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Gastric sleeve using keyhole surgery

Weight Doctors BARIATRICS® Gastric sleeve

In gastric sleeve surgery, a large part of the stomach is removed; what remains is a narrow tube of 150–200 ml. For people with a BMI from 40, in exceptional cases also below.

How your therapy is structured

Two building blocks.
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The Weight Doctors® MEMBERSHIP is the foundation of every therapy: medical oversight, progress monitoring and aftercare. The treatment you choose together with your specialist builds on it.

Building block 1

Weight Doctors® MEMBERSHIP

The foundation for every Weight Doctors® therapy – with the tools that support your treatment and record your progress for your medical consultations.

  • Weight Doctors® AppKeep an eye on weight, activity and sleep, for iOS and Android
  • Digital body scalesBluetooth scales – the readings flow straight into the app
  • 3D BodyscanMeasure body composition objectively, up to twice a year
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  • 360 coaches and Weight Doctors® MiraNutrition and behaviour in everyday life, aftercare with your coaches
  • E-prescription servicePrescriptions issued digitally – after medical approval
More on the Membership
Building block 2

Weight Doctors BARIATRICS® gastric sleeve

In gastric sleeve surgery, a large part of the stomach is removed; what remains is a narrow tube of 150–200 ml. For people with a BMI from 40, in exceptional cases also below.

Procedure
Minimally invasive surgery (keyhole technique)
Duration
approx. 75 minutes
Price
from €2,900
Costs

The Membership does not replace a medical decision: whether treatment makes sense, and which one, is decided by your specialist after a medical assessment.

Personally here for youDr. med. Oliver Scheffel · Bariatric surgery

Your guide

Gastric sleeve surgery at a glance

Everything you should know before making your decision – from the technique and the possible results to the question of which procedure suits you.

How the gastric sleeve works

In gastric sleeve surgery, the largest part of the stomach is permanently removed. What remains is a narrow stomach tube, 2–3 cm wide, which takes over the job of the previous stomach – about the size of a small banana. Even small amounts stretch the stomach wall, the brain receives the “full” signal sooner, and the feeling of fullness sets in: the principle of food restriction.

  • In addition, the surgery sets hormonal processes in motionThere are strong indications that the stomach afterwards produces less of the hunger hormone ghrelin and that appetite-suppressing messenger substances such as GLP-⁠1 and peptide YY are released. This can also have a favourable effect on metabolism; this is why it is called metabolic surgery.
  • There is no large abdominal incisionThe operation is carried out using keyhole surgery (laparoscopy).

Gastric sleeve surgery is recognised worldwide; in Germany, it is the most frequently performed procedure in obesity surgery. It is part of Weight Doctors BARIATRICS®, the procedures for permanent stomach reduction through surgery, and is suitable above all for people for whom an endoscopic stomach reduction can no longer help sufficiently.

Diagram: with the gastric sleeve, a narrow tube remains along the lesser curvature, and the larger part of the stomach is removed.
Gastric sleeve – remainsis removedStapled closure
  • 2–3 cmthe width of the remaining stomach tube
  • 150–200 mlthe stomach’s capacity afterwards – about a small banana
  • approx. 75 minthe duration of the operation using keyhole surgery

What defines the gastric sleeve

  • Restriction and hormonesThe smaller stomach limits the amount of food; at the same time, less hunger hormone and more appetite-suppressing messenger substances can curb appetite.
  • Permanent reductionThe larger part of the stomach is removed: the reduction is permanent and greater than with the endoscopic procedures.
  • In type 2 diabetesRelated conditions such as type 2 diabetes mellitus can improve. The more they weigh in, the more likely the gastric sleeve is the more suitable option.
  • Usually just one nightAfter gastric sleeve surgery, you can usually go home after just 1 night.
  • Safely cared for after the operationThe Weight Doctors® Nationalklinik has its own intermediate care unit: if anything unexpected occurs after the operation, you continue to be cared for right on site.
  • Can be combinedIf you need an additional boost after some years, the gastric sleeve can be combined with other Weight Doctors® procedures.

Who is the gastric sleeve suitable for?

For many people, severe excess weight is a struggle lasting years. Morbid excess weight (obesity) is more than a question of appearance: it increases the risk of serious secondary diseases, can considerably limit physical and mental performance and can shorten life expectancy.

