Gastric Sleeve Surgery: Procedure, Benefits, Requirements

Gastric sleeve surgery (also known as sleeve gastrectomy, vertical sleeve gastrectomy, or VSG) is one of the most widely performed metabolic procedures in the world. During the operation, surgeons remove about 70 to 80 percent of the stomach along the greater curvature and reshape the remainder into a narrow tube. This smaller stomach limits food volume, suppresses the hunger hormone ghrelin, and improves the balance of key metabolic hormones such as leptin, insulin, and GLP-1. These changes help patients feel satisfied with smaller portions and support long-term weight control.

Although gastric sleeve is an effective weight-loss procedure, it is not a shortcut. It is the first step toward a different lifestyle. Surgery reduces hunger and improves metabolism, but lasting success depends on daily habits. Patients who follow structured nutrition plans, stay active, and maintain regular follow-up care reach healthier weights and protect their long-term results.

For many people living with obesity, gastric sleeve surgery provides a new starting point. It improves quality of life, reduces obesity-related health problems, and helps patients build the foundation for a sustainable, healthier future.

Gastric sleeve surgery, also called sleeve gastrectomy or vertical sleeve gastrectomy (VSG), is a metabolic procedure where approximately 70–80 percent of the stomach is removed to create a narrow, tube-shaped stomach. A gastric sleeve is often done laparoscopically and most known bariatric surgery method.

The gastric sleeve procedure not only reduces stomach size but also changes key hormones that regulate hunger, metabolism, and blood sugar. The ghrelin hormone (a.k.a. hunger hormone) is removed, so patients feel less hungry. GLP-1 (glucagon-like peptide-1), leptin, and insulin are regulated, leading to satiety and enhanced glucose control, helping manage blood sugar more efficiently. 

VSG is one of the most commonly performed bariatric surgeries worldwide because it promotes long-term weight loss and improves obesity-related conditions such as type 2 diabetes, sleep apnea, and hypertension.

During the surgery, the surgeon removes approximately 70–80 percent of the stomach, leaving a narrow, tube-shaped sleeve. Because the stomach is significantly smaller, it holds less food, helping patients feel full sooner. Removing this portion also reduces ghrelin, the hormone that triggers hunger, while regulating leptin, insulin, and GLP-1, which improves satiety, blood sugar control, and overall metabolic balance.

These changes support both digestive and metabolic improvements, helping the body manage energy more efficiently and promoting sustainable weight loss. The intestines remain intact, so nutrient absorption continues normally.

Gastric sleeve surgery is performed in a carefully planned sequence of steps to maximize safety, metabolic outcomes, and recovery. Each step is designed to minimize risks, optimize hormone regulation, and support sustainable weight loss. The gastric sleeve procedure can be explained in nine steps, from anesthesia to the end. 

• Pre-Operative Evaluation (Step 1): Before surgery, patients undergo a thorough assessment to ensure they are physically and mentally ready.
• Anesthesia and Surgical Preparation (Step 2): Patients receive general anesthesia administered by a board-certified anesthesiologist, and the abdomen is cleaned and prepped for surgery.
• Laparoscopic Entry (Step 3): The surgeon makes small incisions for laparoscopic instruments and a camera, allowing minimally invasive access to the stomach.
• Stomach Resection (Step 4): Approximately 70–80% of the stomach along the greater curvature is removed, reducing capacity and regulating hunger hormones like ghrelin, while supporting metabolic improvements.
• Bougie Calibration (Step 5): A flexible bougie tube is inserted to measure and shape the remaining stomach sleeve, ensuring proper size and safety.
• Stapling and Reinforcement (Step 6): Surgical staplers close the stomach, and the staple line may be reinforced to prevent leaks and bleeding.
• Leak Test (Step 7): The surgeon checks the sleeve for leaks to ensure it is sealed correctly and prevent post-operative complications.
• Immediate Post-Operative Monitoring (Step 8): Patients are closely monitored for vital signs, pain management, and early signs of complications, while hydration and early mobilization begin.
• First 24–48 Hour Check-ups (Step 9): Patients start walking, take clear fluids, and follow initial post-op guidelines; medical staff monitor recovery and metabolic responses closely.

