Gastric sleeve (sleeve gastrectomy): who can have it, risks and recovery

The NHS describes weight loss surgery, also called bariatric surgery, as a treatment for people who are severely obese. It makes the stomach smaller so that you feel fuller sooner and eat less. The main types listed are gastric bypass, gastric band, gastric balloon and sleeve gastrectomy.

In a sleeve gastrectomy, a surgeon removes part of the stomach. The NHS says about 80% of the stomach is taken away to make it much smaller and sleeve-shaped. It is done using keyhole surgery, which means about 5 small cuts in the tummy, and the abdomen is filled with air so that the surgeon can see and operate. The procedure is done under general anaesthetic and usually takes 1 to 3 hours.

The sleeve is a surgical decision rather than a treatment on its own. The NHS says you will need to agree to lifestyle and diet changes and to regular check-ups after surgery, and recommends that people first try to lose weight through a healthy diet, exercise and medicine.

The NHS says weight loss surgery may be available if you have a body mass index (BMI) of 40 or more, or a BMI between 35 and 40 and a condition that might improve if you lost weight, such as high blood pressure, diabetes, arthritis, breathing problems or asthma. You also need to agree to make healthy lifestyle changes and attend regular check-ups after surgery.

The NHS adds that if you have a South Asian, Chinese, other Asian, Middle Eastern, Black African or African-Caribbean family background, surgery may be considered with a BMI below 40. It also says availability varies across areas of the UK, and that you can pay for surgery privately but this can be expensive.

In practice, assessment is carried out by a specialist weight management team, which looks at your history of previous weight loss attempts, your overall health and whether you are ready for the changes that follow. Your GP is the usual route into that service.

The NHS describes several procedures. They differ in how they change the stomach and in the length of the operation and recovery.

The NHS says weight loss surgery is a common and safe procedure but that, as with any operation, there are risks, which your doctor will explain. Possible complications it lists include blood clots, a stomach leak after bypass or sleeve gastrectomy, wound infection, a blocked gut, gallstones and excess skin.

A leak happens when food leaks out of the stomach into the abdomen in the days or weeks after surgery; the NHS says this is a small chance but can cause a serious infection that needs antibiotics. Blood clots may start in the lower leg and sometimes travel to the lungs, and anticoagulant medicines can be given. A blocked gut can be reduced by cutting food into small chunks, chewing thoroughly and not drinking during meals. Gallstones can form when you lose weight quickly. Loose skin may remain after large weight loss, and surgery to remove it is usually considered cosmetic, so it is not always available on the NHS.

The NHS gives specific advice for people who have had weight loss surgery. Call 999 or go to A&E if you have difficulty breathing with pain and swelling in a leg, chest pain with leg pain and swelling, severe tummy pain, non-stop bleeding from the bottom, a lot of blood in the toilet or large clots, or you vomit blood or your vomit looks like coffee grounds.

Ask for an urgent GP appointment or call NHS 111 if you have redness, tenderness, swelling or pain in a leg that is not getting better, a high temperature or feeling hot, cold or shivery, a fast heartbeat, tummy pain, fast breathing, difficulty swallowing or regular vomiting. These could be signs of a blood clot or a problem with the stomach. See a GP for pain around a wound, red, hot and swollen skin or pus from a wound.

The NHS says you usually go home 1 to 3 days after weight loss surgery and that recovery is usually 4 to 6 weeks. Regular check-ups are a condition of being offered surgery on the NHS, since the operation changes how much you can eat and how your body takes in nutrients.

Preparing for life after a sleeve means long-term changes in eating habits: smaller portions, chewing carefully and eating slowly, and following the dietary advice your team gives. The NHS recommends cutting food into small chunks and avoiding drinking during meals to lower the risk of a blockage. Questions about vitamins, supplements and blood tests should be taken to the specialist team, since needs differ between people and procedures.

On the NHS, surgery is offered through specialist weight management services after you meet the criteria above, and the operation and follow-up are free at the point of use, although waiting times and local availability vary. Privately, people can pay for surgery themselves, which the NHS notes can be expensive.

Whichever route you use, it is sensible to ask who will provide the long-term check-ups, what happens if there is a complication, and whether the team is able to deal with problems directly. Because the operation changes the digestive tract permanently, continuity of follow-up matters as much as the operation itself.