Gastric Sleeve Pros and Cons

Written by Emily Burch, RD and medically reviewed by Dr. Stephen Boyce, MD

What you should know if you are considering the gastric sleeve

If you are thinking about taking the next step in your weight loss journey and you are interested in bariatric surgery, then this is the article for you. You will get an inside look at the pros and cons of the gastric sleeve, one of the most popular forms of bariatric surgery.

In this article, you will learn what the procedure is and how it benefits you, as well as, the risks associated with the procedure. You will also learn the best ways to set yourself up for a successful weight loss journey before, during, and after the gastric sleeve. So, let’s get started!

What is the gastric sleeve…and how does it work?

The sleeve gastrectomy, commonly called the gastric sleeve, is a surgical technique that involves the removal of about 75-80% of the stomach. During the procedure, the stomach will be shaped into a tube-like structure or a “sleeve” that is about the size of a banana.

Restricting the size of your stomach has multiple benefits that lead to weight loss.

First, shrinking the size of the stomach reduces the amount of food that you are able to eat.

Second, it affects hormones related to hunger which results in decreased appetite and food intake.

And third, it can help your body get its metabolism back on track.

Let’s quickly introduce the two main hormones impacted by the gastric sleeve and show you how they positively impact your appetite and food intake following the procedure.

  • Ghrelin aka the “hunger hormone” is a hormone that sends signals to your brain informing it that you are hungry. Its job is to stimulate appetite, increase food intake, and promote fat storage.
  • Leptin is the opposite, this hormone signals to your body that you are full. Often times someone who is obese has built up a tolerance or resistance to leptin and your body cannot properly identify when it has had enough food.
Gastric sleeve causes changes in gut hormones

During the gastric sleeve procedure, the part of the stomach that produces most of your body’s Ghrelin is removed which leads to decreased production of Ghrelin and an overall decrease in appetite.

Following the gastric sleeve, leptin levels change in your body and over time your body can learn to regulate leptin levels and reduce its resistance to leptin. This leads to a reduction in food intake and your body feeling fuller longer.

Pros and cons of gastric sleeve are beneficial hormonal changes

The gastric sleeve is effective because it involves so much more than just shrinking the size of your stomach. This is why the gastric sleeve has become one of the most commonly performed bariatric operations.

This procedure has been shown to be a successful method in achieving considerable weight loss in a short amount of time while also improving quality of life.

Now that we have an idea of the procedure… let’s review the benefits

Benefits of gastric sleeve surgery

There are a variety of positive effects that you may experience after having a sleeve gastrectomy performed. These effects include a reduction in…

  • Body Mass Index (BMI)
  • Weight
  • Blood pressure
  • Stroke
  • Cancer

Studies have also shown that the gastric sleeve can lead to remission of obesity-related diseases including:

  • Type 2 diabetes (T2D)
  • Non-alcoholic fatty liver (NAFLD)
  • Cardiovascular disease
  • Obstructive sleep apnea
  • Craniopharyngioma-related hypothalamic obesity

Studies have also shown noted improvements in non-obesity-related diseases such as:

  • Gout
  • Musculoskeletal problems
  • Ovarian disorders
  • Urinary incontinence

Financial benefits related to bariatric surgery

So what about the financial benefits related to bariatric surgery? It’s possible that the high upfront cost of bariatric surgery can be intimidating, but research shows that it can be worth it in the long run (or actually a shorter run than you might think).

Gastric sleeve surgery is less expensive in the long run

One study published in the Obesity Reviews reveals that obesity alone, without any other related diseases or conditions, can cost an additional $1,723 dollars a year.

If you are thinking that isn’t a lot of money… Just wait until you factor in other conditions like diabetes. A study published by the Obesity Society estimated the yearly cost for managing diabetes is about $13,243 dollars. Now that’s a significant amount of money.

The costs of managing obesity are higher than the initial cost of surgery

Historically for bariatric surgery patients, the initial investment averaged about $29,000 for open surgeries in 2004-2007 and $19,000 for laparoscopic surgeries in 2004-2007. A study conducted by Klein et al. evaluated cost savings associated with surgery in patients with diabetes.

This study found that savings started accruing around the third month following surgery and the total surgery costs were fully recovered on average after 29 months for open surgeries in 2004-2007; and after 26 months for laparoscopic surgeries in 2004-2007.

Overall bariatric surgery may seem like a financial mountain that you cannot climb, but obesity and obesity-related diseases can be very expensive. Bariatric surgery can help to provide a long term financial solution.

Benefits related to improvements in quality of life

Many studies have shown that gastric sleeve has led to improved quality of life. Research has shown noted improvements in self-esteem, physical activity, and social life.

