The Gastric Sleeve, formally known as Sleeve Gastrectomy, is a modern weight-loss procedure that has rapidly become the most common bariatric surgery worldwide. It is categorized as a restrictive procedure because it permanently removes approximately 80% of the stomach, leaving a narrow, banana-shaped pouch. The primary mechanism is the reduction of food intake capacity, but it also influences hunger by removing the portion of the stomach that produces the appetite-stimulating hormone ghrelin. The “invention” of the gastric sleeve was not a single moment of creation, but a decades-long evolution from a surgical component to a definitive, standalone treatment.
Early Surgical Precursors
The technique of stapling and removing a large portion of the stomach was not originally conceived as a stand-alone operation for weight loss. Its origins lie in the development of complex malabsorptive surgeries designed to treat severe obesity. The sleeve component was a necessary first step in the Biliopancreatic Diversion with Duodenal Switch (BPD/DS), a procedure that combines stomach restriction with intestinal rerouting to limit calorie absorption.
The first open sleeve gastrectomy was performed by Dr. Doug Hess in March 1988 as an integral part of the Duodenal Switch procedure in Bowling Green, Ohio. This initial vertical gastrectomy reduced the stomach’s capacity, making the subsequent intestinal bypass safer and more tolerable. The sleeve merely prepared the patient for the malabsorptive part and was not considered the final solution. The BPD/DS technique was refined throughout the 1990s, but the sleeve portion remained a preparatory step for the full, two-part operation.
The Transition to a Standalone Procedure
The conceptual shift that truly “invented” the gastric sleeve as a definitive procedure occurred in the early 2000s, driven by the need to manage extremely high-risk patients. Surgeons realized that for patients with a Body Mass Index (BMI) above 60 kg/m², performing the full BPD/DS or a Gastric Bypass in a single operation carried a significantly elevated risk of complications. This led to the development of a “staged” approach.
The first stage involved only the sleeve gastrectomy, allowing the patient to lose weight and improve medical conditions before undergoing the second, more complicated intestinal bypass. Dr. Michel Gagner, a pioneer of laparoscopic bariatric surgery, was instrumental in this transition, having performed the first laparoscopic Duodenal Switch in 1999. He subsequently developed the technique of staging the full procedure, performing the laparoscopic sleeve gastrectomy (LSG) first.
Initial reports between 2001 and 2003 showed that patients who underwent only the sleeve experienced highly effective weight loss and resolution of comorbidities. This unexpected success demonstrated the power of the restrictive element and its hormonal effect, prompting surgeons to question the necessity of the second stage. In 2004, a study by Almogy et al. formally proposed longitudinal gastrectomy as a safe and effective alternative for high-risk patients. The period from 2003 to 2005 marks when the sleeve was recognized and intentionally offered as a stand-alone, definitive operation.
Standardization and Global Adoption
Following its recognition as a standalone treatment, the Laparoscopic Sleeve Gastrectomy (LSG) began a rapid ascent in global popularity. Its relative technical simplicity compared to a Roux-en-Y Gastric Bypass, along with the absence of an intestinal connection (anastomosis) that can lead to ulcers or internal hernias, made it appealing to surgeons and patients alike. The procedure was also found to offer favorable metabolic results, similar to those seen in more complex surgeries.
Professional organizations played a significant role in standardizing the operation. The International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) and the American Society for Metabolic and Bariatric Surgery (ASMBS) began to formally recognize and endorse the procedure in the mid-to-late 2000s. By the early 2010s, consensus conferences were held to refine and standardize the surgical technique, ensuring consistency and safety across the surgical community.
The LSG became the most frequently performed weight-loss surgery worldwide between 2016 and 2020. This widespread adoption was fueled by long-term data confirming its safety, efficacy, and lower complication rates compared to the initial malabsorptive operations. It continues to be the dominant choice globally, representing a successful evolution from a complex procedure’s component to a primary surgical intervention.