A significant, lasting weight loss can reduce these risks considerably and ease many symptoms. The most common related conditions include type 2 diabetes mellitus and high blood pressure, which in turn can lead to heart disease; breathing difficulties and asthma, sleep disorders and pauses in breathing during sleep, joint problems in the arms and legs, and back pain are also common.

You are not alone in this: excess weight and obesity affect millions of people. You can also read when an operation is an option with a high BMI and related conditions in the article Weight Doctors BARIATRICS® for high BMIs. For the gastric sleeve, the following applies:

Weight Doctors® doctor and adviser in the consultation room
  • Recommended from a BMI of 40, in exceptional cases also below – only for adults aged 18 and over.
  • For weight-loss goals of around 40–50 kg.
  • If several attempts to lose weight, a change of diet and lifestyle, and medically supervised conservative approaches have not brought lasting success.
  • If you are ready to change your diet, behaviour and exercise permanently. Take the decision calmly, not in an acutely stressful situation.
  • Not suitable with existing reflux disease – here the Weight Doctors SLEEVE® as an extended sleeve is an option.
  • Not the first choice if your excess weight comes mainly from sweet foods, sweet drinks or regular alcohol: such calories simply flow through the gastric sleeve. The gastric bypass then makes more sense.

“A gastric sleeve operation from Weight Doctors BARIATRICS® is suitable above all for patients who want to achieve a weight loss of between 40 and 50 kg.”

Prof. Dr. med. Karl Miller
  1. BMI from 35German health insurance possible with related conditions
  2. BMI from 40Gastric sleeve recommended
  3. BMI from 45Gastric bypass more sensible
BMI scale according to the WHOCalculate your BMI

How the operation works

In advance, a gastroenterological preliminary examination clarifies whether anything speaks against the surgery. The operation itself takes about 75 minutes:

Two surgeons wearing 3D glasses operating by keyhole technique, with the monitor behind them
  1. Anaesthesia and accessThe operation is carried out under general anaesthesia and using keyhole surgery: a camera and fine instruments are introduced through a few small punctures in the abdominal wall.
  2. Creating visibilityThe abdominal cavity is filled with carbon dioxide. This gives the surgeon better access and a view of the abdominal organs.
  3. Forming the tubeA stapler runs along the greater curvature: it separates the larger part of the stomach and at the same time seals the 2–3 cm narrow stomach tube. A time-consuming hand suture is no longer needed.
  4. Checking for leaksThe separated part of the stomach is removed in a sterile retrieval bag. Dye introduced through a gastric tube shows whether the staple line is leak-proof.
  5. Short stayAfterwards you usually stay 1 night as an inpatient. You are generally socially presentable again after 10–14 days.

After surgery: step by step back to everyday life

The first weeks after gastric sleeve surgery are decisive for good healing: the stomach has to get used to its new shape, and the staple line needs time to heal firmly.

You therefore rebuild your diet in stages – first liquid, after the check-up with soft food, then with small, protein-rich meals. Eat slowly and in small bites: eating hastily, large bites and fizzy drinks can cause discomfort, especially at the beginning. Drink enough, and avoid sweet drinks.

Your treatment team accompanies you every step of the way. This is what the journey typically looks like:

  1. Day of surgeryProcedure under general anaesthesiaAbout 75 minutes using keyhole surgery, after which experienced nursing staff look after you.
  2. Day 1Usually already homeGenerally 1 night as an inpatient; a few blood tests follow before discharge.
  3. after 10–14 daysFit to socialise againThe small punctures have healed, everyday life returns.
  4. 4–6 weeksLiquid diet, then rebuildingAfter the check-up, you gradually rebuild your diet with our coaches.
  5. for lifeVitamins and check-upsNutritional supplements based on your blood values and regular check-ups secure success.

How Weight Doctors BARIATRICS® ensures your safety

The aim is to keep the medical risks and your time off after the surgery as low as possible. This is why, at Weight Doctors®, specialist doctors with many years of experience in obesity surgery operate. The procedures of Weight Doctors BARIATRICS® are scientifically studied and established in medicine.

Current laparoscopic technology is used, along with instruments and materials from well-known manufacturers such as Aesculap or Johnson & Johnson. Checking the staple line for leaks with dye is part of every gastric sleeve operation.

