{"id":12826,"date":"2026-11-15T10:00:00","date_gmt":"2026-11-15T09:00:00","guid":{"rendered":"https:\/\/www.medespoir.ch\/blog\/?p=12826"},"modified":"2026-11-15T10:00:00","modified_gmt":"2026-11-15T09:00:00","slug":"sleeve-gastrectomy-in-detail-tunisia","status":"publish","type":"post","link":"https:\/\/www.medespoir.ch\/blog\/sleeve-gastrectomy-in-detail-tunisia\/","title":{"rendered":"Sleeve gastrectomy in detail: technique, long-term results, recovery and who it suits"},"content":{"rendered":"<p><strong>In short:<\/strong> A sleeve gastrectomy removes most of the stomach by keyhole surgery and turns what remains into a narrow tube. It works by reducing volume and, importantly, by removing the part of the stomach that produces most of the hunger hormone ghrelin. Ten-year results from the Swiss SM-BOSS trial and the Finnish SLEEVEPASS trial show lasting weight loss for many patients, but also more reflux and more second operations than after a gastric bypass. The sleeve suits many people with severe obesity who do not have significant reflux, and it keeps the digestive route intact. It is not a good choice for people with severe reflux or Barrett&rsquo;s oesophagus. In Tunisia, Medespoir plans six to eight days on site, including two to four nights in hospital; bariatric surgery there is significantly cheaper than in Switzerland, and the exact price is given in a free personal quote within 48 hours.<\/p>\n<p>This guide is for people living in Switzerland, including English-speaking expatriates in Geneva, Zurich, Basel and Lausanne, who are considering a sleeve and want to understand it in depth before deciding. Our guide on <a href=\"https:\/\/www.medespoir.ch\/blog\/sleeve-or-bypass-choosing-weight-loss-surgery-tunisia\/\">choosing between sleeve, bypass and other options<\/a> compares the operations, and our guides on <a href=\"https:\/\/www.medespoir.ch\/blog\/life-after-bariatric-surgery-tunisia-swiss-follow-up\/\">life after bariatric surgery<\/a> and <a href=\"https:\/\/www.medespoir.ch\/blog\/revision-bariatric-surgery-tunisia-guide\/\">revision surgery<\/a> cover what comes later. Here we look at the sleeve itself: how it is done, why it works, what the long-term studies show, who it suits, and how the operation is organised in Tunisia.<\/p>\n<h2 id=\"contents\">Contents<\/h2>\n<ul>\n<li><a href=\"#news\">What is new in 2025 and 2026?<\/a><\/li>\n<li><a href=\"#what\">What exactly is a sleeve?<\/a><\/li>\n<li><a href=\"#how\">How does the sleeve work?<\/a><\/li>\n<li><a href=\"#technique\">The operation step by step<\/a><\/li>\n<li><a href=\"#results\">Long-term results<\/a><\/li>\n<li><a href=\"#reflux\">Reflux and Barrett&rsquo;s oesophagus<\/a><\/li>\n<li><a href=\"#nutrition\">Nutrition and deficiencies<\/a><\/li>\n<li><a href=\"#who\">Who is a good candidate?<\/a><\/li>\n<li><a href=\"#not\">Who should avoid a sleeve?<\/a><\/li>\n<li><a href=\"#recovery\">Recovery: the first weeks<\/a><\/li>\n<li><a href=\"#risks\">Risks and complications<\/a><\/li>\n<li><a href=\"#glp1\">The sleeve and weight-loss medicines<\/a><\/li>\n<li><a href=\"#myths\">Common myths about the sleeve<\/a><\/li>\n<li><a href=\"#insurance\">Swiss criteria and insurance<\/a><\/li>\n<li><a href=\"#tunisia\">A sleeve in Tunisia<\/a><\/li>\n<li><a href=\"#price\">Price<\/a><\/li>\n<li><a href=\"#sources\">Sources<\/a><\/li>\n<li><a href=\"#faq\">Frequently asked questions<\/a><\/li>\n<\/ul>\n<h2 id=\"news\">What is new in 2025 and 2026?<\/h2>\n<h3>What did the Swiss SM-BOSS trial show after more than ten years?<\/h3>\n<p>The Swiss Multicenter Bypass or Sleeve Study (SM-BOSS) randomised 217 patients between 2007 and 2011 in four Swiss centres to a sleeve or a gastric bypass. Its long-term results were published in <em>JAMA Surgery<\/em> in April 2025 (Kraljevic, Peterli and colleagues), with follow-up until July 2023. Total weight loss after ten years did not differ significantly: about 25.5% of initial weight after the sleeve and 27.7% after the bypass. However, 29.9% of sleeve patients had been converted to another operation because of insufficient weight loss or reflux, compared with 5.5% after a bypass, and new reflux was more frequent after the sleeve.<\/p>\n<h3>What about nutrition ten years later?<\/h3>\n<p>A secondary analysis of the Finnish SLEEVEPASS trial, published in the <em>British Journal of Surgery<\/em> in July 2025 (Saarinen and colleagues), found that long-term vitamin and mineral deficiencies were rare after both a sleeve and a bypass at ten years, with similar rates of vitamin D insufficiency, low calcium and vitamin B12 deficiency. Iron deficiency was less common after the sleeve (14% versus 41% of those tested). But adherence to supplements was lower after the sleeve: 71% of sleeve patients still took them, compared with 89% after a bypass.<\/p>\n<h3>Do the randomised trials agree overall?<\/h3>\n<p>A meta-analysis of nine randomised trials with at least five years of follow-up, published in <em>Obesity Surgery<\/em> in August 2025 (Monteiro Delgado and colleagues, 1,489 patients), found greater long-term weight loss, better diabetes remission and better reflux control after a bypass, but fewer late major complications after a sleeve. There was no significant difference for high blood pressure, blood fats, sleep apnoea or joint pain. The authors stressed choosing according to each patient&rsquo;s profile, not on weight loss alone.