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Gastric Sleeve Surgery (Sleeve Gastrectomy)
Gastric sleeve surgery (vertical sleeve gastrectomy/VSG) is the most popular weight loss surgery worldwide, permanently removing 75-80% of your stomach to create a narrow "sleeve" about the size of a banana. This dramatically reduces hunger hormones (ghrelin), leading to 50-70% excess weight loss (60-100+ lbs average) within 12-18 months.
Unlike gastric bypass, the sleeve is a simpler, safer procedure with no intestinal rerouting or malabsorption. It's a permanent, irreversible solution for morbid obesity that also resolves diabetes, hypertension, sleep apnea, and other obesity-related conditions in 80%+ of patients.
How Gastric Sleeve Works
- Restriction: Tiny stomach (150-200ml) holds only 4-6 oz food at a time (vs 32-40 oz normal)
- Ghrelin Removal: Part of stomach removed produces ghrelin (hunger hormone) - you feel less hungry
- Early Satiety: Feel full after eating very small portions
- Metabolic Changes: Alters gut hormones improving insulin sensitivity (diabetes remission)
Gastric Sleeve vs Other Weight Loss Surgeries
✓ Gastric Sleeve (Our Most Common)
- ✓ 60-70% excess weight loss
- ✓ Simpler surgery (no intestinal rerouting)
- ✓ Lower complication rate than bypass
- ✓ No dumping syndrome
- ✓ Vitamin deficiency less severe
- • Irreversible (stomach permanently removed)
- • Higher GERD risk (acid reflux)
Gastric Bypass (Roux-en-Y)
- • 70-80% excess weight loss (slightly more)
- • Better for severe diabetes (higher remission)
- • Reduces GERD (good if existing reflux)
- • More complex surgery, higher complications
- • Severe dumping syndrome risk
- • Lifelong vitamin deficiencies (B12, iron, calcium)
Gastric Band (Lap-Band)
- • Only 40-50% excess weight loss (least effective)
- • Reversible, adjustable
- • No cutting of stomach
- • High failure rate (50% removed within 10 years)
- • Frequent office visits for adjustments
- • Being phased out - rarely performed now
The Surgical Procedure
Approach: Laparoscopic (Minimally Invasive)
5-6 small incisions (5-12mm each) in abdomen. Camera and instruments inserted. NO large open incision.
Surgery Duration: 60-90 minutes | Anesthesia: General
Step 1: Stomach Mobilization
Surgeon separates stomach from surrounding attachments (spleen, pancreas, liver) to expose left side where cutting will occur.
Step 2: Stomach Division (The Key Step)
Using surgical staplers, surgeon divides and removes 75-80% of stomach vertically along its greater curvature (left side). A narrow gastric tube remains, shaped like a banana/sleeve. Removed portion includes fundus (where ghrelin produced).
Step 3: Staple Line Reinforcement
Staple line oversewn or reinforced to prevent leaks (most serious complication). Some surgeons place absorbable reinforcement material over staples.
Step 4: Leak Test
Stomach filled with blue dye or air to check for leaks. If leak detected, repaired immediately.
Step 5: Closure & Drain
Removed stomach portion extracted through small incision. Drain placed near staple line (removed 1-3 days post-op). Incisions closed with dissolving sutures.
Recovery Timeline
2-3 Days: Pain managed with IV meds. Liquid diet starts day 1. Walk same day (prevents blood clots). Leak test on day 2 before discharge.
Clear liquids only (broth, protein shakes, water). Moderate pain/soreness. Fatigue. Walk daily 15-20 mins. No lifting >10 lbs.
Progress to pureed foods (yogurt, cottage cheese, mashed foods). Return to desk work week 2-3. Can drive when off narcotics.
Soft solid foods. Weight losing rapidly (10-20 lbs/month). Begin exercise. Resume all normal activities.
Active Weight Loss Phase: Most weight loss occurs. Average 60-70% excess weight loss by month 12-18. Energy levels normalized.
Expected Weight Loss Results
Average Results:
- Total Weight Loss: 60-100+ lbs (depends on starting weight)
- % Excess Weight Lost: 60-70% on average
- BMI Reduction: 10-15 points
- Example: Starting 300 lbs → End 200-220 lbs (100 lbs lost)
Long-Term: 10-20% of lost weight typically regained by year 5 (normal/expected). Maintaining loss requires permanent lifestyle changes.
Health Benefits Beyond Weight Loss
Type 2 Diabetes
80-90% remission rate - stop medications, normal blood sugar within weeks
Hypertension (High BP)
70% resolution - eliminate or reduce BP medications
Sleep Apnea
85% improvement - stop using CPAP machine
Joint Pain
Significant reduction in knee/hip/back pain from weight reduction
Potential Complications
- Staple Line Leak (1-3%): Most serious complication. Requires emergency surgery if occurs. Risk highest first 7 days.
- GERD/Acid Reflux (20-30%): New or worsened reflux common. Treated with PPIs. If severe, may need conversion to bypass.
- Stricture (1-5%): Narrowing of sleeve causing vomiting. Requires endoscopic dilation.
- Bleeding (1-2%): Rare. May require transfusion or re-operation.
- Blood Clots (0.5%): Prevented with early walking + blood thinners.
- Vitamin Deficiency: Less severe than bypass but requires lifelong multivitamin + B12.
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Am I a Candidate?
Standard Criteria:
- BMI ≥40 (morbidly obese) OR
- BMI 35-39.9 with obesity-related illness (diabetes, hypertension, sleep apnea)
- Age 18-65 (case-by-case outside range)
- Failed non-surgical weight loss attempts
- Committed to lifelong lifestyle changes
- Psychologically stable, no active substance abuse
NOT suitable if: Pregnancy, severe heart disease, uncontrolled psychiatric disorder, active drug/alcohol abuse
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