Gastric Sleeve Regret: Why It Happens

Gastric sleeve surgery (sleeve gastrectomy) is an operation in which about 75-80% of the stomach is removed laparoscopically, leaving a narrow, tube-shaped stomach. It is the most frequently performed obesity operation in the world today. One of the topics patients research most before deciding is the experience of people who regret having it. The answer should be sought not in individual online stories but in studies that have followed patients for years after surgery.

Do People Regret Gastric Sleeve Surgery?

Some do, but fewer than is often assumed. In studies following patients for 5-6 years after surgery, the proportion who clearly regret their decision is reported at about 7-8%. A study of sleeve patients in Turkey also found generally low levels of regret.

Important Note: A low rate does not mean regret is unimportant. Patients who regret their decision show a markedly smaller improvement in quality of life. This is why the reasons behind regret should be known before surgery.

The Most Common Reasons for Regret

1. Not Losing the Expected Weight, or Regaining It

Patients who report regret have, on average, lost noticeably less weight; the more weight patients lose, the less regret they report.

• Insufficient Weight Loss: Weight loss varies from person to person. Diet, activity level and associated conditions directly affect the result.
• Weight Regain: Weight usually reaches its lowest point 12-18 months after surgery. Some regain in the following years is common; marked regain is usually linked to a return of old eating habits.

2. Reflux (Heartburn)

After a sleeve, pressure inside the stomach rises and the valve mechanism between the oesophagus and the stomach can weaken.

• New Reflux: In studies, about one in four or five patients who had no reflux before surgery develop it afterwards.
• Damage to the Oesophagus: In the long term, inflammation of the oesophagus (oesophagitis) can develop. Less often, a cell change called Barrett's oesophagus is seen, which is why endoscopy is important in follow-up.

Important Note: In patients with significant reflux or a hiatal hernia before surgery, gastric bypass or another operation may be preferred over the sleeve. More information is available on our reflux surgery page.

3. Digestive Symptoms

Bloating, early fullness, nausea and constipation are common after surgery. Bloating has been reported about twice as often in patients who regret their decision.

4. Hair Loss

Hair loss is common during the period of rapid weight loss and has been reported in about half of patients after bariatric surgery. It is usually temporary. Adequate protein intake and regular use of vitamin and mineral supplements are important.

5. Excess Skin

After substantial weight loss, excess skin can develop on the abdomen, arms, chest and thighs. Most patients would like body contouring surgery, but only a minority go on to have it. Knowing this before surgery helps to set realistic expectations.

6. A Changed Relationship With Food

Small portions, the need to eat slowly and difficulty with meals in social settings can leave some patients with an unexpected sense of loss. New eating habits take time to settle.

7. Psychological Difficulties

Most patients' mood and social life improve after surgery. Some, however, develop depression, eating disorders or difficulty adapting to their new body image. Studies show that mental health also needs careful attention after surgery.

8. Unrealistic Expectations

The belief that "surgery will solve everything" is one of the main sources of regret. A gastric sleeve is a powerful tool that makes weight loss easier; the long-term result depends on diet, physical activity and attending follow-up.

Travelling Abroad for Surgery: Plan Your Aftercare

Many of the problems that lead to regret, such as reflux, weight regain and vitamin deficiencies, appear months or years after the operation, when patients who travelled for surgery are already back home.

• Before Travelling: Agree in advance who will follow you up in the long term and how blood tests and vitamin monitoring will be organised.
• Written Summary: Ask the surgical team for a written summary of your operation, your supplement plan and blood test schedule, and share it with your GP.
• Staying in Contact: Make sure you know how to reach the surgical team if symptoms develop.

European obesity and bariatric surgery societies published joint recommendations in 2025 for patients travelling abroad for surgery; preoperative assessment and structured follow-up are among their central points.

Can You Fail to Lose Weight After a Gastric Sleeve?

Yes, although it is uncommon. The cause should be established first:

• Diet: Frequent snacking, high-calorie drinks and sugary beverages are the most common causes.
• Eating Behaviour: Binge or emotional eating can continue after surgery.
• Medical Causes: Hormonal conditions and weight-promoting medicines are investigated.
• Technical Causes: Where needed, the stomach volume is assessed with endoscopy and imaging.

Steps Before Surgery to Prevent Regret

1. Careful Patient Selection: Eligibility is not determined by BMI alone; associated conditions, eating behaviour and the ability to attend follow-up are assessed together. See Who Is Eligible for Gastric Sleeve Surgery? for details.
2. Reflux Assessment: An endoscopy is performed before surgery, and the type of operation is chosen accordingly if significant reflux or a hiatal hernia is present.
3. Realistic Expectations: How much weight the operation can achieve, when weight loss slows and the possibility of regain should be discussed openly.
4. Psychological Assessment: Eating disorders, depression and anxiety should be assessed and treated before surgery.
5. A Follow-Up Plan: Dietitian appointments, regular blood tests and vitamin supplements should be planned before the operation.

