Gastric Sleeve Outcomes – Weight Loss
Published Studies
There have been 100s of studies published on gastric sleeve weight loss, by 100s of surgeons, and the results are surprisingly variable. Some surgeons report average weight loss to be as low as 40% EWL (excess weight loss), and some report average weight loss to be as high as 80% EWL.*
This is a very large range – the difference between 40% EWL and 80% EWL is more than 40 pounds for the typical patient, and more for higher BMI patients. The published studies clearly show that some surgeons achieve much better gastric sleeve weight loss results than other surgeons.*
Outcomes vary between surgeons
Industry Average Weight Loss
Different surgeons report widely variable weight loss results, but what is the overall industry average weight loss for all surgeons? A recent study by Gagner et al attempts to answer this question.
Gagner et al compiled weight loss data from 130 surgeons and 46,133 gastric sleeve operations and found overall average gastric sleeve weight loss to be 55-59% EWL at 1-3 years after surgery (59.3% EWL at 1 year, 59.0% EWL at 2 years, 54.7% EWL at 3 years).*
Dr. Oliak’s Weight Loss Statistics
Orange County gastric sleeve surgeon Dr. Oliak’s weight loss statistics are significantly better than the industry averages. Dr. Oliak’s patients average 75-80% EWL at 1-3 years after surgery (76% EWL at 1 year, 80% EWL at 2 years, and 75% EWL at 3 years).*
Gastric sleeve outcomes update 2016
Why are Dr. Oliak’s gastric sleeve weight loss results better than the industry averages? Superior surgery and superior patient care.
Superior Surgery
A smaller sleeve is better for weight loss than a larger sleeve. A smaller sleeve, however, is more difficult and takes longer to do well than a larger sleeve. With a smaller sleeve the details of the operation need to be executed well to prevent complications. With a larger sleeve the details don’t have to be as exact, so the operation can be done much more quickly.*
Therefore, constructing a small, technically excellent gastric sleeve requires both skill and time; not all surgeons have the skill, and not all surgeons are willing to invest the time.
Because health insurance reimburses the same amount whether an operation takes 1/2 hour or 2 1/2 hours, speed of surgery is generally prioritized highly by surgeons and hospitals. This results in larger sleeves and less weight loss.*
Dr. Oliak’s approach is to prioritize patients first. This means treating patients like he would treat his own family members – by devoting the necessary time and effort to achieve the best surgery and therefore the best outcomes possible.*
Choice of surgeon impacts outcomes
Why outcomes vary by surgeon
Superior Patient Care
Surgery is a highly effective tool for weight loss, but the fact remains – surgery is only a tool. For maximum success, the surgical tool needs to be used appropriately. This means patients need to establish and maintain appropriate eating/exercise habits after surgery.*
Dr. Oliak’s approach is to prioritize thorough and complete preoperative education, frequent early postoperative follow-up, and ongoing support to help patients establish the habits that will ensure long-term weight loss success.*
Choice of surgeon impacts outcomes
Why outcomes vary by surgeon
* The gastric sleeve weight loss statistics quoted on this page are averages. Individual patient results vary – patients can lose more or less weight than the average.
Gastric Sleeve Surgeon Dr. Oliak’s Weight Loss Statistics*
61% EWL after 6 months
76% EWL after 1 year
80% EWL after 2 years
75% EWL after 3 years
Gastric Sleeve Surgeon Dr. Oliak’s Weight Loss Statistics Compared to Industry Averages
| Time after surgery |
Dr. Oliak’s %EWL* |
Industry average %EWL* |
|---|---|---|
| 1 year |
76% |
59.3% |
| 2 years |
80% |
59.0% |
| 3 years |
75% |
54.7% |
* The weight loss results above are averages. Individual patients can lose more or less weight than the average.
Gastric sleeve surgeon Dr. Oliak’s %EWL (excess weight loss) statistics are for all gastric sleeve operations completed 2008-2017 (n=375). Industry average %EWL statistics are from a study by Gagner et al of 130 surgeons and 46,133 gastric sleeve operations.