Before surgery, patients should be evaluated to see if they are ready to undergo anesthesia. Evaluation tests include:

• Blood tests: Complete blood count, liver and kidney function, blood sugar, electrolytes, and vitamin levels
• Cardiovascular assessment: ECG, echocardiogram, or stress tests if needed
• Respiratory evaluation: Lung function tests and screening for sleep apnea
• Psychological evaluation: Assessing readiness for lifestyle changes and post-op compliance
• Dietitian consultation: Pre-op nutrition planning and guidance for the post-operative diet
  

The surgical part of the procedure usually takes 60–120 minutes. Factors such as abdominal fat distribution, liver size, and previous abdominal surgeries can slightly shorten or extend this time. 

Gastric sleeve surgery is performed under general anesthesia, and the preparation stage begins before the first incision. In the operating room, the anesthesia team places monitoring equipment, administers IV medications, and ensures the patient is fully asleep and stable before the laparoscopic entry starts.

Most patients open their eyes within minutes and are transferred to the recovery unit, where nurses closely monitor breathing, oxygen saturation, and pain levels.

The portion of the stomach removed contains the majority of ghrelin-producing cells. Ghrelin is the primary hormone that signals hunger to the brain. By reducing ghrelin levels, patients naturally feel less hungry and consume fewer calories. By removing 70-80% of the stomach, the insulin sensitivity improves. The risk of type 2 diabetes reduces and the body regulates blood sugar more efficiently. GLP-1 levels increase, which enhances satiety and stabilizes post-meal glucose. Leptin regulation improves, which supports long-term appetite control and weight maintenance.

These hormonal changes are why gastric sleeve surgery is considered a metabolic procedure, not simply a restrictive surgery that reduces stomach size.

Ghrelin, the hormone that stimulates hunger, decreases, helping patients naturally control portion sizes. At the same time, insulin sensitivity improves, stabilizing blood sugar levels and reducing cravings. GLP-1, a hormone that signals fullness, increases, so patients feel satisfied with smaller meals. Leptin regulation also improves, further enhancing appetite control and supporting long-term weight management. 

Together, these hormonal adjustments help patients adopt healthier eating habits naturally, without relying solely on willpower.

Patients typically lose 60–70 percent of their excess weight within the first 12–18 months after surgery. The rapidity of weight loss depends on several factors. 

• Metabolic rate: Each patient’s resting energy expenditure influences how quickly calories are burned.
• Diet adherence: Following the post-operative nutrition plan is critical to maintain steady weight loss.
• Physical activity: Regular exercise supports fat loss and muscle preservation.
• Hormonal adaptation: Changes in ghrelin, GLP-1, leptin, and insulin help reduce appetite, improve glucose control, and support long-term weight management.
• Post-operative follow-up: Regular check-ups with the surgeon, dietitian, and support staff help prevent plateaus and maintain healthy lifestyle habits.
  

No, the surgery does not change nutrient absorption. Because the intestines are untouched, nutrient absorption is mostly unchanged. Patients can digest proteins, carbohydrates, fats, vitamins, and minerals normally. However, rapid weight loss may increase the need for multivitamin and mineral supplementation, especially vitamin B12, iron, calcium, and vitamin D.

No, most patients describe gastric sleeve surgery as uncomfortable rather than painful. The procedure is performed under general anesthesia, so there is no pain during surgery. After waking up, the main source of discomfort comes from the laparoscopic openings and the gas used to inflate the abdomen, not from the stomach itself.

Patients often feel tightness or pressure around the incisions, gas-related shoulder or abdominal discomfort, mild nausea from anesthesia, and a sensation of fullness when drinking fluids.

Pain is managed with IV medication during the first hours and oral medication on the following day. Early mobilization helps reduce gas discomfort, and most patients report feeling significantly better within 48 to 72 hours. By the end of the first week, daily activities usually become easier, and pain continues to decrease.

No, gastric sleeve surgery is considered permanent. During the procedure, the surgeon removes a large portion of the stomach, leaving a narrow sleeve. Because the removed part cannot be restored, the operation cannot be reversed.

However, the digestive tract remains intact, and no intestines are bypassed, which is why the gastric sleeve preserves normal nutrient absorption. If a patient requires further treatment in the future, other bariatric procedures, such as gastric bypass or duodenal switch, can still be performed on top of the sleeve if medically necessary.

