The gastric sleeve operation is available as a gastric restrictive procedure and has all the disadvantages of such procedures, in that it only restricts solid foods to some extent and not liquids. The stomach remaining will gradually stretch and permit larger meals. In addition there is no band or other permanently restrictive device.
For these reasons it should probably be reserved for the treatment of truly massive individuals (500 to 600 lbs. or more) as a first stage of a BPD (bilio-pancreatic diversion) or its modification, the duodenal switch, or possibly a gastric by-pass, in cases where it would be too dangerous or difficult to perform the secondary or main operation in one stage. For experienced bariatric surgeons it should rarely be necessary to perform a gastric bypass in 2 stages.
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