What is excess weight?
Excess weight is the amount of weight over ideal weight. Ideal weight can be found in Metropolitan Life Insurance height-weight tables. Ideal weight is considered to be the middle weight in the medium frame size range. For example, ideal weight (not goal weight) for a 5’4″ woman is considered to be 134 pounds, and ideal weight (not goal weight) for a 5’11” man is considered to be 164 pounds.
Gastric Sleeve Outcomes – Complications
Sleeve gastrectomy has been proven to be a safe operation. As with all operations, however, complications can occur. The most important early complication is generally considered to be leak, and the most important late complication is generally considered to be acid reflux (heartburn).
Gastric Sleeve Leak
A gastric sleeve leak is a hole in the stomach along the line of division that occurs early after surgery before complete healing has occurred. A gastric sleeve leak is a serious, potentially life-threatening complication that all sleeve gastrectomy surgeons try hard to prevent.
Published Studies
Published gastric sleeve outcomes studies show that gastric sleeve leak rates vary widely between surgeons, from 0-9%.** The best study reports 0 leaks in 529 patients, and the worst study reports 4 leaks in 45 patients. Clearly some surgeons are able to achieve much lower gastric sleeve leak rates than other surgeons.**
Outcomes vary between surgeons.
Industry Average Leak Rate
Leak rates vary by surgeon from a low of 0% to a high of 9%, but what is the overall industry average for all sleeve gastrectomy surgeons? A recent published study by Aurora et al attempts to answer this question.
Aurora et al compiled leak data from 29 different studies with a total of 4,888 gastric sleeve operations, and found the overall gastric sleeve leak rate to be 2.4% (1 in 40 operations).**
Dr. Oliak’s Gastric Sleeve Leak Statistics
Orange County sleeve gastrectomy surgeon Dr. Oliak’s leak rate is 0% (0 in 375 operations).** This ranks among the best reported leak statistics in the field, and is significantly lower than the industry average gastric sleeve leak rate of 2.4%.
Why is Dr. Oliak’s leak rate lower than the industry average? Superior surgery and superior patient care.
Superior Surgery and Patient Care
Leaks are caused largely by poor surgical technique and/or patient care. There is no other way to explain why some surgeons have a 0% leak rate, and others have a 5-9% leak rate.
What ultimately causes a leak is too much pressure in the gastric sleeve early after surgery. Imagine doing sit-ups after an operation that involves a big abdominal incision. Straining with the abdominal muscles will put strain on the incision and potentially cause it to break open.
With gastric sleeve, the big incision is not on the abdominal wall, but along the length of the stomach. Strain on the stomach can come from poor surgical technique or poor patient behavior.
If the geometry of the sleeve is such that food and liquid cannot pass through easily (poor surgical technique), pressure will increase in the sleeve and the risk for a leak will go up. If a patient overeats or over drinks early after surgery (poor patient education/behavior), the pressure in the sleeve will increase and the risk for a leak will go up.
The way to minimize the risk for leaks is to do technically excellent surgery and good patient care/education. Technically excellent surgery is difficult and time consuming to do, especially when making the sleeve small. Even after doing many hundreds of sleeve gastrectomy operations, it remains difficult and time consuming to make a small, geometrically symmetric, ideal sleeve.
Dr. Oliak’s approach is to prioritize patients first. This means treating patients like he would treat his own family members – by devoting the necessary time and effort to achieve the best surgery and therefore the best outcomes possible.**
Choice of surgeon impacts outcomes
Why outcomes vary by surgeon
** Leaks can occur after gastric sleeve surgery. Past performance is not necessary indicative of future results.
Sleeve Gastrectomy Surgeon Dr. Oliak’s Leak Rate Compared to Industry Average
| Outcome parameter |
Dr. Oliak’s leak rate** |
Industry average leak rate** |
|---|---|---|
| Leak rate |
0% (0 in 375 operations) |
2.4% (1 in 40 operations) |
** Orange County sleeve gastrectomy surgeon Dr. Oliak’s 0% leak rate statistic applies to all gastric sleeve operations (primary and revision) completed 2008-2017 (n=375). Industry average leak rate statistic from Aurora et al study which compiled leak data from 29 studies with a total of 4,888 gastric sleeve operations.