Although the sleeve cannot be reversed, the remaining stomach can gradually stretch over the years if the portion of the food increases. This may reduce the long-term effectiveness of the surgery.

Metabolic Improvement,  Impact on Obesity-Related Conditions

Gastric sleeve surgery offers both weight loss and deep metabolic improvements. It reduces stomach capacity, decreases hunger, and helps regulate hormones that influence appetite, blood sugar, and fat storage. The intestines stay intact, which means nutrient absorption remains normal.

• Sustained Weight Loss: Most patients lose 60 to 70% of their excess weight within the first year. Weight loss continues gradually for 18 months as the stomach adapts to its new shape and the body reaches a healthier metabolic balance.
• Improved Metabolic Health: The surgery removes the part of the stomach that produces most of the hunger hormone ghrelin. This reduces constant appetite and makes portion control easier. The procedure also improves the activity of insulin, leptin, and GLP-1, which helps regulate blood sugar and reduces insulin resistance.
• Impact on Obesity-Related Conditions: Clinical studies show that gastric sleeve surgery helps improve or resolve several conditions related to obesity, such as Type 2 diabetes, sleep apnea, high blood pressure, non-alcoholic fatty liver disease, polycystic ovary syndrome (PCOS), high cholesterol, and joint pain and mobility limitations. 
• Normal Nutrient Absorption: Unlike bypass procedures, gastric sleeve surgery does not alter the intestines. Vitamins and minerals are absorbed normally. Patients still take supplements for support, but the risk of long-term nutritional deficiency is lower.
• Better Quality of Life: Weight loss improves mobility, physical comfort, and energy levels. Daily activities become easier. Many patients report better sleep, improved mood, and stronger self-esteem as their health stabilizes.
• Lower Surgical Risk: The gastric sleeve is done laparoscopically. This approach reduces scarring, infection risk, and postoperative pain and speeds up recovery. Most patients return to normal routines earlier compared to other bariatric procedures.

The cost of gastric sleeve surgery starts from €3,800 and goes up to €23,00 internationally. The prices vary depending on the country, hospital standards, and included services. 

Country	Estimated Cost (USD / €)
Turkey (Istanbul)	€3,800–€6,800
USA	€14,000–€23,000
UK	€14,000–€23,000
Spain	€9,000–€15,000
Thailand	€5,700–€9,500
Mexico	€4,700–€8,500

In Turkey, the procedure is often more affordable than in the UK, US, or Europe, while maintaining high medical quality and internationally accredited facilities. When in the USA, the price only includes the surgery fee, and other elements such as hospital stay or anesthesia remain as a hidden fee; Turkey offers all-inclusive packages that even include hotel accommodation. 

In the USA, the price is only given for the surgery fee. Anesthesia, hospital stay will be calculated as extra. In Europe, follow-ups can be charged as extra.

In Turkey, all-inclusive packages are offered for international patients. These typically cover the surgeon’s fees, hospital stay, anesthesia, laparoscopic instruments, post-operative medications, IV fluids, nutritional guidance, hotel accommodation, and airport transfers. Optional extras may include extended hospital stay or additional private services, but the base packages are designed to be transparent, fixed, and comprehensive.

Even in reputable clinics, certain expenses may not be included in the standard gastric sleeve prices.. Patients should be aware of potential additional costs, such as:

• Extended hospital stays if complications arise
• Specialized nutritional supplements or vitamins beyond the routine post-op plan
• Extra diagnostic tests or imaging outside the standard pre- or post-operative care
• Follow-up consultations or long-term monitoring visits not included in the initial package

Insurance coverage depends on your country, policy, and medical necessity. In many European and US plans, bariatric surgery may be partially covered for patients with obesity-related comorbidities. Coverage usually requires documentation of previous weight-loss attempts, consultations, and pre-approval.

In Turkey, most international patients pay out-of-pocket, though some travel insurers may reimburse a portion depending on policy terms. However, without insurance coverage, patients find Turkey prices even more affordable.

