and high blood pressure, can improve following weight loss and therefore treatment/surgery can help.  It is vital that you inform the specialist nurse and your doctors of any investigations or treatments you are receiving to ensure all tests and investigations are completed before proceeding as this will best ensure your safety and reduce the risks associated with surgery.

What is the mortality rate?
The national mortality rate for sleeve gastrectomy is 0.3% though there have been no related deaths following this procedure at Spire Manchester Hospital.

What if I am still very hungry after surgery?
Most patients experience a reduction in hunger following sleeve gastrectomy as the part of the stomach responsible for the chemicals related to hunger is removed. If hunger continues to be a problem, it is important to make lifestyle changes and change eating habits to best manage those symptoms. ‘Head hunger’ and ‘stomach hunger’ can be different and it is important to learn to recognise the difference at the early stages, as habit and food dependence may need to be addressed to reduce those symptoms. 

What can I eat after surgery?

You will liaise very closely with our in house dietetics team who will give you a specific diet plan tailored to your individual needs after your surgery.

Will I have big scars?
You will have five very small scars equally spaced across your upper abdomen. The skin is closed with either soluble stitches or surgical glue. Wounds are generally covered for one week following which the dressings can be taken off. Wounds should be healed within two to three weeks and scars fade over time.

Will I be able to drink alcohol after surgery?
We would suggest that alcohol is avoided for the first six to eight weeks of the ‘weaning’ period immediately following your surgery. Many people enjoy an alcoholic beverage and there is no reason why it should be completely avoided but alcohol must be consumed in moderation. The national guidelines are that women should have no more than 14 units of alcohol per week, and men to have no more than 21 units of alcohol per week. However, alcohol is high in calories and therefore reducing consumption can assist in weight loss. Following bariatric surgery you will find that alcohol is absorbed into your blood stream much more rapidly, you may feel intoxicated much quicker as there is less food to absorb the alcohol in your stomach. Fizzy drinks are also a significant problem following surgery as the gas can cause pain and distension of the stomach pouch. An occasional glass of wine may be easier to tolerate that beer or mixers.

How long has this procedure been available?
Sleeve gastrectomy has been carried out for about two years as a stand alone procedure. Historically it was the first part of a two part approach for patients with significant obesity problems.  It was found that many of those patients did not need to proceed to the second stage as weight loss and health improvement had been accomplished.

What does laparoscopic mean?
Laparoscopic surgery, also known as minimally invasive surgery, is a technique that allows surgery to be performed without the long traditional incision (cut). By using multiple small incisions, each between 5- 15mm long, the surgeon inserts instruments including a tiny camera. The camera allows the surgeon to see the surgery.

Can the surgery be reversed?
No. A large part of the stomach is completely removed during sleeve gastrectomy and it is therefore not reversible. Patients must make a lifelong commitment to the lifestyle changes required before undertaking this surgery.

Is it safe to fly after surgery?
We would suggest that you do not fly long haul during the weaning period. There is a risk of blood clots related to surgery and you will be provided with medication, stockings and advice about how best to reduce your risks.

Holidays abroad are best avoided during this time as dietary requirements may be difficult to manage if away from home.