As the most common weight loss surgery procedure performed today, Gastric Sleeve Surgery is extremely effective and low-risk – especially compared to the previous “gold standard”, Roux-en-Y Gastric Bypass. By removing 85% of the stomach, the Vertical Sleeve Gastrectomy (VSG) is popular because it is easily revised.
Unfortunately, no weight loss procedure is 100% effective for all patients, including gastric sleeve. Failure rates are uncommon, but happen from time to time. The good thing is that gastric sleeve surgery has a variety of revision options.
Why Does Gastric Sleeve Failure?
Research shows that two years after the sleeve operation, the volume of stomach can double—as I’ve said, that’s natural and it’s no one’s fault. As the stomach expands, some patients begin to eat more. This group may benefit from a revision. Options include conversion to a bypass, conversion to a duodenal switch or re-sleeving. 
Advantages of Gastric Sleeve Surgery Revision
- Less complex than RNY Gastric Bypass and Duodenal Switch
- Less complications and higher expected weight loss than Lap Band
- Easily revised if failed surgery
Laparoscopic Sleeve Gastrectomy (LSG) carries many advantages and is a great “starting point” for patients deciding which procedure they should undergo.
If the patient have not had sufficient weight loss or has regained weight despite a good diet, the gastric sleeve can be revised to:
Revision Option #1: Gastric Sleeve Revision to Gastric Bypass
Gastric sleeve to bypass revision surgery is by far the most popular option available and widely used. Gastric bypass surgery adds malabsorption through bypassing a portion of the small intestine while forming a new stomach pouch.
The success rate of sleeve to bypass revision has the highest success rate compared to other revision procedures. The average excess weight loss (%EWL) at 3, 6 and 12 months was 33.3%, 49% and 56.7%.
Revision Option #2: Gastric Sleeve Re-Sleeve
In a few cases, we may also consider re-sleeving—trimming a portion for the stomach that has re-expanded to create a smaller tube, or sleeve.
The ReSleeve (ReSG) may be a viable option for failure of gastric sleeve surgery. Long-term results of do not have enough solid date to know it’s overall weight loss results and success rate.
Resleeve gastrectomy is a viable option if the sleeve was not done tight and / or pouch has been dilated. A good candidate for resleeve is a patient with a correctable anatomic defect. Anticipate thicker tissues along the staple line due to the first surgery. Considerations when re-sleeving:
- Using a smaller Bougie
- Avoid creating ischemic zone (the new staple line should be inside the old one)
Revision Option #3: Adjustable Gastric Banded Gastric Sleeve
Adjustable gastric banding over a sleeve after “failed” sleeve gastrectomy is performed but not recommended. Lap Band used to be popular, but now is known for its complications, risks, and it’s failure. Adding a lap band to an existing gastric sleeve is an option, but rarely performed by most bariatric surgeons.
Revision Option #4: Sleeve to Duodenal Switch Revision
Gastric sleeve conversion to duodenal switch is a viable option but is a very aggressive option. The perk of revising sleeve to DS is that the first part of the DS is already completed with gastric sleeve surgery – because the sleeve-shaped stomach is already in place. Therefore, the surgeon has to perform the second step which is to reroute a significant portion of the small intestine to absorb less calories while eating and digesting food.
Success Rate of Gastric Sleeve Revision
Patients who had revision surgery due to inadequate weight loss experienced a significant decrease in body mass index (BMI), from an average of 55.4 to an average of 35, and an average loss of 68.9 percent of excess body weight. The outcome depends completely on the revision surgery option and the effectiveness it has on the patient.