<\/p>\n<h3>What happens in real-life practice over 14 years?<\/h3>\n<p>A study of 830 patients operated on between 2010 and 2014 in three American centres, published in <em>Obesity Surgery<\/em> in February 2026 (Abedalqader and colleagues), found that weight loss peaked at about 29% of initial weight two years after surgery. Over a median of almost ten years, most patients regained some weight from their lowest point, 15.8% had a suboptimal response, and 10.1% needed revision surgery. Type 2 diabetes resolved in 58.7% and sleep apnoea in 65.8% of those who had them. Regular follow-up visits were associated with less weight regain.<\/p>\n<h3>How common is Barrett&rsquo;s oesophagus after a sleeve?<\/h3>\n<p>A meta-analysis of 19 studies with long-term follow-up, published in <em>Clinical Gastroenterology and Hepatology<\/em> in January 2025 (Chandan and colleagues, 2,046 patients), found a pooled rate of new Barrett&rsquo;s oesophagus of 5.6% after a sleeve. Barrett&rsquo;s oesophagus is a change in the lining of the gullet caused by chronic reflux, which slightly increases the risk of cancer. The authors recommended routine screening of sleeve patients with endoscopy.<\/p>\n<h3>Have treatments for leaks improved?<\/h3>\n<p>A 2025 meta-analysis in <em>Obesity Surgery<\/em> (Galloro and colleagues, 79 studies, 2,205 patients) found that endoscopic treatments for staple-line leaks after a sleeve succeeded in 84.1% of cases overall, with the best results for internal drainage with double-pigtail stents and endoscopic vacuum therapy. Leaks remain the most feared complication, but they can increasingly be treated without a major reoperation.<\/p>\n<h2 id=\"what\">What exactly is a sleeve?<\/h2>\n<h3>What part of the stomach is removed?<\/h3>\n<p>The sleeve gastrectomy, also called vertical or longitudinal gastrectomy, removes the outer, curved part of the stomach along its length, including the fundus, the dome at the top. Medespoir&rsquo;s sleeve page describes the removal of about two thirds of the stomach, leaving a tube. The outlet of the stomach (the pylorus) and the connection to the small intestine are not changed.<\/p>\n<h3>Is it reversible?<\/h3>\n<p>No. The removed part of the stomach cannot be put back. A sleeve can, however, be converted into another operation, most often a gastric bypass, if needed later. This is why it is sometimes described as a first step in a two-stage strategy for people with very high body weight.<\/p>\n<h3>Does a sleeve leave a foreign body?<\/h3>\n<p>No. Unlike a gastric band, no device stays in the body. The stomach is cut and closed with surgical staples, which remain but are not a foreign device in the usual sense. Medespoir&rsquo;s obesity surgery guide lists this as one of the sleeve&rsquo;s advantages.<\/p>\n<h3>Why has the sleeve become so popular?<\/h3>\n<p>Because it is technically simpler than a bypass, does not reroute the intestine, keeps normal absorption of nutrients and medicines, avoids the risk of internal hernia that exists after a bypass, and gives substantial weight loss. It is now the most frequently performed bariatric operation in the world, as several of the 2025-2026 studies above note.<\/p>\n<h2 id=\"how\">How does the sleeve work?<\/h2>\n<h3>Is it only a question of a smaller stomach?<\/h3>\n<p>No. The reduced volume makes you feel full sooner, but Medespoir&rsquo;s guide highlights a second, less known effect: the removed portion is the one that produces most of the hunger hormone ghrelin, and its removal durably reduces the sensation of hunger. This is what distinguishes the sleeve from a simple mechanical restriction.<\/p>\n<h3>What other hormonal changes occur?<\/h3>\n<p>Food passes more quickly from the tubular stomach into the small intestine, which increases the release of gut hormones such as GLP-1 and PYY that signal fullness and improve blood sugar control. These are the same pathways targeted by modern weight-loss medicines. This partly explains why diabetes can improve after a sleeve before significant weight has been lost.<\/p>\n<h3>Why do some people regain weight after a sleeve?<\/h3>\n<p>The tube can dilate somewhat over years, hunger signals partly return, and eating habits can drift, especially grazing on small, calorie-dense foods and drinking calories, which pass easily through a sleeve. Genetics, medicines, mental health and life events also play a role. The 14-year study above found that adherence to follow-up was associated with less regain. Our guide on <a href=\"https:\/\/www.medespoir.ch\/blog\/revision-bariatric-surgery-tunisia-guide\/\">revision surgery<\/a> covers what can be done.<\/p>\n<h3>Does the sleeve change taste and food preferences?<\/h3>\n<p>Many patients report that their tastes change, with less desire for very sweet or fatty foods and a quicker feeling of being satisfied. These changes vary between people and may fade over time. They are a help, not a guarantee.