Gastric Sleeve Surgery in Northern Virginia

Accuracy of the medical content was verified by Dr. Matthew Fitzer, M.D., FACS, FASMBS, a board-certified bariatric surgeon. (He authored most of it.) Read Dr. Fitzer's professional bio

Gastric sleeve surgery is the most common weight loss surgery in the world. You may also hear it called laparoscopic sleeve gastrectomy, vertical sleeve gastrectomy (VSG), or simply "the sleeve."

The operation removes about 80% of the stomach and leaves a slim, banana-shaped tube behind. That smaller stomach holds far less food, so it limits food intake. Used right, it gives you a strong sense of fullness after a surprisingly small amount of food.

The surgery also reduces your appetite through hormone changes. The portion of stomach we remove produces most of your ghrelin, the main hunger hormone. When Ghrelin drops, most patients notice a decrease in appetite throughout their day. It adds to the effectiveness of the smaller stomach.

The result is substantial, lasting weight loss and real improvement in obesity-related conditions.

How gastric sleeve surgery works

Dr. Fitzer performs the sleeve laparoscopically, with the patient under general anesthesia. This minimally invasive approach avoids the single long cut used in open surgery; he works through several small incisions with a camera and slender instruments. Smaller incisions mean faster recovery and fewer wound problems. Most cases take 35 to 75 minutes. You can watch Dr. Fitzer perform a sleeve on our YouTube channel.

During the operation he removes the outer, expandable portion of the stomach and seals the remaining edge, creating the narrow sleeve.

The small intestine is left alone. Because food still travels its normal path, your body absorbs nutrients nearly as well as it did before, and the risk of nutritional deficiency is lower than with operations that reroute the bowel.

One thing to understand clearly: the sleeve is not reversible. The removed portion of the stomach is gone permanently. It can, however, be converted to another operation later if you ever need that.

Weighing the sleeve against the bypass? See our side-by-side comparison of gastric bypass and sleeve gastrectomy.

How much weight will I lose after gastric sleeve surgery?

Long-term weight loss outcomes

Sleeve patients lose more weight than LAP-BAND patients, though somewhat less than gastric bypass patients. Among Virginia Bariatric patients, excess weight loss averages over 70% from year one through year nine. Below is a graph of average % excess weight loss of Dr. Fitzer's actual sleeve patients from year one through year nine following their surgery. It was automatically generated by the electronic health record provider (Baritrax360) for the practice. Identical data was submitted to the MBSAQIP registry.

Weight regain after sleeve gastrectomy

If you are already years out from a sleeve and the weight is creeping back, read our guide to managing weight regain after bariatric surgery, which covers the biology behind regain, GLP-1 medications after surgery, and revision options.

Training matters

The large national registries (e.g., the MBSAQIP), provide data about the average long-term weight loss with sleeve surgery in the United States. The national average is steady at 60%, although weight loss varies from practice to practice. The important factor seems to be the focus of the operating surgeon.

More than half the sleeve procedures done each year in the U.S. are performed by surgeons who lack formal fellowship training in weight loss surgery. Sleeves may be a small part of their overall case volume.

When sleeve surgery is performed without formal training, the stomach often gets an over-cautious trim, not a proper volume reduction. Below are a few examples of patients with excessively large sleeves who were referred to Dr. Fitzer for sleeve revision:

The other type of sleeve surgeon is the bariatric surgeon. Bariatric surgeons typically have one or more years of formal fellowship training under their belt, and their practices are devoted exclusively to bariatric medicine and surgery.

Dr. Fitzer is this kind. He completed a year-long bariatric surgery fellowship at the University of Missouri in 2005-2006. Since fellowship, nearly 100% of his annual caseload has been bariatric procedures.

Bariatric surgeons can be relied on to perform proper stomach reduction. Here are a few examples of imaging studies from Dr. Fitzer's own sleeve patients (identifying information removed):

When someone loses very little after a sleeve or regains most of the lost weight, the sleeve may be at fault. The good news is that an underperforming sleeve can usually be repaired without much difficulty. See Revisions.

Health benefits of sleeve gastrectomy beyond weight loss

Losing weight with the sleeve often improves obesity-related conditions, and in many cases clears them entirely. Type 2 diabetes, high blood pressure, high cholesterol, sleep apnea, and joint pain all tend to get better.

Blood sugar control often improves within days of surgery, long before you have lost much weight. Favorable changes in your gut hormones drive that early effect.

The sleeve also offers several practical advantages over more complex operations:

• It is a simpler operation than gastric bypass, with a shorter time under anesthesia.
• The hospital stay is usually a single night.
• Complication rates are low.
• Nutrient absorption stays close to normal, because the small intestine is untouched.
• Your stomach and intestine remain reachable by endoscope, which matters if you ever need one.

