The sleeve gastrectomy has been around for more than a decade, but it has recently been coming into favor. As a percentage of all bariatric surgery done, it is growing faster than any other operation. It is almost always done laparoscopically, and it takes anywhere from 45 minutes to 90 minutes.

With the sleeve, most of the stomach is removed. At the end of the operation, the patient is left with a narrow tube or “sleeve” of stomach – just enough to connect the end of the esophagus to the starting point of the intestine. This narrow tube can’t fit anywhere near as much food as the old, bag-like stomach did. As with all restrictive surgeries, sleeve patients find they get full with much smaller quantities of food, so they eat less.

Weight-loss with the sleeve gastrectomy is better than with adjustable banding, but not quite as good as with the bypass. Excess weight lost averages 60-65%. If a patient decides their weight loss with the sleeve is unsatisfactory, consideration can be given to converting it into a duodenal switch, which adds a malabsorptive effect to boost the weight loss.

The sleeve doesn’t involve the small intestine, and it therefore is often a good choice for patients with small intestinal disease. Unlike the bypass and the adjustable bands, the sleeve is not reversible.

As a newer operation, the sleeve hasn’t yet found quite as wide acceptance with health insurance companies.