<\/p>\n<h2 id=\"technique\">The operation step by step<\/h2>\n<h3>How is the operation done?<\/h3>\n<p>By laparoscopy (keyhole surgery), under general anaesthesia, through several small incisions in the abdomen. The surgeon inflates the abdomen with gas to create space, frees the outer edge of the stomach from its blood vessels, then places a calibration tube (a \u00ab\u00a0bougie\u00a0\u00bb) through the mouth into the stomach. Using it as a guide, the stomach is divided along its length with a surgical stapler. The removed part is taken out through one of the incisions.<\/p>\n<h3>How long does it take?<\/h3>\n<p>Medespoir&rsquo;s obesity surgery guide gives a duration of about one to two hours. Its sleeve page mentions about 120 minutes. The duration depends on your anatomy, previous surgery and whether a hiatal hernia is repaired at the same time.<\/p>\n<h3>What is the bougie, and why does its size matter?<\/h3>\n<p>The bougie determines the width of the sleeve. A tube that is too narrow increases the risk of narrowing and possibly leaks; one that is too wide may reduce long-term weight loss. Surgeons follow consensus ranges and their own experience. You can ask your surgeon which size they use and why.<\/p>\n<h3>What is a hiatal hernia repair?<\/h3>\n<p>A hiatal hernia occurs when part of the stomach slides up through the opening in the diaphragm into the chest. It contributes to reflux. Many surgeons look for it during the sleeve and repair it at the same time by tightening the opening. Finding it beforehand with an endoscopy helps plan the operation.<\/p>\n<h3>Is the staple line reinforced?<\/h3>\n<p>Some surgeons reinforce the staple line with sutures or buttress materials to reduce bleeding; practices vary. Most also test the staple line during surgery, for example with air or a dye, to check for leaks.<\/p>\n<h3>Why is an endoscopy needed before a sleeve?<\/h3>\n<p>Because a sleeve can worsen pre-existing reflux. Medespoir&rsquo;s guide calls a prior endoscopy indispensable. It looks for oesophagitis, a hiatal hernia, Barrett&rsquo;s oesophagus and the bacterium <em>Helicobacter pylori<\/em>, which is usually treated before surgery. The result can change the choice of operation.<\/p>\n<table>\n<thead>\n<tr>\n<th>Step<\/th>\n<th>What happens<\/th>\n<th>Why it matters<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<td>Endoscopy before surgery<\/td>\n<td>Camera examination of the gullet and stomach<\/td>\n<td>Detects reflux damage, hiatal hernia, Barrett&rsquo;s, Helicobacter<\/td>\n<\/tr>\n<tr>\n<td>Anaesthesia<\/td>\n<td>General anaesthesia<\/td>\n<td>Fasting and medicine adjustments required, including GLP-1 medicines<\/td>\n<\/tr>\n<tr>\n<td>Laparoscopy<\/td>\n<td>Several small incisions, gas in the abdomen<\/td>\n<td>Less pain and faster recovery than open surgery<\/td>\n<\/tr>\n<tr>\n<td>Calibration<\/td>\n<td>Bougie placed in the stomach<\/td>\n<td>Sets the width of the sleeve<\/td>\n<\/tr>\n<tr>\n<td>Stapling<\/td>\n<td>Stomach divided along its length<\/td>\n<td>Removes the fundus and most ghrelin production<\/td>\n<\/tr>\n<tr>\n<td>Checks<\/td>\n<td>Staple line inspected and tested<\/td>\n<td>Reduces the risk of unnoticed bleeding or leak<\/td>\n<\/tr>\n<tr>\n<td>Hiatal repair if needed<\/td>\n<td>Diaphragm opening tightened<\/td>\n<td>Limits reflux after surgery<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h2 id=\"results\">Long-term results<\/h2>\n<h3>How much weight will I lose?<\/h3>\n<p>On average, people lose around a quarter to a third of their initial body weight, with the maximum usually reached between one and two years after surgery. In SM-BOSS, total weight loss after ten years was about a quarter of initial weight. Individual results vary widely: some lose more, others less, and some regain a significant part.<\/p>\n<h3>What does \u00ab\u00a0excess weight loss\u00a0\u00bb mean?<\/h3>\n<p>Studies often report the percentage of excess weight lost, meaning the weight above a body mass index (BMI) of 25. Losing 60% of excess weight is a good result even though you may still be above a \u00ab\u00a0normal\u00a0\u00bb BMI. Total weight loss, as a percentage of your starting weight, is easier to understand and is increasingly used.<\/p>\n<h3>What happens to diabetes, blood pressure and sleep apnoea?<\/h3>\n<p>They often improve. In the 14-year study, type 2 diabetes resolved in 58.7% of those who had it, high blood pressure in 45.0% and sleep apnoea in 65.8%, with some recurrence over time. The randomised trials show that diabetes remission is on average better after a bypass. Our guide on <a href=\"https:\/\/www.medespoir.ch\/blog\/type-2-diabetes-metabolic-surgery-tunisia\/\">type 2 diabetes and metabolic surgery<\/a> explains this in more detail.<\/p>\n<h3>How many people need a second operation?<\/h3>\n<p>More than after a bypass. In SM-BOSS, almost three in ten sleeve patients had been converted after ten years, mainly for reflux or insufficient weight loss. In the American 14-year study, one in ten needed revision. These figures should be part of your decision: a sleeve is a durable operation for many, but not a one-time solution for all.<\/p>\n<h3>Does quality of life improve?