Weight loss surgery
Sleeve gastrectomy: the most popular weight loss operation worldwide.
Your surgeon: Stefanos Lazaridis MD, FRCS, Director, 11th Surgical Clinic for Obesity & Reflux, Metropolitan General, Athens · formerly NHS Consultant in Upper GI & Bariatric Surgery, London
Short answer
In a gastric sleeve about 80% of the stomach is removed by keyhole surgery, leaving a narrow tube of about 150 ml. You feel full with much smaller meals, and because the removed part produces most of the hunger hormone ghrelin, appetite drops. Food still follows its normal route through the gut. Typical results are 60–75% of excess weight lost at 12–18 months.
Who it suits
How it is done
The operation is done laparoscopically through five small incisions of about 1.5 cm and takes about one to one and a half hours. The surgeon removes the outer curve of the stomach with a stapling device and checks the staple line for leaks. The valve at the stomach outlet (pylorus) and the stomach nerves are preserved.
You will be up and walking, and drinking fluids, on the day of surgery. The hospital stay is about 24 hours. If you are travelling from abroad, plan to stay in Athens for at least seven days after surgery. The diet then moves through liquids, purées and soft food over about four to six weeks.
Results
Weight loss is fastest in the first year. Some regain over time is common, which is why long-term follow-up matters.
| Time after surgery | Excess weight lost |
|---|---|
| 12–18 months | 60–75% |
| 5 years | about 60% |
| 10 years | about 45% |
Sources: Salminen P. et al., SLEEVEPASS 10-year results, JAMA Surgery 2022. Peterli R. et al., SM-BOSS 5-year results, JAMA 2018. Figures refer to the percentage of excess weight lost.
Reflux after sleeve
The sleeve turns the stomach into a higher-pressure tube, and in some people this causes or worsens reflux. In the SLEEVEPASS trial, signs of oesophagitis were found in 31% of sleeve patients at 10 years, compared with 7% after bypass. This is why I check for reflux and hiatus hernia before surgery. If you already have reflux or a significant hiatus hernia, I will usually recommend a bypass instead.
If troublesome reflux develops later, it can be treated with medication, or by converting the sleeve to a bypass.
Advantages and risks
Travelling for surgery
Length of stay, flying home, follow-up and emergencies: information for international patients.
We start with a video call. You send your history and any tests, and we decide together whether surgery makes sense before you book a flight.
With your consent I send a full report to your GP or specialist at home. The specialist follow-up stays with us.
Regular follow-up by video call and email, with a clear plan for blood tests and supplements that you can arrange locally.
Questions
The bypass gives somewhat greater long-term weight loss and treats reflux; the sleeve is simpler and keeps the gut intact. In the SM-BOSS trial, excess weight lost at 5 years was 61% after sleeve and 68% after bypass. The best choice depends on you, and we decide it together.
No. The removed part of the stomach cannot be put back. It can, however, be converted to a bypass.
Most people with office jobs return after about two weeks. Heavy physical work usually needs four to six weeks.
The sleeve can widen a little over the years, especially with large portions. Following the diet advice and attending follow-up helps keep results stable.
At least seven days after surgery, unless you live a short trip away. The hospital stay itself is about 24 hours after a sleeve and 48 hours after a bypass; the rest of the week lets us check your recovery before you travel.
Next step
Send us your details and I will contact you to discuss your options, by phone or video call.