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En España, fuimos el equipo pionero en la intervención de manga gástrica. Hemos realizado más de 600 operaciones desde 2007, con mínimas complicaciones, resultados exitosos y sin mortalidad. A continuación describimos algunas de nuestros puntos claves:

1- Nuestra técnica es más eficaz y segura:

  • Minuciosa preparación prequirúrgica.
  • Laparoscopia y anestesia mini-invasiva.
  • Ingreso de tan solo 24h, gracias al protocolo postoperatorio Fast Track.
  • Recuperación en 1-2 dias y vida normal en 7 días.
  • Técnica altamente segura. Incluye “dos operaciones en una”:
    • 1º fase (realizada por la mayoría de cirujanos): Grapado y sección gástrica.
    • 2º fase (exclusiva de pocos cirujanos por su complejidad): Plicatura invaginante de toda la línea de sección del estómago, remodelando una forma perfectamente tubular y homogénea.

Ventajas:

  • Mínimo riesgo de posibles fístulas o hemorragias (< 1 % en nuestra casuística), o fístulas (< 0,1 % en nuestra casuística)
  • Mayor eficacia del tratamiento
  • Menor frecuencia de dilataciones a largo plazo

2- Tenemos menos dilataciones a largo plazo:

Realizamos un estómago perfectamente tubular, sin zonas dilatadas, y lo mas fino posible conseguimos:

  • Efectividad terapéutica mayor, desde el inicio y también en el futuro.
  • Baja probabilidad de dilataciones a largo plazo, con posible recuperación del peso perdido.
  • Gracias a nuestra habilidad quirúrgica y a nuestra experiencia, podemos efectuar con la máxima seguridad un estómago más fino sobre una sonda de 36 Fr con una forma tubular perfecta.

3- Seguridad de la cirugía y anestesia Mini-invasiva:

Se cuenta con la tecnología más avanzada para realizar una intervención en el abdomen, evitando provocar daño o estrés al organismo: Laparoscopia y Anestesia Miniinvasiva << Puerto único asistido>>.
Esta metodología permite:

  • En la zona abdominal sin provocar lesiones por lo que podría llevarse a cabo las veces que pudiesen necesitarse.
  • Reduce de forma significativa la reacción inflamatoria propia de las intervenciones.
  • Permite una pronta recuperación: 18 – 24 horas.
  • Produce un defecto estético mínimo.
  • Posibilita una incorporación rápida a una vida normal: 5 – 7 días.

4- Un equipo quirúrgico experto y minucioso:

El Dr. Ferrer, cirujano cualificado como «Experto en Cirugía De la Obesidad» es quien realiza la operación. Le acompaña un equipo de cirujanos con una larga trayectoria profesional en la cirugía de la obesidad. Las intervenciones se realizan siguiendo las recomendaciones de la ASMBS.

Treatments · Obesity surgery

Gastric sleeve

Obesity treatments

Also known as sleeve gastrectomy or gastric tube. It is the most frequently performed obesity operation in the world and the most physiological technique for weight control: it reduces the stomach, leaves the intestine untouched and does not require long-term vitamins.

  • 60 minin theatre
  • 24 hhospital stay, no ICU
  • 5–7 daysback to normal life
  • 24 monthsof multidisciplinary follow-up
Diagram of the stomach after a gastric sleeve

Treatment overview

The gastric sleeve is performed under general anaesthesia using minimally invasive laparoscopic surgery, usually through 4 small incisions of between 0.5 and 1.2 cm (one of them is enlarged to 1.5 cm at the end to remove the excised portion of stomach).

During the operation, the "pouch" of the stomach (part of the body and the gastric fundus) is removed; this is the area that allows the stomach to stretch and hold more during meals. The stomach changes from the shape of a "wineskin" to a tube or cylindrical sleeve, and its capacity is reduced from about 1,500 cc to about 200–250 cc.

The parts the stomach needs in order to function are preserved intact: the entry valve, the pylorus (exit valve), the body and gastric antrum (reduced in size), the vagus nerves and the gastric arteries. The small intestine is not altered, so digestion and absorption of food remain normal.

