Gastric Sleeve Surgery or Vertical Sleeve Gastrectomy (VSG) is a widely-known and popular surgery done for weight loss. Patients anticipate dropping more than 50 pounds due to restricted food intake and hormonal changes.

While sleeve bariatric procedure is an effective remedy for obesity and its related diseases, it may not always be successful. Sleeve surgery failure is multifactorial and warrants a revision. Understanding the reasons why gastric sleeve fails helps you to be a success. This article will dive deeper into why gastric sleeve fails and suggest possible steps forward.

Characterization of gastric sleeve failure:

A variety of elements can define gastric sleeve letdown:

  • The patient does not lose much weight
  • The patient does not reach their goal weight
  • The patient regains weight after initial weight loss
  • Surgical risks or complications
  • Side Effects that impact daily life

Is it possible for the gastric sleeve not to work?

Yes, weight drop from laparoscopic sleeve gastrectomy can be unsustainable. Although this is rare, some patients do not experience the results intended with bariatric surgery.

Remember hitting plateaus after weight loss surgery is normal and temporary. Don’t panic!

Weight loss stalls because your metabolism adjusts to reduced caloric intake. Here are 5 ways to beat stalls after bariatric surgery.

What is the failure rate of the gastric sleeve?

Sleeve debacle could be related to,

  • Surgical technique – not all gastric sleeves are created equally.
  • Physiological – gradual pouch dilation and hormonal adaption.
  • Psychological – reverting to improper eating habits.

A five-year study on the outcomes of sleeve surgery was published in NCBI. According to this study, the patients’ mishaps (%EWL of less than 50%) are:

  • 3.9% after 1 year
  • 4.9% after 2 years
  • 10.5% after 3 years
  • 17.9% after 4 years
  • 27.0% after 5 years

In a research study done by Mexico Bariatric Center® based on 726 Gastric Sleeve patients between 6 months and 24 months post-op, there was a 2.62% fail rate which amounted to no weight loss or weight gain.

MBC survey data shows a low statistical percentage of gastric sleeve surgery not being effective, and there are many testimonials and success stories to serve as evidence.

Why does gastric sleeve stop working?

Here are seven reasons for undesirable gastric sleeve results:

  1. Unhealthy Diet: Returning to old eating habits is one of the biggest causes of gastric sleeve inadequacy. Some dietary reasons for being unsuccessful are consuming a lot of high dietary fats, carbonated drinks, and refined sugar. Creating a diet plan or exercising to burn calories will help in the long term.
  2. Lack of Exercise: Returning to a sedentary lifestyle can hinder weight loss progress. Physical activity is critical to protect you from obesity-related medical conditions such as type 2 diabetes, high blood pressure, or heart disease. 
  3. Pouch Stretching or Loose Sleeve: The sleeve can still be big after surgery which over time causes the restriction to be lost. The dilation could be related to the initial resected fundus volume and bougie size. They can also have long intestines, which absorb too much of the calories they eat.
  4. Surgical Complications: Serious complications that result in lifelong health problems can be classified as failure, including Chronic nausea, vomiting, infection, and obstruction of the stomach.
  5. Poor Vitamin Intake: A study by NIH analyzed how not taking vitamins after surgery can lead to more health issues. “The patient under discussion was admitted with severe anemia that was mainly attributed to her poor compliance with vitamin supplements.”
  6. Medication: Many people take meds daily without knowing the potential weight gain side effects.
  7. Negative Side Effects: Including acid reflux, hair loss, constipation, nausea, etc.

Why does gastric sleeve fail

How many years does a gastric sleeve last?

The first 18 months of post-op is known as the “Honeymoon Phase” because it is a time when weight loss is almost inevitable as long as healthy habits are in place. What tends to happen after 18 months is that your weight loss will stop, and the return of food cravings will begin.

According to Matthew Weiner, MD, “Weight gain is common after a sleeve gastrectomy in 2-3 years and after a Gastric Bypass in 4-5 years”. Weight gain is not a sign of personal failure; it is preventable through weight management, such as building muscle and better nutrition.

Unhappy with your sleeve?

Gastric Sleeve may not yield the outcomes you were looking for. If you didn’t lose dramatic weight or regained weight, you can take a look at non-surgical weight loss options or do a correction surgery. Non-surgical weight loss options include diet, exercise, or medication. Reaching out to a fitness trainer and nutritionist can help you get back on your feet.

If you are experiencing unmet weight loss results or unpleasant side effects after gastric sleeve, revision surgery may be needed. A modification of gastric sleeve surgery may be required:

  • Rising ghrelin levels
  • Stretched stomach pouch or damaged sleeve
  • Other health complications: Gastric sleeve side effects some patients suffer post-operatively are acid reflux (GERD) or hiatal hernia. If these side effects affect your daily life, a revision can be done to alleviate these symptoms.

Types of revision surgeries:

According to the Journal of Obesity and Weight-loss Medication, a study shows that “Revisional bariatric surgery performed using the laparoscopic approach can be completed with acceptable postoperative morbidity risks and shows satisfactory short-term weight loss.” Options include conversion to a bypass, conversion to a duodenal switch, or re-sleeving:

  • Gastric Re-sleeve: Tightening the sleeved pouch to create the lost restriction and remove more hunger hormones could be viable in certain circumstances. This revision can be performed laparoscopically or endoscopically.
  • Gastric Bypass: Unlike the gastric sleeve, which is only restrictive, the gastric bypass is both restrictive and malabsorptive, so it has a double effect in reducing weight.
  • Mini Gastric Bypass: This is a modification of the RNY gastric bypass. It is also called the omega loop because it makes a loop when bypassing the intestines.
  • Duodenal Switch: Combines two methods of popular weight loss procedures: the sleeve gastrectomy and the RNY gastric bypass.

Types of Gastric Sleeve Revision

Note: The risks of revision surgery may be higher than the initial surgery, so it may not be a suitable option for everyone. Please consult your bariatric team or medical professional to see what revision surgery option works for you.


Choose a center with qualified and experienced bariatric doctors to better your weight loss journey. The surgeon’s skill determines the level of success of laparoscopic sleeve surgery. Also, the chance of a complication is much lower when you undergo the operation with the top Mexican bariatric surgeons. Mexico Bariatric Center’s highly trained surgical teams specialize in the intervention of gastric sleeve failure.