Gastric sleeve, also known as sleeve gastrectomy, is a bariatric surgery technique that aims to achieve a faster feeling of fullness in the patient. Along with high blood pressure and type 2 diabetes, obesity represents a social and economic problem and a health problem of increasing importance—terms such as global epidemic and pandemic use in connection with these diseases.
| Operation Duration | Length of hospitalization | Recovery Time |
| 1-2 hours | 2-3 days | 3-5 weeks |
Surgical treatment of obesity has a history of several decades. Surgical methods have evolved, and we need to find a way to define them as the gold standard. This is how we described the gastric bypass procedure in the recent past. But more recent studies with results at 5 and 10 years after surgery, unfortunately, didn’t fulfill the optimistic assumptions and were quite disappointing. Long-term outcomes seem to depend more on patients’ lifestyle changes after surgery than we think.
The gastric sleeve began to appear at the beginning of the first decade of this century. Surgeons associated its initial use with operations in highly obese patients where tubulization was part of an operation with a duodenal switch and biliopancreatic diversion. For these patients, surgeons divided this surgery into two techniques to reduce the risk.
In the first surgery, surgeons performed a tube resection of the stomach, then left the patients to lose weight. Then the specialists performed the second part of the operation. This is the stage of reconnecting the small intestine. During this procedure, experts found that many patients had already lost enough weight after tube resection and didn’t progress to the second stage. Based on these experiences, experts began to use the gastric sleeve procedure as a separate operation.
Aside from some disappointment with the long-term results of gastric bypass surgery, surgeons are beginning to realize that gastric sleeve surgery produces almost identical results. For this reason, some workplaces have begun directly comparing these two operations in studies.
In short, it is possible to say that the effect on weight loss is almost the same. Gastric bypass, on the other hand, has a higher impact on the recovery of type 2 diabetes. However, gastric bypass has a higher percentage of complications. At the same time, post-operative monitoring is more complicated due to malabsorption. The procedure requires more intensive vitamin and trace element supplementation.
What is Gastric Sleeve?
Gastric sleeve is a physiologically restrictive surgery that aims to reduce the amount of food consumed by overweight people and treat obesity. Surgeons perform this procedure by removing part of the stomach. The process aids weight loss by reducing the amount of food.
Gastric sleeve surgery generally recommends for people who are overweight and have a Body Mass Index (BMI) of 40 or higher or those with a BMI of 35 or higher and have obesity-related health problems (such as high blood pressure, diabetes, or sleep apnea). They can also recommend it to people.
Gastric sleeves are generally considered a treatment option for people unable to achieve significant weight loss through other methods, such as diet and exercise. They don’t recommend it for people with a BMI below 35 or those without obesity-related health problems.
At the same time, during the procedure, there is a decrease in the hormone ghrelin (hunger hormone), produced mainly in the part of the stomach that surgeons remove with this surgery. Consistent with this, up to 75% of patients state that they feel a slight feeling of hunger. This significantly helps them get used to a new diet with significantly smaller food portions after surgery.
However, there are many more hormonal changes, and they are related to the hormones produced in the small intestine, the so-called incretins. In particular, changes in the levels of these hormones are responsible for the improvement of type 2 diabetes in these patients. Therefore, we rightly call this operation not only bariatric (surgical treatment of obesity) but also metabolic (treatment of diseases that aren’t directly related to the operated stomach).
Regarding actual weight loss, published data mentions losing an average of 55% of excess weight over 2 to 3 years. As with all bariatric surgeries, the results in the following years are highly dependent on the changes in the patient’s lifestyle, that is, in eating habits and physical activity.
It is currently the most preferred weight loss surgery by surgeons worldwide. A little more than 10 years ago, specialists performed only 9% of bariatric surgeries with this method, but today it has reached almost 90%.
Gastric sleeve is a restrictive procedure as it reduces the capacity or size of the stomach, forcing us to eat less. However, the truth is that in addition to the benefits of shrinking our tube stomach, it also causes changes and positive effects on the hormones we produce and our metabolism. This helps to strengthen and guarantee weight loss. An example of the hormonal and metabolic changes we can expect after surgery decreases appetite. This occurs because, as mentioned above, when a large part of the stomach removes, a significant portion of the cells that produce the hormone ghrelin is also removed or eliminated.
Surgeons perform the surgery laparoscopically with 4 or 5 small incisions ranging from 5 to 12 mm. Processing time can vary between 1 and 2 hours. Overall, the risks of sleeve gastrectomy are in the 0.3% range and are almost four times lower than with cholecystectomy (removal of the gallbladder). The only difference is that sleeve gastrectomy is never an emergency operation but a cholecystectomy. Therefore, we can say that the risks are relatively similar.
