Gastric Sleeve Surgery Cost and Procedure Information
Gastric sleeve surgery is a form of weight loss surgery. The medical term given to all types of weight loss surgery is bariatric surgery. Bariatric surgery can provide an effective way to tackle obesity. It can result in significant weight loss that is both long-lasting and beneficial for your health.
The procedure achieves this by reducing the amount of food that you can physically consume. This page specifically looks at the gastric sleeve procedure, which aims to create substantial and sustained weight loss by removing a portion of the stomach and reshaping it.
What is a gastric sleeve operation?
Each type of operation has specific benefits. Some of the most common reasons that people opt for a gastric sleeve over any other type of weight loss surgery include:
- Unlike some of the other procedures, the digestive tract remains intact
- Nutritional supplements are required for a shorter period of time postoperatively
- Potential excess weight loss of up to 60-70% in the first 12 months
- Suitable for patients with a BMI greater than 30
Here, you can find a general overview of what the operation involves.
Your surgeon will use small, 'keyhole' incisions to remove up to 70% of your stomach. He or she will then staple the remaining 30% into a small, banana-shaped tube. This technique physically limits the amount of food you can eat and allows you to feel full by eating less. Unlike other types of weight loss surgery, your normal digestive tract will remain intact. Consequently, you will only require nutritional supplements for a short period after your surgery. As outlined above, this is a key benefit of gastric sleeve surgery over other types of weight loss treatment. Of course, your surgeon will discuss all of the options available to you. They will explain which technique they think is most appropriate for you and help you to make an informed decision.
Who is a suitable candidate for a gastric sleeve?
Suitable candidates for a gastric sleeve procedure include:
- People who have a BMI of >30 and a medical condition that can benefit from weight loss (e.g. diabetes or high blood pressure)
- People who have a BMI of >40 with no other medical problems
- Those who are experiencing health issues due to their obesity
- People with mobility issues as a result of their obesity
- Those who suffer from depression or self-esteem issues because of their obesity
- People who have tried diet and exercise to lose weight with no or limited success
- Those who are willing to commit to a new, healthier lifestyle post-surgery
- People with a positive outlook for their surgery
- Those who have realistic goals for their surgery
These are some general attributes that suitable weight loss surgery candidates may have. As a result, it is not a requirement to possess all of these, in fact, most patients do not.
Also, there are relatively few specific features which make somebody a suitable gastric sleeve candidate over another form of surgery. The decision is ultimately yours based on the advice of your surgeon and your preferences.
Having said that, each type of surgery has its own advantages and disadvantages. For a gastric sleeve procedure, these include:
- Faster weight loss after a gastric sleeve than after a gastric band
- A higher proportion of significant weight loss in people who have a gastric sleeve than a gastric band
- A higher risk of surgical complications after a gastric sleeve in comparison to other procedures
- A gastric sleeve is permanent and unlike a gastric band, cannot be reversed if problems arise
There are different types of surgical techniques your surgeon can use for your weight loss surgery. Consequently, the technique that they decide to use will depend on a number of factors. These may include:
- The goals you have for your weight loss surgery
- Your current BMI
- Your current health status
- The possible risks you may encounter with each procedure
Is a gastric sleeve right for me?
Weight loss surgery in general is an increasingly popular way to tackle obesity. Obesity is medically defined as having a body mass index, or BMI, of 30 or more. As well as having excess body fat, people who are obese are also at risk of a number of other serious health problems. These can include but are not limited to:
- Type 2 Diabetes
- Coronary heart disease
It is important to lose weight to reduce your health risks from obesity. Typically, many people can achieve weight loss by doing regular exercise and maintaining a healthy and balanced diet. However, this is not the case for everyone. Some obese people really struggle to lose their excess weight, even when trying their best with diet and exercise. Others may lose weight at first with diet and exercise but then, after a certain point, their weight loss stops. This can cause their weight to plateau before they reach their desired goal weight. A gastric sleeve is suitable for these people with obesity who need further help with their weight loss. It is a good option for those who would like to have definitive surgery to aid their weight loss.
What will a gastric sleeve not resolve?
The benefits of gastric sleeve treatment are vast and can help you to achieve your weight loss goals. However, as with any other treatment, there are limitations. For this reason, it is very important to discuss your goals in detail with your surgeon. This will ensure you pick the most suitable procedure to achieve your desired outcomes.