  • GermanyNetherlandsDr. ScheffelSpecialist in general and bariatric surgery
  • GermanyAustriaProf. MillerSpecialist in general and visceral surgery
  • GermanyPD Dr. WichmannSpecialist in visceral surgery & expert in endobariatrics
  • NetherlandsProf. GreveSpecialist in visceral and bariatric surgery

All specialists

What results are possible?

Studies show that after gastric sleeve surgery, patients lose on average between 33 and 83% of their excess weight, usually within 6–12 months. First long-term studies suggest that the success lasts longer than with many conservative approaches.

A related earlier procedure, the Magenstraße-Mill operation, gives an indication of the long-term effect: this also created a stomach tube, but the remaining stomach stayed in the body. In one study, excess weight loss after five years was 60%.

Results vary from person to person. Every stomach reduction – without a procedure, endoscopic or surgical – can only work as well as you are willing to change your diet, behaviour and exercise permanently. Weight Doctors® 360° nutrition coaching is available alongside.

In the long term, weight-loss surgery can also bring about the following:

  • Substantial weight loss, ideally down to normal weight
  • Improvement in type 2 diabetes mellitus
  • Lower blood pressure and lower cholesterol levels
  • Fewer pauses in breathing during sleep (sleep apnoea), relief from asthma
  • Less strain on the joints, more mobility and resilience
  • Better mood, more self-esteem, fewer migraine attacks

Results vary from person to person. The images show Weight Doctors® patients who have consented to their publication.

Risks and what you should bear in mind in the long term

Like any operation, gastric sleeve surgery carries risks. Possible are an infection from stomach juices leaking, with a risk of peritonitis, wound infections at the puncture sites, injury to other organs or blood vessels with bleeding, weakening of the abdominal wall or abdominal wall hernias, adhesions, gallbladder diseases or gallstones, blood clots with possible pulmonary embolism, vitamin deficiency and (temporary) disorders of gastrointestinal function. Life-threatening emergencies can also occur, for example due to the anaesthesia. Your individual risk depends heavily on your state of health.

Weight Doctors® team with fresh fruit and vegetables
  • Heartburn (reflux)Acid reflux and heartburn can newly occur or worsen after the operation; we therefore advise against the gastric sleeve if you have existing reflux disease. Symptoms after the operation can be treated – more under Reflux after gastric sleeve.
  • Vitamins for lifeThe operation fundamentally changes your digestion. You take multivitamin preparations every day and, depending on your blood values, also vitamin D, vitamin B, iron and calcium supplements. The intestine can no longer absorb enough vitamin B12; it is supplied for life, for example by injection into the muscle or as a short infusion. Results are better if you eat a balanced diet, take the supplements regularly and attend check-ups.
  • When the stomach stretchesOver time, the stomach tube can widen. Larger portions then fit in again, and the feeling of fullness sets in later – you can eat more than in the early period, cravings return, or weight rises over months. A gastroscopy and imaging can measure whether and how much the stomach has widened. Have such signs checked early – more under Regained weight after weight-loss surgery.
  • Not reversible, but correctableThe removed part of the stomach does not grow back; the reduction is permanent. If weight returns after years, your Weight Doctors® team supports you with nutrition and exercise programmes, in person and digitally. If the effect wears off, a correction is possible, for example a re-sleeve or conversion to a bypass: Weight Doctors® REVISION.

Gastric sleeve, extended sleeve or gastric bypass?

Many people face the choice: as gently as possible with a non-surgical stomach reduction – or straight to an operation from Weight Doctors BARIATRICS®? The three most important paths at a glance:

  • Weight Doctors SLEEVE® (extended sleeve)Endoscopically through the mouth, without an incision. With fine anchors and sutures, the stomach wall is folded and stitched over its whole length, making the stomach narrower and shorter. As an outpatient, usually under 60 minutes; afterwards 6–8 weeks of liquid diet so that the sutures grow in firmly. More about the Weight Doctors SLEEVE® and the pose®2 technique.
  • Gastric sleeveSurgically using keyhole surgery, about 75 minutes, usually 1 night as an inpatient. The largest part of the stomach is removed, leaving a tube 2–3 cm wide. The reduction by 75–80% is permanent and greater than with the endoscopic procedures; in addition, less hunger hormone can curb appetite. Recommended from a BMI of 40.
  • Gastric bypassThe greatest change among weight-loss operations. A small pouch is formed from the upper stomach, to which part of the small intestine is connected; up to 90% of food passes by the remaining stomach and part of the small intestine. Variants: Roux-en-Y and omega-loop – the “mini bypass” is no less invasive. About 120 minutes. More about the gastric bypass.
  • Which path suits you?We clarify this together in the consultation. What matters is your BMI, related conditions such as diabetes or reflux, your eating habits – for example plenty of sweet foods or sweet drinks – and your weight-loss goal. Medication such as GLP-⁠1 pharmacotherapy can also play a role. You can find the direct comparison of all procedures in the overview of services.
ServiceGastric sleeveGastric bypass
TechniqueLaparoscopic sleeve gastrectomy (LSG)Roux-en-Y or omega loop
MethodKeyhole surgeryKeyhole surgery
Recommended BMIfrom 40from 45
Stomach reduction75–80 %85–90 %
Weight-loss goal40–50 kgsignificantly more than 40 kg
Anaesthesiaapprox. 75 minutesapprox. 120 minutes
Hospital stay1 night as an inpatient1–3 nights as an inpatient
Weight Doctors® Appincludedincluded

Gastric sleeve

Technique
Laparoscopic sleeve gastrectomy (LSG)
Method
Keyhole surgery
Recommended BMI
from 40
Stomach reduction
75–80 %
Weight-loss goal
40–50 kg
Anaesthesia
approx. 75 minutes
Hospital stay
1 night as an inpatient
Weight Doctors® App
included

Gastric bypass

Technique
Roux-en-Y or omega loop
Method
Keyhole surgery
Recommended BMI
from 45
Stomach reduction
85–90 %
Weight-loss goal
significantly more than 40 kg
Anaesthesia
approx. 120 minutes
Hospital stay
1–3 nights as an inpatient
Weight Doctors® App
included

Weight-loss goal and values are guide values – results vary from person to person.

What does a gastric sleeve cost – and what does German health insurance pay?

Gastric sleeve surgery, also called sleeve surgery, with Weight Doctors BARIATRICS® is also available through German statutory health insurance if the medical indication is established in line with the guidelines. Without health insurance, the treatment is available to self-paying patients. Prices start at €2,900; we set the exact price in the consultation. The price includes private-practice preliminary examination and aftercare, laboratory tests, anaesthesia, the clinic stay, medication and materials during the stay, one year of the Weight Doctors® App with a digital scale and Weight Doctors® Mira, and two 3D Bodyscans.

As a self-paying patient, you start without a waiting period, can pay in instalments and may be able to deduct the costs from your tax as extraordinary expenses. In our experience, simpler conditions apply to privately insured patients: if the procedure is considered medically necessary, many private insurers cover the costs in full or in part.

Patients with German statutory health insurance have a chance of cost coverage if the medical indication meets the guidelines; the decision is made case by case, based on BMI and recognised related conditions. This is usually preceded by the six-month multimodal programme (MMK) with nutrition counselling, an exercise log, a psychological assessment, gastroscopy and a full blood count; the MMK itself is not a service covered by the health insurer. With a primary indication – BMI from 50 or from 35 with type 2 diabetes that has exhausted treatment options – immediate surgery is possible.

There is no prior application: we organise the MMK and the surgery appointment, we check all the requirements for you before the surgery, and billing with your German health insurer follows directly after the surgery. You do not have to speak to your health insurer. You can read more in the article Weight-loss surgery and health insurance. This is how the costs are split:

What statutory health insurance pays*

  • Surgery by a specialist
  • Anaesthesia
  • Materials and medication in the clinic
  • Double room at the Nationalklinik
  • Informed consent discussion
  • Aftercare in the clinic
  • No follow-up cost insurance needed

* For patients with German statutory health insurance: if the medical indication is established in line with the DGAV guidelines, reimbursement may be possible.