How it produces weight loss

  • Smaller capacity and less stretch. The new stomach holds between a dessert plate and half a dinner plate of food. The tubular walls do not stretch when eating, so the feeling of fullness is stronger, more intense and comes sooner than before.
  • Lower ghrelin levels. The part of the stomach that is removed produces most of this hormone, which triggers appetite in the central nervous system. Removing it allows better regulation of the hunger drive and reduces food cravings. Patients experience this as strong physical and emotional control over what they eat.

Preserving the pylorus and gastric antrum maintains the physiology of the first stage of digestion and ensures that food empties into the intestine at a suitable pace.

Advantages of the technique

  • The stomach keeps its physiological functions: food intake, digestion and emptying.
  • You can eat a wide variety of foods; no foods are poorly tolerated.
  • Everything you eat is absorbed: there is no loss of micronutrients.
  • No long-term vitamin or mineral supplements are required.
  • It is less "artificial" than gastric bypass or SADI-S, in which the small intestine is also altered to reduce its absorptive capacity.
  • Balanced, never excessive weight loss, with normal physical strength and stamina.
  • It suits any lifestyle and profession.

Why it is performed

The gastric sleeve is performed to achieve significant, gradual and healthy weight loss in people with obesity, without having to restrict intake or diet: thanks to the surgery, the patient can only eat small amounts, feels full and well nourished with much less food than they were used to, and loses the urge that drove them to eat quickly and uncontrollably.

No operation is "better" than another in absolute terms: every person with obesity has their ideal operation. The indication must come from a rigorous assessment by a multidisciplinary team experienced in the gastric sleeve and in other effective, safe techniques (Roux-en-Y gastric bypass, SADI-S bypass).

Who is a candidate?

The profile with the best results is the patient with grade II/III obesity (BMI between 35 and 45 kg/m²), used to eating large amounts and able to lead an active life:

  • People who have lost weight with diets and lifestyle changes but have regained it over time.
  • People who do not yet have metabolic syndrome, or have only a mild form (high blood pressure, high cholesterol or triglycerides, diabetes).
  • Social and emotional problems related to obesity.
  • Young patients, women who may want to become pregnant in the future and people over 70, because of its simplicity.
  • Patients who need a lot of long-term medication and whose intestinal absorption should not be altered.

The final indication is always made by the medical team after the pre-operative assessment; not all patients with obesity benefit equally from this technique.

Medical conditions it helps to treat

The main goal is to control obesity and, through weight loss, improve the diseases associated with it. After a gastric sleeve, patients experience a substantial improvement in their health, with changes such as:

  • Resolution of sleep apnoea and snoring.
  • Lower, more stable blood sugar levels.
  • Lower blood pressure.
  • Lower cholesterol levels.
  • Improvement in virtually all laboratory parameters.
  • Improvement of mild gastro-oesophageal reflux, thanks to weight loss.

As a result, the patient significantly reduces or stops the medication they were taking. There are also major improvements in quality of life: food cravings disappear, mobility and physical capacity increase, body image improves and self-esteem grows.

How to prepare

Pre-operative preparation can be done remotely and includes:

  • Multidisciplinary assessment by the team of professionals (surgeon, dietitian and psychologist), with medical evaluation and recommendation.
  • Full pre-operative work-up: gastroscopy under sedation, abdominal ultrasound, blood tests, ECG and chest X-ray. Tests may vary depending on the patient. Gastroscopy is especially important to rule out hiatus hernia and reflux, which are very common in obesity because of increased abdominal pressure; in some cases pH monitoring or impedance testing is added.
  • Optimisation of medical treatment for pre-existing conditions.
  • Improving physical fitness: walking for at least 1 hour a day at a moderate to brisk pace.
  • Pre-operative weight loss: a strict diet for 1 to 6 weeks depending on the patient, plus a specific regimen in the 48 hours before surgery.
  • Appointment with the anaesthetist and second appointment with the surgeon.

The pre-operative diet

It is followed for 1 to 6 weeks before the operation, always under medical and nutritional supervision. It reduces the size of the liver and abdominal fat, which makes laparoscopy easier, shortens the surgery and lowers the surgical risk.