Some of the limitations of gastric sleeve surgery are listed below. These can be covered in greater depth during your consultation with your BAPRAS surgeon.
A gastric sleeve will not improve your dietary habits
A gastric sleeve will enable you to feel full more quickly. This will reduce the portion sizes that you eat. However, it will not change the food content that you do decide to eat. As you will be eating less food, it is even more important than the food you eat is nutritious and healthy. Your diet is something that you will need to control yourself. You will not automatically feel a desire to eat more healthily simply by having a gastric sleeve procedure. Instead, you will need to dedicate some time to improving your diet. You may benefit from engaging with a dietitian for advice about what you should and shouldn't eat. Your patient care adviser at Medbelle will also be happy to direct you to advice for healthy eating.
A gastric sleeve is not a cure for obesity
A gastric sleeve operation is just the beginning of your journey to a lower BMI and healthier lifestyle. Although a gastric sleeve will enable you to lose weight, it will also require hard work and determination. A gastric sleeve will provide the most effective results if paired with a healthy diet, regular exercise and good lifestyle choices. You should, therefore, be prepared to make healthy changes in your life to supplement the surgery and achieve your weight loss targets.
Weight loss effects are not instantaneous
A gastric sleeve is not a quick fix. Although many people will achieve significant weight loss soon after treatment, you should not expect to see a BMI reduction straight away. The gastric sleeve works by reducing your food intake. Therefore, you will be consuming a reduced number of calories. It will take time for your weight to reduce as a consequence of this. However, this process of gradual weight loss will achieve a reduced BMI in a controlled and long-term way. We are confident that you will be happy with the end results.
What can I expect from my gastric sleeve consultation?
Your gastric sleeve consultation is the first step in your gastric sleeve journey. This is an opportunity for you to meet with your surgeon and have a one-on-one interaction. You will be able to discuss all the questions you may have after reading the information you've been provided with. Your surgeon will equally want to explore your treatment goals and ask you about what you're hoping to achieve.
The consultation can last anywhere between fifteen minutes and one hour. Although there are specific elements that your surgeon will want to cover, the consultation is also your chance to become well informed of the procedure. Your BAPRAS surgeon will need to assess whether you are fit and healthy for a gastric sleeve operation. They will outline the risks and complications, as well as what the treatment can help you achieve. At the same time, it is important that you gather all the information that you can to ensure that the procedure is definitely the right choice for you.
What will my surgeon want to know?
All medical procedures carry some risks. Your surgeon will want to explore your medical background. This is to ensure that you are a suitable candidate for the procedure. Equally, it enables them to minimise any risks that there may be given your medical history.
It is a good idea to arrive at your consultation with a list of all the medications you take, including the dose and frequency, and the reason why you take them.
Your surgeon may want to explore the following areas of your medical background with you which may include but is not limited to:
- What is your current health status?
- Do you suffer from any serious health conditions?
- What is your past medical and surgical history?
- Do you take any regular medications? (This includes any prescribed, over-the-counter and herbal medications).
- Can you tell me a bit about your previous attempts at weight loss?
- What is your current diet and exercise regimen like?
- Do you smoke, drink alcohol and/or use any recreational drugs?
- Are you prepared to make lifestyle adjustments post-surgery to get the best results possible?
While this may seem like a lot of information to share with your surgeon, it is important that you answer these questions as honestly as possible. Remember, your surgeon is a healthcare professional. They ask these questions in order to determine the best possible treatment plan suitable for you.
In addition to learning about your general health, your surgeon may also wish to explore your weight. They may ask you questions about your previous attempts to lose weight, your motivation for losing weight, and your ability to make lifestyle adjustments post-surgery in order to achieve your goals.
What questions should I ask during my consultation?
This gastric sleeve consultation is the perfect opportunity for you to ask any questions you may have. It is a chance for you to clarify any details you may not quite understand or double check your understanding of things you’re unsure about. Therefore, we generally advise patients to think carefully about what they would like to ask before they come to this meeting. Some patients find it useful to write down their questions on a sheet of paper. That way, they can bring it with them and are less likely to forget to ask things that are important to them.
Below, we have made a list of questions you may like to ask during your gastric sleeve consultation, but feel free to add your own. Remember, there is no such thing as a stupid question!
- Do you think my goals for this procedure are realistic?