Acid Reflux after Gastric Sleeve
Acid reflux is the most important potential long-term complication after sleeve gastrectomy surgery. Minor or moderate acid reflux after gastric sleeve surgery can generally be successfully treated with antacid medications. More severe acid reflux may require an operation to address the cause (hiatal hernia, dilated upper sleeve), or in rare cases to convert to a different operation, usually gastric bypass.
Published Studies
The published studies on acid reflux after gastric sleeve surgery report widely variable results. Many studies report that acid reflux typically improves or resolves after gastric sleeve surgery, but many also report that acid reflux typically worsens after gastric sleeve surgery.
Industry Average Acid Reflux Rates
What is the industry average percentage of patients who have a worsening of acid reflux after gastric sleeve surgery? This is a difficult question to answer. A 2015 study by Oor et al attempted to answer this question.
Oor et al reviewed 33 studies on acid reflux after gastric sleeve, and basically concluded that it was not possible to determine the industry average acid reflux rate. Surgeon heterogeneity (differences in outcomes between surgeons) between the studies was so large that estimations of industry averages could not be made.
This finding of extreme surgeon heterogeneity makes sense given the lack of agreement on what specific surgical techniques are required to prevent acid reflux. Different surgeons have widely variable techniques, and these different techniques translate into widely variable long-term acid reflux rates.
Dr. Oliak’s Acid Reflux Statistics
Of Dr. Oliak’s gastric sleeve patients with at least 1 year of follow-up after surgery, new or worsened acid reflux occurred in 10% of patients. This statistic ranks among the better published statistics on acid reflux after gastric sleeve.*
What does it take to achieve low acid reflux rates after gastric sleeve surgery? Dr. Oliak’s experience has been that it takes the same thing as it takes to achieve excellent weight loss results and low leak rates – superior surgery.
Superior Surgery
Dr. Oliak’s experience has been that the key to minimizing the risk for acid reflux is to repair, at the time of the gastric sleeve operation, any abnormalities that can cause acid reflux (e.g. hiatal hernia), even small abnormalities, and to repair them well such that they don’t recur.
Small abnormalities (e.g. small hiatal hernia, dilated hiatus) are often not apparent unless a dedicated effort is made to look for them. Dr. Oliak’s approach is to be aggressive about looking for abnormalities and repairing them if present.
Also important is the method for repair. There is a easy and quick way to repair a hiatal hernia, and there is a hard and more time consuming way. In Dr. Oliak’s experience, the hard way (as usual) is the better way.
Dr. Oliak’s approach is not the universal approach. A more typical approach is to not look very hard for abnormalities, and assume there is none. When an abnormality is obvious (e.g. large hiatal hernia), a more typical approach is to do the repair the quick/easy way instead of the hard and more time consuming way.
Surgeons justify this approach by saying there is no firm scientific proof that a more aggressive approach is better. Technically true, but this stance is almost certainly influenced by the fact that insurance generally doesn’t reimburse for hiatal hernia repair when done as part of a gastric sleeve operation.
Dr. Oliak’s approach is to prioritize patients first. This means treating patients like he would treat his own family members – by devoting the necessary time and effort to achieve the best surgery and therefore the best outcomes possible.*
Choice of surgeon impacts outcomes
Why outcomes vary by surgeon
Gastric Sleeve Improves Medical Conditions
Medical problems associated with weight, including diabetes, high blood pressure, hyperlipidemia, sleep apnea, joint pain, asthma, depression, infertility, urinary stress incontinence, lower extremity swelling, and headaches all tend to resolve or improve with weight loss after sleeve gastrectomy surgery.*
Weight Loss Surgery Patients Live Longer
Numerous published studies have shown that weight loss surgery patients live longer than similarly obese patients who don’t have surgery. This is because the surgery patients lose weight, become healthier, and suffer fewer heart attacks, fewer strokes, and less cancer (reference).*
