Weight loss with the sleeve
On average we expect weight loss results for gastric sleeve patients to be approx 60-70% of their excess weight during the first two years, although most of the weight is lost during the first year. Some people will inevitably do better than this, and some not so well.
Yes, it is possible to regain weight following gastric sleeve surgery and this tends to happen if patients return to old eating habits. A sleeve is extremely effective if you follow our guidelines but it is important to remember that a gastric sleeve is not a “cure” for your weight problems, rather a powerful tool to help you manage your weight. If you consume high quantities of junk food and don’t engage in physical activity, you may put weight back on, but this is the case for all weight loss options. It’s important to continue to plan your meals, eat small portions and to engage in physical activity in order to maximise and, more importantly, maintain your new, lower weight.
Every medical treatment has a failure rate, and the sleeve gastrectomy is no exception. A small proportion of sleeve patients, about 10%, won’t be successful for a variety of reasons such as an inability to comply with nutritional requirements or a lack of physical activity. Some patients can also experience problems if they fail to take vitamin and mineral supplements.
Eligibility for the sleeve
As a general guide, you are eligible for gastric sleeve surgery if you have a BMI of 35kg/m2 or over, and have exhausted other option without success. Use our BMI checker to calculate your own BMI, and see if you’re eligible. You can read more about your eligibility for sleeve surgery, both in the private sector and in the NHS by following this link.
Gastric sleeve operations are done in the NHS, as are gastric bypass and gastric band procedures. Due to strict NHS eligibility criteria, driven by limited budgets, only a tiny proportion of those who are eligible for weight loss surgery will be offered it in the NHS. We calculate that only about 1 in 2,500 people in the UK eligible for gastric sleeve will have surgery in the NHS.
You can read more about NHS and private eligibility criteria here.
About gastric sleeve surgery
As with all surgical operations, there are associated risks and a gastric sleeve is a more invasive procedure than a gastric band which is why it is important to choose a specialist bariatric surgeon with considerable gastric sleeve experience. In the hands of a highly experienced Healthier Weight surgeon, the gastric sleeve is still a safe and effective procedure. Read more about our sleeve centres and surgeons here.
*For information on the non-surgical alternative, please see endoscopic sleeve gastroplasty
Prior to gastric sleeve surgery, you will be required to follow a low-calorie pre-operative diet. The length of time that you will follow the pre-op diet will depend on your starting BMI and will range from a minimum of 5 days for lower BMIs, up to a maximum of 6 weeks for higher BMI.
Sleeve surgery is performed laparoscopically (keyhole) and takes approximately 45-60 mins. Patients usually stay in a hospital for 2 nights.
It is common to experience some discomfort after gastric sleeve surgery. The pain will mainly tend to be from the abdomen, but you may also experience some mild left shoulder pain as a result of the gas (carbon dioxide) that is used to inflate the abdomen during the operation. However, whatever discomfort you do experience is usually quickly alleviated by simple painkillers.
Sleeve complications and side effects
It is possible that a gastric sleeve could cause constipation. As you will be eating less, the amount of fibre in your diet will drop, and your bowel activity will decrease. However, there are plenty of very effective remedies that can help with constipation, and you will be given additional advice about this following your operation.
Acid reflux can be a side effect of gastric sleeve surgery in some patients. For this reason, if you suffer from reflux prior to surgery, a gastric sleeve will not be recommended, instead, we’ll usually look at gastric bypass in preference. Read more on how a gastric sleeve and gastric bypass compare.
Occasionally patients may experience some hair loss following gastric sleeve surgery but this is usually temporary. We recommend sea kelp tablets to minimise hair loss.
Yes it is possible to stretch the stomach following gastric sleeve surgery, but if you follow the nutritional guidelines provided and do not eat excess portion sizes, this is unlikely.
There is minimal scarring with gastric sleeve surgery. During the operation, the operating ports are placed through 5 narrow (between 5 and 12 mm) incisions which are sutured and/or glued and will normally take about 10-14 days to heal. These abdominal scars should then fade gradually. Some individuals have a greater tendency to form keloid, and this may result in thicker and more prominent scarring. Its very important to follow our wound care advice in the days and weeks after surgery, especially when washing, as this will minimise your risk of an infection.
Life after sleeve surgery - Recovery
Most sleeve patients will stay in a hospital for 2 nights before going home. You should start to feel much more comfortable around 2 weeks after surgery, but it typically takes around 6-8 weeks for your stomach to heal completely.
We advise that you should not drive a motor vehicle for 2-3 days after your sleeve operation. This is to allow the effects of the anaesthetic and any post-operative analgesia (painkillers) to wear off. It will take around 10-14 days for your wounds to heal, so at first you may find that driving is a little uncomfortable.
This will depend upon the nature of your occupation; if you have a physically inactive job, then you can generally expect to return to work in 1-2 weeks, as by this time the wounds will have healed and you should be feeling a lot less discomfort. If your job is physically demanding then you may need a little more time before you’re able to return to work. Your stomach will typically take 6-8 weeks to heal, and during this period it’s important that you follow the special dietary guidelines as closely as possible. This may leave you feeling a little short on energy if you physically exert yourself.