<\/h3>\n<p>Most patients report better mobility, energy and self-esteem. Quality of life can be affected by reflux, food intolerance or regain. Psychological support before and after surgery improves the chances of a good experience.<\/p>\n<p><strong>Considering a sleeve?<\/strong> Request your <a href=\"https:\/\/www.medespoir.ch\/devis.php\">free quote<\/a> with your weight, height, medical history, any reflux symptoms and your current medicines. You will receive a personal answer within 48 hours.<\/p>\n<h2 id=\"reflux\">Reflux and Barrett&rsquo;s oesophagus<\/h2>\n<h3>Why does a sleeve cause reflux?<\/h3>\n<p>Several mechanisms combine: the narrow tube creates higher pressure inside the stomach, the angle between the stomach and the gullet changes, the valve at the bottom of the gullet may be weakened, and part of the sleeve can slide upwards through the diaphragm. Medespoir&rsquo;s guide notes that the sleeve can worsen pre-existing reflux.<\/p>\n<h3>What are the symptoms?<\/h3>\n<p>Heartburn, acid or food coming back up, especially when lying down, a sour taste in the morning, a chronic cough or hoarse voice, and sometimes pain behind the breastbone. Some people have reflux damage without obvious symptoms, which is why endoscopic surveillance is recommended.<\/p>\n<h3>How is reflux after a sleeve treated?<\/h3>\n<p>First with lifestyle measures (small meals, not eating late, raising the head of the bed) and acid-reducing medicines. If reflux is severe, damages the gullet or does not respond to treatment, conversion to a gastric bypass is the reference solution. Our revision guide explains this step.<\/p>\n<h3>Should I have endoscopies after a sleeve?<\/h3>\n<p>Given the 2025 meta-analysis on Barrett&rsquo;s oesophagus, many experts recommend endoscopic surveillance after a sleeve, even without symptoms, at intervals set by your gastroenterologist. In Switzerland, discuss this with your GP or the bariatric team that follows you after your return.<\/p>\n<h2 id=\"nutrition\">Nutrition and deficiencies<\/h2>\n<h3>Do I need vitamins for life after a sleeve?<\/h3>\n<p>Yes. The guidelines of the Swiss Society for the Study of Morbid Obesity and Metabolic Disorders (SMOB) recommend long-term multivitamins with minerals and trace elements after a band, a sleeve or a bypass. Medespoir&rsquo;s guide notes that the supplementation required after a sleeve is lighter than after mixed operations, but it is still necessary.<\/p>\n<h3>Which deficiencies are most common?<\/h3>\n<p>Iron, vitamin B12, vitamin D, calcium, folic acid and zinc. Vitamin B12 absorption can decrease after a sleeve because part of the stomach that helps absorb it is removed and acid is reduced. The SLEEVEPASS ten-year analysis found deficiencies to be rare when patients were followed, but adherence to supplements fell over time, especially after a sleeve.<\/p>\n<h3>What blood tests are needed?<\/h3>\n<p>The SMOB guidelines list annual laboratory tests including blood count, iron and ferritin, liver and kidney values, albumin, glucose and HbA1c, blood lipids, parathyroid hormone and vitamin status. More frequent tests are done in the first year.<\/p>\n<h3>How much protein do I need?<\/h3>\n<p>Protein is a priority after a sleeve, because the stomach is small and muscle loss must be limited. Your dietitian will give you a target according to your weight and activity. Protein comes first at every meal, followed by vegetables, then starch in small amounts.<\/p>\n<h3>How does eating change after a sleeve?<\/h3>\n<p>You progress from liquids to pur\u00e9es, then soft and finally normal textures over several weeks. Portions are small, meals are eaten slowly and drinks are taken between, not with, meals. Our <a href=\"https:\/\/www.medespoir.ch\/blog\/life-after-bariatric-surgery-tunisia-swiss-follow-up\/\">guide to life after bariatric surgery<\/a> details the phases and the practical habits.<\/p>\n<h2 id=\"who\">Who is a good candidate?<\/h2>\n<h3>What BMI is required?<\/h3>\n<p>The 2022 joint guidelines of the American Society for Metabolic and Bariatric Surgery (ASMBS) and the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) recommend surgery from a BMI of 35 regardless of other conditions, and suggest considering it from a BMI of 30 in people with metabolic disease. Medespoir&rsquo;s sleeve page states that a BMI above 40 is a typical indication, and that people with a BMI of 35 with an associated disease can also be candidates; the surgeon decides in every case.<\/p>\n<h3>Which profiles suit a sleeve particularly well?<\/h3>\n<ul>\n<li>People without significant reflux or hiatal hernia.<\/li>\n<li>People who take medicines whose absorption must remain predictable, such as some psychiatric medicines, anti-epileptics or immunosuppressants.<\/li>\n<li>People with inflammatory bowel disease or previous abdominal surgery that makes a bypass riskier.<\/li>\n<li>People with a very high BMI, as a first step before a possible second operation.<\/li>\n<li>People who want to avoid the risk of internal hernia and dumping linked to a bypass.<\/li>\n<\/ul>\n<h3>Is a sleeve suitable for young adults?