Highlights
- Gastric sleeve surgery effectively promotes weight loss and improves obesity-related health issues.
- Advancements in surgical techniques and patient evaluation enhance safety and outcomes of the procedure.
Summary and Overview
Gastric sleeve surgery (sleeve gastrectomy, SG) is a common bariatric procedure that removes about 75–80% of the stomach, creating a narrow sleeve to limit food intake and promote weight loss. It is effective for adults with severe obesity (BMI ≥40) and some with BMI 30–35 with metabolic diseases. Preoperative evaluation, including esophagogastroduodenoscopy (EGD), aids patient selection by identifying conditions affecting outcomes. Advances such as robotic-assisted surgery and AI-guided decision-making improve precision and results. SG typically achieves over 50% excess weight loss sustained up to ten years and improves obesity-related conditions but carries risks like leaks, bleeding, GERD, nutritional deficiencies, and weight regain. Increasing global obesity and medical tourism drive demand for SG, with ongoing research focused on optimizing outcomes and reducing complications.
Procedure and Eligibility
Performed mainly laparoscopically, gastric sleeve surgery removes a large portion of the stomach through small abdominal incisions, creating a tube-shaped stomach to restrict intake. Open surgery is rare. Preoperative steps include nutritional and psychosocial assessments. Eligibility follows ASMBS and IFSO guidelines: adults with BMI ≥40 or BMI 30–35 with uncontrolled comorbidities qualify. Patients with severe acid reflux may be directed to gastric bypass instead. Adolescents as young as 13 can be candidates, provided criteria and compliance are met.
Outcomes and Risks
SG offers significant weight loss, averaging 51–54% excess weight loss maintained up to 10 years. It improves or resolves type 2 diabetes, hypertension, and other metabolic conditions, often within two years. Mental health benefits include reduced depression and increased self-esteem. However, about 20% may experience long-term issues like weight regain or food tolerance problems. Risks include early bleeding and staple line leaks, and late complications such as gastric stenosis, nutrient deficiencies, GERD, and gallstones. Severe GERD may require conversion to gastric bypass. Lifelong monitoring and supplementation are necessary to manage complications.
Recovery and Lifestyle
Recovery involves strict dietary progression from liquids to solids and lifelong lifestyle changes, including diet and physical activity, to sustain weight loss. Mental health support through counseling and support groups aids emotional adjustment. Correction of preoperative nutritional deficiencies is important, though lifelong supplementation is typically required post-surgery.
Advances and Alternatives
In 2025, laparoscopic sleeve gastrectomy remains standard, enhanced by robotic assistance for improved precision and safety. Endoscopic techniques like Endoscopic Sleeve Gastroplasty offer less invasive alternatives. AI-guided surgical planning is emerging to personalize care. Alternatives include Roux-en-Y gastric bypass (restrictive and malabsorptive) and laparoscopic adjustable gastric banding (device-based restriction). Non-surgical options such as gastric balloons and pharmacologic therapies complement surgical approaches. Procedure choice depends on patient factors and medical necessity.
Epidemiology and Impact
Obesity prevalence has increased globally, reaching 39.6% among U.S. adults and 18.5% among adolescents as of 2015–2016. SG is now the most common bariatric surgery in the U.S., favored for safety and effectiveness. Bariatric surgery reduces obesity-related morbidity and mortality and lowers healthcare costs by decreasing chronic disease burden. It improves quality of life and productivity, with expanding indications including patients with class I obesity and significant impairments. Medical device companies continue to innovate to meet rising demand.
The content is provided by Jordan Fields, Scopewires
