Sleeve gastrectomy, also known as laparoscopic sleeve gastrectomy, primary sleeve gastrectomy, or vertical sleeve gastrectomy, is a permanent metabolic and bariatric surgical procedure. The primary goal of this intervention is to achieve significant long-term weight reduction and induce metabolic remission of obesity-related comorbid conditions, such as type 2 diabetes mellitus, hypertension, and obstructive sleep apnea. The procedure operates through two synergistic mechanisms: physical volume restriction and hormonal modulation. By surgical excision of the gastric fundus—the primary site of ghrelin synthesis—the procedure reduces circulating hunger signals while accelerating gastric emptying and nutrient transit to the distal intestine, which enhances peptide YY and glucagon-like peptide-1 release.

Sleeve gastrectomy is performed under general anesthesia in an inpatient surgical setting. The patient is placed in the split-leg reverse Trendelenburg position. Abdominal access is established via laparoscopic ports or a robotic platform. The surgeon opens the gastrocolic omentum to access the lesser sac, dividing the short gastric vessels and greater omentum attachments along the greater curvature of the stomach from 4 to 6 centimeters proximal to the pylorus up to the left crus of the diaphragm. A 36 to 40 French bougie is advanced orally through the esophagus into the duodenum along the lesser curvature to serve as a sizing template. An endoscopic linear stapler with tissue-appropriate staple heights is applied repeatedly from the antrum upward to the angle of His. The staple line is visually inspected, tested for intraoperative leaks using intraoperative endoscopy or air-leak testing, and reinforced if indicated. The resected gastric tissue is placed in an extraction bag and removed through an port site. Abdominal ports are closed, and the patient is transferred to the post-anesthesia care unit.

Clinical trials demonstrate that sleeve gastrectomy yields substantial and sustained physiological improvements. According to the SM-BOSS and SLEEVEPASS randomized controlled trials, patients achieve an average total body weight loss of 25 to 30 percent at one year, with 15 to 25 percent total body weight loss maintained at ten years post-procedure. Metabolic benefits include remission of type 2 diabetes in 60 to 70 percent of patients, improvement or resolution of hypertension in 50 to 60 percent, and resolution of obstructive sleep apnea in over 70 percent. Additionally, patients exhibit reductions in systemic inflammatory markers, improved lipid profiles, and enhanced physical functional capacity.

Short-term recovery involves hospital discharge on postoperative day one or two once the patient tolerates oral fluids, demonstrates adequate pain control, and walks independently. Patients typically return to non-strenuous desk work within ten to fourteen days. Full physical recovery and clearance for vigorous exercise occur six weeks post-surgery following clinical review. Long-term recovery requires lifelong adherence to protein-focused dietary guidelines, daily micronutrient supplementation, regular physical activity, and routine clinical monitoring to ensure nutritional adequacy and monitor metabolic health.

Sleeve gastrectomy is indicated for individuals diagnosed with class III obesity, defined as a body mass index (BMI) of 35 kg/m² or greater, or class II obesity with a BMI of 30.0 to 34.9 kg/m² combined with severe metabolic comorbidities. Conditions effectively treated or improved include type 2 diabetes mellitus, essential hypertension, obstructive sleep apnea, dyslipidemia, non-alcoholic fatty liver disease (metabolic dysfunction-associated steatotic liver disease), gastroesophageal reflux disease without severe esophagitis, weight-bearing joint osteoarthritis, polycystic ovary syndrome, and idiopathic intracranial hypertension.

Pre-operative preparation begins three to six months prior to surgery. Patients undergo comprehensive evaluations including baseline laboratory testing (complete blood count, metabolic panel, hemoglobin A1c, lipid panel, baseline micronutrient levels), abdominal ultrasound, upper endoscopy (esophagogastroduodenoscopy) to evaluate for hiatal hernia or baseline gastritis, and cardiopulmonary risk assessment. A low-calorie, reduced-carbohydrate liquid diet is initiated two weeks prior to surgery to mobilize hepatic glycogen stores and reduce left liver lobe volume, improving surgical exposure. Patients must stop tobacco and nicotine products at least six weeks before surgery to reduce staple line healing complications and marginal ulceration risks. Oral antidiabetic and anticoagulant medications are adjusted by the medical team during the immediate pre-operative week.

Complications after sleeve gastrectomy are classified by frequency and clinical severity. Early major risks include staple line leak (0.5 to 1.5 percent incidence), intra-abdominal hemorrhage (1 to 2 percent), deep vein thrombosis or pulmonary embolism (less than 1 percent), and wound infections. Early minor risks include nausea, dehydration, and incisional hematoma. Late risks include new-onset or worsened gastroesophageal reflux disease (15 to 30 percent long-term), esophageal stricture or sleeve stenosis (1 to 3 percent), nutritional and micronutrient deficiencies (iron, vitamin B12, folate, calcium, and vitamin D), gallstone formation due to rapid weight loss (15 to 30 percent without prophylactic ursodeoxycholic acid), and weight regain over a multi-year timeframe.

The clinical path for sleeve gastrectomy begins with a comprehensive multidisciplinary evaluation lasting three to six months, involving metabolic testing, nutritional assessment, and psychological clearance. Patients complete a pre-operative low-calorie liquid diet for two weeks to shrink liver volume. Surgery is performed under general anesthesia via laparoscopic or robotic techniques, typically lasting 60 to 90 minutes. Hospitalization spans one to two days for postoperative monitoring, fluid management, and early ambulation. Phase-based diet advancement proceeds over four to six weeks, transitioning from clear liquids to full liquids, pureed foods, soft solids, and eventually a solid protein-centric diet. Clinical follow-up occurs at regular intervals during the first year and annually thereafter to assess weight loss, metabolic outcomes, and micronutrient status.