Weight Loss Surgery

Sleeve gastrectomy

Sleeve gastrectomy (gastric sleeve) is the most commonly performed metabolic and bariatric surgery in the U.S. During the sleeve gastrectomy, the surgeon removes most of the stomach, creating a new banana-shaped pouch from the remaining stomach.

This procedure helps with weight loss by:

• Reducing hunger – It lowers ghrelin production, the hormone responsible for hunger.
• Increasing fullness – The smaller stomach processes food more quickly, helping you feel full faster.

Patients who have a sleeve gastrectomy often experience the following benefits:

• 50% to 60% loss of excess body weight
• Improved weight-related conditions such as type 2 diabetes and hypertension
• Increased life expectancy
• Fewer intestinal complications compared to other weight loss procedures

How is sleeve gastrectomy performed?

Sleeve gastrectomy is a non-reversible, minimally invasive procedure using laparoscopic or robotic surgery. During the procedure:

• You’ll receive general anesthesia so you don’t feel anything during the procedure.
• Your surgeon will make four to five small incisions in your abdomen to insert surgical instruments.
• Using these instruments, the surgeon will remove most of your stomach, creating a new banana-shaped pouch from your remaining stomach.

The procedure typically takes 60 to 90 minutes. Most patients stay in the hospital overnight and return home the next morning. Home Hospital also might be any option for you.

Gastric bypass (Roux-en-Y gastric bypass, or RYGB)

In a RYGB procedure, your surgeon creates a “shortcut” from your stomach to your small intestine. This involves separating the upper part of the stomach from the lower part and connecting the upper part directly to the small intestine.

Roux-en-Y gastric bypass surgery can help you achieve the following benefits:

• Average loss of 65 to 75% of excess body weight
• Reduced hunger and increased fullness
• Improvement in conditions such as type 2 diabetes, gastroesophageal reflux disease (GERD) and hypertension
• Increased life expectancy

How is Roux-en-Y gastric bypass performed?

RYGB promotes weight loss by changing how your stomach and small intestine process food. The surgery has two steps:

1. Creating a smaller stomach pouch—Your surgeon forms a small upper section (about the size of a golf ball) while leaving the lower portion of the stomach in place. The upper pouch is where food will go after surgery.
2. Bypassing a part of the your small intestine—The surgeon connects a section of the small intestine to the new pouch, allowing food to bypass the upper part of the intestine. This reduces calorie absorption and lowers hunger hormone (ghrelin) production, helping you feel full faster.

At Mass General Brigham, Roux-en-Y gastric bypass surgery is usually performed minimally invasively using laparoscopic or robotic techniques. During the procedure:

• You’ll receive general anesthesia so you don’t feel anything during the procedure.
• Your surgeon will make four to five small incisions in your abdomen to insert surgical instruments.

The procedure typically takes 3 to 3.5 hours. Most patients stay in the hospital overnight and return home the next morning.

Conversion and revisional surgery

Bariatric conversion surgery or revisional surgery may be an option for patients experiencing complications or weight regain after a previous weight loss surgery.

If you’ve had bariatric surgery but are not seeing the expected results or are experiencing complications, your doctor may recommend conversion or revisional surgery.

• Conversion surgery — Changing one type of weight loss surgery into another (e.g., sleeve gastrectomy to gastric bypass).
• Revision surgery — Correcting a previous surgery to reduce complications and improve discomfort.

Conversion and revisional surgery may be necessary for:

• Patients who have not lost enough weight after a previous bariatric surgery.
• Patients with surgery-related complications from a previous weight loss surgery, such as ulcers, vomiting, and acid reflux.
• Patients with severe malnutrition after surgery.

If you are looking for a revision of your weight loss surgery, please reach out to our surgical program for possible options.

How is conversion and revisional surgery performed?

Your conversion or revisional surgery will depend on the weight loss surgery you had before and what you are being treated for. Your surgeon will discuss the details of your surgery during your consultation.

For all procedures, you will first be placed under general anesthesia, so you don’t feel anything during the surgery. Most conversion and revision surgeries at Mass General Brigham are performed with minimally invasive methods, which can help reduce pain, bleeding, and other complications after surgery.

How safe is conversion and revisional surgery?

Conversion and revision surgeries have higher risks than the first weight loss surgery you received. This is because conversional and revisional bariatric surgeries try to correct an already-existing complication with another surgery. Generally, surgeries that try to correct inadequate weight loss have lower risk for complications, while surgeries that try to correct too much weight loss have higher risk.

Your experienced Mass General Brigham surgeon will create a surgical plan that seeks to minimize your risk for complications. While no surgery is totally risk-free, the expertise of Mass General Brigham bariatric surgeons who have done conversion and revision surgeries many times before can help lower your risk of developing complications.

