Gastric Sleeve: 10 answers from Dr. Grzegorz Kowalski, MD, PhD

Gastric sleeve surgery, or laparoscopic sleeve gastrectomy, is a weight-loss procedure that involves reducing the size of your stomach in order to reduce the amount of food intake.

Dr. Grzegorz Kowalski, MD, PhD is KCM Clinic’s General Surgery Specialist, Oncological Surgery Specialist, and Bariatrician. His specialty fields include oncological surgery, laparoscopic surgery for general surgery and bariatrics, and endocrine surgery. He’s a member of the Polish Medical Society and the Metabolic and Bariatric Section of the Society of Polish Surgeons, among the others.

Dr. Kowalski gently agreed on taking a few minutes out of his busy schedule at KCM Clinic to sit down with us and answer some questions about gastric sleeve surgery. The following 10 questions are the most frequently asked questions by our patients so we hope that they will be useful for you, too.

1. Dr. Kowalski, thank you for your time. First of all, can you give us a brief introduction to gastric sleeve surgery?

“Today, gastric sleeve surgery is considered the gold standard of bariatric surgery. It’s the most innovative and effective surgical procedure to help individuals who suffer from severe obesity or obesity-related conditions. As for the procedure itself, it’s performed under general anaesthesia. Once the patient is asleep, we will start with the laparoscopy, which means we will make a few small incisions to access the abdomen. We will cut and reduce the stomach to about one third of its original size, leaving a banana-shaped pouch. The new stomach will be stitched together, instruments removed and we will wait for the patient to wake up. The whole procedure takes about 1-2 hours. Patients need to stay at the hospital for about 3 days after the procedure to ensure that everything proceeds well.”

2. What is the difference between gastric sleeve and gastric bypass?

“That’s a good question because many patients ask us about these two procedures so I’m happy to clarify. While both bariatric procedures aim to reduce the amount of food intake, the way they work is fundamentally different. As already mentioned, with gastric sleeve, the stomach size is reduced by two thirds, making the patients feel full sooner. On the other hand, gastric bypass, also known as Roux-en-Y gastric bypass, involves dividing the stomach into a small pouch and rearranging the small intestine. This pouch is connected directly to the small intestine, speeding up absorption and digestion. Both procedures yield very good outcomes. We will decide with the patient what procedure best works in their case. ”

You can find a detailed explanation of all the differences between these two procedures in this article.

3. How much weight can patients expect to lose after gastric sleeve surgery?

“Given the patient follows all recommended post-op guidelines and starts a well balanced lifestyle, you can expect to lose around 55-60% of your weight over the first two years after surgery.”

4. Is gastric sleeve surgery a safe procedure?

“Overall, gastric sleeve surgery can be considered a safe procedure. Like any surgery, it has some risks, including bleeding, infection, nausea or vomiting. Keeping our patients at our facility for the first three days after surgery allows us to monitor their recovery and make sure that surgery was successful.”

5. Who is gastric sleeve surgery for?

​​”Gastric sleeve surgery is typically recommended to patients whose BMI is higher than 40 or higher than 35 if there are obesity-related conditions, e.g. type 2 diabetes, sleep apnea, or hypertension. We need to assess each patient who comes to us to see whether a gastric sleeve is a viable solution in their case.”

6. How long will patients be off their feet after surgery?

“Gastric sleeve surgery is performed laparoscopically, which means a few small incisions are made in the abdomen of the patient to access the stomach. These incisions take 2-3 weeks to heal and recovery of the newly shaped stomach will take around 6-8 weeks. While we encourage patients to walk around and do light exercise in the weeks following surgery, it is important not to do any strenuous activity for at least 30 days after the operation.”

7. What do you recommend to your patients before and after the procedure?

“Like for all weight-loss procedures, patients should carefully follow pre- and post-op recommendations that are crucial for the success of the procedure. Before surgery, patients should be on a liquid diet for around 5 days to prepare the stomach for the procedure. After the procedure, patients will have to follow a specific diet for the following 3 months, which includes starting with liquid food and slowly transitioning to puréed and solid food.”

8. Is gastric sleeve surgery reversible?

“No, gastric sleeve surgery is a non-reversible procedure. As mentioned earlier, part of the stomach is removed. If patients are looking for a reversible procedure, they might consider endoscopic sleeve gastroplasty. This procedure also involves reducing the size of the stomach but it’s performed endoscopically using stitches, which can be removed within a certain timeframe. However, eligibility is different and we would advise each patient on what we think the best course of action is in their specific case.”

You can read more about the differences between sleeve gastrectomy and endoscopic sleeve gastroplasty in this article.

9. Do many patients come back to you for revision surgery?

“Weight-loss surgery relapse could happen for a variety of reasons and bariatric surgery revision can involve the revision of a procedure or a conversion to a new one. Gastric sleeve surgery is one of the most successful weight-loss procedures and if patients follow all pre- and post-op guidelines, it is very unlikely that they will need a revision in the future. ”

10. Some advice about what patients should keep in mind before planning the procedure?

“The first thing to keep in mind is that gastric sleeve, like any other bariatric procedure, is not a quick fix. It’s only the first step towards a new lifestyle. This is why it’s important that we talk to the patient, understand their medical history, and what their expectations are. Each patient should commit to drastically changing their eating habits and doing regular exercise. KCM Clinic has a team of specialists who will help them in their health journey.”

We’d like to thank Dr. Grzegorz Kowalski, MD, for taking the time to join our interview. If you’d like to receive more information about any bariatric procedure, feel free to get in touch with us via the form below.