Short answer
Sleeve gastrectomy is a bariatric operation in which the larger portion of the stomach is removed laparoscopically without altering intestinal anatomy. It is one of the most commonly performed bariatric procedures worldwide thanks to its relatively short operative time and preservation of bowel continuity. Reflux history, eating habits and comorbidities influence whether it is the right choice.
What is this procedure?
Also known as vertical sleeve gastrectomy, the procedure removes the greater curvature of the stomach using staplers, leaving a tubular pouch of roughly 100–150 mL. This restricts food volume and also reduces ghrelin, a hormone involved in appetite regulation, by removing most of the fundus. Because the intestinal tract is not rerouted, nutrient absorption is largely preserved.
Who may be a candidate?
- Adults with BMI ≥ 35 according to the 2022 ASMBS/IFSO indications.
- Selected patients with BMI 30–34.9 and type 2 diabetes or other uncontrolled metabolic disease.
- Patients who have not achieved durable results with diet, exercise and medical therapy.
- Patients without significant medical or anaesthetic contraindications.
Final candidacy is determined after clinical examination, blood work, endoscopy, imaging, anaesthesia review and, when needed, endocrinology, cardiology and psychiatry input.
Who may NOT be suitable?
- Severe, treatment-resistant reflux or significant hiatus hernia (gastric bypass may be preferred).
- Uncontrolled severe cardiac, pulmonary or hepatic disease.
- Active substance/alcohol use disorder or unstable severe psychiatric illness.
- Patients unable to commit to long-term lifestyle and follow-up changes.
How the procedure is performed
The operation is performed under general anaesthesia. Four to five small ports give access to the abdomen. The vessels along the greater curvature are divided and, alongside a calibration tube, the stomach is divided vertically with staplers. The resected stomach is removed. The staple line is checked and a leak test may be performed. The operation typically takes 60–90 minutes.
Preoperative preparation
Full blood count, biochemistry, thyroid function, vitamin/mineral panel (B12, vitamin D, iron, folate), HbA1c, chest X-ray, ECG, upper GI endoscopy and abdominal ultrasound when needed are requested. Anaesthesia consultation is performed. A 1–2 week high-protein, low-carbohydrate liver-shrinking diet is followed. Smoking should be stopped at least 4–6 weeks before surgery. Anticoagulant medication is managed by the team.
Hospital stay
The first few hours after surgery are spent in recovery. Early mobilisation begins the same day to reduce thromboembolism risk. A leak check is performed on day one before clear liquids are introduced. Pain control, antibiotic and anticoagulant prophylaxis are routine. Hospital stay is typically 3–4 nights. Before discharge, the diet plan, medications, activity and follow-up schedule are reviewed in detail.
Postoperative nutrition and follow-up
Nutrition progresses through clear and full liquids (1–2 weeks), pureed foods (2–4 weeks), soft foods (4–6 weeks) and then gradual return to regular textures. A daily protein target around 60–80 g, at least 1.5 L of fluids, a complete multivitamin, B12, vitamin D and iron as needed are part of standard follow-up. Laboratory and clinical reviews are advised every 3 months in the first year and at least yearly thereafter. Dietitian and psychological support together with regular physical activity are key to sustainable results.
See also: Nutrition after bariatric surgery.
Possible risks and complications
Early risks include staple-line leak, bleeding, infection, deep vein thrombosis, pulmonary embolism and anaesthesia-related complications. Long-term issues may include new or worsening reflux, vitamin and mineral deficiencies, gallstone formation, temporary hair loss and long-term weight regain. Risks are managed through careful patient selection, an experienced team, sound surgical technique and structured follow-up. Results vary between individuals.
Alternative methods
| Feature | Sleeve Gastrectomy | Gastric Bypass | Mini Bypass | Gastric Balloon |
|---|---|---|---|---|
| Type | Surgical (permanent) | Surgical (permanent) | Surgical (permanent) | Endoscopic (temporary) |
| Average duration | 60–90 min | 2–3 hours | 1.5–2 hours | 20–30 min |
| Hospital stay | 3–4 days | 4–5 days | 3–4 days | Same day / 1 day |
| Mechanism | Restrictive + hormonal | Restrictive + malabsorptive | Restrictive + malabsorptive | Satiety effect |
| Effect on reflux | May increase | May improve | Variable | Limited effect |
| Effect on type 2 diabetes | Marked | Very marked | Marked | Limited / temporary |
| Vitamin & mineral follow-up | Required | Strictly required | Strictly required | Limited |
| Reversibility | No | Limited | Limited | Yes (6–12 mo) |
Table is for information only; method selection is made together with the physician after examination, tests and multidisciplinary evaluation.
Frequently asked questions
Who is a candidate for sleeve gastrectomy?
In line with the 2022 ASMBS/IFSO indications, sleeve gastrectomy may be considered for adults with BMI ≥ 35 regardless of comorbidities, and for selected patients with BMI 30–34.9 and metabolic disease (e.g. type 2 diabetes). Reflux history, hiatus hernia, dietary patterns and endoscopy findings influence the final method selection.
How long does the operation take and how long is the hospital stay?
Sleeve gastrectomy typically takes 60–90 minutes. Hospital stay is on average 3–4 nights, depending on individual recovery, leak-test results and pain management.
Does sleeve gastrectomy cause reflux?
A subgroup of patients experience new or worsening reflux after sleeve gastrectomy. Pre-existing reflux, hiatus hernia and surgical technique all play a role. If symptoms become significant, medical therapy, lifestyle changes or rarely surgical revision may be considered.
How much weight will I lose?
Weight loss depends on starting weight, lifestyle change, follow-up compliance and metabolic factors. Promising specific numbers is not ethical. Long-term success is shaped by regular follow-up, dietitian support and physical activity.
Related pages
Sources
- • Eisenberg D et al., 2022 ASMBS and IFSO Indications for Metabolic and Bariatric Surgery.
- • Mechanick JI et al., Clinical Practice Guidelines for the Perioperative Nutrition, Metabolic, and Nonsurgical Support of Patients Undergoing Bariatric Procedures — 2019 Update.
- • World Health Organization — Obesity and overweight fact sheet.
Last updated: 28.06.2026 · Medical content: Op.Dr.Gökhan ATEŞ
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