What to expect for weight loss surgery

Your journey begins with a virtual webinar to learn more about our Weight Loss Surgery Program and the surgical options we offer. If you decide that surgery is the right choice for you, the next step is meeting with our care team. Your first visits will include:

• Meeting with a registered dietitian and psychologist to discuss your lifestyle, nutrition, and mental preparedness for surgery.
• Meeting with the surgical team to evaluate your overall health and determine if you’re a good candidate for metabolic and bariatric surgery.

Together, we will help you prepare for surgery and what to expect after surgery. Some insurance plans may require additional visits with our care team before approving the procedure.

Your team will ask you to:

• Follow a special pre-surgery diet
• Avoid or add certain foods or drinks
• Avoid alcohol, tobacco, or other substances
• Adjust or stop certain medications
• Arrange for a ride home after your procedure
• Maintain physical activity

Specific preparation instructions vary by patient. Please answer all your care team’s questions so they can create the best preparation and recovery plan for you.

Before weight loss surgery

Our program is designed to provide you with the information you will need for successful weight loss and to reduce the risk of complications after surgery.

Many insurance companies and our Weight Loss Surgery Program team require you to attend a pre-surgery program that helps you prepare for surgery both physically and psychologically. Program education focuses on achieving pre-surgery weight loss to reduce surgical risks and learning essential nutrition and lifestyle changes for long-term success.

As surgery approaches, you will:

• Meet with your care team to review your health.
• Attend a group nutrition class to learn about your pre- and post surgery diet and lifestyle changes for the two weeks following surgery.
• Have additional visits with your surgical team to prepare you for surgery and answer final questions.

After weight loss surgery

At the Mass General Brigham Weight Loss Surgery Program, your care team develops an individualized plan to support you after weight loss surgery. Follow-up care includes regular visits with your surgical team, registered dietitian, and psychologist for the first 18 months. They will monitor your nutrition and eating habits, addressing any vitamin or mineral deficiencies.

Frequently asked questions

What happens after surgery?

You may feel some pain or discomfort as you heal. Your surgeon will provide guidance on pain management, dietary restrictions, and recovery steps.

• Gastric sleeve and gastric bypass — You should avoid lifting anything heavier than 10 pounds for four weeks after surgery. We also recommend that you take three to four weeks off work.
• Conversion and revisional surgery — Your hospital stay and recovery time will depend on the type surgery you have. Most patients are discharged within two to three days if there are no major post-surgical complications. However, full recovery may take longer.

At the Mass General Brigham Weight Loss Surgery Program, your care team develops an individualized plan to support you after weight loss surgery. Follow-up care includes regular visits with your surgical team, registered dietitian, and psychologist for the first 18 months. They will monitor your nutrition and eating habits, addressing any vitamin or mineral deficiencies.

How effective is weight loss surgery?

Metabolic and bariatric surgery is considered the most effective treatment for obesity, helping patients achieve sustained weight loss and improve other obesity-related conditions. The amount of weight you lose depends on the type of bariatric surgery you have and your commitment to post-surgical lifestyle changes.

It is important to keep all follow-up visits so your care team can monitor and support your weight loss.

What are the benefits of weight loss surgery?

The benefits of bariatric surgery include:

• Improved quality of life
• Reduced risk of other obesity-related diseases
• Longer lifespan
• Reduction of cardiovascular risk
• Stroke prevention
• Obesity-related cancer prevention

Is weight loss surgery safe?

While any surgery carries risks, metabolic and bariatric surgery is among the safest elective procedures (similar to gallbladder surgery and hip replacement surgery).

The Mass General Brigham Weight Loss Surgery Program team performs a high volume of weight loss surgeries, which leads to:

• Lower complication rates
• Improved patient outcomes

When can I expect to return to daily life after weight loss surgery?

Most patients stand and walk within hours after surgery and are discharged within 24 hours. You should avoid high-impact exercise and lifting anything heavier than 10 pounds for at least four weeks after surgery. We also recommend that you take three to four weeks off work.

In the first few weeks after surgery, you may be less energetic due to a lower-calorie intake (liquid diet). Energy levels typically return once you transition back to solid foods.

Will I need plastic surgery after bariatric surgery?

Weight loss can result in loose or sagging skin, which varies based on total weight loss, hydration and nutrition, genetics and skin elasticity, and lifestyle habits.

If you are considering plastic surgery to remove excess skin, we recommend waiting until your weight stabilizes before undergoing a body contouring procedure.

Will insurance cover my weight loss surgery?

Many insurance companies cover weight loss surgery if you meet their qualification requirements. To learn more about insurance coverage, call our Weight Loss Surgery Program staff at Massachusetts General Hospital (617-643-4002) or Brigham and Women's Hospital (617-525-3597).