Laparoscopic Sleeve Gastrectomy

The sleeve gastrectomy — also called the gastric sleeve — is the most commonly performed weight loss surgery in the United States today, and it is the procedure I perform most frequently in my practice. It is highly effective, minimally invasive, and for the right patient, it can be truly life-changing. Let me walk you through exactly what it is, how it works, and what you can expect.

What Is a Sleeve Gastrectomy?

A sleeve gastrectomy permanently reduces the size of your stomach by about 70 to 80%, transforming it from its normal rounded, football size shape into a narrow, banana-shaped tube — or sleeve. Part of the large portion of the stomach that is removed is called the fundus, and this is where most of the hunger hormone ghrelin is produced. This is what makes the sleeve so much more powerful than simply going on a diet — we are not just making your stomach smaller, we are also dramatically reducing the hormone that makes you feel hungry in the first place. Most patients are genuinely surprised by how little hunger they feel in the months after surgery, and that hormonal advantage is one of the biggest reasons the sleeve works so well.

How Is the Surgery Performed?

Sleeve gastrectomy is performed laparoscopically — meaning through five small keyhole incisions rather than one large cut. You will be completely asleep under general anesthesia and will feel nothing during the procedure. Through these small incisions, we insert a tiny camera and thin surgical instruments that allow us to see and work inside the abdomen with great precision. A thin sizing tube called a bougie is placed inside the stomach to guide the shape of the new sleeve. A surgical stapling device is then used to divide the stomach from bottom to top along the length of the bougie, removing the large outer portion and leaving behind a narrow, tube-shaped sleeve stomach about the size of a banana. The staple line is carefully tested to make sure it is completely sealed before we close. I routinely doubly reinforce this staple line, either through specialized buttress material or oversewing the entire staple line to decrease any chances of complications such as leaks or bleeding. If a hiatal hernia is found during surgery — which is very common in bariatric patients — we repair it at the same time, which helps reduce the risk of acid reflux after surgery. The entire procedure typically takes 60 to 90 minutes, and most patients go home the very next day.

What to Expect After Surgery

Most patients are up and walking within a few hours of surgery — and we strongly encourage early movement because it is one of the best things you can do to speed up your recovery and prevent blood clots. Pain is typically mild to moderate and well controlled with medication. The majority of my sleeve patients go home the morning after surgery and are back to desk work within about one week.

Your diet will progress gradually through several stages to allow your new sleeve to heal properly:

• Weeks 1 to 2 — clear liquids and protein shakes, sipped slowly in small amounts throughout the day
• Weeks 3 to 4 — pureed foods with a smooth, soft consistency
• Weeks 5 to 6 — soft, moist, easily chewed foods
• After 6 weeks — a healthy regular diet with small portions, focused on lean protein, vegetables, and whole grains

Protein and hydration are the two most important priorities after surgery — and lifelong vitamin supplementation, including a bariatric multivitamin, calcium, vitamin D, and B12 — is essential and non-negotiable.

What Results Can You Expect?

Most patients lose at least 5-10% of their total body weight in the first month after surgery. Over the first 12 to 18 months, total excess weight loss of 50 to 70% is typical. Beyond the weight loss, the health improvements are remarkable — diabetes improves or resolves in up to 70% of patients, blood pressure improves in up to 75%, sleep apnea resolves in up to 85%, and joint pain, cholesterol, fatty liver disease, and hormonal conditions all improve significantly in the majority of patients. Most people tell me that the change they notice first and appreciate most is simply feeling in control of their hunger for the first time in years.

What Are the Risks?

Like all surgery, the sleeve carries risks that I discuss openly and thoroughly with every patient. The most serious early complication is a staple line leak — where the staple line does not seal properly — which occurs in about 1 to 2% of cases and requires prompt treatment. Bleeding occurs in about 1 to 3% of cases. Blood clots are prevented through early walking, compression devices, and blood thinning medications. Long term, the most important consideration for sleeve patients is acid reflux — the sleeve can worsen or cause new reflux in some patients, which is why I evaluate every patient carefully before surgery and repair hiatal hernias at the time of the procedure. Some patients experience temporary hair loss in the first few months after surgery — this is normal, related to rapid weight loss, and resolves on its own. Vitamin deficiencies are preventable with consistent supplementation and regular follow-up blood work.

Is the Sleeve Right for You?

The sleeve gastrectomy is an excellent option for patients who meet the BMI and health criteria for bariatric surgery, have minimal or well-controlled acid reflux, and are committed to lifelong dietary changes and vitamin supplementation. It may not be the best choice for patients with significant acid reflux, Barrett's esophagus, or large hiatal hernias — for whom gastric bypass is generally the better option. The best way to find out if the sleeve is right for you is to schedule a consultation so we can review your full medical history, discuss your goals, and make the decision together.