<\/h3>\n<p>It is frequently chosen for young adults because it does not reroute the intestine. Medespoir&rsquo;s sleeve page mentions that adolescents can be operated on after medical examination and a favourable surgical opinion; in practice this requires a specialised paediatric or adolescent obesity team. For a young adult, the long horizon makes reflux surveillance and lifelong supplements especially important.<\/p>\n<h3>What about women who want children?<\/h3>\n<p>Pregnancy is possible after a sleeve, and fertility often improves with weight loss. Medespoir&rsquo;s page on pregnancy after a sleeve recommends waiting twelve months, with nutritional monitoring during pregnancy. Use reliable contraception during the period of rapid weight loss.<\/p>\n<h3>What does \u00ab\u00a0good candidate\u00a0\u00bb mean psychologically?<\/h3>\n<p>Understanding that surgery is a tool, being ready to change eating habits, accepting lifelong follow-up and supplements, and having support around you. An assessment by a psychologist or psychiatrist looks for untreated eating disorders, depression and substance use, which should be addressed before surgery. Our guide on <a href=\"https:\/\/www.medespoir.ch\/blog\/preparing-for-bariatric-surgery-tunisia-diet-tests\/\">preparing for bariatric surgery<\/a> explains the assessment.<\/p>\n<h2 id=\"not\">Who should avoid a sleeve?<\/h2>\n<h3>Is reflux a contraindication?<\/h3>\n<p>Severe reflux, reflux damage to the gullet and especially Barrett&rsquo;s oesophagus are strong reasons to prefer a bypass. Mild reflux is not always a contraindication, particularly if a hiatal hernia is repaired, but it must be discussed openly with the surgeon after the endoscopy.<\/p>\n<h3>Which general contraindications apply?<\/h3>\n<p>The SMOB guidelines list contraindications that apply to all bariatric operations, including ongoing pregnancy, unstable heart disease such as a heart attack in the past six months, severe kidney failure without dialysis, advanced liver cirrhosis, a pulmonary embolism or deep vein thrombosis in the past six months, uncontrolled cancer, severe mental illness with repeated decompensation, persistent substance abuse, and inability to understand or follow treatment.<\/p>\n<h3>Is type 2 diabetes a reason to choose a bypass instead?<\/h3>\n<p>Not automatically. The sleeve improves diabetes in many patients, but the randomised trials show somewhat better remission after a bypass. For people with long-standing diabetes treated with insulin, a bypass is often preferred. The choice is made with the surgeon and, ideally, an endocrinologist.<\/p>\n<h3>What if I already had a gastric band?<\/h3>\n<p>Converting a band into a sleeve is possible but technically more demanding, because the stomach wall may be scarred. Some surgeons prefer a bypass in this situation. A detailed assessment is required.<\/p>\n<h2 id=\"recovery\">Recovery: the first weeks<\/h2>\n<h3>How long will I stay in hospital?<\/h3>\n<p>Medespoir&rsquo;s obesity guide indicates six to eight days on site depending on the technique, of which two to four nights in hospital. You walk from the day after surgery, start sips of liquids progressively, and are monitored for tolerance and vital signs before discharge to the hotel.<\/p>\n<h3>Is it painful?<\/h3>\n<p>Medespoir&rsquo;s guide describes moderate pain covered by painkillers, shoulder discomfort caused by the gas used during laparoscopy that disappears within a few days, possible nausea in the first days, marked but improving fatigue and an initial difficulty staying hydrated that requires a conscious effort.<\/p>\n<h3>When can I return to work and drive?<\/h3>\n<p>According to Medespoir&rsquo;s guide, normal daily activities resume in the week after your return, work usually within two to four weeks depending on its nature, sport progressively after the surgeon&rsquo;s agreement, and driving once you have stopped painkillers.<\/p>\n<h3>Why is drinking enough so important?<\/h3>\n<p>Because dehydration is one of the main reasons for readmission after a sleeve. The small stomach fills quickly and you cannot drink large amounts at once. Sip all day long, keep a bottle with you and watch for dark urine, dizziness or headaches.<\/p>\n<h3>When will I see the first results?<\/h3>\n<p>Weight loss is fastest in the first months. Plateaus are normal: Medespoir&rsquo;s guide notes that the body adapts in phases and that weight can stay stable for several weeks despite perfect behaviour, and suggests measuring your waist as well as your weight.<\/p>\n<h2 id=\"risks\">Risks and complications<\/h2>\n<h3>What are the early risks?<\/h3>\n<p>Bleeding from the staple line, a leak, infection, blood clots in the legs or lungs, and the general risks of anaesthesia. A leak usually shows within the first days or weeks with fever, a racing heart, abdominal or left shoulder pain and feeling unwell. It is an emergency. The 2025 meta-analysis shows that most leaks can be treated endoscopically, but they require a specialised team.<\/p>\n<h3>What can happen later?<\/h3>\n<p>Reflux, narrowing or twisting of the sleeve causing vomiting and difficulty eating, gallstones during rapid weight loss, deficiencies, hair loss in the first months, weight regain and, more rarely, psychological difficulties. Our guide to <a href=\"https:\/\/www.medespoir.ch\/blog\/bariatric-surgery-complications-warning-signs\/\">complications and warning signs<\/a> explains when to seek help.