Who Should Have Gastric Sleeve Procedure?
The gastric sleeve procedure is a type of weight loss surgery that involves surgeons removing part of the stomach to reduce the amount of food you can consume and aid weight loss. Usually, experts recommend it for highly obese people with a Body Mass Index (BMI) of 40 or higher or those with a BMI of 35 or higher who suffer from obesity-related health problems such as high blood pressure and diabetes.
Gastric sleeve surgery is generally considered a treatment option for people who cannot achieve significant weight loss with other methods, such as diet and exercise. Experts typically don’t recommend it for people with a BMI under 35 or without obesity-related health problems.
It is important to remember that sleeve gastrectomy is a necessary procedure that carries risks and should not take lightly. You must carefully consider the risks and benefits of the process and discuss your options with a qualified healthcare professional before making a decision. This procedure isn’t suitable for everyone. Consultation with your surgeon is an essential first step in determining whether you are eligible for surgery. While there are no hard and fast eligibility requirements, doctors generally follow these criteria:
- Having a Body Mass Index (BMI) greater than or equal to 40: BMI measures body fat relative to height and weight. A BMI greater than or equal to 25 is considered overweight. More than 30 of them fall into obesity.
- People with a BMI greater than or equal to 35 with an obesity-related condition such as high blood pressure, diabetes, sleep apnea, or high cholesterol.
- A case-by-case decision can make for people with a BMI below 35 who also have type 2 diabetes. In a recent study, gastric bypass resulted in more remissions, fewer diabetes relapses, and better sugar control in type 2 diabetes than sleeve gastrectomy.
What are the Risks of the Gastric Sleeve Process?
Like any procedure, the excellent results of this operation also bring some risks. These are due to the invasiveness of this procedure, in which the stomach is cut lengthwise and sutured simultaneously. Unfortunately, nothing is 100% in surgery, despite using a semi-automatic stapling device, which gives hope that the result will be 100%. Therefore, complications are associated with the gastric suture line, which can divide early and late.
An early complication is an inability to adequately compress one of the broken vessels in the stomach wall with staple clamps and the onset of post-operative bleeding. Its frequency reports are between 1-5% in the literature. A much more serious complication is a late complication that occurs most often around the 7th post-operative day and consists of a defect in the healing of the suture line.
As a result, it crumbles, and a hole appears in the stomach. This causes stomach contents to enter the abdominal cavity and cause peritonitis. Peritonitis is a critical complication requiring weeks or months of ICU stay or other invasive procedures (drainage, stenting).
Experts defined death as a result of these complications. The incidence of this complication is approximately 2.5% in the literature. We don’t know the exact cause of this complication, but one of the reasons may be that the stomach load with too much volume after the operation. In summary, gastric sleeve risks complications like any surgical procedure. Check out some potential risks of sleeve gastrectomy surgery:
- Infection: There is a disease risk at the surgical site or wound.
- Bleeding: There is a risk of bleeding during or after surgery.
- Leaks: There is a risk of leakage from the area where the stomach is stapled or sutured.
- DVT (Deep Vein Thrombosis) or PE (Pulmonary Embolism): There is a risk of blood clots in the legs or lungs.
- Nausea and vomiting: Some people may have nausea and vomiting after surgery.
- Nutrient deficiencies: After the surgery, the stomach will shrink and cannot hold as much food as before. If the diet doesn’t carefully plan and balanced, this can lead to nutrient deficiencies.
- Acid reflux: Some people may experience acid reflux after gastric sleeve.
- Stomach obstruction: There is a risk of stomach blockage after surgery.
- Surgery-related death: Although rare, there is a small risk of death associated with any surgical procedure.
It is essential to discuss the risks of sleeve surgery with an experienced surgeon before deciding whether to have sleeve gastrectomy surgery.
What Will You Encounter During a Gastric Sleeve Consultation?
During a consultation for a gastric sleeve, you can expect to discuss your medical history, current health status, and weight loss goals with an experienced specialist. Surgeons will likely ask about any medical conditions you have, medications you take, and previous weight loss attempts you’ve made. The specialist will also assess your Body Mass Index (BMI) and discuss other factors that may affect your suitability for the procedure, such as age and underlying health conditions.
You will also have the opportunity to ask questions about the procedure, including the potential risks and benefits, the results you expect, and the healing process. Your doctor can also discuss the potential costs of the system and any insurance coverage that may be available. To fully understand the procedure and make an informed decision, it is essential to be honest and forthright and ask any questions you may have during the consultation.
How Should You Prepare for Gastric Sleeve Procedure?