What you pay privately

  • Private medical pre- and post-treatment examinations

MMK+ programme

multimodal programme including Weight Doctors® MEMBERSHIP all-in

  • App with Weight Doctors® Mira, body scales and 3D Bodyscan
  • Specialists around the clock
  • Personal coach
  • Telemedicine and e-prescription
  • Communication with the German health insurer
  • Free choice of clinic for preliminary examination and aftercare
Two paths to stomach reduction on German health insurance

Usual pathwith an advance application to the German health insurer

Weight Doctors®Without advance application

ConsultationInitial consultation and indication
MMKSix months of nutrition, exercise and psychology
ApplicationApplication for cost coverage with all documents to the German health insurer
Expert reportReview by the Medical Service
DecisionWaiting for the decision – appeal if rejected
SurgeryProcedure after approval
ConsultationWe check your medical indication: BMI, related conditions, previous attempts to lose weight.
MMKSix months of nutrition, exercise and psychology – we organise all the appointments. With a primary indication, it is not required.
Final checkBefore surgery, we check all the requirements for you. You do not have to speak to your German health insurer.No advance application
SurgeryYour procedure – billing with your German health insurer follows directly after surgery.

* For patients with German statutory health insurance: if the medical indication is established in line with the DGAV guidelines, reimbursement may be possible.

More on cost coverageAll prices

Paying in instalments: how it works

If you would like to spread the costs over a longer period, payment in instalments via our partner medipay is possible. You decide the instalment amount and term yourself; medipay reviews your application promptly. You submit the application together with us during your consultation, by phone or entirely paperless online – more under Pay in instalments.

The requirement is sufficient creditworthiness. In detail:

  • Main residence in Germany
  • no negative Schufa entries
  • employed or retired, with disposable income
  • Students, trainees and homemakers can enter a second person from the same household as the borrower – a parent, child, spouse or partner

From just €278 per month** Financing through medipay, subject to a credit check.

Apply for instalmentsMore on instalments

Your specialists

In specialist hands.

39 doctors in Germany, Austria, the Netherlands, the United Kingdom and South Africa – at the Weight Doctors® Nationalklinik in Wertheim and at your location.

  • GermanyNetherlandsDr. ScheffelSpecialist in general and bariatric surgery
  • GermanyAustriaProf. MillerSpecialist in general and visceral surgery
  • GermanyPD Dr. WichmannSpecialist in visceral surgery & expert in endobariatrics
  • GermanyM. MargolinsSpecialist in general surgery
  • GermanyM. ShalabiSpecialist in general and visceral surgery
  • GermanyNetherlandsDr. JennerSpecialist in visceral surgery / specialised visceral surgery
  • GermanyDr. SchüderSpecialist in general, visceral and vascular surgery / specialist in specialised visceral surgery
  • GermanyA. SaberSpecialist in orthopaedics and trauma surgery
  • NetherlandsProf. GreveSpecialist in visceral and bariatric surgery
  • South AfricaDr. HanningtonSpecialist in surgery
  • South AfricaDr. MabeSpecialist in surgery
  • South AfricaDr. WolmaransSpecialist in surgery

All specialists

Frequently asked questions

Questions about the Weight Doctors BARIATRICS® gastric sleeve

Your question isn’t listed? Your specialist will take time for it during the consultation.

How long does gastric sleeve surgery take?

The operation itself takes about 75 minutes. It is carried out under general anaesthesia and using keyhole surgery, that is through a few small incisions in the abdominal wall instead of a large abdominal cut. Only a few small scars remain.

What happens before and after gastric sleeve surgery?

In advance, a gastroenterological preliminary examination clarifies whether anything speaks against the surgery. After the procedure, experienced nursing staff look after you; a few blood tests follow before discharge. For good healing, a special liquid-based diet is then prescribed for 4–6 weeks. After a gastroenterological check-up, you gradually rebuild your diet back to normal with our coaches.

How long do I stay at the clinic after the operation?

You usually stay 1 night as an inpatient. A few blood tests follow before discharge. You are generally socially presentable again after 10–14 days.

How much of the stomach is removed?

The stomach is reduced by about 75–80%. What remains is a tube 2–3 cm wide with a volume of about 150–200 ml – roughly the size of a small banana.

From what BMI is a gastric sleeve possible?

We recommend gastric sleeve surgery from a BMI of 40, in exceptional cases also below. For cost coverage by the German health insurer, a BMI from 40 or from 35 with recognised related conditions generally applies. Only adults aged 18 and over are treated.

What does gastric sleeve surgery cost?

Gastric sleeve surgery with Weight Doctors BARIATRICS® is also available through German statutory health insurance if the medical indication is established in line with the guidelines. Without health insurance, the treatment is available to self-paying patients. Prices start at €2,900. Payment in instalments via medipay is possible. All prices at a glance: Costs & prices.