<\/p>\n<h3>Is alcohol more dangerous after a sleeve?<\/h3>\n<p>Alcohol passes more quickly into the blood after a sleeve, so the same drink has a stronger effect. Studies have also found an increased risk of problematic drinking after bariatric surgery, more marked after a bypass. Be cautious, especially in the first year.<\/p>\n<h3>When should I go to an emergency department in Switzerland?<\/h3>\n<p>If you have fever, a heart rate that stays fast, increasing abdominal pain, pain in the left shoulder, vomiting that prevents you from drinking, black stools or vomiting blood, or shortness of breath. Call 144 in an emergency, and tell the team that you have had a sleeve gastrectomy. Bring your operative report.<\/p>\n<h2 id=\"glp1\">The sleeve and weight-loss medicines<\/h2>\n<h3>Do medicines like semaglutide or tirzepatide replace the sleeve?<\/h3>\n<p>They have changed the landscape. They produce substantial weight loss in many people, but they must usually be taken long term, and weight tends to return when they are stopped. Surgery remains the most effective long-term treatment for many people with severe obesity. The choice depends on your BMI, health, preferences and access to treatment.<\/p>\n<h3>Can these medicines be used after a sleeve?<\/h3>\n<p>Yes. They are increasingly used to manage insufficient weight loss or regain after a sleeve, sometimes instead of a second operation. Their use after surgery should be coordinated by a specialist.<\/p>\n<h3>Do I need to stop them before surgery?<\/h3>\n<p>Possibly. They slow stomach emptying, which can increase the risk of inhaling stomach contents during anaesthesia. A multi-society guidance from the American Society of Anesthesiologists in October 2024 recommends that the surgical and anaesthesia teams decide individually, sometimes with a liquid diet for 24 hours before surgery. Always declare them.<\/p>\n<h2 id=\"myths\">Common myths about the sleeve<\/h2>\n<h3>\u00ab\u00a0The stomach grows back to its old size.\u00a0\u00bb<\/h3>\n<p>It does not grow back. The removed part is gone for good. The remaining tube can stretch somewhat over the years, which allows larger portions than in the first months, but it never returns to the volume of a normal stomach. Eating slowly and stopping at the first sign of fullness helps limit this stretching.<\/p>\n<h3>\u00ab\u00a0After a sleeve, you can only eat liquids.\u00a0\u00bb<\/h3>\n<p>Only in the first weeks. After the progressive phases, most people eat normal foods in small portions. Some foods, such as dry meat, soft fresh bread or very fibrous vegetables, can be harder to tolerate, and tolerance varies from person to person.<\/p>\n<h3>\u00ab\u00a0A sleeve is an easy way out.\u00a0\u00bb<\/h3>\n<p>Obesity is a chronic disease with strong biological drivers, and surgery is a medical treatment, not a shortcut. People who have had a sleeve still need to change their habits, take supplements for life and attend follow-up. The operation makes these efforts more effective; it does not replace them.<\/p>\n<h3>\u00ab\u00a0If I regain weight, the operation has failed.\u00a0\u00bb<\/h3>\n<p>Some regain from the lowest point is common, as the long-term studies show. What matters is the overall result over years and the improvement in health. Significant regain should be discussed early with the team, because medical treatment, nutritional support and, in some cases, a second operation can help.<\/p>\n<h3>\u00ab\u00a0Everyone loses the same amount.\u00a0\u00bb<\/h3>\n<p>Results vary widely with starting weight, age, sex, metabolism, medicines, activity and mental health. Comparing yourself with other patients on social media can be discouraging and misleading. Compare yourself with your own starting point and health goals.<\/p>\n<h3>\u00ab\u00a0A sleeve affects absorption of my medicines like a bypass.\u00a0\u00bb<\/h3>\n<p>Much less. Because the intestine is not bypassed, absorption of most medicines remains broadly normal after a sleeve, although faster stomach emptying and reduced acid can change how some medicines work. Large tablets may need to be replaced by smaller or liquid forms in the first weeks. Review all your medicines with your doctor after surgery.<\/p>\n<h2 id=\"insurance\">Swiss criteria and insurance<\/h2>\n<h3>Does Swiss basic insurance pay for a sleeve?<\/h3>\n<p>Yes, under strict conditions and in Switzerland. For surgery covered by basic insurance, an adult must have a BMI of 35 or more, a documented adequate weight-reduction treatment of at least two years in total that did not achieve or maintain a BMI below 35, a good understanding of the lifestyle changes required and written consent to lifelong follow-up. Indication, surgery, quality control and follow-up must follow the SMOB guidelines, and centres recognised by the SMOB are presumed to meet the requirements.<\/p>\n<h3>Is a sleeve in Tunisia reimbursed?