What Should a Patient Who Regrets the Surgery Do?

• Reflux: Medication and dietary changes come first. For severe reflux that does not respond to treatment, conversion of the sleeve to gastric bypass may be considered.
• Weight Regain: Diet and eating behaviour are reorganised; for suitable patients, medication or revisional surgery are among the options.
• Vitamin and Mineral Deficiencies: These are identified with blood tests and treated.
• Psychological Difficulties: Psychological support is an integral part of care.

Important Note: A gastric sleeve cannot be reversed, because the removed part of the stomach cannot be restored. It can, however, be converted to another operation if needed. For an overview of the options, see our obesity surgery page.

Frequently Asked Questions

Do people regret having a gastric sleeve?

Some do, but the rate is low. Long-term studies report marked regret in about 7-8% of patients. Regret is most often linked to insufficient weight loss, weight regain, reflux and digestive symptoms.

What should I do if I regain weight after a gastric sleeve?

The cause of the regain should be investigated first. Diet and eating behaviour are reorganised, and medication or revisional surgery is considered if needed.

Can a gastric sleeve be reversed?

No. The removed part of the stomach cannot be restored. If needed, a sleeve can be converted to another operation such as gastric bypass.

What should be avoided after a gastric sleeve?

In the first weeks the diet starts with liquids and progresses step by step, so solid food is not eaten during this period. Fizzy and sugary drinks, alcohol and smoking should be avoided, and fluids should not be taken together with meals. When to move on to each food group is decided by the surgeon and dietitian.

I had my surgery abroad. Who should follow me up at home?

Long-term follow-up should ideally be agreed before surgery. Share the written summary of your operation and your supplement and blood test plan with your GP. If persistent vomiting, abdominal pain, fever or difficulty swallowing develops, contact your surgical team or seek local medical care promptly.

Important Warnings

1. Do not base the decision on individual stories on social media.
2. Do not stop your vitamin and mineral supplements on your own.
3. Do not miss follow-up appointments; some problems appear years after surgery.
4. Seek medical advice without delay for persistent heartburn, vomiting or difficulty swallowing.
5. If persistent low mood or thoughts of self-harm develop after surgery, contact your GP or a mental health professional; in an emergency, call your local emergency number.

Conclusion

Marked regret after a gastric sleeve is uncommon, but when it occurs it affects quality of life. Many of its most common causes, namely insufficient weight loss, weight regain, reflux and digestive symptoms, can be reduced through careful patient selection, a thorough assessment before surgery and regular follow-up. For patients travelling for surgery, agreeing the aftercare plan in advance is part of the same decision. The decision should be made with an experienced general and bariatric surgery team, once the possible problems have been discussed as openly as the benefits.

References

• Zoumpou T, Fleishman A, Jones DB, Wee CC. Decision regret up to 6 years after sleeve gastrectomy. Surgical Endoscopy, 2023.
• Bartosiak K, Janik MR, Kowalewski P, Walędziak M, Kwiatkowski A. Decision Regret after Laparoscopic Sleeve Gastrectomy — 5 Years' Perspective. Obesity Surgery, 2021.
• Kılınç T, Yayla A, Karaman Özlü Z, Balaban D. The relationship of decision regret with quality of life and comfort level in patients undergoing laparoscopic sleeve gastrectomy: a cross-sectional study. Surgery for Obesity and Related Diseases, 2025.
• Yeung KTD, Penney N, Ashrafian L, Darzi A, Ashrafian H. Does Sleeve Gastrectomy Expose the Distal Esophagus to Severe Reflux? A Systematic Review and Meta-analysis. Annals of Surgery, 2020.
• Salminen P, Grönroos S, Helmiö M, et al. Effect of Laparoscopic Sleeve Gastrectomy vs Roux-en-Y Gastric Bypass on Weight Loss, Comorbidities, and Reflux at 10 Years in Adult Patients With Obesity: The SLEEVEPASS Randomized Clinical Trial. JAMA Surgery, 2022.
• Taghizadeh N, Salhab H, Alirezaei A, et al. Hair Loss and Metabolic and Bariatric Surgery: An Updated Systematic Review and Meta-analysis. Obesity Surgery, 2025.
• Dobbie LJ, Birney S, Breen C, et al. European recommendations from healthcare professionals and people living with obesity on safe practice for bariatric and metabolic surgery medical tourism: a modified Delphi consensus statement from EASO, IFSO-EC, and ECPO. International Journal of Surgery, 2025.