The cost of gastric sleeve surgery varies significantly between countries due to several factors. Medical infrastructure and labor costs are higher in the UK and the US, which increases surgeon and hospital fees. Regulatory and insurance requirements add to the total price, as compliance with national health standards can be expensive. Exchange rates and local operational expenses further influence pricing, making the same procedure more costly in some regions than others. 

What is included in a surgical package, such as pre-operative evaluations, hospital stay, anesthesia, post-op care, and accommodation, affects the final cost and can make pricing more or less predictable for patients. Understanding these differences helps international patients make informed decisions when considering gastric sleeve surgery abroad.

Gastric sleeve surgery is recommended for individuals who meet specific medical and lifestyle criteria. Ideal candidates are those for whom non-surgical weight-loss methods, such as diet, exercise, and medication, have not provided long-term results, and who are motivated to make the lifestyle changes required after surgery. Common criteria include:

• Body Mass Index (BMI): Typically ≥40, or ≥35 with obesity-related health conditions such as type 2 diabetes, hypertension, or sleep apnea.
• Age Range: Most patients are between 18 and 65 years old, though older individuals may be considered after a thorough medical evaluation.
• Commitment to Lifestyle Changes: Patients must be willing to follow post-operative dietary guidelines and engage in regular physical activity.
• Psychological Readiness: Mental preparedness, realistic expectations, and the ability to cope with the behavioral changes required for long-term success.

Not all patients are appropriate candidates for gastric sleeve surgery. Surgery may be unsuitable for individuals who:

• Have severe, untreated psychiatric disorders or active eating disorders.
• Are unable or unwilling to commit to post-operative dietary and lifestyle changes.
• Have certain medical conditions that make anesthesia or surgery high-risk.
• Are pregnant or planning pregnancy in the immediate post-operative period.

Like any major surgery, gastric sleeve carries potential risks. While serious complications are rare, patients should be aware of them to make informed decisions.

• Bleeding: Occurs in about 1–3% of patients, usually managed during or shortly after surgery.
• Staple Line Leaks: Rare, affecting roughly 1% of cases; careful surgical technique and monitoring significantly reduce this risk.
• Infections: Occur in 2–5% of patients and are typically treatable with antibiotics.
• Blood Clots (Deep Vein Thrombosis / Pulmonary Embolism): Affect around 1–2% of patients, prevented through early mobilization, compression devices, and, in some cases, blood-thinning medication.
• Nutritional Deficiencies: Can develop in 5–15% of patients if dietary guidelines and supplementation are not followed.
• Minor Side Effects: Nausea, vomiting, or temporary reflux may occur in the early recovery phase in roughly 5–15% of patients.

Choosing a hospital and an experienced surgeon is the first step. The risk of complications is generally in the hands of the doctor and the medical team.

• Experienced Surgical Technique: Hundreds of successful procedures with no record of major complications.
• Pre-Operative Assessment: Comprehensive blood tests, imaging, and evaluations ensure patients are physically and mentally prepared.
• Post-Operative Monitoring: Continuous observation in the first 24–48 hours to detect any early signs of complications.
• Early Mobilization & Support: Patients are guided to move and hydrate carefully to prevent blood clots and promote recovery.
• Nutritional Counseling: Dieticians ensure patients receive the right vitamins and minerals to support healing and long-term metabolic health.
  

Like all surgical procedures, gastric sleeve surgery can lead to side effects, which are generally classified as short-term or long-term. Understanding these helps patients anticipate changes and take proactive steps for recovery.

Short-term side effects usually occur within the first few weeks after surgery and are generally manageable.

Long-term side effects may appear months or years after surgery and are often related to dietary habits or nutrient absorption.

Short-term side effects include:

• Nausea and Vomiting: Experienced by 5–15% of patients, often due to anesthesia effects, dietary non-compliance, or early gastric irritation.
• Pain or Discomfort: Mild to moderate abdominal pain around laparoscopic incisions is common and typically controlled with prescribed pain medication.
• Reflux or Heartburn: Temporary acid reflux can occur in 5–10% of patients, usually resolving as the stomach adapts.
• Fatigue: Reduced caloric intake in the initial days may cause tiredness or low energy.

