Sleeve Gastrectomy is considered a restrictive and metabolic procedure. Performed most often laparoscopically (five very small incisions), two-thirds of the stomach is cut away and removed, leaving a much smaller and narrow, stomach. The new smaller stomach provides great restriction in food intake thus providing great portion control. The metabolic benefits of this procedure are due to marked decrease in ghrelin release from the new smaller stomach. Ghrelin is a hormone that stimulates appetite and is produced by the fundus of the stomach (removed in sleeve gastrectomy). Additionally, sleeve gastrectomy is favored by many patients and physicians because of lack of alteration of the food pathway through the intestines (vs. gastric bypass).

Weight loss with sleeve gastrectomy is gradual, more than gastric band but less than gastric bypass (excess weight loss about 60 % at 1 year). Although 5-year data supporting the sleeve is excellent, long term data (more than 10 years) is not yet available.