- What have the results of previous gastric sleeve surgeries you have performed been like?
- How much weight can I expect to lose?
- What will my final scars look like?
- Will I be in pain after my surgery?
- Are the results of this surgery permanent?
- What types of lifestyle changes will I have to make post-surgery?
- Will I be able to eat normally again after the surgery?
- Will I need to take nutritional supplements after my surgery?
- How long is the recovery process from gastric sleeve surgery?
How can I prepare for a gastric sleeve?
As the time approaches for you to have your gastric sleeve surgery, it is entirely normal to feel anxious. Fortunately, there is some preparation that you can follow to help distract yourself. These preparation tips are vital and must be followed to give yourself the best chance of successful weight loss and a smooth recovery.
If you are a smoker, you can start preparing for your surgery by stopping smoking for at least 6 weeks to 3 months before the procedure. If you smoke, your risk of anaesthetic and surgical complications both before and after surgery are increased. Therefore, we must stress the importance of stopping as soon as possible before your surgery.
To help build up your body's strength before surgery, it is important that you try to follow a healthy balanced diet and practice regular exercise. Your surgeon will give you further advice on what you will be able to eat and drink in the lead-up to your surgery. It is likely that you will need to follow a strict post-operative diet which your surgeon will outline for you. They will also advise you on which medications you will and will not be able to take on the day of your surgery.
Preparation is also the key to a relaxed, speedy recovery after your gastric sleeve procedure. Below are some things you can do before your surgery to make your recovery as easy as possible.
Household work can sometimes involve a great deal of physical effort. During your recovery, it is important that you do not overexert yourself. Therefore, there are some chores that you may like to get out of the way while you are still fit to do so, before you come into hospital. For example, you may like to take out the bins and do the laundry in advance.
It may also be useful to place some things you know you will need at an accessible level. For example, placing crockery and food items on a shelf or countertop where you will not have to bend down or stretch up. This will prevent you from putting unnecessary stress on your stitches.
You may not feel up to going shopping for some time after your surgery. Therefore, it can be really helpful to do a big food shop to stock up on what you need before your gastric sleeve surgery. Some people also like to cook meals and freeze them so that they don’t have to cook during their recovery. Online shopping is another great resource you can make use of. You may like to make yourself familiar with how this works before your surgery if you are unsure.
Pets and children
If you have any children or pets, you may like to ask friends and family for some help looking after them during your recovery. Pets and children can be hard work so you should ask for help to avoid over-exerting yourself.
You may not be able to drive from 5 to 14 days after your surgery. Your surgeon will be able to give you more specific advice on this during your initial gastric sleeve consultation. Because you will be unable to drive, you will have to organise for a friend or family member to take you home from hospital. If you are struggling with this, we are happy to help arrange a safe way home for you.
Eating and drinking
After the surgery, you will need to reintroduce foods very slowly back into your diet. Your surgeon will give you very precise instructions which you must follow. The general plan involves an initial diet which is limited to clear liquids only, then thicker drinks and soft foods are reintroduced. Eventually solid foods can be reintroduced too but in much smaller portions than you would have enjoyed pre-surgery. When you do return to eating a normal diet, it is important that it is a well-balanced, healthy one.
You should select some loose items of clothing to wear during your recovery. Items that zip at the front are usually less restrictive so may be more comfortable. You may also like to wear slide on shoes or sandals for a week or so to prevent any unnecessary bending. This way, you will not put any unnecessary strain on your stitches and enable your body to heal.
You may like to make sure you have spare pillows or cushions around the house. This way, you can rest or sleep propped up. This will likely be more comfortable for you in the first few days after your surgery. In addition it will help reduce or prevent any swelling. Your surgeon will prescribe pain medication if needed, so that any pain you experience should not affect your ability to sleep.
Before your surgery please discuss any medicines that you take with your surgeon and/or anaesthetist. This includes over the counter medications, herbal remedies and any other drugs not prescribed by your doctor. It is important to follow any instructions about adjustments to your medications or medications that you have been told you should stop prior to your surgery. This is particularly important if you are taking any blood-thinning medications such as warfarin or clopidogrel and/or any oral diabetes medications.
Failure to follow instructions regarding your medications is a common cause for cancelled or delayed procedures and one we should all try to avoid wherever possible.
How is gastric sleeve surgery performed?
