The gastric sleeve, or laparoscopic sleeve gastrectomy performed by Dr. Jacobo Zafrani at Hospital Clínica Bíblica in San José, Costa Rica, is the preferred surgical procedure used to cure Type 2 diabetes in obese patients with a BMI of 30 and higher, and also to induce weight loss in seriously obese people who do no suffer from diabetes. (Calculating your BMI is simple. Click here.)

In this procedure, the bariatric (weight loss) surgeon will remove approximately 60 to 80% of the stomach along the greater curvature, leaving only a small tube, or ‘sleeve’ for the new stomach pouch that extends from the natural stomach opening to the natural stomach outlet (pyloric valve). The procedure helps limit eating by reducing the overall size of the stomach and helps control hunger by removing the part of the stomach that produces the hunger-stimulating hormone Ghrelin.

The cut-away part of the stomach is removed from the body and not left in place, therefore the stomach reduction is permanent and the gastric sleeve procedure is not reversible. Overall, it is a less complicated operation than gastric bypass surgery, since the pyloric valve and small intestine are left intact. Also, the gastric sleeve does not involve implanting a medical device into the body in order to restrict eating as with adjustable gastric banding surgery.

Advantages of the Gastric Sleeve

The advantages of gastric sleeve surgery for obese patients are manifold. The greatest of these is safety: the likelihood of complications from the less-complicated gastric sleeve procedure is lower than that of gastric bypass surgery, which is more complex surgical operation.

The second big advantage of the gastric sleeve is its convenience: the patient doesn’t have to schedule frequent follow-up office visits, as is the case with patients who undergo Lap-Band surgery and need to see their doctor several times in the first year to have the band adjusted. Current data also indicates that the gastric sleeve results in quicker weight loss than gastric banding.

In addition, the gastric sleeve procedure doesn’t require as much active follow-up participation on the part of patients. Patients can get back to normal life that much faster.

Gastric sleeve patients experience fewer restrictions on the types of food that they can eat. The possibility of overeating is itself greatly lessened as well, since the part of the stomach which produces hormones responsible for stimulating hunger is removed from the digestive system during a gastric sleeve operation. This is seen by many patients as being one of the great advantages of the gastric sleeve. Although the procedure reduces the size of the stomach and the amount of food that can be eaten, the stomach otherwise functions normally. And, since the pylorus (the ‘valve’ that allows only measured amounts of food to pass from the stomach into the bowel) is retained during gastric sleeve surgery.

The gastric sleeve operation is not yet FDA-approved, but the results of one FDA-accredited study (U.S. goverment clinical trials indicator NCT00434525) at North Texas Veterans Healthcare System were delivered to the FDA in December 2009.

Of course, no form of surgery is foolproof, and the gastric sleeve procedure is no exception. As with all forms of bariatric surgery, the patient must want success and work for success in order for the operation to succeed as a treatment for curing Type 2 diabetes. Dr. Zafrani and your own doctor will work together with you on monitoring and evaluating your post-operative progress on an agreed schedule and regimen.

Gastric sleeve surgery can be the best option for many obese people with Type 2 diabetes, but only as a part of a total lifestyle change. A common-sense program of diet and exercise, along with daily vitamin supplements and routine check-ups, are vital if the surgery is to succeed. If you’re considering bariatric surgery to cure Type 2 diabetes or obesity, contact Americana WellcareCR to discuss the option of the sleeve gastrectomy with bariatric specialist Dr. Jacobo Zafrani.


Laparoscopic surgery, also referred to as minimally invasive surgery, describes the performance of surgical procedures with the assistance of a video camera and several thin instruments. During the surgical procedure, small incisions of up to half an inch are made and plastic tubes called ports are placed through these incisions. The camera and the instruments are then introduced through the ports which allow access to the inside of the patient.

The camera transmits an image of the organs inside the abdomen onto a television monitor. The surgeon is not able to see directly into the patient without the traditional large incision. The video camera becomes a surgeon’s eyes in laparoscopy surgery, since the surgeon uses the image from the video camera positioned inside the patient’s body to perform the procedure.

The benefits of minimally invasive or laparoscopic procedures are:

  • less post-operative discomfort since the incisions are much smaller
  • quicker recovery times
  • shorter hospital stays
  • earlier return to full activities
  • much smaller scars
  • there may be less internal scarring when the procedures are performed in a minimally invasive fashion compared to standard open surgery


Approach: Restrictive

  • Limits amount of food that can be eaten
  • Reduces hunger sensations

Anatomy Changes: Stomach – Reduces stomach size by removing 60% to 80% of the stomach along the greater curvature, leaving only a narrow tube or ‘sleeve’

Surgery Method – Laparoscopic

Operating Time – One hour

Hospital Stay: Usually 1 day

Adjustable: No

Reversible:  No

Medical Implant: No

Success Rate: 90% successful in curing Type 2 diabetes

Surgery Benefits and Advantages:

  • Does not require a medical device implant into body
  • Pyloric valve and small intestine are kept intact
  • Reduces hunger (the portion of stomach that produces Ghrelin, the hunger stimulating hormone, is removed)
  •  Few food intolerances
  •  Low malnutrition risk
  •  May be converted to gastric bypass or duodenal switch for additional weight loss
  •  Revision option for patients who have had previous gastric band surgery

Time Off Work and Recovery: One week

Dietary Guidelines:

  • 600 to 800 calories per day during weight loss period (1-2 years, if weight loss is also a goal)
  • 1,000-1,200 calories per day, once goal weight is achieved
  • eat protein-rich foods
  • avoid high fat and high calorie foods
  • avoid carbonated drinks and coffee

Eating Habits:

  • eat five small meals a day
  • avoid snacking
  • do not eat and drink at same time
  • chew food thoroughly

Nutritional Supplements (optional):

  •     Multivitamins
  •     Calcium
  •     Vitamin B12

Weight Loss (obese patients):

  • Quick rate of weight loss
  • Short term results primarily favorable, especially in low BMI patients
  • Expected weight loss 60% to 70% of excess weight at two years in morbidly obese patients
  • Low malnutrition risk


  •     General surgical risks
  •     Not reversible
  •     Requires patient effort (changing diet and eating habits) for initial recovery and weight loss