How the Gastric Sleeve Helps You Lose a Lot of Weight

I have many patients come to me, and they say they feel as though the gastric sleeve is right for them based on their weight loss goals. When I ask the patient what they think the gastric sleeve is, I sometimes get crazy explanations. Most commonly, I hear from them that they believe it is an implantable device or sleeve that we are putting around the stomach to help the patient lose weight. 

The gastric sleeve is an operation where we remove about three-quarters of the stomach. We are going from a large, stretchable stomach to a very narrow, high-pressure tube of a stomach. 

We have been doing this operation in the United States for over a decade now. The initial thought was if we reduced the size of your stomach and left behind the part that is not very stretchy, patients wouldn’t be able to eat as much food, which would allow you to lose weight. However, more research over the last several years has shown us that while there is some restriction involved in this operation, there are other mechanisms at work. Removing a large portion of the stomach kicks off this metabolic phase where patients’ bodies want to readjust, or reset, how much weight they’re carrying around. 

How the Gastric Sleeve is Performed

The gastric sleeve, otherwise known as the Vertical Sleeve Gastrectomy (VSG) or the sleeve gastrectomy, is a procedure in which the stomach’s size and shape are changed. 

The vertical sleeve gastrectomy involves placing a tube into the stomach along the lesser curve through the mouth. The surgeon will divide the fat attachments along the greater curve of the stomach. Then, using laparoscopic staplers, the surgeon will separate the stomach along the tube, beginning on the lower edge of the stomach (near the pylorus) to the upper edge (near the esophagus). The surgeon will remove about 70 to 80% of the stomach, leaving a banana-shaped pouch. 

Pros and Cons of a Gastric Sleeve 


The gastric sleeve is an operation where we are only operating on the stomach, and we are staying away from the rest of the small bowel. There is no intestinal bypass that goes along with this operation. Therefore, this procedure is considered less invasive. 

However, with this procedure, patients will absorb 100% of what they are eating or absorb the same amount they would before surgery. This can be a good thing with respect to lowering your risk of vitamin and nutrition deficiencies down the road. Yet, this can also be problematic because when patients start eating what they shouldn’t be, they are more likely to experience weight regain. 

As it relates to weight loss, the gastric sleeve has historically been looked at as the procedure that results in the lowest amount compared to the other invasive bariatric procedures (gastric sleeve, bypass, and duodenal switch). However, a recent study on the sleeve gastrectomy found that although the gastric bypass resulted in a higher degree of excess weight loss after the first year (72.3% versus 63.7%), “there were no statistically significant differences in excess weight loss after two and five years.”

Bariatric Surgery: The Gastric Bypass vs. The Duodenal Switch

In the field of weight loss surgery, there are three standard bariatric procedures that help patients lose weight and keep the weight off. The oldest procedure is the gastric bypass, although the gastric sleeve has gained popularity in recent years due to its perceived simplicity. Yet aside from the bypass and the sleeve, a third bariatric procedure is emerging as an effective tool for bariatric patients with a higher body mass index (BMI) known as the duodenal switch. 

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Bariatric Surgery: The Gastric Bypass vs. The Gastric Sleeve

The Gastric Bypass and the Gastric Sleeve are two weight loss surgery procedures that effectively reduce weight. Aside from the obvious weight loss benefits, the Bypass and the Sleeve also effectively create a metabolic and hormonal effect that results in the improvement and cure of many weight-related medical problems, including diabetes, hypertension, sleep apnea, high cholesterol. 

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Choosing The Right Surgery For You

In previous blogs I’ve talk about the duodenal switch, the gastric bypass, and the gastric sleeve. Today I want to summarize these different operations and talk about what I tell my patients when they come to see us about weight loss surgery.

First off, let’s talk about the gastric sleeve. This operation we started to do in the field of weight loss surgery around 10 years ago and it has gained a lot of popularity over the last several years. In our practice it probably accounts for about 40 to 50% of the procedures that we do. This procedure is a relatively simple technical operation, where we remove about 80 to 90% of the stomach volume leaving the stomach as a small narrow tube.

In effect, what we have done is reduce is the volume of the stomach so a patient eats significantly less. But we also believe that hormones are in play that reduce hunger—so the patient feels much less hunger than they previously did before. As a result of these two effects, reduced volume of food in an early sense of satiety, along with decreased hunger, patients tend to have fairly significant weight loss. I tend to tell my patients that they will lose about 10 to 20% less weight loss than they typically will with the gastric bypass.

Moving on to the gastric bypass, this really has been the mainstay procedure that we have done in the field of weight loss surgery for many, many decades—going back to the 1980s. This probably is the operation that we have the greatest experience with, knowing about it short and long-term weight loss effects.