One study published in the Journal of Obesity found that participants no longer reported difficulty finding clothes in their size and they also had a noted increase in self-confidence.

Another journal article by the International Federation for the Surgery of Obesity and metabolic disorders (IFSO) found improvements related to dietary approach with participants reporting that food plays a less significant role in their lives after surgery.

This is likely related to the hormonal changes that occur following surgery.

There are many potential benefits that can occur related to improvements in quality of life, but it is important to note that changes in quality of life can vary depending on the degree of weight loss and depending on the state of each individual.

Bariatric surgery can lead to benefits in both physical and mental health. However, it is important to note that each individual’s journey with bariatric surgery is different and everyone will experience their own unique set of benefits.

Now that we have evaluated the benefits… let’s take a look at the risks associated with the gastric sleeve

The gastric sleeve is a surgical procedure and with all surgical procedures there comes a certain amount of risk. However, the gastric sleeve is considered as safe if not safer than other forms of surgeries that are approved for morbid obesity.

A study published by Heliyon states that the most common complications of sleeve gastrectomy are bleeding, nutrient deficiencies, and leakage.

However, research shows that the rates of both short-term and long-term complications are low. Below is a list of both short term and long-term complications that may occur following the gastric sleeve procedure.

Short-term complications of gastric sleeve can include

  • Staple line leakage or bleeding
  • Wound infection
  • Pneumonia
  • Internal bleeding
  • Nausea and vomiting
  • Inability to eat certain foods
  • Anesthesia-related complications
  • Blood clots

Long-term complications can include

  • Nutrient deficiencies
  • Leakage
  • Dumping Syndrome
  • Bowel obstruction
  • Acid reflux
  • Hernias
  • Low blood sugar
  • Gallstones
Gastric Sleeve cons are short and longterm complications

Now that you know the facts, let’s look at some additional research

A 5-year study, published in the World Journal for Gastrointestinal Surgery, evaluated the outcomes related to the laparoscopic sleeve gastrectomy. A total of 156 patients were included.

This study found a 0% mortality rate, meaning no deaths occurred following the procedure. They did find a morbidity rate of 5.1% which means that 8 out of the 156 patients experienced a side effect like staple line leakage or bleeding, wound infection, pneumonia, or rash following the gastric sleeve procedure.

There was a higher rate of late-term complications and of those, the most common was acid reflux and gallstones.

In this same study, the average percentage of excess weight loss or %EWL was successful in all of the terms. Meaning that every year the average amount of excess weight loss was greater than 50%.

In the first year there was an average of 82% excess body weight lost, year two 86%, year three 76%, year four 73%, and year five 60 %EWL. These findings are similar to another study published in the Surgery for Obesity and Related Diseases journal.

It is important to note that most weight loss occurred among people with a lower body mass index (BMI) prior to surgery.

This study also evaluated the remission of certain obesity-related disorders and found a 75% remission rate of diabetes and a 71.7% remission rate of hypertension/high blood pressure.

Overall the rate of success in terms of weight loss and remission of obesity-related disorders in this study was impressive. There is still more research that needs to be conducted on the long term benefits of the gastric sleeve, meaning 10 years or more, but the rates of success in current research show very promising statistics.

Finally, let’s look at ways you can decrease your risk of developing complications that are associated with the gastric sleeve

Preventing complications after gastric sleeve is easy

These are all great ways to help prepare you for the gastric sleeve and enable you to stay on track following the procedure. It is important to note that research shows that people with a lower BMI, before having the gastric sleeve performed, have had higher rates of weight loss following the surgery.

That is why it is important to work with a strong team of bariatric health professionals like Physicians and Registered Dietitians so they can help you to get on the right track whether that be weight loss prior to the procedure, establishing good exercising habits, or educating you on what to expect and what to eat before and after surgery.

A study published by Surgical Endoscopy found that smoking prior to or around the time of bariatric surgery can have detrimental effects on postoperative complications.

One study conducted by the Michigan Bariatric Surgery Collaborative shows that smoking cessation or quitting smoking 3 months before the gastric sleeve procedure resulted in the near elimination of risk associated with smoking.

This means if you are a smoker and you want to decrease your risk of smoking-related complications following surgery then you need to quit smoking at least 3 months prior to surgery.

Bariatric surgery can be a difficult but very rewarding process. Overall the risks are minimal in comparison to the benefits. Educating yourself and surrounding yourself with a smart team of professionals is the best way to ensure success with the gastric sleeve.

If you are considering the gastric sleeve, make sure to follow the recommendations on reducing your risk of complications and communicate with your team of bariatric health care professionals.

In doing so, you will be setting yourself for a successful weight loss journey.


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