A gastric sleeve procedure usually takes between 1 and 2 hours to perform. Below is a general guide to what you can expect from a gastric sleeve procedure and what it may involve. When you meet with your surgeon, they will be able to give you more specific details on what to expect.
Before your surgery, you will meet with your surgeon. To confirm that you would like to go ahead with your gastric sleeve procedure you will have to sign a consent form. We advise that you take your time to read the form carefully. Take the time to ensure that you fully understand all of the potential risks and complications of your surgery, and be sure to ask any questions you may have before signing your consent form.
You will also meet your anaesthetist before your surgery. A gastric sleeve operation requires you to be under a general anaesthetic. This means that you will be asleep throughout the operation. You will wake up gradually but may feel a little drowsy for a few hours until the general anaesthetic wears off. You may notice a slight impairment to your memory and concentration for a day or so but this will return to normal with time.
A gastric sleeve procedure does not tend to involve any large incisions as your surgeon will make 3 to 5 ‘keyhole’ incisions in your abdomen, known as a laparoscopic procedure. These incisions will be small, minimally invasive and should therefore leave small scars that heal quickly. Your surgeon will be able to tell you more about the incisions specific to your surgery when you attend your initial consultation. This is because they may be in slightly different positions based on the size and shape of your body. Sometimes, the surgeon can perform the entire surgery via your belly button which will result in almost no scarring.
Forming the sleeve
Once they have gained access to the stomach, your surgeon will remove the majority of it. This involves an incision into the stomach which travels the entire length to allow a large portion to be removed. This enables the surgeon to remove around 70% of the stomach and changes its shape into the sleeve which gives this surgery its name. The stomach is then stitched or stapled into its new tube like shape, leaving only around 200mls of capacity. This is in comparison to a normal stomach which has a capacity of 1 litre, or 1000mls.
Closing of incisions
Your surgeon will use stitches to close your incisions when the surgery is over and will cover the incisions with a dressing. They may insert drains into your tummy to reduce any swelling. You will have to return to the hospital within 10 to 14 days of your surgery so that your surgeon can remove your stitches and drains (if applicable). The staff at the hospital will give you an appointment for this before you are sent home.
Return to the ward
The hospital staff will take you back to the ward when your surgery is complete. You may feel drowsy for a couple of hours before you feel fully awake again. This is because the anaesthetic takes some time to wear off. You may notice a negative effect on your memory and concentration, but this will return to normal within 1 to 2 days. Your surgeon will prescribe appropriate pain medication to manage any pain you may have after your gastric sleeve procedure. You can expect to remain in hospital for 1-3 days after your surgery before you are able to return home.
What can I expect after my gastric sleeve procedure?
Knowing what to expect after your gastric sleeve operation is an important factor to consider when making your decision on whether to have surgery or not. To help you get a better idea of what to expect, we have put together some information on gastric sleeve aftercare that we think you might find useful. The majority of this information is general to all weight loss surgery patients. Your surgeon will be able to give answers to any questions you may have which are specific to you and your surgery.
How will I feel after surgery?
In order to carry out your gastric sleeve procedure, the anaesthetist will give you a general anaesthetic. This means that you will be asleep for the duration of the procedure. You will wake up slowly when the surgery is complete. You may feel a little drowsy and confused but this will wear off within a few hours. Your memory and concentration may be affected to 1 or 2 days but this will soon return to normal. If you experience any discomfort or pain after your surgery, your surgeon will prescribe appropriate pain medication to manage this.
When can I go home after my surgery?
You will need to stay in hospital from 1 to 3 nights after your gastric sleeve surgery. Before you leave, you will be given an appointment to come back within 10 to 14 days. During this appointment, your surgeon will assess your progress and ensure that you are recovering as expected. If you are experiencing any issues, let your surgeon know at this appointment. Of course, if there is a serious problem or you feel very unwell then you should seek medical advice urgently.
When can I drive after my surgery?
You may not be able to drive for 5 to 14 days after your surgery. Your surgeon will be able to advise your more specifically on this during your consultation.
Because you will be unable to drive straight after surgery, you will need to arrange for someone to take you home from hospital. You may like to ask a member of your family or a friend. If you struggle to arrange this, please let us know and we can help you to get home safely.
Will I be in pain after my surgery?
