Sleeve gastrectomy is a RESTRICTIVE procedure. The operation was originally performed years ago as the first part of a two part procedure in very high risk patients. The objective was to enable the patient to lose weight with the sleeve first and when they were less high risk, to convert the sleeve to a gastric bypass for further weight loss. The sleeve operation has been modified over the years and is now a stand-alone procedure with excellent weight loss results. During this operation, the surgeon creates a long thin tube (sleeve) out of the stomach. A long plastic tube or an endoscope is passed into the stomach and the stapler is fired multiple times along side it to create the sleeve. The rest of the stomach is removed through one of the ports. The surgeon then checks the integrity of the staple line to make sure it is not leaking or bleeding or too narrow. Post-operative care for patients with the sleeve gastrectomy is similar to gastric bypass. Fluids are taken on the first day, gradually increasing to pureed diet. The average length of stay is two days. Follow up is similar to gastric bypass.