  • Low-calorie (600–800 kcal/day) and high-protein, based on meal-replacement shakes or soups.
  • At least 2 litres of fluid a day and a 1-hour walk every day.
  • Target weight loss: around 10% of starting weight.

What to expect

During the operation

  • Admission on the day of surgery.
  • General anaesthesia and minimally invasive laparoscopy (assisted single port), which avoids damaging the abdominal wall, significantly reduces the inflammatory response and leaves minimal scarring.
  • Duration: 60 minutes in theatre, plus the time for anaesthetic induction and waking up.
  • "Two operations in one" technique: first, stapling and division of the stomach over a 36 Fr calibration tube, using single-use FDA-approved materials; then, invaginating plication of the entire staple line, which shapes a perfectly tubular, uniform stomach with no dilated areas. Because of its complexity, this second phase is performed by only a few surgeons.
  • We use the "ear" technique and a very refined shaping of the future sleeve to avoid narrowing and twisting, as well as management of the hiatus with repair of any hernias and fixation to prevent future migration of the stomach, which would cause reflux.
  • The operation is performed by Dr Ferrer and his team, accredited as Experts in Obesity Surgery with extensive experience, following ASMBS and IFSO recommendations.

At the end, the patient wakes up in theatre and moves to the post-anaesthesia recovery room, where they stay for one or two hours before going up to their room.

After the operation

The hospital stay follows the Fast Track protocol, designed for an optimised recovery based on each patient's clinical progress:

  1. Private room, no ICU. The patient goes straight up to their room.
  2. After 2 hours they get up and walk.
  3. After 3 hours they drink fluids.
  4. Little discomfort and fewer painkillers. In the first few hours there may be nausea or twinges in the abdomen, which are controlled with ordinary painkillers. The first 24–72 hours involve mild discomfort, often due to abdominal gas and the position adopted during the operation.
  5. Discharge after about 24 hours, following one night in hospital to make sure there are no issues during the initial recovery.

The next day the patient returns home to continue recovering and adapting. During the first few months, with the help and supervision of the multidisciplinary team, they will learn to manage their new situation: they will eat everything, in smaller amounts, without feeling hungry, and will take vitamin and calcium supplements while they complete the adaptation.

Recovery

The first days and weeks

  • Recovery in 1–2 days and back to normal life in 5–7 days, with a quick return to everyday activities depending on clinical progress.
  • Stitches are removed one week after the operation.
  • Walk for 1 hour every day from discharge: you will feel comfortable enough to do so, and it prevents clinical complications typical of patients with obesity after an operation.
  • Lead an active life but avoid strenuous effort or lifting heavy weights during the first 4–5 weeks.
  • Telephone access to one of the surgeons for up to 30 days after the operation, and hospital follow-up during the same period.

How your diet progresses during the first month

  • Days 1–10: liquid phase (including liquid dairy from the first week).
  • Week 2: semi-liquid phase.
  • Week 3: purée phase and soft diet.
  • Week 4: normal diet, in small amounts.
  • In the first few months, soups and stews are better tolerated than dry foods (grilled meat, dry rice dishes); over time, everything is tolerated.

New eating habits

Once on a normal diet, the patient should not diet: they should follow a healthy eating plan guided by their dietitian and improve their emotional relationship with food with the help of the psychologist. The key guidelines are:

  • Eat slowly and chew well, taking about 20 minutes per meal as a guide, and learn to recognise the feeling of fullness, which now comes much sooner. Vomiting after the first few weeks indicates that you are not eating correctly or that there is an emptying problem.
  • Do not drink with meals: have fluids at least 30 minutes before or after, in sips and between meals, so as not to take up space needed for food or make digestion harder.
  • Have at least 5 meals a day, each with at least one solid food, to meet nutrient requirements (especially protein) with small portions. Many patients have 7 or 8 good-quality meals or snacks.
  • Stop snacking between meals and avoid sweets and pastries: they pack a lot of calories into a small volume and displace foods that actually nourish you.
  • Avoid fizzy drinks (including flat and light/zero versions): they gradually stretch the stomach, cause discomfort, and sweeteners worsen the outlook for diabetes.
  • Do not eat more than half a dinner plate at each meal.