Your surgeon will prescribe simple pain relief for approximately the first week after your surgery as this is when you will be in the most discomfort. After this first week, you should be able to switch to over-the-counter pain relief medications. By the third week after your surgery, most of your pain and discomfort should have subsided and you should no longer require pain relief medications.
When can I go back to work after my surgery?
The amount of time you will need to take off work will depend on the type of job that you do. If your job is less active (e.g. office work) then you can probably return 1 to 2 weeks after surgery. If your job requires more physical exertion, (e.g. waitressing) you will probably require 3 to 4 weeks off work before you return. In any case, you should avoid even light activities for at least 2 to 4 weeks.
When can I exercise again after my surgery?
After your gastric sleeve operation, your surgeon will likely advise that you try to do a little light walking every day to avoid the formation of blood clots. Aside from this however, you should avoid all other forms of exercise for at least 4 weeks after surgery. Aerobic activities can increase swelling. Furthermore, you should hold off on all sexual activity for at least 2 weeks after surgery.
From 4 to 8 weeks after your surgery you can begin to reintroduce light aerobic activities like cycling or swimming. You will also be able to take part in activities that do not involve vigorous movement, such as lifting weights.
From 8 weeks after surgery, all activities and sports should be possible again. Keeping active is an essential part of your new healthy lifestyle post-weight loss surgery and will help you to achieve the best possible results.
How can I look after my scars?
You are unlikely to have large scars after a gastric sleeve procedure, but may have several small scars instead. Initially, when your wounds heal, your scars will appear pink and a little lumpy. Regular scar care can help to improve their appearance with time.
Scar care can involve daily massage using a scar gel or a moisturiser. You can begin daily scar care as soon as your wounds have fully healed. As your scars get less tender, you can increase the pressure of your massage to smooth out the scar tissue and reduce the lumpy appearance. It is vital that you follow the exact scar care regime that your surgeon gives to you.
When will I see the final results of my surgery?
It will take some time before you see the final results of your weight loss surgery. It can take from 8 to 12 weeks before your body feels back to normal again after surgery. By this point, you will likely have begun to notice some weight loss.
Following an appropriate diet and exercise regime, you should continue to lose weight steadily. In order to get the best results from your surgery, it is important to try your hardest to encourage natural weight loss through regular exercise and a healthy diet. This will involve eating much smaller portions that you are used to, and making sure that you get enough protein and fibre. You will also require some vitamin supplementation as your new, smaller stomach may not absorb enough nutrients from the food that you eat.
Risks & Complications
What are the main gastric sleeve risks and complications?
Every surgery comes with risks and complications. Before you agree to go ahead with your treatment, it is important that you educate yourself so that you can make an informed decision about having a gastric sleeve. If you have any questions, be sure to ask your surgeon at your consultation. To help, we have made a list of the main gastric sleeve surgery risks and complications. They include, but are not limited to:
A rare but potentially serious complication from the gastric sleeve procedure is a leak from the line where the stomach was cut and stapled back together. This can cause the stomach contents to irritate other organs and can lead to a severe infection. At Medbelle, we only use highly skilled and experienced surgeons to minimise the risk of complications such as leakage.
Bleeding & bruising
If bleeding occurs, it generally happens during or very soon after surgery. However, it is also possible that you may experience some bleeding up to 2 weeks after your surgery. Bleeding and bruising is often minor. If more severe bleeding were to occur, you would have to go back to theatre for further treatment. This may delay your recovery. In addition, you may have a little more bruising than expected. Despite this, your final results should not be affected.
All types of surgery carry the risk of infection. Your surgeon will do everything they can to reduce this risk. If an infection does occur, they are often mild and can be treated with a short course of antibiotics. In some cases however, infections can become more severe and require you to go back to hospital for treatment.
Below are some signs of infection you should look out for:
- A temperature over 38°C.
- Redness spreading away from your wound site >48 hours after surgery.
- Yellow/foul-smelling discharge coming from your wound.
- Pus oozing out of your wound.
- Pain that does not respond to pain medication.
If you have any of these symptoms after your gastric sleeve surgery it is vital that you seek medical help.
Vitamin & mineral deficiencies
There is a risk of developing vitamin and/or mineral deficiencies when you have a gastric sleeve operation. As a result of the surgery, your body may no longer able to absorb essential vitamins and minerals. However, the digestive tract is disturbed less in a gastric sleeve than in other types of surgery for weight loss. This means that this is a less common complication after a gastric sleeve.