If you are considering gastric sleeve surgery, it is crucial that you carefully prepare for the procedure. Check out a few steps you can take to help you have a smooth and successful surgery:
- Understand the procedure. Ensure you fully understand the process and what to expect during and after surgery. Ask your healthcare provider questions and clarify any points that are unclear to you.
- Follow pre-operative instructions. Your surgeon will explain in detail the preparations you need to make for this necessary procedure. This may include stopping certain medications, getting specific tests or screenings, and changing your diet or lifestyle. It is essential to follow these instructions carefully to ensure a successful surgery.
- After surgery, you will need someone to drive you home and stay with you for the first few days to provide support and assistance. Be sure to pre-arrange transportation and support.
- Ensure you have the necessary supplies and equipment at home, such as pain medications, ice packs, and other items your healthcare team recommends.
- You should follow an appropriate exercise program a few weeks before surgery.
- It would be best if you quit smoking during this period. Two weeks before the operation, according to the doctor’s advice, you should increase the consumption of protein foods and reduce the consumption of carbohydrate foods.
- Food and drug restrictions become more stringent a few days before the operation to avoid complications caused by the process. You should consume only liquids two days before the procedure and avoid eating.
- Your drinks should not contain caffeine and sugar.
- Inform your doctor if you are using any supplement, herbal medicine, pain reliever, or other medicine. One week before the procedure, you must stop taking blood thinners such as aspirin, ibuprofen, and vitamin E.
How is Gastric Sleeve Procedure Performed?
Although gastric sleeve specialists can perform the procedure using open surgery, specialists typically perform it laparoscopically using small incisions and special instruments. Check out the gastric sleeve surgery steps:
- Anesthesia
You will receive general anesthesia for your comfort. General anesthesia eliminates any sensitivity in the body, making you utterly numb during the surgery.
- Process
The surgeon will make several small incisions in the abdomen during the procedure. The specialist will insert laparoscopic instruments from them. The surgeon will then remove most of the stomach, leaving a small, tube-shaped stomach the size and shape of a banana. The specialist staples and sews your remaining stomach together to create a new, smaller stomach. The procedure typically takes 1 to 2 hours to complete, and most people stay in the hospital for one to three days after surgery.
It is important to remember that sleeve gastrectomy is a necessary procedure that carries risks and should only perform after careful consideration and consultation with a qualified healthcare professional.
What to Consider After Gastric Sleeve Procedure?
Gastric sleeve surgery, like other weight loss surgeries, requires post-operative care. You can get positive results from your surgery by doing this care. Proper nutrition after the procedure is essential. Because you will reach your goals by following the diet recommended by your obesity surgeon, this restorative procedure is necessary and can significantly impact your diet and lifestyle. It is essential to carefully consider the following factors after surgery to ensure a successful outcome:
- Diet: After surgery, your stomach will be smaller, and you will need to adjust your diet to ensure you get enough nutrients and simultaneously avoid discomfort. You will likely need to follow a strict diet plan for the first few weeks after surgery and gradually introduce new foods as your healthcare team recommends.
- Physical activity: You will need to increase your physical activity gradually as you recover from surgery. This may include walking or other low-impact activities at first and then gradually increasing the intensity and duration as you feel more comfortable. Regular exercise can aid weight loss and overall health.
- Follow-up care: It is essential to attend all follow-up appointments with your healthcare team and raise any concerns or questions. They will monitor your progress and provide support and guidance as needed.
- Coping with weight loss: Losing weight can be a critical adjustment, and it’s essential to prepare for the emotional and psychological changes that may occur. Support from friends, family or a mental health professional can help cope with these changes.
Considering these factors, you can increase your chances of a successful outcome after sleeve gastrectomy.
What is the Recovery Process After Gastric Sleeve?
The recovery period after gastric sleeve surgery isn’t very long, and you can return to your normal activities as soon as possible. After a few days, you will gradually be able to return to your old daily activities. Usually, specialists will recommend multivitamins and calcium supplements after the operation. It would be best if you went for a periodic checkup during the first few months, and the specialist will conduct examinations. Meals should be small so as not to harm the stomach. Take a look at the recovery process after gastric sleeve in general:
- Four weeks after surgery, specialists will allow you to return to your routine diet. Don’t rush to eat for the first few days; eat mostly liquid foods. Eating various foods as before is necessary to pass 6 weeks.
- Recovery after surgery typically includes a combination of rest, a special diet, and physical activity. It is essential to follow your doctor’s instructions closely to ensure a smooth and successful recovery.
- The specialists will give you pain medication to relieve discomfort immediately after the surgery. You will also need to rest and avoid strenuous activities for the first few weeks.
- You will follow a clear liquid diet for the first few days after surgery. As your stomach and digestive system heal, this will gradually progress to a pureed diet and solid food. It is essential to follow the recommended diet and avoid consuming high-fat, high-sugar, or large meals, as this can cause discomfort or complications.
