Sleeve gastrectomy

The greater curvature of the stomach is resected over a bougie, from the angle of His toward the antrum. Meal volume falls. The fundus — the primary source of ghrelin — is removed, which reduces hunger signaling. High-calorie liquids and grazing can still undermine weight loss.

Dr. Elariny’s practice includes sleeve and banded sleeve gastrectomy. A banded sleeve adds a fixed band around the upper sleeve, changing the eating experience and potentially requiring band-related treatment later. His instruction materials use approximately 1-ounce meals for banded sleeve and 2-ounce meals for unbanded sleeve as teaching examples; your own progression and portions are individualized.

See Considerations for meal quality (about 2 oz vs 1 oz), GERD/Barrett’s, the slower diet progression after a banded sleeve, and the role of UGI imaging in assessing sleeve shape and the antrum.

What it is good at

• Can be done across a wide BMI range, including super-obesity
• Preserves the pylorus and intestinal continuity; nutritional monitoring is still needed
• Does not create a stomach-to-intestine anastomosis
• Easier to convert later to duodenal switch or bypass than a classic VBG

What you live with

• Reflux can appear or worsen (acid vs. non-acid)
• Small meals, careful chewing and prompt evaluation of persistent vomiting
• Frequent calorie-dense snacks and liquids can limit weight loss
• Lifelong vitamins still apply, though the list is shorter than after DS
• Leaks, bleeding, narrowing and other surgical complications are possible

Sleeve is one reasonable alternative, not the default because it is popular. Whether it is your operation depends on how you eat, reflux anatomy, and what you will do for the rest of your life. See How we choose.