Gastric Sleeve

What you'll learn on this page:

Qualifications
How to Prepare for Surgery
About the Procedure
Diet After Surgery – Week by Week
Benefits and Risks
An Experienced Team

Gastric sleeve, also referred to as sleeve gastrectomy, is a type of bariatric (weight-loss) surgery that treats obesity and other metabolic disorders such as diabetes, heart disease and stroke.

Gastric sleeve surgery is performed using tiny incisions to remove a portion of your stomach. This is known as a laparoscopic approach because your surgeon uses a small camera to guide the surgical instruments. Minimally invasive surgery such as gastric sleeve results in a faster recovery because the incisions are smaller and quicker to heal, with less pain than gastric bypass.

The procedure restricts what you can eat by surgically reducing your stomach size. It’s common to lose 60 to 70% of excess weight within a year or two after you have sleeve gastrectomy.

At Temple Health, weight-loss surgery is just one part of a lifelong health plan. If you qualify for a gastric sleeve procedure, our multidisciplinary team and motivating support groups will ensure you have all the support you need. We help you lose weight and keep the weight off.

Qualifications

Gastric sleeve may be an option for you if diet and exercise programs have not worked, and if you meet the following criteria:

Your body mass index (BMI) is over 40.
You have a BMI of 35 to 39.9 and have two or more obesity-related conditions metabolic syndrome such as high blood pressure, sleep apnea, diabetes or heart disease.

Check your BMI using our calculator:

Calculate Your BMI Now

Choose your units:

U.S. International

Your BMI score

Your category

Underweight = Less than 18

Healthy weight = 18–24.9

Overweight = 25–29.9

Obese = 30–34.9

Severely obese = 35–39.9

Morbidly obese = 40 and over

Are you a candidate?

Keep in mind that having a weight-loss procedure such as gastric sleeve is a lifetime commitment, and many factors go into deciding if you’re a candidate.

Before you undergo any type of bariatric procedure at Temple, you’ll meet with a bariatric surgeon to discuss whether bariatric surgery is right for you. You will also need to decide if you’re ready for such a big change.

During this initial consultation, you and your surgeon will assess:

Age Restrictions

Although there are no age restrictions associated with gastric sleeve, people older than 65 may have a higher risk of complications.

Medical Conditions

Although gastric sleeve is minimally invasive, no surgery is without risk. Certain medical conditions may put you at higher risk of complications during or after the surgery, including a history of heart problems, kidney stones or liver disease. The Temple team will conduct thorough testing prior to scheduling your surgery, to determine whether you’re eligible for surgery.

Psychological Aspects

As you schedule your procedure, you will need to mentally and emotionally prepare for a new way of living. Psychological conditions such as eating disorders, substance use disorder and depression will need to be addressed to ensure that you’re prepared for the major life change that is to come.

Motivation to Lose the Weight, and Keep It Off

Losing weight is a monumental commitment, and it can be successful in the long-term with motivation and the support of a knowledgeable team. If you meet the qualifications for gastric sleeve, your Temple Health team will help you keep up the momentum.

How to Prepare for Surgery

Part of adjusting to your new normal includes a shift in your focus. Once it is determined that you’re a candidate for gastric sleeve, you’ll want to start preparing. This includes:

Check with Your Insurance Company

Most insurance covers gastric sleeve if you meet the qualifications. Before your procedure, check with your insurance company to make sure you understand your coverage, including any co-pays or out-of-network considerations. Temple will help you with any pre-authorizations or required approvals.

Schedule Any Required Tests

Work with your bariatric team to complete any tests required prior to your procedure. Your bariatric surgeon will determine what tests you need based on insurance requirements and an evaluation of your overall health. These tests may include blood work and chest X-ray as well as an evaluation of your heart and gastrointestinal (GI) system.

Re-Think Your Relationship with Food

You’ll meet with a Temple dietitian in the weeks to months before your procedure to evaluate your nutrition and overall eating patterns. You’ll receive a customized nutrition plan that will help you get in the best shape possible before your procedure. Losing weight before your gastric sleeve will help you recover faster.

Your dietitian will also need to provide required paperwork to your insurance company to show that you’re committed to a successful procedure.

Move As Much As Possible

Successful long-term weight loss is a complex process that includes many different factors of your well-being. One of those factors is physical exercise. Even if you have not exercised in a long time, it’s important to move every single day before your procedure, and after you start your recovery process. Commit to moving just a little bit every day, even if it’s just a few steps.

If You Smoke, Now’s the Time to Quit

Smoking increases your risk of complications during surgery, even laparoscopic surgery such as gastric sleeve. If you smoke cigarettes or use any type of tobacco or nicotine product, talk to your doctor about strategies for quitting prior to your procedure.

Read Up, and Ask Questions

During your initial consultation, you’ll receive a packet to take home and read. But don’t stop there. Conduct your own research about gastric sleeve, talk to others who have been through the procedure, and ask your Temple weight-loss team as many questions as possible.