Multidisciplinary follow-up afterwards

The aim of follow-up is to ensure the long-term success of the surgery. For 24 months, three professionals support the patient in a coordinated way:

Bariatric surgeon

Clinical assessment and follow-up. Telephone access during the first 30 days.

Dietitian

Ongoing dietary education and online support whenever needed.

Clinical psychologist

Cognitive behavioural therapy: relationship with food and control of food intake.

This is complemented by progressive physical exercise tailored to each patient, a patient support group and training workshops.

Follow-up consultation schedule

  1. First 30 daysHospital follow-up and telephone contact with the surgeon
  2. First yearCheck-up every 2–3 months
  3. Second yearCheck-up at least every 6 months
  4. From year 3Annual check-up with full blood tests
  5. At 5 yearsFollow-up gastroscopy, even if there are no symptoms

Why it matters so much

At first, many patients do not feel hungry and lose weight quickly, but the feeling of hunger gradually returns over the months. Psychological and nutritional follow-up from the start helps patients recognise satiety, maintain control of their intake and spot warning signs early. After two years, what determines how weight evolves over the next 5–10 years is the set of habits acquired with the team.

Risks and complications

The gastric sleeve is a simple, safe operation, but it is no safer than gastric bypass or SADI-S when these are performed by expert surgeons. The current probability of a serious post-operative complication is below 2–3%, similar to that of operations seen as simpler (removal of the uterus or gallbladder, knee replacement). It is important to remember that the operation is not reversible.

Complications in the immediate post-operative period

ComplicationPublished averageClínica Obésitas
Deep vein thrombosis0.5%0%
Non-fatal pulmonary embolism0.5%0%
Leak or fistula of the gastric suture1–6%1 case*
Post-operative bleeding< 1%0.8%
Mortality0.25%0%

* Leak in the antrum (the lowest-risk area with the simplest solution), in 2008, caused by a failure of the disposable staple cartridge; that model is no longer used. Other series report wider ranges: leak 2–15% and bleeding 2–8%.

Medium- and long-term complications

  • Gastric dysfunction (< 10%).
  • Gastro-oesophageal reflux (10–30% in the first few months; < 10% in the long term). It can appear especially when the patient "forces the stomach" by regularly eating more than it can hold.
  • Gastric stenosis or severe emptying difficulty (< 2%).
  • Hiatus hernia.
  • Rapid stomach emptying (early dumping), which causes discomfort with soft diets rich in fat and carbohydrates; it appears to be associated with inadequate technique.
  • Stretching of the stomach over time, with increased capacity and regain of the weight lost. This is more likely if a pouch is left in the upper part of the stomach during surgery, an error that can occur with less experienced surgeons.
  • Loose skin: minimal in young, active patients; greater in severe obesity and without physical activity. Plastic surgery is considered from 2 years onwards, once weight is stable.

Most of these complications are uncommon and, in expert hands, can be resolved with medical or surgical treatment. In the event of weight regain or insufficient weight loss, the patient is reassessed to identify the causes and, if indicated, the gastric sleeve can be converted into a gastric bypass or SADI-S bypass laparoscopically, with a 24-hour hospital stay.

How risks are minimised

In addition to careful preparation and the surgical technique described (minimally invasive laparoscopy, stapling plus invagination of the staple line, a perfect tubular shape, single-use materials), the Fast Track protocol prevents medical complications during the hospital stay. In the unlikely event of a complication, the patient does not pay medical fees (hospital costs are still payable).

Results

Expected weight loss

  • Up to 60–80% of the weight is lost in the first 6–8 months.
  • Our own studies: loss of 90% of excess weight at 2 years and 65–75% at 5 years.
  • International studies: at 5 years, 70% of patients maintain the loss of most of their excess weight.
  • A BMI below 30 is usually reached (about 10 kg above the last two digits of your height in centimetres: at 1.60 m, about 72–75 kg). Patients under 35 easily reach a normal weight.
  • The result depends on the initial degree of obesity, age, the technical quality of the surgery and the patient's commitment: the most active patients achieve exceptional results.
Operation% of excess weight lost (5-year studies)
Gastric sleeve65–80%
Gastric bypass70–85%
SADI-S bypass85–90%

Our own 5-year study

  • 560 patients studied, mean age 35.9 years (71.4% women / 28.6% men).
  • Mean initial BMI: 41.1 kg/m².
  • Mean BMI at 5 years: 29.8 kg/m².
  • Patients with an initial BMI over 45 should opt for another technique with greater anti-obesity power.

