How We Started Thinking About This
When we first started researching weight loss surgery, we did not go in assuming the gastric sleeve was the answer. The idea of having roughly 80 percent of your stomach permanently removed felt serious – because it is. We spent several months comparing procedures, reading clinical literature, spending time in patient forums, and having direct conversations with our surgical team at Weight Loss Riga in Latvia before we were confident we had landed on the right choice.
This article is not a universal recommendation for the sleeve over anything else. Every patient is different, and the right procedure depends on individual health history, anatomy, and goals. What we can offer is an honest account of how we thought through the options and why the sleeve made sense for us.
The Procedures We Looked At
We reviewed eight types of bariatric intervention before settling on a shortlist of two. Going through each one helped us understand not just what each procedure does, but what it is and is not suited for.
The intragastric balloon places a temporary balloon inside the stomach to reduce capacity. It stays in place for roughly six months before being removed. For us it felt like a short-term measure rather than a lasting solution – useful perhaps as a step towards surgery for someone who needs to lose weight before an operation, but not what we were looking for.
The gastric band was once the most commonly performed bariatric procedure in the UK. An adjustable ring is placed around the upper stomach to restrict how much food passes through at a time. It fell out of favour significantly over the following decade because of the rate of complications – band slippage, erosion, port problems – and the frequency with which bands needed to be removed. We ruled it out quickly.
Gastric bypass creates a small stomach pouch and reroutes part of the small intestine, meaning food bypasses a significant section of the digestive tract. It produces strong long-term weight loss results and is particularly effective where acid reflux is present. The concern for us was the malabsorption component – because food bypasses part of the gut, nutrient absorption is permanently altered, and the lifelong monitoring requirements are more complex than for the sleeve.
The mini gastric bypass is a simplified version of the full bypass with a single connection rather than two. Similar considerations applied – effective, but the malabsorption element gave us pause.
The duodenal switch combines restriction with aggressive malabsorption and is generally considered a procedure for the most severe cases, where other options have not worked or the degree of obesity is exceptional. It was not relevant to our situation.
Endoscopic sleeve gastroplasty uses sutures placed from the inside to reduce the stomach’s volume without any external incision or removal of tissue. It appealed to us initially because of the non-surgical approach, but the evidence on long-term effectiveness was less robust than for the sleeve, and it does not affect ghrelin production in the same way – an important consideration for us given how much of our overeating was driven by hunger rather than appetite alone.
Gastric plication folds the stomach inward to reduce its volume. No tissue is removed, which means the procedure is technically reversible. We dismissed it for similar reasons – less proven in long-term outcomes, and not addressing the hormonal side of hunger.
The gastric sleeve removes roughly 75 to 80 percent of the stomach, leaving a slim tube-shaped remnant. It restricts capacity significantly and – crucially – removes the fundus of the stomach, which is where most of the hunger hormone ghrelin is produced. That hormonal effect was important to us. Our problem was not simply portion size; it was that we were genuinely hungry, frequently and intensely. A procedure that addressed both volume and hunger signalling made more sense for our situation.
How the Decision Was Finalised
Our clinic booked us provisionally for both the sleeve and the bypass and confirmed the final decision after pre-operative testing, including an endoscopy. The reason for that approach is clinical: if the endoscopy shows evidence of acid reflux or Barrett’s oesophagus, the sleeve is generally not recommended because removing stomach volume can worsen reflux. In those cases, the bypass tends to be safer.
Our endoscopies showed no signs of reflux, so our surgeon recommended the sleeve. That combination of pre-operative assessment and personal research gave us confidence we were making the right call. We were not simply selecting a procedure from a menu – the decision was made in collaboration with a clinical team who had reviewed our specific anatomy and health history.
For both of us, the sleeve offered the clearest path: meaningful restriction, a significant hormonal effect on hunger, natural digestion preserved, and a recovery process that – while serious – was more predictable than bypass surgery.
What We Did Not Expect
A few things caught us off guard despite the research. The first was how quickly the comorbidities resolved. James had severe sleep apnoea, high blood pressure, and pre-diabetic markers before surgery. Within three months of the operation, all three had either resolved completely or improved dramatically – before he had lost anywhere near his total eventual weight. The metabolic effects of the sleeve happen faster than most people expect.
The second was the anaesthetic complication James experienced. He had flagged a previous adverse reaction to anaesthetic during pre-operative consultations, and the team managed it successfully in theatre – but it was a reminder that pre-op disclosure matters and that choosing a team who takes those disclosures seriously is not a minor detail.
Kirsten’s experience was shaped significantly by Crohn’s disease, which affects absorption and created additional complexity around deficiencies in the months following surgery. Having a surgical team with experience managing bariatric patients who also have inflammatory bowel disease was part of why we chose an international clinic with a specific process for complex cases rather than going with the cheapest available option.
Over Two Years On
James has lost over 12 stone from his pre-operative weight of nearly 30 stone. Kirsten has lost over 8 stone from around 18 stone pre-op. Both of us are now well into the maintenance phase.
Looking back at the decision to choose the sleeve over bypass, we still think it was correct for us. The hunger reduction has been sustained. Neither of us has developed significant new reflux. The nutritional demands are manageable with consistent supplementation and monitoring. We have no regrets about the procedure itself.
The most useful thing we can say to anyone at the research stage is this: spend time on the decision, but do not let the volume of information paralyse you. Read the clinical evidence, have the conversations with your team, be honest about your own eating patterns and what is actually driving your weight, and trust the process when a clinical recommendation is made after proper assessment.
Sources
NICE CG189 – Obesity: identification, assessment and management (National Institute for Health and Care Excellence)
BOMSS (British Obesity and Metabolic Surgery Society) – Patient pathway and commissioning guidance for bariatric surgery
Welbourn R et al. – Laparoscopic sleeve gastrectomy: a systematic review (Annals of Surgery, 2019)
Angrisani L et al. – IFSO Worldwide Survey 2016: Primary, Endoluminal, and Revisional Procedures (Obesity Surgery, 2018)
About this content
This blog is written by James and Kirsten, a couple from the UK who had gastric sleeve surgery together in March 2024.
We started this blog because we couldn't find any sources of content that details before surgery, the surgery and then life post surgery - so we decided to write one ourselves.
Everything on this site is based on our own experience and the research we have done along the way. It is not medical advice. Gastric sleeve surgery is a serious procedure and every patient's journey is different. Please always consult your own bariatric team or GP before making any decisions about your health or treatment.
Some posts on this site may contain featured or sponsored content, or affiliate links. Where this is the case, it will always be clearly stated at the top of the article. Our opinions are always our own.
Publish Date: 20 July 2024 | Last Reviewed: 7 June 2026 | Next Planned Review: 7 December 2027