Gastric Sleeve (Sleeve Gastrectomy)

Sleeve gastrectomy is a laparoscopic procedure performed under general anaesthesia, typically lasting sixty to ninety minutes. The surgeon resects approximately seventy-five to eighty per cent of the stomach along the greater curvature using a linear stapling device calibrated over a sizing tube (bougie) placed within the remaining gastric lumen. The resected portion — containing the majority of ghrelin-producing fundic tissue — is removed, leaving a narrow tubular stomach. The staple line is inspected for haemostasis and may be reinforced with buttressing material or oversewn at the surgeon's discretion.

Candidacy is assessed using established bariatric criteria: BMI of 40 or above, or BMI of 35 or above with at least one obesity-related comorbidity (type 2 diabetes, hypertension, obstructive sleep apnoea). Some programmes accept lower BMI thresholds with comorbidities. Pre-operative workup includes nutritional assessment, upper gastrointestinal endoscopy to exclude pathology such as Helicobacter pylori infection, and cardiopulmonary evaluation for high-risk patients. A pre-operative liver-shrinking diet (typically two to four weeks of low-calorie or high-protein nutrition) is almost universally required.

Patients are mobilised the day of surgery and typically discharged after two to three days on a staged post-operative diet progressing from liquids to purées to soft foods over approximately six weeks. Lifelong supplementation with vitamins and minerals — including B12, iron, calcium, and a multivitamin — is mandatory. Weight loss is typically most rapid in the first twelve to eighteen months, with patients losing fifty to seventy per cent of their excess weight. Regular bariatric follow-up is essential for monitoring nutritional status and long-term weight maintenance.

Gastric sleeve pricing abroad typically includes the laparoscopic procedure, general anaesthesia, a two to three night hospital stay, the immediate post-operative diet starter pack, and a defined number of follow-up consultations during the stay. Pre-operative investigations — including blood tests, upper endoscopy, abdominal ultrasound, and cardiology review — may or may not be included and should be confirmed explicitly, as these can add several hundred dollars.

Costs commonly not included in the headline price are pre-operative specialist consultations (dietitian, psychologist — required by many programmes), post-operative nutritional supplements and vitamins for the first year (a recurring lifetime cost), any complications requiring additional hospitalisation, and the ongoing follow-up programme at home. The pre-operative liver-shrinking diet, typically advised for two to four weeks before surgery, also represents a dietary cost. Patients should budget for travel, accommodation for the minimum five to seven day stay, and any accompaniment costs for a carer.

Diet progression is the defining structure of the recovery journey. For the first two weeks, patients consume only clear fluids and then full liquids, allowing the staple line to heal and the new stomach to adjust. Weeks three and four introduce purées and soft, moist foods. From weeks six to eight, most patients can tolerate a normal texture diet in small portions, eating slowly and chewing thoroughly. Discomfort when overeating, nausea, and sensitivity to certain foods (particularly high-fat or high-sugar items) are common in the early months. Most patients return to light work within two to four weeks; physically demanding jobs may require six weeks.

Weight loss is most rapid in the first three to six months and continues, at a slower pace, for twelve to eighteen months post-operatively — the period at which maximum weight loss is typically achieved. Follow-up blood tests at three, six, and twelve months in the first year monitor for nutritional deficiencies, which are managed with supplementation. A one-year post-operative consultation is standard to review weight loss, dietary habits, and overall health. Patients with significant weight-related comorbidities such as type 2 diabetes often see marked improvement within weeks of surgery, well before significant weight loss has occurred.

Gastric sleeve surgery requires a minimum post-operative stay of five to seven days to allow for initial recovery, dietary stage progression, and identification of early complications such as staple line leak. The most serious complication — a staple line leak — typically presents at forty-eight to seventy-two hours post-operatively and, if it occurs after the patient has departed, will require emergency management in the home country by surgeons unfamiliar with the case. Patients should not schedule their return flight until they have been reviewed and cleared by the operating team.

The lifelong follow-up needs of post-bariatric patients are substantial and represent the most significant challenge of seeking this procedure abroad. Nutritional monitoring (blood tests at three, six, and twelve months in the first year, then annually), dietary counselling, and management of complications such as stricture, reflux, or nutritional deficiency will need to be managed by a bariatric team in the home country. Before travelling, patients should identify a bariatric surgeon or physician in their home country willing to accept them for post-operative care and obtain comprehensive operative notes, staple line photographs, and bougie size documentation to share with the home team.