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The Sleeve.



About 75% of the stomach is permanently removed.  The remainder is formed into a long tubular shape, similar to a banana or a shirtsleeve. 


How it works


While making the stomach smaller may contribute to smaller meal sizes initially, the sleeve has more recently been shown to work by increasing the levels of satiety hormones.  This increased in fullness hormone levels is thought occur because the sleeved shape of the stomach funnels food into the small intestine more directly, sending a faster and stronger satiety signal to the rest of the body.  See: How the surgeries work.


The benefits


The sleeve has been shown to produce weight loss of about 60% of excess weight, and resolution and improvement of medical problems of about 80%.  It is also much less prone to ulcers than the gastric bypass and has zero risk of internal hernia, since the small intestines are completely untouched.


The risks


All operations will carry a small risk of bleeding, infection, damage to surrounding structures, and risks of general anesthesia.  The sleeve also carries a small risk of new onset or worsened gastro-esophageal reflux disease (heartburn), which resolves with medication alone and no intervention in 95% of cases.  

The sleeve has also only been performed widely in large volumes since the early 2000s.  Therefore, it has much less data behind it regarding resolution of medical problems, and no data in regards to long-term weight loss. 


You may be a candidate…


If you are a body mass index of 35 or more with one qualifying medical condition, or if you are a body mass index of 40 or more with no medical problems.  These criteria are subject to variation depending on your insurance.  

This operation may also be a better choice for you if you take NSAIDs for pain control, since there is less risk of ulcer.


This may not be the best choice for you…


If you have severe heartburn refractory to or highly dependent on multiple medications, because of the risk of worsened heartburn after surgery.


What is the required work-up prior to having surgery?


We are proud to offer full service at our center and will assist you with ordering any testing and further evaluation that you need.  We require that everyone considering surgery with us undergo preoperative testing and work-up including:


  • Labs, X-rays and EKGS

  • Evidence of up –to –date health maintenance (pap-smears, mammograms, and colonoscopies)

  • Evaluation by a dietician

  • Evaluation by a psychologist or psychiatrist

  • Completion of a medical weight management period, if required by insurance

Further testing and educational and counseling sessions may be required depending on the results of initial testing and evaluation.  

Many insurance companies will also require a medical weight management period, consisting of monthly visits with a program dietician for 3-6 months.   We currently offer these weight management appointments as well as psychological and dietician evaluations at our Lodi location.


I am interested in learning more.  Where do I start?


We will be happy to provide you with more details on our informational forum, which you may attend free of obligation.  Please fill out the form on this website if you would like more information on dates and times for the forum.  We will contact you with further information.


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