Sleeve Gastrectomy

What does the surgery involve?

“The sleeve gastrectomy works by reducing the size of the stomach. The stomach size is reduced from the volume of a Galia melon to the volume of a peeled banana. After the stomach has been divided, the excess stomach tissue is removed.”

Diagram showing the new tubular shape of the stomach following sleeve gastrectomy. The main part of the stomach, shown on the right, is removed. This part contains an appetite secreting area, explaining the reduction in appetite that is commonly reported following this procedure.

How long does the procedure take?

“The sleeve gastrectomy is performed laparoscopically by keyhole surgery and takes generally less than one hour to perform.”

What scars will I have?

Drawing showing the position of the 5 small scars after sleeve surgery

“The procedure is laparoscopic or keyhole surgery, therefore there is no big scar. The procedure involves making five small cuts ranging from 5 mm to 12 mm long in the upper abdomen just below the rib cage.”

How will I feel following surgery?

“The morning after surgery you should be able to walk around your private room, use the bathroom and shower. You should be able to sit comfortably and drink tea, smoothies or milk. Your pain should be well controlled with soluble painkillers.”

How long will I need to stay in hospital?

“One or two nights.”

How long will I need off work?

“One or two weeks.”

How long until I can exercise?

“You will be able to walk around within hours of surgery. The morning after surgery I would expect a patient to be able to walk around relatively comfortably. On discharge from hospital I would recommend increasing activity levels daily including longer and longer walks. More active exercise such as at the gym can be introduced one week after surgery, with a gentle reintroduction to aerobic exercise such as light jogging, cycling or swimming. Any exercise involving heavy lifting should be avoided for one month.”

How soon can I reintroduce solid foods?

“The dietician will give you a detailed description of your pre-and postoperative dietary instructions. Following surgery, a liquid diet should be maintained for one week. This should be followed by a diet of pureed consistency food for one week. The third week should consist of mashed consistency foods and a slow introduction of well chewed solid food should be introduced thereafter. I advise patients to be particularly careful with bread and dried meat, such as chicken, for the first two months after surgery as these are the foods most likely to cause discomfort if not chewed properly.”

What will my eating be like long term?

“Following sleeve gastrectomy food has to be chewed very well and eaten quite slowly at least for six to twelve months after surgery. After this time, most patients report that the amount of food that they can eat increases slightly and the ease of eating also improves. Within a year of surgery, a patient’s weight will have settled and they will report that they are comfortable eating a small starter plate of food before they feel full.”

Will my appetite change?

“Following sleeve gastrectomy most patients report that their appetite decreases significantly. This is usually in terms of a decrease in hunger feeling. When the stomach is removed an appetite hormone (called ghrelin) that is present in this part of the stomach is also removed. This causes a profound decrease in the amount of this appetite hormone that is secreted in times between meals. Appetite tends to return after approximately one year. It however will not be the voracious type of appetite that can occur following intensive dieting, and will be a more normal healthy hunger feeling.”

Comparison of hunger feeling before and 6 and 12 weeks after sleeve gastrectomy. Time on x-axis represents time after a meal.

How much weight can I expect to lose?

“Following a sleeve gastrectomy, patients will lose approximately 70% of their excess weight on average. However, a proportion of patients do very well following sleeve gastrectomy and will lose almost all their excess weight. An example will be in a patient who weighs 20 stone but whose ideal weight is 10 stone, their excess weight would be calculated as 10 stone. Following a sleeve gastrectomy their weight would decrease by 7 stone to a level of 13 stone within nine to twelve months of surgery. With lifestyle changes this weight loss should be easily maintained long term.”

What do I need to do to ensure long term weight loss?

“The sleeve gastrectomy is extremely effective in producing excellent weight loss in the first year and changing the patient’s appetites and food preferences to help maintain this long-term weight loss. However, it is vital that after surgery a patient changes their lifestyle around significantly to help maintain this weight loss for the years to come. This would include changes in the eating pattern to ensure that they have a regular breakfast, lunch and dinner. The stopping or cutting down of unhealthy high calorie foods and finally the introduction of a more active lifestyle. These changes should ensure that weight loss is maintained long term.”

Do I need to take vitamins after surgery?

“We now recommend that following sleeve gastrectomy a patient take a multivitamin and calcium tablet for the first year after surgery whilst they are losing weight. As the sleeve gastrectomy does not involve any malabsorption of food, long term vitamin supplementation should not be necessary if a healthy diet is being taken.”

What health improvements can I expect?

“Following sleeve gastrectomy there are dramatic improvements in all of the medical conditions that are caused by being obese. Approximately 80% of diabetic patients will have a complete remission of this condition or a dramatic improvement in the control of their sugar levels following surgery. Most patients who have high blood pressure will not require medications following their weight loss. High cholesterol is generally normalised. Sleep apnoea is almost always cured following weight loss and a patient will not require further sleeping mask therapy.”

“In patients who did not have any medical conditions before surgery, they will notice a dramatic improvement in not only their underlying healthy but also their feeling of contentment and improved quality of life.”

What are the risks of surgery?

“In the short term, there is an approximately 2% chance of serious complications. These include bleeding from the staple line or leakage from the top of the staple line. These complications require either a blood transfusion or a further operation in the form of a laparoscopy to drain any leakage or stop bleeding. In the unlikely event of a leak then a patient can expect a longer stay in hospital.”

“Occasionally patients can have difficulty with swallowing solid food and occasionally liquids in the early period after surgery. This generally settles down in time.”

“Long term complications following sleeve gastrectomy are very rare but may include the sleeve gastrectomy tube re-dilating up, meaning a person can consume a greater volume of food and therefore increasing the possibility of weight regain.”