Your surgeon or dietitian will be able to advise you on exactly which nutrients your body may be lacking after the surgery. In addition, they will advise you on which supplements you need to take to prevent any deficiencies and resulting side effects.
Most gallstones form as a result of high cholesterol levels. Therefore, patients undergoing a gastric sleeve operation may already have gallstones. Rapid weight loss as a result of weight loss surgery also increases the risk of developing gallstones. It also increases the risk of complications associated with gallstones.
Gallstones can often cause no symptoms. Therefore, many patients may be unaware that they have gallstones. Sometimes however, gallstones can cause recurring episodes of severe stomach pain. The solution to this problem is gallbladder removal, which includes further surgery.
A gastric sleeve procedure will leave you with some small scars as it is carried out laparoscopically. This involves inserting a camera and surgical tools through small, keyhole incisions in your stomach. These incisions heal quickly and leave small scars that fade with time. Ask your surgeon for more advice on how best to look after your scars after surgery.
There is always the risk that you will be unhappy with the results of your surgery for aesthetic reasons. For example, as a result of weight loss you may notice excess skin that you do not like the look of. Your surgeon will be able to advise you on what your options would be if this were the case.
General surgical complications
There are some general complications that can occur with every surgery. These include:
- Blood clots
- Nausea and vomiting
- Side effects of anaesthesia
- Post-operative pain
Your surgeon will make every effort to ensure that none of these complications occur. It is also important that you follow your surgeon's specific guidance before and after surgery. This helps to further reduce the likelihood of gastric sleeve risks and complications. If you have any questions about the risks, you surgeon will be happy to answer them for you.
Here are some common gastric sleeve FAQs that people ask. We hope that they help to answer some of the questions that you may have.
Are the results of a gastric sleeve permanent?
How long the results of your gastric sleeve last will depend on the effort you are willing to put in to maintaining a healthy lifestyle after the surgery. A healthy diet and regular exercise are important to encourage and maintain weight loss. The size of your new stomach can be increased due to stretching if you do not adhere to a healthy, balanced lifestyle.
Will having a gastric sleeve affect my ability to get pregnant?
A gastric sleeve should have a positive impact on pregnancy and childbirth. Many women with obesity suffer from subfertility as a result of their weight. However, as you lose weight, your fertility increases and you are much more likely to be able to conceive. It is important that you are aware of this effect if you want to avoid getting pregnant.
Additionally, losing weight will result in a significant reduction in the risk of complications during pregnancy and childbirth. Your weight loss will allow you to be much more active both during and after pregnancy. This will ensure that you can get maximum enjoyment out of what should be a very happy time in your life.
How do I know if I am suitable for a gastric sleeve?
This will depend on a number of factors. These include your BMI, your age, your current medical and psychological health, and your motivation to go ahead with the surgery. The final decision on your suitability for a gastric sleeve will be made by your surgeon but they will of course involve you in the decision making process.
How quickly will I lose weight?
The rate of weight loss after a gastric sleeve varies from person to person based on many different factors. However, generally we estimate that you can expect to lose about 60% of your excess weight after having a gastric sleeve procedure. A lot of weight loss is often seen in the first 6 months after surgery but some people find that their weight plateaus after this. As with anyone trying to lose weight, it depends on how much you eat and what exercise you do.
What effects do smoking/alcohol/drugs have on surgery?
The risks of complications from gastric sleeve surgery increase greatly if you smoke, drink alcohol or use recreational drugs. In particular, smoking will increase your risk of infection and delay the time it takes for your wounds to heal. Consequently, we strongly advise that you stop smoking and using all nicotine products for at least 6 weeks to 3 months before and after surgery to reduce the risk of complications. We also stress the importance of following your surgeon’s advice regarding smoking and the use of alcohol and recreational drugs.
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All of the information found on our website is sourced from highly reputable experts, government-approved authorities and is widely used by healthcare professionals.
- https://www.nhs.uk/conditions/weight-loss-surgery/ NHS
- Uptodate.com Up to Date
- https://asmbs.org/patients/bariatric-surgery-procedures American Society of Metabolic and Gastric Surgery
Our content is written by our Medical Quality Managers and Patient Care Advisers, all of who have medical backgrounds and training. Prior to publishing, all the information is reviewed by a surgeon specialised within the relevant field.