<\/h3>\n<p>No. Planned surgery abroad is generally not covered by basic insurance. If you meet the Swiss criteria and are willing to follow the Swiss pathway, compare carefully. Many people who choose Tunisia do not meet the Swiss criteria, do not want to wait, or prefer a self-funded route.<\/p>\n<h3>Who pays for follow-up in Switzerland?<\/h3>\n<p>Consultations, blood tests and treatment in Switzerland after your return follow the normal rules of your health insurance, with your deductible and co-payment. Vitamins and supplements may or may not be reimbursed depending on the product and the prescription.<\/p>\n<h2 id=\"tunisia\">A sleeve in Tunisia<\/h2>\n<h3>How does the process start?<\/h3>\n<p>You send your weight, height, medical history, current medicines and any reflux symptoms. The team assesses the indication, the appropriate technique, special precautions and the length of stay. Medespoir&rsquo;s guide states that you receive the technique chosen, what it involves, the length of hospitalisation and stay, and a firm price. It also states that the team will not operate without a complete assessment, nor when lifelong supplementation cannot be ensured.<\/p>\n<h3>What should I prepare in Switzerland?<\/h3>\n<p>Blood tests, an endoscopy if possible, and a dietitian appointment for after your return. Medespoir&rsquo;s guide recommends booking your nutritional follow-up before you leave. Ask your GP to be informed and to coordinate your follow-up, especially if you take medicines for diabetes or blood pressure that will need adjusting.<\/p>\n<h3>What happens on site?<\/h3>\n<p>According to Medespoir&rsquo;s guide: airport pick-up, check-in and a consultation with clinical examination and confirmation of the technique on arrival; additional pre-operative tests if needed, an anaesthesia consultation and fasting the day before; the laparoscopic operation under general anaesthesia; then progressive liquids, early walking, tolerance checks and monitoring. Before you leave, there is a discharge check and you receive the operative report, detailed dietary instructions and the supplement schedule.<\/p>\n<h3>What does the bariatric package include?<\/h3>\n<p>Medespoir&rsquo;s guide describes a single price covering arrival care, the examination, additional tests, anaesthesia, the operation, nights in hospital, monitoring, a nutrition consultation, the convalescence stay with a companion and follow-up for twelve months. Flights, personal expenses, an extension for convenience, care in Switzerland after your return, travel insurance and bank charges are not included.<\/p>\n<h3>Is language a problem?<\/h3>\n<p>Consultations and documents in Tunisia are in French. If your French is limited, ask in advance how communication will be ensured, and consider travelling with a French-speaking companion. Dietary instructions are essential: make sure you understand them fully before leaving.<\/p>\n<h3>What legal protection exists in Tunisia?<\/h3>\n<p>Tunisian Law No. 2024-32 of 19 June 2024 on the rights of health service users and medical liability requires that patients be informed in clear language about the proposed treatment and its risks. Keep copies of your consent, operative report and discharge summary.<\/p>\n<h3>How long after surgery can I fly?<\/h3>\n<p>You fly home after the discharge check, at the end of a stay of six to eight days. Walk in the aisle, drink small sips regularly and wear compression stockings if advised, to reduce the risk of blood clots. Direct flights from Geneva and Basel-Mulhouse take about two hours.<\/p>\n<h2 id=\"price\">Price<\/h2>\n<h3>How much does a sleeve cost in Tunisia?<\/h3>\n<p>A sleeve gastrectomy in Tunisia is significantly cheaper than in Switzerland. The exact price depends on your assessment, the technique and the length of stay, and is given in a free, personal quote in your name within 48 hours.<\/p>\n<h3>What are the long-term costs to plan for?<\/h3>\n<p>Lifelong vitamins and minerals, annual blood tests, dietitian and possibly psychological follow-up, endoscopic surveillance, and possibly body contouring surgery after major weight loss. Include them in your decision.<\/p>\n<p><em>This article provides general information and does not replace a medical consultation. Your surgeon, GP, gastroenterologist and dietitian are the right people to advise you on your situation. In an emergency in Switzerland, call 144.<\/em><\/p>\n<p><strong>Ready to take the next step?<\/strong> Request your <a href=\"https:\/\/www.medespoir.ch\/devis.php\">free quote<\/a> with your weight, height, medical history and medicines. You will receive a personal answer within 48 hours. Medespoir&rsquo;s French-language <a href=\"https:\/\/www.medespoir.ch\/sleeve.php\">sleeve page<\/a>, <a href=\"https:\/\/www.medespoir.ch\/guide-chirurgie-obesite.php\">obesity surgery guide<\/a> and <a href=\"https:\/\/www.medespoir.ch\/bypass.php\">bypass page<\/a> give further details.