• Nutritional Deficiencies: If post-operative supplementation and dietary guidelines are not followed, deficiencies in iron, vitamin B12, vitamin D, calcium, and protein may develop.
• Hair Thinning: Temporary hair loss can occur during rapid weight loss, usually resolving within 6–12 months.
• Gastrointestinal Changes: Some patients experience changes in bowel habits, such as constipation or diarrhea.
• Weight Regain: The stomach can stretch over time if dietary guidelines are ignored, potentially leading to partial weight regain.

Recovery after gastric sleeve surgery follows a structured timeline designed to ensure safety, support metabolic adjustments, and promote sustainable weight loss. Understanding each phase helps patients gradually return to daily life, rebuild strength, and adapt to new dietary and lifestyle habits.

Immediate Post-Operative Care (Days 1–2)

Patients remain under hospital supervision to monitor vital signs, fluid balance, and metabolic responses. IV fluids deliver essential vitamins, minerals, and medications to manage pain and prevent dehydration. Early mobilization is encouraged to reduce the risk of blood clots and improve circulation. Eating is not allowed at this stage; hydration is the primary focus.

Early Recovery Phase (Week 1)

Patients begin to reintroduce fluids gradually under medical guidance. Short, frequent walks help prevent stiffness and support circulation. Fatigue and mild discomfort are common, and patients are encouraged to rest while slowly resuming light daily activities.

Transition Phase (Weeks 2–4)

The diet shifts from clear liquids to soft foods. Portion sizes remain small, and meals are nutrient-focused to support healing and satiety. Physical activity gradually increases. Gentle yoga or stretching, short walks, and light household tasks become feasible. Energy levels typically improve, allowing patients to return to light work duties if cleared by their surgeon.

Intermediate Recovery (Weeks 4–6)

Soft foods are expanded, and some easily digestible solid foods may be introduced. Exercise intensity can gradually increase, including moderate walking, low-impact cardio, and core strengthening. Patients continue to follow hydration and vitamin guidelines closely to prevent nutritional deficiencies.

Late Recovery and Adaptation (Weeks 6–12)

Most patients can return to routine activities and resume more vigorous exercise, such as higher-intensity walking, swimming, or light resistance training. The diet now consists primarily of balanced, nutrient-rich solids, and patients are taught strategies to avoid overeating and prevent weight regain.

Long-Term Maintenance (3+ Months)

By this stage, patients have generally adjusted to smaller portion sizes and the new metabolic state of their stomach. Exercise routines can be further intensified according to individual fitness levels. Regular follow-ups with the surgical and nutrition team ensure continued metabolic health, monitor for any delayed complications, and provide guidance to sustain weight-loss results.

During the first two days, the medical team focuses on stabilization, hydration, pain control, and the early metabolic changes triggered by the surgery. After the patient wakes up from anesthesia, nurses check vital signs at regular intervals, such as heart rate, blood pressure, oxygen levels, and urine output, to ensure the body is responding well.

Fluid intake becomes the primary goal because the stomach is not ready for solid food. Patients receive IV fluids containing electrolytes, vitamins, minerals, and pain medication to support healing and prevent dehydration.

Early mobilization is encouraged within a few hours after surgery. Walking helps improve circulation, supports lung function, and reduces gas pain caused by laparoscopic inflation. The surgeon also evaluates the patient’s initial metabolic response, including appetite changes and early hormonal shifts.

By the end of the 24–48-hour period, patients usually tolerate clear liquids, maintain stable vitals, and prepare for discharge with clear instructions for diet and home care.

In the first 24–48 hours after gastric sleeve surgery, patients consume only clear fluids and very small portions. The stomach’s capacity is significantly reduced, and ghrelin levels drop sharply. As a result, physical hunger is usually minimal.

Some patients may still feel a desire to eat. This sensation is often a learned, brain-driven signal triggered by habits such as chewing or meal timing, rather than a true physiological need for food. Understanding this distinction can help patients stay comfortable during the initial liquid diet phase.

Frequent, small sips of water or prescribed clear fluids help maintain hydration, support metabolism, and ease 

the adjustment to a smaller stomach volume. By recognizing that early hunger cues are mostly behavioral, patients can focus on healing without unnecessary stress or overeating.

