Sleeve gastrectomy: what the operation involves, risks and recovery

A sleeve gastrectomy is one of the standard NHS weight loss operations for people with severe obesity who have not achieved lasting results with diet, exercise and medicines. The NHS says NHS consideration usually requires a BMI of 40 or more and a willingness to commit to lasting diet changes and check-ups for life.

It restricts how much you can eat at one sitting. Unlike a bypass it does not reroute the intestine, so the digestive pathway stays in its usual order. That is attractive to some people, but the Leeds advice sheet warns that approximately 30% develop acid reflux after a sleeve, so anyone who already has troublesome reflux should raise it early with the surgeon.

Surgery is not meant to be a quick option for someone who has not tried or been offered non-surgical help, and the NHS expects previous attempts through diet, exercise and medicine.

The alternatives are a gastric bypass, an adjustable gastric band, a gastric balloon, and continued non-surgical management. The NHS describes all weight loss operations as making the stomach smaller so you feel full sooner and eat less.

The sleeve differs because part of the stomach is permanently removed. A band can in principle be adjusted or taken off, and a balloon is temporary, whereas the removed stomach cannot be put back. Ask your surgeon to explain what each choice means for reflux, vitamins, long-term weight and the possibility of converting to another operation later.

Your team will take you through assessment by a dietitian and often a psychologist, and will ask about reflux, diabetes, sleep apnoea and medicines. A short pre-operative diet to shrink the liver is common, and the details come from your own bariatric dietitian.

On the day you will be told when to stop eating and drinking. Bring your medicines and comfortable clothing, and plan for someone to help at home. If you smoke or vape, stopping before the operation improves healing and lowers chest complications, so ask for support early.

• Tell the team about reflux, hiatus hernia and any previous stomach or bowel operations.

• Agree a plan for diabetes and blood-thinning medicines.

• Discuss contraception and pregnancy timing with your clinic.

The operation is done under general anaesthetic. The NHS says it starts with about five small cuts in the abdomen, which is then filled with air so the surgeon can see and remove part of the stomach. It gives a duration of one to three hours, and North Tees says two to three.

The surgeon uses staples to divide the stomach lengthways and removes the outer, curved part, leaving a narrow tube. The staple line is where a leak can occur, which is why North Tees lists staple line leaks among the risks. Afterwards you wake in recovery and, per the North Tees leaflet, begin with sips of water and then pureed food the next day.

The NHS says most people can leave hospital one to three days after weight loss surgery, and your team will confirm when you are ready.

North Tees lists leaks from the staple line, bleeding, wound infection, injury to nearby organs, blood clots in the leg or lung, and conversion to an open operation. It quotes one death in every 1,000 patients as the risk of weight loss surgery. The NHS describes a leak after sleeve or bypass as a small chance that can cause serious infection inside the abdomen and needs antibiotics.

Further problems named by the NHS and the leaflet include gallstones, narrowing of the stomach, port-site hernias, hair loss in the first six months, excess skin and reflux. The Leeds sheet adds that the sleeve is the operation most linked to reflux, and that longer-term endoscopy is recommended around the fifth year to check for changes.

The NHS describes about four to six weeks to return to normal activities and a staged diet: fluids first, then soft runny foods, then soft foods, and a gradual return to a balanced diet from around week eight. North Tees says to avoid heavy lifting and abdominal exercises for six weeks.

North Tees describes multivitamin and calcium supplements, while Leeds advises these for life, with iron and B12 injections every three months after sleeve or bypass. Blood tests are yearly, and the Leeds sheet adds zinc, copper and selenium checks after a sleeve. A telephone call usually follows within a week of discharge and a clinic visit at six to eight weeks, according to North Tees.

Call 999 for severe abdominal pain, chest pain or breathlessness, continuous bleeding or vomiting blood. The NHS says to ring NHS 111 or your GP the same day for a high temperature, a fast heartbeat, a swollen red calf, repeated vomiting or difficulty swallowing.

In the months and years afterwards, the Leeds advice sheet asks you to see your GP about persistent heartburn or reflux, difficulty swallowing or vomiting, abdominal pain, weight regain and symptoms such as confusion or pins and needles that may reflect vitamin deficiency.

• Given my reflux history, is a sleeve right for me or would a bypass suit better?

• What plan is there if reflux develops afterwards?

• Who does my annual blood tests and reviews my vitamins?

• How would a later conversion to bypass be handled?

The operation is technically the same wherever it is done. In the NHS a specialist weight-management programme normally comes first and waiting times can be long, while a private route may be quicker but varies in what assessment it requires. Whatever route, ask in writing what follow-up is included, because reflux and nutritional review run for years.