When you choose our practice, you are not just choosing a surgeon — you are choosing a team that will be with you every step of the way, before surgery, through recovery, and for the long term. The sleeve gastrectomy can be the beginning of a truly life-changing journey — and I look forward to taking that journey with you.

If you are considering weight loss surgery, the sleeve gastrectomy — also called the gastric sleeve — is one of the most commonly performed and most effective bariatric procedures available today. It is the procedure I perform most frequently in my practice, and for the right patient, it produces life-changing results. Let me walk you through everything you need to know — what it is, how it works, what to expect, and whether it might be the right choice for you.

A sleeve gastrectomy is a surgical procedure that permanently reduces the size of the stomach by approximately 70 to 80%, transforming it from its normal pouch-like shape into a narrow, banana-shaped tube — or sleeve. Part of the portion of the stomach that is removed is the large, rounded section called the gastric fundus — which is not only responsible for the majority of the stomach's storage capacity but is also the primary site of production of ghrelin, the hormone most responsible for driving hunger.

This is a critically important point that distinguishes the sleeve gastrectomy from simple dietary restriction: by removing the fundus, we are not just making the stomach smaller — we are fundamentally altering the hormonal environment that drives hunger and appetite. The result is a procedure that works on two powerful levels simultaneously — restriction and hormonal reset — making it far more effective than any diet alone.

Sleeve gastrectomy is performed laparoscopically — meaning through small keyhole incisions rather than one large open incision. This minimally invasive approach is one of the most important advances in bariatric surgery over the past two decades, and it is the standard of care in experienced hands.

Here is what happens during the procedure, step by step:

Anesthesia

• You will receive general anesthesia — you will be completely asleep and feel nothing during the procedure
• Our anesthesia team is experienced in managing bariatric patients and will monitor you closely throughout

Positioning and Preparation

• You will be positioned on the operating table in a slightly reclined position that optimizes access to the stomach
• The abdomen is cleaned and sterilely draped

Port Placement

• Five small incisions — typically 5 to 12 millimeters in size — are made in the abdomen
• Through these incisions, thin surgical instruments and a small camera called a laparoscope are inserted
• Carbon dioxide gas is used to gently inflate the abdominal cavity, creating space for the surgeon to work safely
• The camera transmits a high-definition view of the surgical field to a monitor, allowing the surgeon to see everything in precise detail

Mobilization of the Stomach

• The first step of the actual stomach procedure is carefully freeing the greater curvature of the stomach — the outer, curved edge — from its attachments to surrounding structures
• This is done using an energy device that seals and divides blood vessels safely as the dissection proceeds
• The dissection extends from the lower portion of the stomach all the way up to the gastroesophageal junction — the point where the esophagus meets the stomach

Sizing the Sleeve

• A calibration tube — called a bougie — is passed through the mouth by the anesthesiologist and positioned inside the stomach along the lesser curvature — the inner, straighter edge
• This bougie serves as a sizing guide to ensure that the sleeve is created to the correct diameter — not too narrow (which increases the risk of obstruction and leaks) and not too wide (which reduces effectiveness)
• The bougie is the internal template around which the new sleeve stomach is created

Stapling and Division

• Using a surgical stapling device — which simultaneously cuts and staples the tissue in two rows — the stomach is divided along its length from bottom to top, using the bougie as a guide
• Multiple applications of the stapler are required to divide the entire length of the stomach
• The staple line runs from the lower portion of the stomach all the way to just below the gastroesophageal junction
• The large portion of the stomach — the fundus and the majority of the body — is completely separated from the remaining sleeve and removed from the abdominal cavity through one of the port sites
• What remains is a narrow, tube-shaped stomach approximately the size and shape of a banana — typically holding between 60 and 150 milliliters, compared to the normal stomach capacity of approximately 1,000 to 1,500 milliliters

Staple Line Reinforcement and Testing

• The staple line — the newly created edge of the sleeve — is carefully inspected for any bleeding or irregularities
• Many surgeons — myself included — reinforce the staple line with additional sutures or a buttressing material to reduce the risk of bleeding and leakage
• The sleeve is then tested for leaks by injecting air through a tube, or endoscopically while the surgeon observes the staple line under direct vision — ensuring the sleeve is completely watertight before closing

