Vertical sleeve gastrectomy

You will receive general anesthesia before this surgery. This is medicine that keeps you asleep and pain-free.

The surgery is usually done using a small camera that is placed in your belly. This type of surgery is called laparoscopy. The camera is called a laparoscope. It allows your surgeon to see inside your belly.

In this surgery:

• Your surgeon makes 2 to 5 small cuts (incisions) in your belly.
• The scope and instruments needed to perform the surgery are inserted through these cuts.
• The camera is connected to a video monitor in the operating room. This allows the surgeon to view inside your belly while doing the operation.
• A harmless gas is pumped into your belly to expand it. This gives the surgeon room to work.
• Your surgeon removes most of your stomach.
• The remaining portions of your stomach are joined together using surgical staples. This creates a long vertical tube or banana-shaped stomach.
• The surgery does not involve cutting or changing the sphincter muscles that allow food to enter or leave the stomach.
• The scope and other tools are removed. The cuts are stitched closed.

The surgery takes 60 to 90 minutes.

Weight-loss surgery may increase your risk for gallstones. Your surgeon may recommend having a cholecystectomy. This is surgery to remove the gallbladder. It may be done before the weight-loss surgery or at the same time.

Weight-loss surgery may be an option if you are very obese and have not been able to lose weight through diet and exercise.

Vertical sleeve gastrectomy is not a quick fix for obesity. It will greatly change your lifestyle. After this surgery, you must eat healthy foods, control portion sizes of what you eat, and exercise. If you do not follow these measures, you may have complications from the surgery and poor weight loss.

This procedure may be recommended if you have:

• A body mass index (BMI) of 40 or more. Someone with a BMI of 40 or more is at least 100 pounds (45 kilograms) over their recommended weight. A normal BMI is between 18.5 and 25.
• A BMI of 35 or more and a serious medical condition that might improve with weight loss. Some of these conditions are obstructive sleep apnea, type 2 diabetes, and heart disease.

Vertical sleeve gastrectomy has most often been done on people who are too heavy to safely have other types of weight-loss surgery. Some people may eventually need a second weight-loss surgery.

This procedure cannot be reversed once it has been done.

Risks for anesthesia and surgery in general are:

• Allergic reactions to medicines
• Breathing problems
• Bleeding, blood clots, infection

Risks for vertical sleeve gastrectomy are:

• Gastritis (inflamed stomach lining), heartburn, or stomach ulcers
• Injury to your stomach, intestines, or other organs during surgery
• Leaking from the line where parts of the stomach have been stapled together
• Poor nutrition, although much less than with gastric bypass surgery
• Scarring inside your belly that could lead to a blockage in your bowel in the future
• Vomiting from eating more than your stomach pouch can hold

Your surgeon will ask you to have tests and visits with your other health care providers before you have this surgery. Some of these are:

• A complete physical exam.
• Blood tests, ultrasound of your gallbladder, and other tests to make sure you are healthy enough to have surgery.
• Visits with your provider to make sure other medical problems you may have, such as diabetes, high blood pressure, and heart or lung problems, are under control.
• Nutritional counseling.
• Classes to help you learn what happens during the surgery, what you should expect afterward, and what risks or problems may occur afterward.
• You may want to visit with a counselor to make sure you are emotionally ready for this surgery. You must be able to make major changes in your lifestyle after surgery.

If you smoke, you should stop several weeks before surgery and not start smoking again after surgery. Smoking slows recovery and increases the risk for problems. Ask your provider for help quitting.

Tell your surgeon:

• If you are or might be pregnant
• What medicines, vitamins, herbs, and other supplements you are taking, even ones you bought without a prescription

During the week before your surgery:

• You may be asked to stop taking blood thinning medicines. These include aspirin, ibuprofen (Advil, Motrin), vitamin E, warfarin (Coumadin, Jantoven), and others.
• Ask your surgeon which medicines you should still take on the day of your surgery.

On the day of your surgery:

• Follow instructions about when to stop eating and drinking.
• Take the medicines your surgeon told you to take with a small sip of water.
• Arrive at the hospital on time.

You can usually go home 2 days after your surgery. You should be able to drink clear liquids on the day after surgery, and then go on a pureed diet by the time you go home.

When you go home, you will probably be given pain pills or liquids and a medicine called a proton pump inhibitor, which reduces the amount of acid in your stomach.

When you eat after having this surgery, the small pouch will fill quickly. You will feel full after eating a very small amount of food.

The surgeon, nurse, or dietitian will recommend a diet for you. Meals should be small to avoid stretching the remaining stomach.

The final weight loss may not be as large as with gastric bypass. This may be enough for many people. Talk with your surgeon about which procedure is best for you.

The weight will usually come off more slowly than with gastric bypass. You should keep losing weight for up to 2 to 3 years.

Losing enough weight after surgery can improve many medical conditions you might also have. Conditions that may improve are asthma, type 2 diabetes, arthritis, high blood pressure, obstructive sleep apnea, high cholesterol, and gastroesophageal disease (GERD).

Weighing less should also make it much easier for you to move around and do your everyday activities.

This surgery alone is not a solution to losing weight. It can train you to eat less, but you still have to do much of the work. To lose weight and avoid complications from the procedure, you will need to follow the exercise and eating guidelines that your surgeon and dietitian give you.

Gastrectomy - sleeve; Gastrectomy - greater curvature; Gastrectomy - parietal; Gastric reduction; Vertical gastroplasty

American Society for Metabolic and Bariatric Surgery website. Bariatric surgery procedures. asmbs.org/patients/bariatric-surgery-procedures. Accessed April 6, 2023.

Richards WO, Khaitan L, Torquati A. Morbid obesity. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 21st ed. St Louis, MO: Elsevier; 2022:chap 48.

Sullivan S, Edmundowicz SA, Morton JM. Surgical and endoscopic treatment of obesity. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 8.

Updated by: Debra G. Wechter, MD, FACS, General Surgery Practice Specializing in Breast Cancer, Virginia Mason Medical Center, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.