<\/p>\n<h2 id=\"sources\">Sources<\/h2>\n<ul>\n<li>Kraljevic M., Peterli R. et al., Long-term outcomes of laparoscopic Roux-en-Y gastric bypass vs laparoscopic sleeve gastrectomy for obesity: the SM-BOSS randomized clinical trial, <em>JAMA Surgery<\/em>, 2025: <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/39969869\/\">pubmed.ncbi.nlm.nih.gov<\/a><\/li>\n<li>Saarinen I. et al., Nutritional deficiencies after sleeve gastrectomy and Roux-en-Y gastric bypass at 10 years: secondary analysis of the SLEEVEPASS trial, <em>British Journal of Surgery<\/em>, 2025: <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/40613787\/\">pubmed.ncbi.nlm.nih.gov<\/a><\/li>\n<li>Salminen P. et al., Effect of laparoscopic sleeve gastrectomy vs Roux-en-Y gastric bypass on weight loss, comorbidities, and reflux at 10 years: the SLEEVEPASS trial, <em>JAMA Surgery<\/em>, 2022: <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/35731535\/\">pubmed.ncbi.nlm.nih.gov<\/a><\/li>\n<li>Monteiro Delgado L. et al., Long-term outcomes in sleeve gastrectomy versus Roux-en-Y gastric bypass: a systematic review and meta-analysis of randomized trials, <em>Obesity Surgery<\/em>, 2025: <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/40622470\/\">pubmed.ncbi.nlm.nih.gov<\/a><\/li>\n<li>Abedalqader T. et al., Comprehensive long-term outcomes and durability of sleeve gastrectomy with up to 14 years of follow-up, <em>Obesity Surgery<\/em>, 2026: <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/41410827\/\">pubmed.ncbi.nlm.nih.gov<\/a><\/li>\n<li>Chandan S. et al., Risk of de novo Barrett&rsquo;s esophagus post sleeve gastrectomy: a systematic review and meta-analysis, <em>Clinical Gastroenterology and Hepatology<\/em>, 2025: <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/39059544\/\">pubmed.ncbi.nlm.nih.gov<\/a><\/li>\n<li>Galloro G. et al., Endoscopic treatment of staple-line leaks after sleeve gastrectomy: a systematic review with meta-analysis, <em>Obesity Surgery<\/em>, 2025: <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/41111120\/\">pubmed.ncbi.nlm.nih.gov<\/a><\/li>\n<li>ASMBS and IFSO, 2022 indications for metabolic and bariatric surgery, <em>Surgery for Obesity and Related Diseases<\/em>, 2022<\/li>\n<li>American Society of Anesthesiologists, multi-society guidance on GLP-1 medicines before surgery, October 2024: <a href=\"https:\/\/www.asahq.org\/about-asa\/newsroom\/news-releases\/2024\/10\/new-multi-society-glp-1-guidance\">asahq.org<\/a><\/li>\n<li>Swiss Society for the Study of Morbid Obesity and Metabolic Disorders (SMOB), guidelines in force since 1 July 2023: <a href=\"https:\/\/www.smob.ch\/\">smob.ch<\/a><\/li>\n<li>Health Care Benefits Ordinance (KLV\/OPAS), Annex 1: <a href=\"https:\/\/www.fedlex.admin.ch\/eli\/cc\/1995\/4964_4964_4964\/en\">fedlex.admin.ch<\/a><\/li>\n<li>Tunisian Law No. 2024-32 of 19 June 2024 (in French): <a href=\"https:\/\/www.ordremedecins.tn\/loi-responsabilite-medicale.html\">ordremedecins.tn<\/a><\/li>\n<li>Medespoir (in French): <a href=\"https:\/\/www.medespoir.ch\/sleeve.php\">sleeve<\/a>, <a href=\"https:\/\/www.medespoir.ch\/guide-chirurgie-obesite.php\">obesity surgery guide<\/a>, <a href=\"https:\/\/www.medespoir.ch\/bypass.php\">gastric bypass<\/a>, <a href=\"https:\/\/www.medespoir.ch\/grossesse-apres-sleeve.php\">pregnancy after a sleeve<\/a><\/li>\n<\/ul>\n<h2 id=\"faq\">Frequently asked questions<\/h2>\n<h3>How much of the stomach is removed in a sleeve?<\/h3>\n<p>About two thirds, along its outer curve, including the fundus that produces most of the hunger hormone ghrelin.<\/p>\n<h3>Can a sleeve be reversed?<\/h3>\n<p>No, but it can be converted into another operation, most often a gastric bypass, if needed.<\/p>\n<h3>How long does a sleeve operation take?<\/h3>\n<p>About one to two hours by keyhole surgery under general anaesthesia.<\/p>\n<h3>How long will I stay in Tunisia for a sleeve?<\/h3>\n<p>Six to eight days according to Medespoir&rsquo;s guide, including two to four nights in hospital.<\/p>\n<h3>Will I regain weight after a sleeve?<\/h3>\n<p>Some regain from the lowest weight is common over the years. Regular follow-up, good habits and, if needed, medicines or revision help limit it.<\/p>\n<h3>Does a sleeve cause reflux?<\/h3>\n<p>It can cause new reflux or worsen existing reflux. An endoscopy before surgery and surveillance afterwards are recommended.<\/p>\n<h3>Do I need vitamins after a sleeve?<\/h3>\n<p>Yes, multivitamins with minerals for life, plus targeted supplements such as vitamin B12, iron or vitamin D according to blood tests.<\/p>\n<h3>Is a sleeve better than a bypass?<\/h3>\n<p>Neither is better for everyone. A bypass gives slightly more weight loss and better reflux control; a sleeve has fewer late major complications and keeps the digestive route intact.<\/p>\n<h3>When can I eat normally after a sleeve?<\/h3>\n<p>After several weeks of progression from liquids to pur\u00e9es and soft foods, with small portions for life.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>How a sleeve gastrectomy is performed and why it works, ten-year results from the Swiss SM-BOSS and Finnish SLEEVEPASS trials, reflux and Barrett&rsquo;s oesophagus, vitamins, who it suits and how the operation is organised in Tunisia.<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[288],"tags":[],"class_list":["post-12826","post","type-post","status-publish","format-standard","hentry","category-tunisia-en"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin 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