Most patients can resume desk-based work within 1–2 weeks, depending on individual recovery and energy levels. Jobs requiring heavy physical activity or lifting may require 3–6 weeks before returning safely. It is essential to listen to your body and gradually increase activity rather than rush the process.

Light walking is encouraged immediately after surgery to reduce blood clot risk and promote healing. Moderate exercise, such as yoga or stretching, can usually begin 2–4 weeks post-op, while vigorous exercise or resistance training should typically wait 6–8 weeks, as advised by your surgeon.

Rapid or significant weight loss can sometimes lead to loose skin, especially in the abdomen, arms, and thighs. Factors influencing skin elasticity include age, genetics, and the amount of weight lost. While exercise, hydration, and gradual weight loss help, some patients may consider surgical body contouring for aesthetic improvement once weight stabilizes.

By following the post-operative plan and attending regular follow-ups, patients can achieve safe recovery, maintain muscle strength, and maximize the metabolic and health benefits of the surgery.

Over time, the sleeve can slightly expand, but significant stretching is rare. It typically happens only if patients regularly overeat or consume high-calorie liquids. With proper post-operative guidance and adherence to diet and lifestyle recommendations, the sleeve maintains its long-term effectiveness.

The post-operative diet after gastric sleeve surgery is the most important part of a successful recovery, metabolic adaptation, and long-term weight management. Because the stomach is surgically reduced to 20–30% of its original size, food intake must be carefully managed to prevent stretching, avoid discomfort, and optimize hormonal and metabolic changes.

Recovery begins with clear liquids and gradual hydration to support tissue healing, maintain electrolyte balance, and deliver essential vitamins and minerals. As the stomach heals, patients progress to soft foods, which allow chewing practice, gentle digestion, and adequate protein intake while still respecting the new stomach volume.

Eventually, patients transition to regular, nutrient-dense solid foods, establishing lifelong eating habits that support satiety, maintain lean body mass, and prevent weight regain. This stepwise approach is designed to retrain the brain and body, helping patients recognize true hunger versus behavioral cravings and adapt to a smaller, more efficient digestive system.

The diet after gastric sleeve surgery progresses gradually to ensure healing, optimize metabolism, and retrain appetite signals. Each phase is designed to protect the new stomach, support nutrient absorption, and prevent complications.

Liquid Phase (Days 1–7)

• It starts immediately after surgery while the patient is still in the hospital. 
• Only clear fluids, broths, water, sugar-free tea, and prescribed protein shakes are allowed. 
• Small, frequent sips are recommended to maintain hydration, support electrolyte balance, and provide essential nutrients while the stomach begins to heal. 
• Physical hunger is minimal due to the reduced stomach capacity and suppressed ghrelin levels. 
• This phase helps patients adapt to their smaller stomachs, prevent nausea or vomiting, and prepare for the gradual introduction of soft foods.

• Patients begin consuming soft foods such as yogurt, eggs, mashed vegetables, soft fish, and cottage cheese.
• Portion sizes remain small, typically 3–6 tablespoons per meal, and foods should be chewed thoroughly to prevent stretching the new stomach.
• Protein intake is emphasized to support tissue healing, maintain muscle mass, and enhance metabolic recovery.
• Light physical activity, such as short walks, gentle stretching, and household tasks, is encouraged to improve circulation and overall well-being.
• This phase helps the patient transition safely from liquids to more substantial foods while respecting the stomach’s reduced capacity.
  

• Patients gradually reintroduce regular, nutrient-dense meals, including lean proteins, vegetables, and limited healthy carbohydrates.
• Portion sizes remain controlled, and meals are eaten slowly to ensure satiety and prevent overeating.
• Physical activity can progressively include moderate walking, yoga, swimming, or low-impact cardio, with resistance training and higher-intensity exercises introduced after 6–8 weeks.
• Nutrient monitoring is crucial, particularly for iron, vitamin B12, calcium, vitamin D, and protein, to prevent deficiencies.
• Patients learn to distinguish true hunger from habitual cravings, helping maintain long-term weight loss.
  