Durability

  • Maximum known follow-up of 10 years, with weight loss maintained: it is considered permanent.
  • With continued dietary excess, some weight may be regained; in many cases due to snacking on high-calorie foods, not to stretching of the sleeve.
  • In the few cases of weight regain, it can be converted into a gastric bypass laparoscopically with a 24-hour hospital stay.

Three pillars of long-term success: proper patient selection, correct surgical technique and healthy habits maintained for life.

Quality of life

  • No restrictions: any physical activity and almost any job.
  • Strict diets and forbidden foods are a thing of the past; control lies in the quantities.
  • Food cravings virtually disappear.
  • Greater lightness, mobility and physical capacity.
  • Greater satisfaction with body image and higher self-esteem.

Is the gastric sleeve the right operation for you?

Request a personalised preliminary study. We will provide a medical assessment and recommendation with no obligation.

Start my personalised study

Frequently asked questions

Is this operation right for me?
  • You can check whether your profile is suitable with our test, in the section What treatment do I need?
  • Pay attention to the advantages and disadvantages of each surgical technique, and check the patient profile required for each operation. We also recommend that you consult our comparison table of obesity operations and the recommendations of the scientific societies.
What support does Clínicas Obésitas give to gastric sleeve patients?

The professionals at Clínica Obésitas are available to patients at all times, providing detailed, personalised multidisciplinary treatment:

  • Clinical follow-up by our team of surgeons.
  • Dietary and nutritional treatment and education by our dietitians.
  • Changes in habits and lifestyle (suitable physical exercise based on each patient's needs).
  • Emotional support from our Clinical Psychologist (cognitive behavioural therapy).
  • If desired, the multidisciplinary treatment is carried out over a period of 24 months and consists of a protocol of treatment and follow-up consultations.
For which patients is it recommended?

Patients with a BMI of 35–45 kg/m²:

  • Patients who have followed diets and made lifestyle changes with specialists, who have managed to lose weight but have regained it over time.
  • Patients with metabolic syndrome (hypertension, hypercholesterolaemia / hypertriglyceridaemia, mild or recently diagnosed diabetes).
  • Patients with social and emotional problems related to obesity.
  • Patients for whom gastric bypass is contraindicated: chronic anaemia, Crohn's disease, hiatus hernia and/or gastro-oesophageal reflux, previous abdominal surgery or other complex medical conditions.

Patients with a BMI > 60 (super-obesity):

  • Gastric bypass would be the ideal technique in this case; however, these patients involve great technical complexity and poorer general health.
  • A gastric sleeve can be performed as a first stage, after which the patient usually reaches a BMI below 35.
  • The gastric sleeve is converted to a gastric bypass if the patient has not lost enough weight or starts to regain the weight lost, thereby reducing the risk of the operation.
How much weight will I lose with a gastric sleeve?

Weight loss varies and depends on the technical quality of the surgery (the best long-term result is achieved with a smaller stomach and a better tubular shape) and on the positive influence of the multidisciplinary team.

Type of operation% of excess weight lost (5-year studies)
Gastric plication50–65%
Gastric sleeve65–80%
Gastric bypass70–85%

Results vary depending on initial BMI. Up to 60–80% of the weight is lost during the first 6–8 months.

How much does gastric sleeve surgery cost?

The cost of gastric sleeve surgery at our clinic is €11,900. It is also important to have multidisciplinary follow-up and education with a bariatric surgeon, dietitian and clinical psychologist, to ensure healthy weight loss and a good long-term result.

What does gastric sleeve surgery involve?

It is one of the most widely used techniques to fight obesity worldwide. It is a restrictive, permanent operation that reduces the capacity of the stomach. Using minimally invasive laparoscopic or robotic surgery, the "pouch" that allows the stomach to stretch during meals and considerably increase its capacity is removed. The parts that are important for its function are left intact: the entry valve, the exit valve, the body and gastric antrum (reduced in size), the vagus nerves and the gastric arteries. In this way, the stomach works completely normally and all kinds of food can be eaten; what is limited is the capacity.

