Gastric Sleeve Surgery in Northern Virginia

Gastric sleeve surgery—also called laparoscopic sleeve gastrectomy, vertical sleeve gastrectomy (VSG), or simply "the sleeve"—is the most commonly performed bariatric surgery procedure in the world. It is a minimally invasive operation, done through several small incisions, in which about 80% of the stomach is removed, leaving a slim, banana-shaped tube, or "sleeve." Schematically, the sleeve looks like this:

This smaller stomach comfortably holds a much smaller amount of food, so you feel full sooner and eat less. Just as importantly, removing the outer portion of the stomach lowers levels of ghrelin, a hormone that drives hunger—so many patients find their appetite is genuinely reduced, not just restricted. The result is significant, durable weight loss and meaningful improvement in obesity-related medical conditions.

How gastric sleeve surgery works

Dr. Fitzer performs the VSG laparoscopically with the patient under general anesthesia. Rather than one large incision, he operates through several small incisions, using a camera and slender instruments. Small incisions speed recovery and reduce risks related to wound healing. In most cases, this bariatric surgery procedure takes 35–75 minutes. You can watch Dr. Fitzer perform a sleeve on our YouTube channel. During surgery, the outer, expandable portion of the stomach is removed, and the remaining edge is sealed, creating the narrow "sleeve." The small intestine is not involved in sleeve surgery, so nutrient absorption is not impacted. The risk of nutritional deficiencies is therefore lower than with procedures that do involve manipulation of the small bowel. Unlike the gastric bypass or the adjustable band, sleeve gastrectomy surgery is not reversible, since the excess stomach is removed during surgery.

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

Weight loss with the sleeve is generally better than with the LAP-BAND but not as substantial as with gastric bypass. Excess weight loss averages over 70% from year one through year nine among Virginia Bariatric patients. Below is a graph depicting the average % excess weight loss of Dr. Fitzer's actual sleeve patients over years one through nine following their surgery:

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.

Professional vs. amateur sleeve surgeons

The large national databases of bariatric surgery patient outcomes (like the MBSAQIP, for instance) show that for patients several years out from sleeve surgery, the average weight loss with the sleeve is somewhat lower than the 70% at Virginia Bariatric. It's closer to 60%.

The 10% discrepancy reflects the fact that there are two different types of surgeons that contribute outcomes data to the sleeve database. The first type is the professional bariatric surgeon, a surgeon who has one or more years of formal, specialized training in performing bariatric operations. Their surgery practices tend to focus exclusively on bariatric surgery. Dr. Fitzer is in this category: He completed a year-long bariatric surgery fellowship at the University of Missouri in 2006, and since then, close to 100% of his annual case load has consisted of bariatric procedures.

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

Surprisingly, more than half of the sleeve operations performed in the United States are performed by the other type of sleeve surgeon: the general surgeon who dabbles in sleeve surgery. For such surgeons, their sleeve cases usually comprise a relatively small percentage of their total case volume, sometime in the single digits. The rest of the time, they do other kinds of general surgery procedures, like breast surgery, hernia repairs, etc.

Surgeons without proper bariatric training or experience tend to do a very different sleeve operation than those with specific training. The stomach often ends up with only a modest "trim" instead of a proper volume reduction. Below are a few examples of patients with excessively large sleeves who came to Dr. Fitzer for revisional surgery:

An over-large sleeve won't have normal restrictive function, and the weight-loss outcomes usually suffer because of it. Because half of the sleeve case data in U.S. databases is contributed by relative amateurs, the result is a national average (60%) that is lower than that seen by many surgical practices.

If you've encountered somebody who had unsatisfactory weight loss after a sleeve and/or near-total weight regain, odds are that they had a suboptimal sleeve operation. Fortunately, sleeves can be repaired without much difficulty. See Revisions.

Health benefits of sleeve gastrectomy beyond weight loss

Weight loss from the sleeve is frequently accompanied by improvement or resolution of obesity-related medical conditions, including type 2 diabetes, high blood pressure, high cholesterol, obstructive sleep apnea, and joint pain. Blood-sugar control often improves quickly, sometimes within days of surgery, because of favorable changes in gut hormones. Compared with more complex operations, the sleeve also offers some practical advantages:

• A simpler, faster operation with no intestinal rerouting and no implanted device
• A short hospital stay — typically a single overnight — and only a few small incisions to heal
• Very low rates of surgical complications and fewer long-term side effects than malabsorptive operations
• Normal absorption of nutrients, with a low risk of nutritional deficiencies
• Preserved access to the rest of the GI tract by endoscopy, if ever needed

Who is a candidate for gastric sleeve surgery?