Who is a candidate for gastric sleeve surgery?

We offer the sleeve to adults with a body mass index (BMI) of 35 or higher. A BMI of 30 or higher also qualifies if you have an obesity-related health condition. For patients of East Asian descent, those numbers drop to 32.5 and 27.5.

But your BMI is not the whole picture. We look at your medical history. We look at what you have already tried through diet and exercise. And we look at whether you are ready to change how you eat for good. See our full bariatric surgery requirements for BMI thresholds, comorbidity criteria, and age guidance.

One caution matters here. The sleeve can trigger or worsen acid reflux. If you already have bad reflux (GERD), a gastric bypass may suit you better. Bypass usually improves reflux instead of making it worse. Dr. Fitzer will discuss this and other considerations with you.

Recovery after gastric sleeve surgery

Recovery timeline

The hospital stay is short. Most patients go home after one night and return to normal activities within four weeks.

Your diet advances in stages. You start clear liquids in the hospital, move to liquids and protein shakes at home for the first week, then spend a week on pureed and soft foods. After about eight weeks you are back to regular solid food, in much smaller portions than before surgery.

Daily vitamins begin the day you get home. The recommended vitamin supplements can be viewed or downloaded here. Over your first year you will see Dr. Fitzer and his dietitian regularly.

Many patients find the shift to smaller meals easier than they feared. Even so, one-on-one work with an experienced eating coach makes a real difference. Building new eating habits takes time and support, and our team provides both throughout.

Risks and side effects of sleeve gastrectomy

Sleeve gastrectomy has a strong safety record, and serious complications are rare.

The operation carries the risks common to all abdominal surgery: bleeding, infection, and blood clots. During the first month, the complication of greatest concern is a leak from the staple line. Leaks are exceptionally rare, but they require prompt treatment.

Early side effects are usually mild and temporary. Nausea, fatigue, and soreness at the incisions typically settle within the first few weeks as your diet advances.

Long term complications are uncommon, except for one. Some 10 or 20% of patients get new or worse acid reflux.

Why should sleeve surgery cause reflux? The pictures below help explain it.

Notice how the normal stomach contains more fluid, yet the waterline settled below the opening of the esophagus. In the sleeved stomach, the fluid sits on top of the esophageal opening. While the patient remains supine, gravity works to pull acidic fluid back into their esophagus. If their LES pressure is low, reflux and heartburn result.

It’s normal for the esophagus to get some exposure to stomach acid. Reflux symptoms and esophageal damage only tend to develop when the daily duration of exposure rises above a threshold of 4-6%.

Because of the anatomic change, sleeve patients who sleep on their back often experience reflux at night. Even a little extra nighttime exposure can push a patient over the symptom threshold.

Gastric sleeve surgery: frequently asked questions

Is any part of my stomach or intestine bypassed?

No. The sleeve removes part of your stomach, but it does not reroute your intestines. Food follows its normal path. That is one reason nutrient absorption holds up better than it does after a gastric bypass.

Sleeve or bypass — which is better?

Both are excellent operations, with similar weight loss and similar rates of diabetes remission. The sleeve is simpler and carries fewer complications. Bypass is often the better choice if you have significant acid reflux or certain metabolic conditions. The right answer is individual. See our detailed sleeve vs. bypass comparison for a side-by-side look.

Can the sleeve be reversed?

No. Part of your stomach is removed permanently, so the sleeve cannot be undone. It can, however, be converted to another operation later if you ever need that.

How long is recovery after gastric sleeve surgery?

Most patients stay one night in the hospital and return to normal activities within about four weeks. You start on a liquid diet right away, then move through pureed, soft, and regular foods over the next eight weeks.

Is gastric sleeve covered by insurance?

Many major insurers cover sleeve gastrectomy when you meet their medical criteria, usually a BMI of 40 or higher, or 35 or higher with an obesity-related condition. Our team verifies your benefits and walks you through authorization. Our insurance coverage guide has plan-specific detail on Anthem BCBS, Aetna, Medicare, and others.

What diet do I follow after sleeve gastrectomy?

Eating advances week by week for eight weeks: clear liquids, then full liquids and protein shakes, then pureed and soft foods, and finally regular solid food. Sleeve-specific diet instructions can be found here, Our dietitian is there to support you through every stage.

Next steps: schedule a gastric sleeve consultation

Considering the sleeve? The first step is a consultation. We review your health history and your goals, and we figure out together whether the sleeve is the right option for you.

Last updated: August 31, 2026