How long does gastric sleeve surgery take?

The duration varies depending on each patient and the team's experience. At Clínica Obésitas we perform the operation by minimally invasive laparoscopy, taking about 60 minutes, plus the time for anaesthetic induction and waking up. With our safe and minimally invasive approach, patients walk around their room and drink fluids within a few hours and are discharged from hospital the next day. On discharge, they are advised to walk for 1 hour a day, because they feel comfortable and well, and this prevents possible clinical complications typical of patients with obesity after an operation.

What are the risks of a gastric sleeve?

Possible complications in the immediate post-operative period: deep vein thrombosis (0.5%), non-fatal pulmonary embolism (0.5%), leak and fistula of the stomach suture (< 1%), post-operative bleeding (< 1%), mortality rate (0.25%). These figures are even lower in teams and centres of excellence; at Clínica Obésitas mortality is 0% and we have had only one case of leak.

Possible medium- to long-term complications: gastric dysfunction, gastro-oesophageal reflux, gastric stenosis and possible stretching over the years. Most of these problems are uncommon and, in expert hands, can be resolved with medical or surgical treatment. Some complications, including weight regain, may over the years require the gastric sleeve to be converted into a gastric bypass or a SADI-S bypass.

What are the benefits of a gastric sleeve?

Gradual, healthy weight loss with no need for long-term vitamin supplements. This technique leaves a smaller stomach that nevertheless works completely normally. Food absorption is not affected and the small intestine is not altered. As a result, the patient feels full and satisfied with less food, while still being able to nourish themselves without any harm to their health; vitamins are only needed at the beginning, during the phase of rapid weight loss.

How much weight do you lose after a gastric sleeve?

Weight loss varies depending on the initial degree of obesity, the patient's age, etc. A BMI below 30 is usually reached, weighing about 10 kilos more than the last two digits of your height in centimetres: if I am 1.60 m tall, I will end up at about 72–75 kg. Patients under 35 easily reach a normal weight (60 kg in the example above). Both the quality of the surgical technique and the support and education the patient receives in the following months play a role; the patient's commitment is essential, and "the sportiest" achieve exceptional results. Our own studies show a loss of 90% of excess weight at 2 years and 65–75% at 5 years.

What can you eat after a gastric sleeve?

All kinds of food, although a balanced, healthy diet should be maintained. Right after the operation, the patient follows a diet with progressive textures during the first month: liquid, semi-liquid, soft and normal phases. In the first few months they may have some difficulty with dry foods (meat, chicken breast, dry rice dishes such as paella) and feel more comfortable with soups and stewed meat. As the months go by, patients tolerate all foods most of the time.

What is the difference between a gastric sleeve and a bypass?

The difference is the intestinal bypass performed in the bypass operation. The gastric sleeve is a purely restrictive technique (the size of the stomach is reduced), whereas gastric bypass is a restrictive and malabsorptive technique (the stomach is reduced and the first part of the duodenum and ileum is bypassed). With the gastric sleeve, the effect is a reduction in how much food fits in the stomach, combined with lower ghrelin levels and fewer food cravings. With the bypass, in addition, food does not pass through the first metre and a half of the intestine, which reduces fat absorption and improves the balance of carbohydrate absorption (improving the diabetes and prediabetes typical of obesity). Overall, the gastric sleeve is mainly indicated for patients with less severe obesity (BMI < 45), younger patients and women who may want to become pregnant in the future, but also for people over 70, because of its simplicity. Gastric bypass is indicated for patients with diabetes and more severe metabolic problems, and for more severe obesity (BMI > 45).

Is the weight loss from a gastric sleeve permanent?
  • The longest known follow-up for this operation worldwide is 10 years.
  • Patients maintain their weight loss throughout this period; after this length of time it is considered permanent.
  • If the patient engages in continued dietary excess, some of the weight lost may be regained over the years.
  • In the few cases of weight regain, it can be converted into a gastric bypass, laparoscopically and with a 24-hour hospital stay.
Clínicas Obésitas
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