The sleeve operation is generally offered to adults with a body mass index (BMI) of 35 or higher, or 30 or higher with an obesity-related health condition. For patients of East-Asian descent, the BMI thresholds drop to 32.5 and 27.5. Candidacy also depends on your medical history, prior weight-loss efforts, and willingness to accept lifelong dietary and lifestyle changes. See our full bariatric surgery requirements for BMI thresholds, comorbidity criteria, and age guidance.

One important consideration: the sleeve sometimes triggers (or worsens) acid reflux, so patients who already have significant reflux (GERD) may be better served by a gastric bypass. The bypass usually improves reflux instead of aggravating it. Dr. Fitzer will discuss this and other considerations with you.

Recovery after gastric sleeve surgery

Recovery timeline

The hospital stay is short: most patients return home after one night and resume normal activities within four weeks. Patients begin a liquid diet right away after surgery, and the diet is advanced by stages over the following weeks. Clear liquids during the hospital stay become liquids and protein shakes at home for the first week, followed by a week of pureed and soft foods, and so on. After eight weeks of stepwise advancement, patients are back to eating regular, solid foods — in a much smaller amount of food per meal than before surgery.

Daily vitamin supplementation begins upon returning home. The recommended vitamin supplements can be viewed or downloaded here.

Over the first year following sleeve surgery, there is regular follow-up with Dr. Fitzer and his dietitian. Some patients find the transition to smaller meals more manageable than they expected, but one-on-one sessions with an experienced eating coach benefit the process significantly. Building the right set of new eating habits takes time and support, which our team provides throughout.

Risks and side effects of sleeve gastrectomy

Sleeve gastrectomy surgery has a strong safety record, and serious complications are rare. There are certain operative risks that are common to all abdominal surgery, including bleeding, infection, and blood clots. During the first month after surgery, the complication of greatest concern is a leak from the staple line. Such leaks are exceptionally rare but require prompt treatment.

Early side effects are usually mild and temporary — nausea, fatigue, and soreness at the small incisions — and they typically settle within the first few weeks as the diet advances. Over the longer term, the most common issue is new or worsening acid reflux. For most patients, reflux is successfully managed with some behavioral changes and/or medications. In about 5% of sleeve patients, such conservative measures fail, and conversion to a gastric bypass is required to control the heartburn.

Gastric sleeve surgery: frequently asked questions

Is any part of my stomach or intestine bypassed?

No. The sleeve removes part of the stomach but does not reroute the intestines. Food follows its normal path, which is one reason nutrient absorption is better preserved than with gastric bypass.

Sleeve or bypass—which is better?

Both are excellent operations with similar weight loss and diabetes remission. The sleeve is simpler with fewer complications; bypass is often preferred for patients with significant acid reflux or certain metabolic conditions. The best choice is individual.

Can the sleeve be reversed?

No. Because part of the stomach is permanently removed, the sleeve is not reversible—though it can be converted to another procedure if needed in the future.

How long is recovery after gastric sleeve surgery?

Most patients stay overnight in the hospital and return to normal activities within about four weeks. You will begin a liquid diet immediately and advance through pureed, soft, and regular foods over the following eight weeks.

Is gastric sleeve covered by insurance?

Many major insurers cover sleeve gastrectomy surgery when medical criteria are met, such as a BMI of 35 or higher, or 30 or higher with an obesity-related condition. Our team verifies benefits and helps you through the authorization process—see our insurance coverage guide for plan-specific details on Anthem BCBS, Aetna, Medicare, and others.

What diet do I follow after sleeve gastrectomy?

Recovery eating progresses in stages: clear liquids, full liquids and protein shakes, pureed and soft foods, and finally regular solid foods. Daily vitamin supplementation begins right away, and our dietitian supports you through each stage.

Next steps: schedule a gastric sleeve consultation

If you are considering the sleeve operation, the first step is a consultation to review your health history, goals, and whether the sleeve is the right operation for you. Our team provides comprehensive evaluation and long-term support to help you achieve and maintain your results. Contact our office to schedule an appointment.