Sleeve gastrectomy is a bariatric surgery that results in a tube-shaped stomach. It was first developed in 1985 as part of the duodenal switch operation; starting in 2000, sleeve gastrectomy was done without the duodenal switch.

In 2010, insurance companies started authorizing sleeve gastrectomy because five-year results confirmed it was superior to gastric banding and almost equal to gastric bypass. Today, sleeve gastrectomy is the most commonly performed bariatric surgery.

How Sleeve Gastrectomy Works

This procedure removes a large volume of the stomach that allows people to eat large portions. The resulting tube-shaped stomach is called the “sleeve” because it looks similar to a shirt sleeve. The removed stomach section contains most of the cells that produce the hunger hormone (ghrelin), and there’s some evidence that this also reduces hunger.

The remaining sleeve stomach retains stretch and pressure receptors as well as the stomach valves (lower esophageal sphincter and pylorus). People with sleeve gastrectomy tend to notice early fullness, lasting fullness and much less hunger in between meals.

Pouch size is usually one to two ounces in the first year. After one year, many patients report an increase in pouch size to four ounces, the size of a deck of cards.

Benefits

Sleeve gastrectomy has become the most common weight loss operation because its weight loss and diabetes cure rates are similar to a gastric bypass, but it doesn’t carry the risks of bypass. It has the best safety profile over time.

People who don’t achieve enough weight loss or diabetes remission after sleeve gastrectomy have the option of an intestinal bypass a year or two later. However, this surgical revision often results in less than 10 pounds weight loss.

Considerations and Risks

• The removal of the stomach is permanent. This is generally not a major concern because the stomach usually expands somewhat. Years later, patients often ask if even more stomach can be removed again (the answer is almost always no).
• After sleeve gastrectomy you may experience reflux. Your doctor may recommend a hiatal hernia repair if one is detected. Only eight percent of patients remain on antacids one year after surgery.
• Staple line leaks can occur in the first two weeks after surgery. After the first few weeks, the staple line heals and leaks don’t occur.
• Inadequate weight loss or weight regain may occur due to grazing on high-calorie snacks and liquids. This is true for all weight loss operations. Only diet and exercise will keep you at your new healthy weight in the years after surgery.