Hiatal Hernia Repair

• As discussed in the GERD section, hiatal hernias are present in a large proportion of bariatric patients
• When a hiatal hernia is identified during the procedure — either on preoperative imaging or directly visualized during surgery — I repair it at the same time
• This is an important step that significantly reduces the risk of postoperative acid reflux after sleeve gastrectomy

Closure

• The laparoscopic instruments are removed, the abdominal gas is released, and the small port incisions are closed with absorbable sutures beneath the skin — typically requiring no visible external stitches
• Small dressings are placed over each incision site
• The entire procedure typically takes between 60 and 90 minutes in experienced hands

After surgery, you will be taken to the recovery room where our nursing team will monitor you closely as you wake from anesthesia. You can expect:

• Monitoring of vital signs, oxygen levels, and pain levels
• Intravenous fluids and medications for pain and nausea
• Encouragement to take slow, deep breaths — important for lung health after any abdominal surgery
• Assessment of your readiness to move to your hospital room

Most patients move from the recovery room to their hospital room within 1 to 2 hours after surgery.

Day of Surgery:

• Once you are settled in your room and feeling stable, our nursing team will help you sit up and take your first steps — typically within a few hours of surgery
• Early walking is one of the single most important things you can do after surgery — it reduces the risk of blood clots, promotes bowel function, and accelerates recovery
• You will begin sipping small amounts of water — typically 1 to 2 ounces at a time — to begin hydrating your new sleeve
• Pain is managed with a combination of intravenous and oral medications — most patients describe discomfort rather than severe pain, and it is well controlled with modern pain management protocols

Day One After Surgery:

• You will continue walking frequently — every few hours — and gradually increasing your activity
• Your diet advances to clear liquids — water, broth, sugar-free popsicles, diluted protein drinks
• Our nursing team and dietitian will visit to begin your dietary education and answer questions
• The majority of sleeve gastrectomy patients are ready to go home on the first day after surgery

Going Home:

• Before discharge, you will receive detailed written instructions covering your diet progression, activity restrictions, medications, warning signs to watch for, and follow-up appointment schedule
• You will go home with prescriptions for pain medication, anti-nausea medication, a proton pump inhibitor to protect the staple line, and blood clot prevention medication
• Our care team is available by phone around the clock for any questions or concerns after discharge

One of the most important aspects of your recovery and long-term success after sleeve gastrectomy is following the dietary progression carefully. Rushing through the stages before your sleeve has fully healed risks serious complications — and I ask every patient to trust the process and follow the plan:

Weeks 1-2 — Clear and Full Liquids

• Water, broth, sugar-free popsicles, diluted protein shakes
• The goal is hydration and beginning to introduce protein
• Sip slowly — no gulping — and aim for small volumes frequently throughout the day
• Target at least 64 ounces of fluid and 60 to 80 grams of protein daily — working toward these goals gradually

Weeks 3-4 — Pureed Foods

• Smooth, blended foods with a consistency similar to applesauce or yogurt
• High protein options — pureed chicken, fish, eggs, cottage cheese, Greek yogurt
• No chunks, lumps, or fibrous textures
• Continue prioritizing protein and fluid

Weeks 5-6 — Soft Foods

• Soft, moist, easily chewed foods — soft fish, ground meat, soft cooked vegetables, scrambled eggs
• Chew everything thoroughly — 20 to 30 chews per bite
• Continue to eat protein first at every meal

After 6 Weeks — Regular Healthy Diet

• A healthy, balanced diet focused on lean protein, vegetables, whole grains, and healthy fats
• Portion sizes remain small — typically 3 to 6 ounces per meal initially, gradually increasing
• Avoid high-sugar, high-fat, and highly processed foods
• Separate eating and drinking — do not drink with meals or for 30 minutes after eating
• Lifelong vitamin supplementation — a comprehensive bariatric multivitamin, calcium citrate, vitamin D, vitamin B12, and iron (for women) — is essential and non-negotiable

Weight Loss:

• Most patients lose 5-10% or more of their total body weight in the first month after surgery
• Total excess weight loss of 50 to 70% is typical at one to two years after sleeve gastrectomy
• Weight loss is most rapid in the first 6 to 12 months — the period of greatest hormonal advantage and highest motivation
• Most patients reach their maximum weight loss at approximately 12 to 18 months after surgery

Health Improvements:

• Type 2 diabetes — improves or resolves in 50 to 70% of patients
• High blood pressure — improves or resolves in 60 to 75% of patients
• Sleep apnea — improves or resolves in 80 to 85% of patients
• High cholesterol — improves significantly in 70 to 80% of patients
• Joint pain and mobility — improves dramatically in the majority of patients
• Fatty liver disease — improves or resolves in the majority of patients
• PCOS and hormonal conditions — improve significantly in most women
• Energy levels, mood, and quality of life — improve profoundly for most patients

