- Removes roughly 75-80% of the stomach; the intestine stays intact.
- Typical loss: about 20-30% of total body weight.
- Keyhole surgery of 45-75 minutes under general anaesthesia.
- Irreversible; reflux can get worse.
- Covered by Dutch basic insurance with a referral and indication.
What is a gastric sleeve?
During a sleeve gastrectomy the surgeon staples the stomach lengthwise and removes the larger, curved part. What remains is a tube-shaped stomach that holds far less food. The operation is done laparoscopically through four or five small incisions, and takes about 45 to 75 minutes.
Because the removed part of the stomach produces most of the hunger hormone ghrelin, many people notice much less appetite in the first months. Unlike a bypass, the route food takes through the intestine does not change, so absorption of nutrients is affected less, although you still need lifelong supplements.
When do Dutch centres choose a sleeve rather than a bypass?
Vitalys explains that Dutch centres generally prefer the bypass because they have more experience with it, while both operations can give comparable weight loss. A sleeve is preferred with many adhesions from earlier abdominal surgery, a BMI above 60, and intestinal diseases such as Crohn's disease or ulcerative colitis. With a BMI above 60, the sleeve is often a first step, with a SADI or bypass considered about two years later.
What are the risks and drawbacks of a gastric sleeve?
The most important drawback specific to the sleeve is reflux: the narrow tube is under higher pressure, so stomach acid flows back more easily. Persistent reflux is a known reason for later revision to a bypass. Severe existing reflux is therefore an argument against a sleeve.
Other risks are those of any bariatric operation: leakage at the staple line (rare but serious), bleeding and thrombosis around the operation, and deficiencies later on. The sleeve is irreversible because part of the stomach is removed. Nationally, 1.4 percent of Dutch patients had a serious complication in 2024.
Advantages and points of attention: gastric sleeve
Advantages
| Advantage | Explanation |
|---|---|
| Intestine intact | no rerouting, less malabsorption than a bypass |
| Less hunger | ghrelin-producing part of the stomach removed |
| Shorter operation | about 45-75 minutes |
| Useful first step | at very high BMI, followed later by SADI or bypass |
Points of attention
| Point of attention | Explanation |
|---|---|
| Reflux | can increase; may need revision |
| Irreversible | part of the stomach is removed |
| Weight regain | possible after several years |
| Supplements | lifelong WLS multivitamin and calcium |
Cost and insurance (2026)
With a GP referral and a valid indication the full pathway is covered by the Dutch basic package; you pay your mandatory deductible.
| Item | Amount or arrangement |
|---|---|
| Covered pathway | €385 deductible (2026) |
| Self-pay in the Netherlands | roughly €7,000 to €11,000 |
| WLS vitamins and calcium | about €10-€15 a month, not covered |
Gastric sleeve: key figures
| Feature | Value |
|---|---|
| Stomach removed | about 75-80% |
| Operation time | 45-75 minutes |
| Weight loss | about 20-30% of total body weight |
| Calcium after a sleeve | at least 1,000 mg a day |
| Serious complications nationally (2024) | 1.4% |
Gastric sleeve compared with a gastric bypass
| Feature | Gastric sleeve | Gastric bypass |
|---|---|---|
| Intestine rerouted | no | yes |
| Operation time | 45-75 min | 90-120 min |
| Effect on reflux | can increase | usually decreases |
| Dumping | rare | common after sugar and fat |
| Reversible | no | technically possible |
Step by step
- Referral. Your GP refers you to a DATO-certified centre.
- Screening. Internist, psychologist and dietitian assess you.
- Preparation. Stop smoking, keep your weight stable.
- Surgery. Keyhole operation, short hospital stay.
- Aftercare. Checks at 6, 12 and 18 months, then yearly to five years.
Read next
- Gastric bypass as an alternative — stomach and intestine
- Types of weight loss surgery — all options
- Cost of a gastric sleeve — and Dutch coverage
- Eligibility for a gastric sleeve — BMI and conditions
Frequently asked questions about the gastric sleeve
On average about 20 to 30 percent of your total body weight, most of it in the first year. Results vary with starting weight, eating habits and exercise, and some weight can return after five to ten years.
Yes. With a GP referral and a valid indication it is covered by the basic package. You only pay your mandatory deductible, 385 euros in 2026. Vitamins are not covered.
About 45 to 75 minutes as keyhole surgery under general anaesthesia. Including anaesthesia and recovery room, you are away from the ward for a few hours.
No. Part of the stomach is permanently removed. It can be converted to a bypass or SADI in a revision operation, for example because of reflux or weight regain.
It can. The narrow tube is under higher pressure, so acid flows back more easily. Many cases respond to acid-reducing medication; persistent reflux can be a reason to convert to a bypass.
Most people recover in three to six weeks. Office work is often possible after about two weeks, heavy work after four to six weeks. You may not lift more than 2.5 kilograms in the first four to six weeks.
Yes, for life: a WLS multivitamin designed for the sleeve plus at least 1,000 mg of calcium with vitamin D a day. A standard multivitamin from the drugstore is not enough.
People with many abdominal adhesions, a BMI above 60, or intestinal disease such as Crohn's disease. With type 2 diabetes or significant reflux, a bypass is usually the better option.
Yes, but wait at least the first year, when you lose weight fastest. Take 400 micrograms of folic acid from four weeks before conception, alongside your WLS vitamins, and inform your bariatric centre.
At one of the 20 DATO-certified centres, hospitals and independent clinics that meet national volume and quality standards. Check which centres your insurer has contracted before your referral.
Call +31 6 38048347 (Mon–Fri 09:00–17:00) or email info@maagverkleining-info.nl. This page is also available in Dutch.
Sources
- Vitalys (Rijnstate): sleeve or bypass, FAQ
- WeightWorks: gastric sleeve
- DATO Annual Report 2024, DICA
- Richtlijn Chirurgische behandeling van obesitas, NVvH
Search terms leading here: gastric sleeve Netherlands, sleeve gastrectomy Netherlands, gastric sleeve cost Netherlands, gastric sleeve insurance Netherlands.
Author: Gijs Bodenstaff. Last reviewed: September 2026.