You are the center of your own healthcare team, so make sure you are well-informed.

Download our bariatric surgery checklist >

About the Procedure

Gastric sleeve is also known as vertical sleeve gastrectomy because your surgeon divides your stomach vertically (up and down) to remove a large portion of the stomach. The remaining portion, or sleeve, is about the size of a banana. The stomach nerves and outlet valve (pylorus) stay in place to help the stomach function.

Doctors also remove the part of your stomach that makes ghrelin – an appetite-stimulating hormone. This helps to reduce your appetite.

Minimally Invasive Gastric Sleeve

Temple bariatric surgeons perform sleeve gastrectomy with a minimally invasive approach. Because the incisions are smaller, this results in fewer complications and faster recovery.

gastric sleeve surgery before and after graphic

During the procedure, tiny incisions are made in your belly. A small camera (laparoscope) and surgical instruments are then inserted through the incisions. The camera is connected to a video monitor in the operating room. This allows your surgeon to view the inside of your belly.

To give the surgeon room to work within your belly, gas is pumped in to expand the area. Your stomach is then divided vertically, and a large portion of it is removed through a small incision. The remaining stomach portion is closed using surgical staples. What remains is a “sleeve” shaped much like a banana. The surgical instruments and camera are then removed and your incisions are closed.

After you have gastric sleeve, you’ll feel full after eating less food. This, combined with behavior modification and dietary compliance, will help you achieve successful weight loss. You’ll lose weight since you’re taking in fewer calories.

Diet After Surgery – Week by Week

Your diet will be restricted immediately following your gastric sleeve to allow your body time to heal and adjust. Over time, in stages, you’ll begin to add foods with more substance. As you learn to eat more solid foods, keep in mind:

It’s important to chew food thoroughly – 20 to 30 chews per bite – and stop before you’re full.
Overeating may cause nausea or stretch your stomach.
When it’s time, introduce new foods slowly to see how your body responds.

Week 1: Clear Liquid Diet

While in the hospital, you will start slowly, drinking 1-2 ounces of clear liquid every hour. Once discharged, you may increase your fluid intake to 3-8 ounces every hour. Over the next week, you will increase your intake slowly until you work up to 48-64 ounces daily. During this time, your primary focus should be to avoid dehydration.

Acceptable clear liquids include:

Water
Decaf tea and coffee
Sugar-free non-carbonated beverages
Broth
Sugar-free gelatin, such as Jello
Sugar-free popsicles

Weeks 2-3: Full Liquid Diet

Once you’ve adjusted to a clear liquid diet and are taking 48-64 ounces daily, you may begin a full liquid diet. During this time, you may also add in protein shakes as directed by your dietitian. To maintain nutrition and avoid dehydration, you will aim for 64 ounces of fluid per day.

In addition to clear liquids, you may now include the following:

Strained low-fat cream soups
Fat-free or low-fat milk, or a milk alternative
Low-fat yogurt
Sugar and fat-free pudding
Protein shakes made with whey

Weeks 3-6: Pureed Diet

You may start to puree some foods in a blender. This allows your body to continue healing and helps you get used to foods with texture. Make sure to eat 3 small meals per day and think variety. Try to eat the protein portion of your meal first to help you feel full, and supplement with liquids.

Your Temple dietitian can work with you to create a list of foods customized for you. These may include:

Fruits: Applesauce, mashed bananas, mashed canned fruits, pureed pears, peaches, apricots
Vegetables: Potatoes/sweet potatoes, squash, spinach, carrots
Grains: Oatmeal, cream of wheat, grits
Proteins: Yogurt, creamed soups, protein shakes or drinks, cottage cheese, cooked eggs, white meats (chicken and turkey), white fish

Weeks 6-8: Soft Diet

Although protein shakes continue to play a significant role in your diet and nutrition, you will continue to layer in texture as tolerated. The focus at this stage is foods that may be mashed easily with a fork. Your average meal size should measure about 1/2 cup.

Foods to introduce at this stage include:

Ground meats, including hamburger, turkey and chicken
Canned meats, such as salmon, chicken and tuna
Scrambled eggs
Beans
Tofu
Fruits, canned in water or natural juice

Week 9: Regular Diet

Usually by week 9, you can start to shift to a regular diet. Lean on your dietitian to help you develop meal plans and learn as much as you can about healthy options.

Use common sense at this point and continue to use best practice strategies to ensure proper digestion and nutrition. These include:

Focus on protein first to help fill you up, then progress to vegetables, then fruit
Meals should measure about 4-8 ounces, or 1/2 to 1 cup
Drink your liquids between meals, not during
Avoid certain foods, such as breads, rice, pasta and high-sugar and high-fat foods
Fibrous vegetables should be avoided
Sodas and other carbonated beverages may not be well tolerated
Practice mindful eating – quit eating when you’re almost full

Learn more strategies and tips on maintaining proper nutrition before and after gastric sleeve >

Vitamins and Supplements

Daily vitamins and supplements are an important component of balanced nutrition following your gastric sleeve procedure. They not only help your incisions heal, but also help you prevent vitamin and mineral deficiencies that can cause problems down the road.