- You will also be encouraged to increase your physical activity as you gradually recover. This may include walking or other low-impact activities at first and then gradually increasing the intensity and duration as you feel more comfortable.
- You must attend all follow-up appointments with your healthcare team and raise any concerns or questions. Most people can return to normal activities within a few weeks to a few months after surgery.
How Long After Gastric Sleeve Will You See the Final Result?
Between the first year and 18 months after the gastric sleeve, you will lose approximately 60% of your excess weight. Note that this procedure alone isn’t enough to lose weight. If you have had this procedure, you should exercise appropriately after the surgery and consume foods that effectively lose weight.
Gastric sleeve results are very successful, and surgery is an effective weight loss method in the medium term. The amount of weight loss you will achieve in this way depends on your physical condition and lifestyle. Generally, the rate of weight loss in sleeve gastrectomy surgery is lower than in gastric bypass surgery, and reaching the desired weight takes place within 2 to 3 years. Of course, we consider this process ideal for many people according to their expectations and conditions. The sleeve method allows 50% weight loss within two years.
In addition to weight loss, gastric sleeve surgery has an essential effect on improving obesity-related symptoms. Among the most critical obesity-related complications that you will resolve with this procedure are the following:
- Heart disease
- High blood pressure
- High cholesterol levels
- Sleep apnea
- Type 2 diabetes
- Stroke risk
- Infertility issues
With post-operative weight loss, your lifestyle changes dramatically. You should increase sports and social activities even more. Generally, there is a significant improvement in the person’s quality of life after the operation.
How Much Does Gastric Sleeve Cost?
Gastric sleeve costs can vary greatly depending on several factors, including the location of the surgery, materials, methods, techniques, and whether the procedure is in a hospital or clinic. However, some health insurance plans may cover some or all of the costs of this surgery. Also, coverage may vary depending on the specific project and individual circumstances.
It’s also worth noting that sleeve gastrectomy surgery may not include all the associated costs, such as pre-operative testing, follow-up care, and necessary medications or supplies. It is essential to consider these additional costs when evaluating the overall price of the procedure.
In Which Countries is the Cheapest Gastric Sleeve Procedure Performed?
In general, the cost of medical procedures, including sleeve gastrectomy, is usually lower in countries with a low cost of living compared to countries with a high cost of living.
It is difficult to determine which countries offer the lowest price for gastric sleeve surgery as prices can vary depending on various factors. However, it is worth noting that traveling to another country for medical tourism or medical treatment is a growing trend. Some people go through medical procedures in other countries to save money or access treatments not available in their home country.
Suppose you are considering gastric sleeve surgery in another country. In that case, it is essential to carefully research the quality of care and the reputation of the facility and surgeon you are considering. It is also necessary to be aware of the potential risks or complications associated with medical tourism, including the possibility of infection, language barriers, and the potential for unexpected costs or complications. Here are the gastric sleeve costs by country:
| COUNTRY | COSTS |
| United States | $15000 to $25000 |
| Brazil | $11000 to $15000 |
| China | $11200 to $19500 |
| Japan | $11300 to $20000 |
| South Korea | $6000 to $11000 |
| India | $6000 to $11500 |
| Argentina | $10500 to $16000 |
| Mexico | $4300 to $8900 |
| Germany | $12000 to $18000 |
| Turkey | $3250 to $5500 |
| Colombia | $5000 to $10000 |
| Italy | $12600 to $19250 |
| France | $11500 to $16000 |
| Spain | $13000 to $20100 |
| Taiwan | $5500 to $7200 |
| Venezuela | $5100 to $7000 |
| United Kingdom | $14000 to $22000 |
| Netherlands | $11000 to $15500 |
| Egypt | $5500 to $10000 |
| Peru | $6250 to $12500 |
| AVERAGE COST | $3250 to $25000 |
Attention: For Information Purposes Only
Please note that the content of this website is not a substitute for professional medical advice. You should always consult a specialist surgeon for personal guidance.
References
https://pubmed.ncbi.nlm.nih.gov/19536054/
https://link.springer.com/article/10.1007/s11695-010-0316-7
https://www.ncbi.nlm.nih.gov/books/NBK519035/
https://pubmed.ncbi.nlm.nih.gov/32359172/
https://www.nature.com/articles/s41366-020-00660-x
https://pubmed.ncbi.nlm.nih.gov/29625744/
https://link.springer.com/article/10.1007/s11239-009-0434-z
https://pubmed.ncbi.nlm.nih.gov/34613354/
https://pubmed.ncbi.nlm.nih.gov/16105402/