• Patients follow a balanced diet emphasizing protein, fiber, healthy fats, and adequate hydration.
• Portion control and mindful eating are reinforced to prevent stretching of the sleeve and future weight regain.
• Regular physical activity, structured follow-ups with dieticians, and ongoing behavioral support help consolidate healthy habits and sustain metabolic improvements.
• Continuous monitoring and adaptation of diet and lifestyle choices are essential for maintaining long-term success and preventing nutritional deficiencies.

Not every patient needs a strict pre-op diet. When needed, the goal is to reduce liver fat, stabilize blood sugar, make laparoscopic surgery safer, and to give a habit for post-op diet. If your liver size, ultrasound, or blood results show a need, your doctor will recommend a personalized plan.

2 Weeks Before Surgery (If Recommended)

• A high-protein, low-carbohydrate eating pattern may be suggested to help reduce liver size.
• Patients focus on lean proteins, non-starchy vegetables, and limited fats.
• Sugary foods, soft drinks, bread, pasta, and high-carb snacks are restricted to lower glycogen stores in the liver.
• Hydration becomes essential to support metabolic preparation.
  

• The diet becomes more structured if liver fat reduction is still needed.
• Calorie intake may be lowered slightly to promote further liver shrinkage, improving laparoscopic visibility.
• Patients continue protein-focused meals to preserve muscle mass.
• Some may be asked to switch to partial liquid supplementation depending on liver response and ultrasound results.
  

• Many patients transition to a mostly liquid-based diet only if their liver still appears enlarged or if the surgeon needs to minimize intra-abdominal tension.
• This phase helps reduce stomach residue and ensures the body is in the safest metabolic state for anesthesia.
  

• Clear liquids only.
• This step minimizes gastric content and reduces aspiration risk during anesthesia.

Long-term success depends on adherence to dietary guidelines, mindful eating, regular protein intake, and ongoing physical activity. If patients consume large portions or high-calorie foods too frequently, the sleeve can gradually stretch, increasing the risk of weight regain. 

Following dietary guidelines and supporting your diet with exercise is essential to maintain results.

Gastric sleeve surgery is one of several evidence-based bariatric procedures used to treat obesity and improve metabolic health. Each method works differently on stomach size, hormone regulation, and nutrient absorption. The best choice depends on BMI, eating behavior, comorbidities, and long-term goals.

Bariatric Procedure	How It Works	Weight Loss Expectation	Effect on Hormones	Nutrient Absorption	Typical Recovery	Best For
Gastric Sleeve (VSG)	Removes 70 to 80 percent of the stomach and forms a tubular sleeve	60 to 70 percent excess weight loss	Strong reduction in ghrelin and improved GLP-1 and insulin response	Normal absorption because intestines stay intact	Return to work in 7 to 14 days	Patients who want strong results without intestinal bypass
Gastric Bypass (Roux-en-Y)	Creates a small stomach pouch and reroutes a section of the small intestine	70 to 80 percent excess weight loss	Significant hormonal impact on insulin regulation	Moderate malabsorption of calories and micronutrients	Return to work in 14 to 21 days	Patients with diabetes, reflux, or severe obesity
Transit Bipartition	Preserves the stomach but diverts part of the food stream to the ileum	70 to 85 percent excess weight loss	Strong GLP-1 stimulation and metabolic improvement	Lesser malabsorption compared with bypass	Return to work in 10 to 14 days	Patients with type 2 diabetes needing maximum metabolic benefit
Duodenal Switch	Combines sleeve gastrectomy with extensive intestinal bypass	80 to 90 percent excess weight loss	Very strong hormonal and metabolic changes	High malabsorption of fat and fat-soluble vitamins	Longer recovery, more nutritional monitoring	Patients with super obesity or severe metabolic disease
Gastric Balloon	Temporary silicone balloon placed endoscopically	10 to 20 percent total body weight loss	Minimal hormonal effect	Normal absorption	Quick recovery, same day discharge	Patients who want a non-surgical option
Gastric Botox	Botox injected into stomach muscle to slow gastric emptying	Mild weight loss	No significant hormonal effect	Normal absorption	Same day return to activities	Patients who want temporary appetite reduction

Gastric sleeve is the most commonly selected surgery because it balances strong weight loss, hormonal improvement, and a low risk profile without altering the intestines. However, patients with advanced metabolic disease or severe reflux may benefit more from alternatives such as bypass or transit bipartition.