Regular physical activity is very important in achieving your weight loss goals. You will be given specific information and advice about physical activity after your sleeve operation, but to begin with, we recommend walking. In fact, you will be asked to get out of bed and walk around as soon as you have recovered from the procedure. As you become fitter you may wish to try more strenuous forms of activity, and there is no exercise that must be excluded because you’ve had gastric sleeve surgery.
Life after sleeve surgery - Eating
Yes, you can drink alcohol with a gastric sleeve, but in moderation. Alcohol has a high calorific value (7 kcal/gram) and consumption leads to a lot of unwanted calories. If you do drink it is most important that you do so in moderation and that would equate to a maximum of about 1 unit of alcohol per day (1 unit of alcohol = half a pint of normal strength beer, half a standard (175ml) glass of wine or small single measure of spirits.
We normally recommend that you stay caffeine-free for the first few days after gastric sleeve surgery to allow your stomach to settle. Following that there is no reason why coffee should not be drunk. The exception to this would be if you suffer from reflux, then our advice would be to refrain from drinking coffee or acidic drinks, both of which can be contributors to acid reflux.
For the first two weeks after sleeve surgery, you should follow a liquids only diet (usually consisting of shakes and soups). This is to allow your stomach time to heal internally following the surgery. For weeks three and four, you will be able to eat soft solids (shakes, soups with more texture, blended meals). Then from week five onwards, you should be able to return to eating normal food, but please be aware that you will need to reduce your portion sizes due to the reduction in stomach capacity.
You can eat most foods, providing they don’t cause you discomfort. However, because you will be consuming less food in general, it is important that you include foods that are rich in protein, but low in fat and sugar. We encourage you to eat vegetables, fruit, wholegrains, lean meat and fish. You will be provided with detailed nutritional information following your gastric sleeve operation.
There are no specific rules on when to eat, this will depend on your personal preference and lifestyle. Many patients, however, find that eating small amounts more frequently throughout the day suits their new smaller stomach.
One of the benefits of gastric sleeve surgery is the impact on appetite regulating hormones. Levels of the appetite stimulant ghrelin fall after gastric sleeve surgery which means that your appetite will be reduced and you will feel less hungry. You may also notice that your taste preferences change away from fatty, sugary foods.
Life after sleeve surgery - Health and lifestyle
The amount of excess skin that you’ll be left with following a gastric sleeve operation varies from patient to patient. The amount of lax skin partly depends upon your age and weight before the procedure. Generally, the heavier and older you are, the more likely you are to have excess skin. Younger patients tend to not have as much lax skin due to greater natural skin elasticity.
For sleeve patients that choose to have excess skin removed, the most common request is to have the abdominal apron removed, though some patients extend this to other areas and opt for a “body-contouring” procedure. We recommend that you wait around 2 years before making any decisions on cosmetic surgery, in order to see how much your skin can recover of its own accord. If you are interested in cosmetic surgery, please contact us and we will arrange a consultation with our own specialist bariatric cosmetic surgeon.
Usually, you will be able to continue to take your regular medication after gastric sleeve surgery. However, if your tablets are quite large, or if you have problems digesting them, it may be necessary to break them up (most good chemists will have a little contraption to do this). We recommend that you try your regular tablets first, and if you feel that they are getting stuck, you can crush them up and maybe even take them with a spoonful of yoghurt. However, before doing so, you should check with your pharmacist that it’s okay to do this. Some tablets are specially formulated to be released slowly or coated to protect the stomach, and these properties may be destroyed if you crush them. Capsules should not be a problem because they are soft and designed to soften and melt inside the stomach.
It is absolutely essential for you to take vitamin and mineral supplements for life after sleeve surgery. Without supplementation, deficiencies in iron, folic acid, vitamin B12, calcium, zinc and vitamin D can occur, resulting in anaemia and bone disease such as osteoporosis.
We recommend that you start taking vitamin and mineral supplements as you enter the pureed (soft foods) stage 2 weeks after your sleeve surgery (on soft foods). It is important that you take a vitamin and mineral supplement. We also include blood tests within your package to ensure that you are nutritionally well. It is most important you attend for these tests to monitor your well being for the longer term.
Providing the additional surgery does not involve the upper part of the stomach or digestive tract, it is usually perfectly fine to have other surgical procedures when you have a gastric sleeve. It is essential, however, that you inform your surgeon and anaesthetist about your gastric sleeve prior to having any other surgery performed.
Yes, you will still be able to get pregnant with a gastric sleeve, in fact, there are several reasons why gastric sleeve surgery has a positive impact on pregnancy and childbirth. Firstly, as you lose weight your fertility increases and you are much more likely to conceive (if you don’t want to get pregnant you need to be aware of this!) Secondly, losing weight will result in a significantly lower risk of complications for both you, and the baby. Healthier Weight will give you all the help, advice and support you need should you become pregnant following a gastric sleeve operation.
There is no reason why you should not fly as normal with a gastric sleeve. We do not recommend that sleeve patients fly short haul (e.g. Europe) within 7 days of their surgery and that they wait 21 days before flying medium to long haul. Of course, these timelines may extend if your recovery is slower than expected. Your airline may have specific guidance about flying after surgery and you may wish to check with them before you fly.