Sleeve Gastrectomy

Your surgeon divides the stomach lengthwise with a stapler and removes about four fifths of it, leaving a narrow tube along the inner curve roughly the shape and size of a banana. The removed part is taken out and does not go back.

Two things change. The stomach holds far less, so you feel full on a small meal; and the part removed is where most ghrelin is made, the hormone that drives hunger, so the appetite itself usually falls away. That second change is why people describe it as no longer thinking about food all day.

The bowel is not rerouted and nothing is bypassed, so absorption of food stays broadly normal. The operation is one part of a programme that includes a dietitian, a physician and often a psychologist, both before and for years afterwards, and the result depends heavily on that part.

You will have been assessed by the team, had endoscopy and blood tests, and usually followed a low-calorie diet for two weeks beforehand to shrink the liver and make the operation safer. You are admitted the day before or on the morning of surgery, fasting, and have a general anaesthetic.

Your surgeon makes four or five small cuts in the upper abdomen, fills it with carbon dioxide gas and passes a camera. The blood vessels along the outer curve of the stomach are sealed and divided, a calibration tube is passed down to set the width, and the stapler is fired up the length of the stomach. The staple line is checked for leaks and bleeding, and the removed portion is lifted out through one of the cuts. Most take about an hour to an hour and a half.

You are sat up and walking the same evening, and started on sips of water. Expect two to three nights in hospital, with a swallow test on some protocols before you go home.

You go home on liquids and move through pureed, then soft, then normal textures over about six weeks, guided by the dietitian. Eat slowly, stop when you feel full, and keep fluids separate from meals. Desk work is realistic at two weeks and lifting and gym at four to six.

Weight comes off fastest in the first six months and continues to around 12 to 18 months, with most people losing roughly 55 to 70 percent of their excess weight. Diabetes, blood pressure and sleep apnoea often improve markedly within months. Some weight regain after two to three years is common, and how much depends on eating patterns and activity. Lifelong follow-up, annual blood tests and a daily multivitamin are part of the deal, and so is a vitamin B12 and iron check.