Your Temple dietitian can work with you to identify the types of supplements and vitamins you should take on a daily basis — and for the rest of your life.

During the first year after your procedure and then yearly, you’ll have periodic blood tests that provide a snapshot of your nutritional profile. This is done to ensure your body is absorbing the proper level of nutrients and will help guide any needed adjustments.

Benefits and Risks

Before choosing to have a gastric sleeve procedure, be sure you understand both the benefits and risks of the procedure. Since gastric sleeve is a minimally invasive procedure using a laparoscope (small camera), it generally results in decreased risk of infection and a faster recovery, with less pain.

Benefits	Risks
Significant long-term weight loss	Bleeding
Reversal of Type 2 diabetes	Breathing problems
Improvement in chronic conditions, such as: High blood pressure High cholesterol Sleep apnea Urinary incontinence	Infection
Relief from arthritis-related pain and inflammation	DVT and pulmonary embolism
Ease depression and anxiety	Staple site leaking
	Diarrhea
	Dumping syndrome
	Blood clots
	Malabsorption of nutrients

Advantages of gastric sleeve include:

Your stomach is smaller, but you can still eat and digest most foods, in smaller amounts.
You can absorb most medications normally.
You will make a decreased amount of ghrelin, the appetite-increasing hormone.
There is a lower risk of ulcers, intestinal blockage, anemia, osteoporosis and malnutrition versus gastric bypass surgery.
This is a minimally invasive laparoscopic procedure, which for many patients can mean a quicker recovery.

Additional Risks

Complications, such as infection, are associated with any surgery, additional risks include:

Leaking Incision

Leaking can occur in both your internal and external incision sites. This generally happens when your incisions have not yet healed. Be sure to work with your dietitian before and after your procedure to make sure you’re getting proper nutrition to support faster healing.

GERD (Gastroesophageal Reflux Disease)

If you consistently experience heartburn as a result of stomach contents backing up into your esophagus, you may have GERD. GERD occurs in some 23%of people who have gastric sleeve surgery.

Gastric Sleeve Stricture

Stricture, or narrowing, of the gastric passages may occur following sleeve gastrectomy. This may result in nausea and vomiting or a feeling of fullness that does not go away.

Nutritional Deficiencies

You will have periodic blood work following your gastric sleeve procedure. This ensures your body is absorbing the nutrients it needs to stay healthy.

Common nutritional deficiencies include iron, vitamin D, folic acid, vitamin B1 and vitamin B12. Follow your dietitian’s advice with regard to supplements and vitamins.

An Experienced Team

The Temple multidisciplinary team collaborates to manage obesity and weight loss. With decades of experience in bariatric care and surgical procedures, we can address the sensitive and complex problems of obesity and metabolic syndrome. At the Temple Bariatric Program, you receive high-level care that includes:

Skilled Surgeons

The Temple Bariatric Program offers a skilled team with a history of successful outcomes. For over a decade, our specialists have exclusively cared for patients receiving bariatric surgery.

Get to know our gastric sleeve specialists >

Superior Clinical Outcomes

In 2017, Healthgrades recognized our superior clinical outcomes in weight-loss surgery with the Bariatric Surgery Excellence Award^TM.

Positive Patient Experiences

After so many years of trying to do it myself, I had to get medical help.

LOIS

Lois — after weight-loss surgery.

Lois struggled for years with gaining and losing weight. She decided to take a different approach by exploring bariatric surgery. Before surgery she weighed 353 pounds, and she is now down to 165 pounds.

Hear Lois's Story >

I met with the whole staff, everybody was so helpful and they still are.

JOAN

Joan — after weight-loss surgery.

Joan had many co-existing conditions (the occurrence of more than one disorder at the same time) that she struggled with throughout her life. She tried all the fad diets, but never felt successful. After research, she felt she made the right move to get bariatric surgery. The staff provided guidance and support throughout her surgery process.

Hear Joan's Story >

Direct Access to Your Dedicated Team

Our team of bariatric surgeons, dietitians and psychologists see patients at both Temple University Hospital and Temple University Hospital – Jeanes Campus.

Temple University Hospital is one of the region's most respected academic medical centers.
Jeanes Campus provides sophisticated surgical services in a convenient, community-based setting.

Ready for an Appointment?

Find a doctor near you, request an appointment, or call 800-TEMPLE-MED (800-836-7536) today.

The locations listed below are physician practices on Temple Health campuses. For a full list of providers, go to our Find a Doctor search.

Page medically reviewed by:
Rohit Soans, MD
December 20, 2019