As the most common weight loss surgery procedure performed today, Gastric Sleeve Surgery  or Vertical Sleeve Gastrectomy (VSG) is extremely effective and low-risk. Most gastric sleeve patients lose about 65 to 75% of their excess weight (EW) in the first two years and come to a healthy weight.

Unfortunately, no bariatric surgery is 100% effective for all patients, including gastric sleeve. Failure to lose weight or develop complications is uncommon but happens from time to time mainly due to improper diet, sleeve enlargement, and hormonal factors.

One of the reasons that gastric sleeve is so popular because it has many revisional options. Mexico Bariatric Center® facilitates rescue and correction of previous weight loss surgeries in Tijuana, Mexico. MBC’s best weight loss surgeons have extensive experience in revising failed vertical sleeve surgeries and getting you back on track.

Gastric Surgery Revision

What Can Go Wrong with Gastric Sleeve Surgery?

Botched gastric sleeve surgery could be due to unsuccessful weight loss or having problems with the operation. Here are a few reasons you may need to fix your gastric sleeve;

1. Lack of Weight Loss – The most obvious reason for poor outcome is repetitive unhealthy eating habits. Consuming high caloric meals and not following post-op diet instructions can and will affect the surgery’s outcome.

2. Weight Regain – Some patients regain weight after the first weight loss procedure.

  • Changes in diet
  • Gradual dilatation of sleeve – As the stomach expands you eat more
  • Physiological – Rising hormone (ghrelin) levels

3. Post-Operative Problems – Possible surgical or medical complications after gastric sleeve include;

  • Sleeve stenosis (stricture or narrowing)1, twisting torsion of sleeve
  • Gastroesophageal reflux disease

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When Sleeve Revision is Needed

Gastric sleeve procedure is an acquired tool to help you lose weight, however, diet and exercise are equally important. If you have not been successful in losing all the weight, does not mean you should undergo sleeve revision. Here are things to consider:

Your Diet 

Keep track of your daily diet as accurately as you can in a food diary. This would help your doctor and nutritionist to analyze your progress and find the right solution. If your diet is to be blamed, modifying that helps you avoid an unnecessary procedure. Try out the 5-day pouch reset diet.

Exercise

Eating less and eating healthier isn’t enough to lose excess weight and keep it off. Part of your post-surgery instruction is to get a moderate amount of activity as soon as your body has healed. Mexico Bariatric Center supports post-bariatric patients’ weight loss efforts by offering Nutritional Bootcamps.

Gastric Sleeve to Bypass Revision Surgery Before and After Patient Photo

1. Gastric Sleeve Revision to Gastric Bypass or Mini Bypass Surgery

Gastric sleeve to gastric bypass or mini-bypass revision surgery is by far the most popular option available and widely used in case of a lack of weight loss or post-op problems. RNY gastric bypass procedure adds malabsorption through bypassing a portion of the small intestine while forming a new stomach pouch.[2]

The success rate of the gastric sleeve to bypass revision is the highest compared to other re-interventions. The average excess weight loss (%EWL) at 3, 6, and 12 months was 33.3%, 49%, and 56.7%.[3]

Gastric Sleeve Revision to Gastric Bypass Surgery - Bariatric Surgery Revision

Advantages of Gastric Sleeve to Gastric Bypass Revision Surgery

Besides a fresh start with revising the gastric sleeve to a gastric bypass, there are many advantages that may benefit your health.

  • Adds malabsorption which limits food intake stored in fat cells
  • Relieve Acid Reflux and GERD that worsened with gastric sleeve
  • Higher success rates with least amount of side effects compared to other types of VSG revision procedures
  • If gastric sleeve was not effective the entire duration post-op, your body is more e likely to favor the malabsorption of RNY Bypass
  • Favorable in boosting remission rates of obesity-related health issues like Type II Diabetes, Cardiovascular Disease, and debilitating illnesses

Disadvantages of Gastric Sleeve to Gastric Bypass Revision Surgery

  • Nutrient deficiencies require a daily vitamin/supplement regime
  • Not likely to revise again after sleeve to bypass is completed
  • 100% effort is given and habits are altered before surgery
  • Changes to anatomy due to bypassing (rerouting a portion of intestines)

2. Re-Sleeve Gastrectomy (Tightening)

In a few cases, the surgeon may also consider re-sleeving – trimming a portion for the stomach that has re-expanded to create a smaller tube or sleeve.[4] ReSleeve Gastrectomy (RSG) is a viable option if the sleeve was not done right and/or the pouch has been dilated. Generally, the patient can tell if the restriction they felt earlier is gone and do not feel it anymore. Research shows that two years after the sleeve operation, the volume of the stomach can double.

a) Laparoscopic Re-Sleeve

A good candidate for laparoscopic re-sleeve is a patient with a correctable anatomic defect as thicker tissues are anticipated along the staple line due to the first surgery.

The surgeon also will; 1) Use a smaller bougie 2) Avoid creating an ischemic zone (the new staple line should be inside the old one). There is not enough solid data to know its long-term, overall weight loss results, and success rate.

b) Gastric Sleeve Revision with Endoscopic Suturing

Endoscopic Sleeve Gastroplasty (ESG) is a non-surgical procedure performed with a suturing device on the tip of an endoscope. The endoscopic plication device introduced through the mouth sews the gastric body to shrink and restores the original size of the sleeve gastrectomy. This restriction recreates the feeling of fullness with meals and enables further weight loss. This non-surgical procedure can be done on an outpatient basis with no hospital stay required.

3. Gastric Sleeve to Duodenal Switch Revision

Gastric sleeve conversion to duodenal switch is a viable option but is a very aggressive one. The perk of revising sleeve to DS is that the first part of the DS is already completed with gastric sleeve surgery as 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 fewer calories while eating and digesting food. Mexico bariatric surgeon also looks to tighten the original sleeved stomach if it is stretched and needed to be resleeved.

Gastric Sleeve to Duodenal Switch Revision Surgery - Revising VSG to DS
Gastric Sleeve Revision to Adjustable Banded Sleeve - Adding Gastric Band to Sleeve

4. Gastric Sleeve with Adjustable Gastric Band

Adjustable gastric banding over a “failed” sleeve gastrectomy is an alternative but not recommended. Lap Band used to be popular, but now is known for its complications, risks, and it’s a failure. Adding a lap band to an existing gastric sleeve is an option, but rarely performed by most bariatric surgeons.

Gastric sleeve revision surgery starting at $5,795 $5,345*

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.[5] The outcome depends completely on the revision surgery option and the effectiveness it has on the patient.

At Mexico Bariatric Center, less than 4% of sleeve patients need a second surgery to get to their ideal weight. Converting gastric sleeve to mini bypass at MBC Tijuana surgical center has been the most effective revision option.

Advantages of Gastric Sleeve Procedure

Laparoscopic Sleeve Gastrectomy (LSG) carries many advantages and is a great “starting point” for patients deciding which procedure they should undergo.

  • Fewer advers effects and higher expected weight loss than Lap Band
  • Less complex than RNY Gastric Bypass and Duodenal Switch
  • Easily corrected if results are not satisfactory