Gastric sleeve surgery (sleeve gastrectomy)

It’s weight loss surgery to remove part of your stomach, leaving the left side in a long, sleeve-like shape.

This reduces your stomach size, limiting the amount you can eat. It also changes the way your hormones work, so you’ll feel full more quickly than before.

Other benefits are an improvement or a reduced risk of developing weight-related conditions such as type 2 diabetes and heart disease.

Who needs it?

If your body mass index (BMI) is 35 or more and you’ve been struggling to lose weight even while maintaining a healthy lifestyle, this could be an option for you.

You must also be fit for surgery and general anaesthetic to be considered for gastric sleeve surgery.

Sometimes, gastric sleeve surgery is carried out before you can have gastric bypass surgery. In this case, you’ll need to wait for up to 18 months after your gastric sleeve surgery before being assessed for the second operation. By that time, you should have lost a significant amount of weight.

Gastric sleeve surgery is different to a gastric bypass as a bypass involves creating a small pouch at the top of the stomach which is then connected to the small intestine, redirecting past (bypassing) the rest of the stomach.

Long term results

The surgery won’t stop you craving or eating unhealthy food, so you must be willing to make long-term lifestyle changes. To ensure your sleeve surgery will work long-term, you need to be committed to eating three low-sugar meals a day while avoiding snacks and sugary drinks. You should also avoid drinking liquids with your meals and increase the amount of exercise you do.

You should also consider other ways to relax or improve your mood, instead of relying on food.

It’s an operation to remove one side of your stomach to help you lose weight. This works in two ways:

• It reduces your stomach size by around 75%, limiting the amount you can eat
• It removes the portion of your stomach mainly involved in releasing the hunger hormone ghrelin, so you should feel full much more quickly

The benefits are:

• You can expect to lose around 30-50% of your excess weight in the first 12 months after your operation, and over two thirds in total
• Improvements in any weight-related conditions that you might have such as type 2 diabetes, heart disease, osteoarthritis, obstructive sleep apnoea, high cholesterol, and polycystic ovaries
• You'll be more able to do physical activity which can lead to increased energy, fitness, strength, stamina, bone density, improved mood and self-confidence
• Improvements in fatigue and shortness of breath

Who will be involved?

As well as your bariatric surgeon, you’ll also be seen by a:

• Dietitian – to talk to you about your diet
• Clinical Nurse Specialist
• Anaesthetist – to administer anaesthetic during the operation

You may be seen by a psychologist as well, who will talk to you about the emotional aspects of your gastric sleeve surgery and understand how we can support you through this process.

Before surgery

You’ll be assessed to check that you’re fit for the operation. This may include blood tests, X-rays and scans, as well as an explanation of the surgery and long-term outlook.

You may need to lose weight and follow a calorie-controlled diet, low in carbohydrates and fats, to reduce the size of your liver. This is important for gastric sleeve surgery as your liver will have to be moved out of the way so your surgeon can access the stomach. If the liver is smaller, the operation will be easier and safer.

During surgery

Gastric sleeve surgery is usually done by laparoscopic (keyhole) surgery. This has a faster recovery time than traditional open surgery. As the resulting stomach restricts the amount of food and drink you can hold, it’s known as a restrictive operation. The surgery is carried out under general anaesthetic so you’ll be asleep.

During the operation your surgeon will:

• Make small incisions and insert a telescopic instrument with a camera on the end – called a laparoscope
• Temporarily inflate your abdomen with carbon dioxide gas – this will create more space for the surgeon to work within
• Divide and seal any blood vessels supplying the part of your stomach to be removed
• Surgically remove around 75% of your stomach, leaving the remainder in a sleeve-like shape
• Leave in place the valve that releases food into your small intestine so your digestive system isn’t changed
• Close your incisions

If your surgeon thinks keyhole surgery isn’t suitable for you, they may suggest open surgery, which involves making one single, larger cut.

How long does gastric sleeve surgery take?

Between one and two hours.

Pain after gastric sleeve surgery

It’s normal to experience some pain or discomfort after gastric sleeve surgery, but your healthcare team will make sure you have appropriate pain relief medication.

Your hospital stay

You’ll stay in hospital for at least two nights. After your surgery, you will be given compression stockings or blood-thinning medication to reduce your risk of blood clots which can lead to complications such as DVT (deep vein thrombosis) and pulmonary embolisms. You may also be transferred to the High Dependency Unit where nursing staff can monitor your blood pressure and other vital measurements throughout the night.

You’ll then be transferred to the ward and stay until you have completed your normal swallow test and started your diet plan, this can be a further one to two days.

Recovery time

You can usually leave hospital two days after your surgery and it’s normal to feel very tired at first.

You may be able to return to work as soon as one week after your surgery but this is dependent on how strenuous your job is, most people get back to work after three weeks. You can expect to drive within four weeks but you should check with your doctor and motor insurance company first.

You should feel comfortable doing most everyday activities within four to six weeks. For three to six months afterwards, you may also get symptoms due to rapid weight loss, such as:

• Aching
• Dry skin
• Feeling cold
• Mood changes
• Thinning hair
• Tiredness

After two years, most of your weight loss will have happened.

Aftercare and ongoing treatment

Your healthcare team will explain what you need to do during your recovery. This will include:

• Pain relief
• A review of any medicines you’re taking for weight-related conditions, such as diabetes or high blood pressure
• A carefully controlled diet plan for the first four to six weeks, moving from liquids to pureed, soft then solid foods, plus advice on eating and portion sizes
• An exercise plan to help speed up your weight loss and improve your fitness
• Blood tests to check if you need extra vitamin and mineral supplements

Your lifestyle after treatment

Even though you won’t be able to eat as much as before your surgery, it’s important to follow a healthy diet and lifestyle and perhaps change your eating habits. This way you’ll maximise your weight loss and reduce your risk of weight-related diseases. Our dietitians will help you.

You should drink plenty of fluids throughout the day to avoid dehydration and constipation. Chewing your food thoroughly and not drinking and eating at the same time will reduce your risk of dumping syndrome. This is a collection of uncomfortable symptoms that occur when food enters the small intestine too quickly, including nausea, vomiting, dizziness, sweating and diarrhoea.

Gastric sleeve surgery will not change how well the stomach can absorb food, but it can change the absorption of iron and vitamin B12. You may need to be on some supplements long-term.

You should avoid getting pregnant for the first 18 months after gastric sleeve surgery so your weight can stabilise.

To maintain the benefits of your weight loss surgery, you’ll need regular check-ups for the rest of your life. These will become less often as time goes on.

Most people have gastric sleeve surgery without complications, but all surgery carries some risks. Your consultant will explain them to you before you go ahead.

Gastric sleeve surgery complications can include:

• Blood clots
• Infection
• Internal bleeding
• Leaking from where the stomach has been closed
• Acid reflux – when stomach acid leaks back up into your oesophagus (the tube that connects your mouth and stomach)
• Nausea and vomiting, which usually gets better over time
• Nutritional deficiencies
• Folds of skin due to rapid weight loss
• Stomach ulcers
• Stricture – where the connection between the stomach and intestine narrows
• Adhesion – where scar tissue forms between two or more organs and it results in them sticking together
• Deep vein thrombosis (DVT) and pulmonary embolism
• Infertility
• Changes in mental health such as depression and maladaptive eating
• Weight gain or recurrence of obesity-related illnesses

Anaesthetic complications can include:

• Unexpected reaction to the anaesthetic
• Chest infections