How much can I lose with a gastric sleeve?

The gastric sleeve is intended for weight-loss goals of around 40–50 kg. Studies show an average loss of 33–83% of excess weight within 6–12 months. Results vary from person to person and depend heavily on how consistently you change your diet and exercise.

Gastric sleeve or gastric bypass – which suits me better?

The gastric sleeve is usually the first choice from a BMI of 40, the gastric bypass rather from 45 and with a very large weight-loss goal. If your excess weight comes mainly from sweet foods, sweet drinks or alcohol, or if you already have reflux, the bypass often makes more sense. We decide this together in the consultation.

Are there risks associated with gastric sleeve surgery?

Yes, as with any operation: infection from stomach juices leaking, with a risk of peritonitis, wound infections at the puncture sites, injury to other organs or blood vessels with bleeding, weakening of the abdominal wall or abdominal wall hernias, adhesions, gallbladder diseases or gallstones, blood clots with possible pulmonary embolism, vitamin deficiency and (temporary) disorders of gastrointestinal function. Life-threatening emergencies can also occur, for example due to the anaesthesia. Your individual risk depends heavily on your state of health.

Can I get heartburn after a gastric sleeve?

Yes, acid reflux and heartburn can newly occur or worsen after the operation. We therefore advise against the gastric sleeve if you have existing reflux disease. Symptoms after the operation can be treated – more under Reflux after gastric sleeve.

What do I need to bear in mind after a gastric sleeve?

The operation is not reversible and fundamentally changes your digestion. You therefore take nutritional supplements for life: daily multivitamin preparations and, depending on your blood values, also vitamin D, vitamin B, iron and calcium supplements. The intestine can no longer absorb enough vitamin B12; it is supplied for life, for example by injection into the muscle or as a short infusion. In the long term, results are better if you eat a balanced diet, take the supplements regularly and attend check-ups.

Can the gastric sleeve stretch?

Yes, over time the stomach tube can widen. Larger portions then fit in again, and the feeling of fullness sets in later. Typical signs: you can eat more than in the early period, cravings return, or weight rises over months. A gastroscopy and imaging can measure whether and how much the stomach has widened. Have such signs checked early – more under Regained weight after weight-loss surgery.

Can I regain weight after a gastric sleeve?

Yes, in some people weight returns after years. Your Weight Doctors® team therefore supports you with nutrition and exercise programmes, in person and digitally. If the effect wears off, a correction is possible, for example a re-sleeve or conversion to a bypass: Weight Doctors® REVISION.

Can a gastric sleeve be reversed?

No. The removed part of the stomach does not grow back; the reduction is permanent. If the effect wears off after years or symptoms occur, however, a correction is possible, for example a re-sleeve or conversion to a gastric bypass.

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Other treatments

All paths.
From gentle to surgical.

Every method has its place. Here you can see at a glance how major the procedure is, how long it takes and what starting price you can expect.

Wide range of services
no procedure
Surgery
Long-lastingNewAt the Weight Doctors® Nationalklinik

Weight Doctors® hydroGMA

Endoscopic, no incisions

Losing weight without medication: lowering the hunger hormone endoscopically – no surgery, no incisions. On its own or combined with an endo sleeve.

Durationapprox. 30 min
Priceon request
More on Weight Doctors® hydroGMA
No surgeryHealth insurance cover also possible*

Weight Doctors SLEEVE®

Endoscopic, permanent

Permanent stomach reduction without conventional surgery – endoscopic, outpatient, without scars.

Duration30–60 min
Pricefrom €5,500or from €199 a month*
More on Weight Doctors SLEEVE®
You are hereWith surgeryHealth insurance cover also possible*

Weight Doctors BARIATRICS®

Surgical, minimally invasive

Gastric bypass or gastric sleeve surgery for higher BMIs, incl. private medical preliminary examination and aftercare.

Duration1–3 nights
Pricefrom €2,900or from €278 a month*
More on Weight Doctors BARIATRICS®

* For patients with German statutory health insurance: if the medical indication is established in line with the DGAV guidelines, reimbursement may be possible.

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* For patients with German statutory health insurance: if the medical indication is established in line with the DGAV guidelines, reimbursement may be possible.

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