The gastric bypass involves creating a small pouch out of the stomach and rerouting the small intestine up to that pouch. Effectively what we’ve done with this operation is bypass the main part of the stomach to divert food away from the duodenum, which is the first part of the small intestine. Therefore, the digestive process begins further downstream; probably somewhere in the 20 to 30% range. So effectively what we’ve done is shorten the small intestine by about 20 to 30% and also made the stomach smaller so that when we eat we have a much earlier sense of satiety.

I tell my patients that the weight loss effects probably have more to do with some of the hormonal effects that we believe are occurring. Certainly patients eat significantly less as a result of the operation but by bypassing the first part of the duodenum, we believe that we are altering hormones that regulate our metabolism. Thereby, resulting in significant weight loss. Typically I would expect most of our patients lose somewhere in the 60 to 80% excess weight loss range with this operation.

The duodenal switch is an operation less commonly performed and in our practice probably about 10% of patients receive this operation. The easiest way to look at this procedure is to think of a sleeve gastrectomy along with the gastric bypass. We do the sleeve, like was previously described in earlier blogs that I’ve written about, and we also bypass the duodenum like we do with the gastric bypass.

But instead of bypassing somewhere in the neighborhood of 20 to 30% of the small intestine, we’re bypassing an excess of 70 to 80% of the small intestine.  So the duodenal switch not only has all of the benefits of the sleeve gastrectomy and the gastric bypass, but there is also significant malabsorption.

And although one might think that this would be a good thing, it certainly does have some side effects. Nutritional deficiencies are much more likely to occur after the duodenal switch and there are fairly significant changes in the bowel pattern.

So what you might be asking yourself is why would we do this procedure. Well typically I would look to this operation as a potential choice for our patients who are in the heavier weight range.

So to summarize, when I see a patient for the first time and we’re talking about the various different procedures and what might be more or less effective for them, I tend to look at two things; number one what are the medical problems the patient is suffering from and also what range weight are they starting at. So to generalize, if a patient is in the lower weight range and does not have significant ongoing medical co-morbidities, like diabetes and hypertension, I tend to lean more to the sleeve gastrectomy.

For patients more in, what I would consider the middle-weight range, maybe somewhere with a body mass index in the mid-to-upper 40s and lower 50s range, or particularly with patients who suffer from diabetes where they may be taking multiple injectable type medications, I would lean more to the gastric bypass.

And then for our patients who are in the heavier weight range, and I would consider those people to be in the body mass index range of 55 and particularly above 60, I tend to direct direct those individuals to the duodenal switch. And the reason being is that for our heavier patients, although they will have significant weight loss with the sleeve and the gastric bypass, they may not achieve the degree of weight loss that we would like to see—whereby they would reduce their body mass index to a more medically acceptable range (typically under a body mass index of 40). But it is just not statistically likely that those patients in the upper body weight ranges with body mass indices above 60 are probably going to achieve that degree of weight loss with a gastric bypass or a sleeve. Now, it’s not to say that doesn’t happen, and it certainly does occur quite frequently, but just as a statistical matter a fair number of people will not achieve that degree of weight loss. Thereby in my practice I start to look toward a duodenal switch for these individuals.

Certainly there is a lot more to know about these operations. When a patient comes to see us in our practice and they go through the initial consultation and education process, we get into much greater detail about all of the procedures. We encourage any individual that is suffering from weight-related medical problems to at least seek some treatment. This doesn’t necessarily have to involve surgery, but certainly should be directed towards an aggressive medical weight loss program. And if it’s felt that a surgical approach is an option for that patient, seeing a competent bariatric surgeon who is at a center of excellence designated facility would be something that that you should certainly get more information about. Therefore you can learn what your treatment options are for this serious medical problem—the disease of obesity.

Well I thank you for listening and if you’d like more information you can check out our other blogs or come to our weight loss seminars. We have both surgical and nonsurgical weight loss seminars directed towards treating this disease.

Duodenal Switch & What It’s All About

If you have ever researched the term “weight loss” or “bariatric surgery“, you have probably heard about the gastric bypass or sleeve gastrectomy.  However there is another successful weight loss procedure that is not as common, known as the biliopancreatic diversion with duodenal switch.  Over the last several months, I have posted details about the other commonly performed weight loss surgeries. In this blog post today, I will detail the science behind the biliopancreatic diversion with duodenial switch.

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Gastric Sleeve Surgery & What It’s All About

The gastric sleeve, similar to the gastric bypass, is a commonly performed weight loss procedure. The gastric sleeve removes a large portion of the stomach in an effort to limit the patient’s food intake and thus contribute to weight loss surgery. In this blog post, I will detail the science behind this weight loss procedure and exactly what happens to the stomach.

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Gastric Bypass Surgery & What It’s All About

If you have researched weight loss or bariatric surgery, you have probably heard the term “gastric bypass”. But do you really know what it is all about and how you lose weight from this type of surgical procedure? In this blog post I will detail the science behind this weight loss procedure and exactly what happens to the stomach—you don’t want to bypass this, believe me. 

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