Sleeve Gastrectomy

Sleeve Gastrectomy

Sleeve gastrectomy, sometimes called vertical sleeve gastrectomy or VSG, is the most commonly performed bariatric surgery worldwide. The procedure is laparoscopic in nearly all modern practice. The surgeon removes approximately 75-80% of the stomach along its greater curvature, leaving a long, narrow tubular “sleeve” of stomach that holds substantially less food than the intact organ.

The mechanism of weight loss is partly restrictive (the smaller stomach holds less food and produces earlier satiety) and partly hormonal — sleeve gastrectomy reduces circulating ghrelin (the “hunger hormone” produced largely by cells in the gastric fundus that is removed during the procedure) and alters secretion of GLP-1, PYY, and other gut hormones in ways that reduce appetite and improve glycemic control.

Average outcomes at 1-2 years: 20-25% total body weight loss, substantial improvement or remission of type 2 diabetes in many patients, improvement in obstructive sleep apnea, and reduction in cardiovascular risk factors. Long-term outcomes show some weight regain over 5-10 years, with average maintained weight loss in the 15-20% range. Complications can include leak at the staple line, stenosis, gastroesophageal reflux disease, and the risks of any abdominal surgery.

Newer obesity pharmacotherapy — particularly Phase 3 readouts of triple-agonist therapy — is approaching the weight-loss magnitude of sleeve gastrectomy through medication alone. Retatrutide TRIUMPH-1 reported -28.3% mean weight loss at 80 weeks at the 12 mg dose, with 45.3% of participants achieving ≥30% weight loss. This represents the first time a pharmacological intervention has reached this range in a pivotal trial.