After a lull following the COVID-19 pandemic, the use of bariatric surgery as a treatment for morbid obesity is on the rise again in the United States. And while mainstay bariatric procedures like Roux-en-Y gastric bypass and adjustable gastric banding remain popular options, another type that has become more common is gastric sleeve surgery. Like other types of bariatric surgery, gastric sleeve can indeed be a helpful way to promote weight loss. Yet for all the positives, there are also a number of potential complications that need to be taken into account when considering it. 

How Does a Sleeve Gastrectomy Work?        

Technically known as a vertical sleeve gastrectomy (VSG), the basic goal of the gastric sleeve procedure is to reshape the stomach so that it has a smaller volume. By having a smaller stomach, the patient can literally not fit as much food when eating a meal. In addition to ingesting fewer calories by default, the reduced stomach volume means feeling full faster after eating less food. Over time, the patient will be able to lose weight by experiencing fewer cravings and through adjusting to a lower-calorie diet. 

In a laparoscopic sleeve gastrectomy, small incisions are made in the abdomen that are the entry points for the laparoscope; a laparoscope is a long fiber optic tool with a camera and surgical instruments mounted on the end. The use of laparoscopy makes this type of weight loss surgery a minimally invasive surgical procedure. Because there are no large incisions, there is usually less bleeding and fewer complications during the surgery. This also makes the postoperative recovery process much shorter than it would be after open surgery.   

The first step in the procedure is to insert a bougie through the esophagus and into the stomach; a bougie is a tube that acts as a reference size for the new stomach shape. The bariatric surgeon then uses surgical staples to divide and seal the new section. The excess stomach from the fundus to the antrum is resected along the staple line and is removed from the abdomen. When the procedure is complete, what remains is a new sleeve-shaped stomach that is approximately 25% of the former volume.  

How Much Weight Can You Lose? 

Generally speaking, a procedure like a sleeve gastrectomy is intended for patients with morbid obesity and a body mass index (BMI) of 35 or higher. Beyond helping a person lose weight, it can improve high blood pressure, type 2 diabetes, sleep apnea, as well as reduce the risk of numerous obesity-related conditions. How much weight a person can lose depends on their starting weight and their adherence to new lifestyle changes like a healthy diet and increased physical activity. If a person is dedicated, it is possible to lose 60% or more of excess body weight within the first two years.  

Common Complications and Risks

Laparoscopic sleeve gastrectomy is one of the most common types of weight loss surgery in the world, and it is considered a relatively safe procedure. But as with any kind of surgery, there are always both short-term and long-term risks. Also, some people who have been obese for a long time may already have related health conditions that make surgery inherently more risky. Even though gastric sleeve surgery is considered a minimally invasive surgery, there are a number of complications and side effects to keep in mind: 

Short Term

• Bleeding related to the laparoscopic incisions. 
• Blood clots in the legs. 
• Infection at the site of the incisions. 
• Staple line leak: leakage of stomach contents through the staples may cause abdominal pain and require a separate follow-up procedure to correct. 
• Stenosis: an overall narrowing of the new stomach cavity or a stricture in a particular section may require an endoscopic dilation procedure to correct. 
• Adverse reaction to anesthesia.  

Long Term

• Heartburn: either occasional bouts of acute acid reflux or the development of chronic gastroesophageal reflux disease (GERD) in rare cases. 
• Malnutrition: reduced stomach volume may lead to a nutritional deficiency that requires a special diet or the inclusion of nutritional supplements.  
• Excess skin: rapid weight loss can lead to excess skin that is stretched out and might need to be surgically removed. 
• Gastrointestinal obstruction: in rare cases, the gastric sleeve surgery can cause the formation of bands of tissue (adhesions) that may lead to a bowel obstruction. 
• Gallstones: gallbladder problems generally and gallstones are more likely in obese people, but they can remain a potential complication with rapid weight loss due to changes in bile acid circulation. 
• Hernia: though rare, it is possible for the newly reformed stomach to herniate through the opening in the diaphragm between the stomach and esophagus.
• Ulcers: incidence of nausea and vomiting after gastric sleeve surgery are most likely caused by an ulcer formed at the staple line.  
• Dumping syndrome: the smaller stomach volume means that there is a higher likelihood of stomach contents emptying into the small intestine too soon and may also cause nausea and vomiting and other gastrointestinal symptoms.  

Alternatives to Sleeve Gastrectomy   

Improvements in surgical methods over the years have made many of the possible side effects listed above a relatively rare occurrence for sleeve gastrectomy patients. But even though it is a minimally invasive procedure that is performed laparoscopically, the fact that incisions are necessary adds inherent risks. The good news is that there is an even newer frontier in weight loss surgery that uses endobariatric methods. Endobariatric procedures are performed using endoscopy and therefore do not require any incisions. Without incisions, they are safer, they have fewer complications, and they have a much shorter recovery time. At True You Weight Loss, we specialize in endobariatric procedures that offer comparable weight loss with far fewer risks:   

• ESG: Short for endoscopic sleeve gastroplasty, ESG is very similar to sleeve gastrectomy. But instead of laparoscopic incision, the entire procedure is done via endoscope through the esophagus. Once the endoscope is placed, the doctor creates the smaller, sleeve-shaped stomach section using special sutures that are placed from inside the stomach. These sutures are painless to put in place and achieve the same result of reducing stomach volume by 75-80%. After a short, 30 to 45-minute procedure, the work is done and you’ll be able to go home that day. And because there are no external incisions, the recovery process takes a fraction of the time. 
• Gastric balloon: True You offers both the ORBERA® Intragastric Balloon System and the Spatz3 adjustable balloon. In both cases, a silicone balloon is inserted into the stomach via endoscope. Once in place, it is filled with a harmless saline solution and takes up space in the stomach. During the 6-8 months the balloon is in your stomach, you’ll feel full faster and won’t be able to eat as much food in a single sitting. Over time, this can help you develop new long-term eating habits that will help you continue to lose weight even after the balloon is removed.  

Over the years, many patients have come to True You looking for results they just weren’t able to find with other weight loss methods. One example of a patient who had tremendous success with ESG is Sabrina Longley. Sabrina was 208 pounds when she first came to True You, but one year after the procedure she weighs 147 pounds. Another example is Jess Wilson: she was 185 pounds before discovering the ORBERA balloon, but one year later she is down to 145 pounds. These transformations are possible because the procedures are designed to promote long-term changes.     

Contact True You for More Information 

Losing weight can be very challenging, and sometimes more substantial interventions are needed to help a person turn the corner toward long-term success. Gastric sleeve surgery can be a good choice for some people, but it also has inherent risks related to surgery. If you’re interested in a non-surgical alternative—or if you have a medical condition that makes surgery dangerous—please contact us to request a consultation. We are passionate about helping people take a new approach to weight loss and finally find the freedom they’ve been looking for.