The Hunger Hormone Advantage:

• One of the most powerful and most appreciated benefits of sleeve gastrectomy is the dramatic reduction in hunger in the early months after surgery
• Ghrelin levels drop by approximately 60 to 70% after sleeve gastrectomy — meaning most patients feel genuinely and comfortably less hungry than they have in years
• This hormonal advantage is most pronounced in the first 12 to 18 months after surgery and gradually attenuates over time — which is why maximizing weight loss during this window is so important

I believe deeply in complete transparency with my patients about surgical risks — because informed patients make better decisions and have better outcomes. The sleeve gastrectomy is a safe procedure in experienced hands, but like all surgery, it carries risks that deserve honest discussion:

Short-Term Risks:

• Staple line leak — the most serious early complication, occurring in approximately 1 to 2% of cases. A leak occurs when the staple line does not heal properly, allowing stomach contents to escape into the abdominal cavity. Leaks require prompt recognition and treatment — sometimes including reoperation, drainage procedures, or endoscopic stenting
• Bleeding — from the staple line or surrounding vessels, occurring in approximately 1 to 3% of cases. Most bleeding is managed without reoperation
• Blood clots — deep vein thrombosis or pulmonary embolism, prevented through early ambulation, compression devices, and blood thinning medications
• Anesthetic complications — managed by our experienced anesthesia team
• Wound infection — uncommon with laparoscopic surgery
• Nausea and vomiting — common in the early postoperative period, managed with medications

Long-Term Considerations:

• GERD and acid reflux — as discussed extensively in the GERD section, sleeve gastrectomy can worsen or cause new onset acid reflux in a significant proportion of patients. This is the most important long-term consideration for sleeve patients and is why preoperative reflux evaluation and hiatal hernia repair at the time of surgery are so important in my practice
• Sleeve dilation — over time, the sleeve can gradually stretch — particularly with overeating — reducing its restrictive effect and contributing to weight regain
• Weight recurrence— as with all bariatric procedures, some degree of weight regain over time is possible and should be expected. Long-term success requires sustained commitment to dietary guidelines, physical activity, vitamin supplementation, and follow-up care
• Vitamin deficiencies — lifelong supplementation is essential to prevent deficiencies in iron, vitamin B12, vitamin D, calcium, and other nutrients
• Hair loss — temporary hair shedding is common in the first 3 to 6 months after surgery, driven by the physiological stress of rapid weight loss. This is temporary and resolves as weight stabilizes and nutrition is optimized

The sleeve gastrectomy is an excellent choice for many patients — but it is not the right choice for everyone. In general, sleeve gastrectomy may be the preferred option for patients who:

• Meet the BMI and comorbidity criteria for bariatric surgery
• Have minimal or well-controlled acid reflux without significant hiatal hernia or Barrett's esophagus
• Prefer a simpler procedure with no rerouting of the intestine
• Do not have a history of significant esophageal motility disorders
• Are willing to commit to lifelong dietary guidelines and vitamin supplementation
• Have realistic expectations about weight loss and the commitment required for long-term success

Sleeve gastrectomy may not be the best choice for patients with:

• Significant pre-existing GERD, large hiatal hernia, or Barrett's esophagus — for whom gastric bypass is generally preferred
• A history of esophageal motility disorders
• Need for the most maximal possible weight loss — in which case gastric bypass or duodenal switch may be more appropriate

Choosing to have bariatric surgery is one of the most significant health decisions you will ever make — and choosing the right surgeon and program to guide you through it matters enormously. When you choose our practice for your sleeve gastrectomy, you are choosing:

• A board-certified, experienced bariatric surgeon who performs a high volume of sleeve gastrectomies and revisional procedures
• A comprehensive multidisciplinary team — surgeon, dietitian, psychologist, and care coordinators — dedicated to your success before, during, and after surgery
• A program built on the philosophy that bariatric surgery is the beginning of a lifelong journey — not a one-time event — and that our commitment to you extends far beyond the operating room
• Transparent, honest communication about risks, realistic expectations, and everything you need to make a fully informed decision
• Compassionate, judgment-free care that recognizes obesity as a chronic disease and treats you with the dignity and respect you deserve

The bottom line: sleeve gastrectomy is one of the most effective, safest, and most transformative weight loss procedures available today — and for the right patient, it can be the beginning of a genuinely life-changing journey. If you are ready to learn more and find out whether sleeve gastrectomy is the right choice for you, I look forward to meeting you and walking through every detail together. That conversation starts here.