The gastric sleeve also called Vertical Sleeve Gastrectomy or VSG is one of the most effective bariatric procedures with the lowest possible risk. Most patients undergoing this procedure usually lose up to 75% of excess weight within the first 2 years of the surgery.

However, as no bariatric procedure is 100% effective, some patients may need revision surgery. Patients often develop complications after the surgery, though very rare, due to hormonal factors, sleeve enlargement, and poor diet. Other patients may fail to lose adequate weight.

The gastric sleeve offers all the options for revision, which makes it a preferred choice amongst patients.

What are the Reasons to Undergo Gastric Sleeve Revision?

Failed gastric sleeve is the result of complications and insufficient weight loss after the surgery. There are some reasons why patients want to fix their gastric sleeve:

#1: Insufficient Weight Loss: Not losing enough weight is the first and foremost reason to consider gastric sleeve revision. Having a diet high in calories and not adhering to the post-operative diet

#2: Substantial Weight Regain: Some patients start regaining weight after bariatric surgery. There may be several underlying reasons for such weight regain, including changes in food habits, gradual sleeve dilation, and increasing levels of ghrelin hormone.

#3: Post-operative Challenges: There may be multiple post-operative challenges, both medical and surgical. Some common problems include sleeve stenosis, sleeve twisting torsion, and gastroesophageal reflux disease.

When is a Gastric Sleeve Revision Needed?

Gastric sleeve surgery is a specially acquired tool that helps patients lose weight. When combined with a healthy diet and regular exercise, it can help a person lose weight successfully. People who do not succeed in losing their excess weight do not necessarily have to undergo gastric sleeve revision. There are a few things to consider before opting for revision surgery – diet and exercise.

It is very important to keep a track of diet accurately. Maintain a food journal. This can help the nutritionist and the doctor to understand your progress and give you an optimum solution. If the diet is the reason for slower weight loss or weight regain, modification can help. Try to make changes to your diet before undergoing revision surgery.

Exercise is an important aspect of your weight loss routine. It not only helps patients lose weight but also assists with weight management. After the first surgery, patients are given instructions to resume moderate activities as the body heals. Try to exercise daily for better weight management.

Options for Gastric Sleeve Revision Surgery

#1: Gastric Sleeve to Gastric Bypass/Mini Bypass

Gastric sleeve surgery can be revised with either gastric bypass surgery or mini bypass surgery. These procedures, however, are only to be considered when there are post-operative problems or insufficient weight loss. Gastric bypass surgery adds malabsorption by bypassing a part of the patient’s small intestines while creating a stomach pouch.

Gastric sleeve surgery to gastric bypass revision has the highest rate of success compared to any other revision surgery. On average, a patient can lose 33.3% of their excess weight in 3 months, 49% in 6 months, and 56.77% in 12 months.

Pros & Cons

Pros

  • Adds malabsorption that restricts food intake in the fat cells
  • Relieves GERD and acid reflux
  • The highest rate of success with minimum side effects
  • Efficiently boosts remission rate of obesity and associated health diseases like cardiovascular disease, type II diabetes, and other debilitating illnesses

Cons

  • Malabsorption of nutrients causes nutrient deficiency
  • Daily vitamin and mineral supplement is essential
  • Changes to physical anatomy because of the surgery

#2: Re-Sleeve Gastrectomy (RSG)

Re-sleeving is a common procedure prompted to patients who want revision surgery. In this case, a part of the stomach is trimmed to create a smaller sleeve. It is also called tightening. It is one viable option if the first surgery was not correctly done or the pouch becomes dilated. Research reveals that after 2 years of the first surgery, the stomach volume can double.

There are two ways to do the revision surgery – laparoscopically and endoscopically.

A patient who is an ideal candidate for laparoscopic re-sleeve surgery is the one with correctable anatomic defects like thicker tissues expected along the line of the staple from the first surgery. To perform this surgery, the surgeon uses a smaller bougie and does not create an ischemic zone.

Endoscopic sleeve gastroplasty, or ESG, is a non-invasive procedure done using a stitching device attached at the tip of the endoscope. An endoscopic plication instrument is led through the patient’s mouth that sutures the gastric element to shrink the stomach and restore its original sleeve gastrectomy size. The restriction further recreates the fuller feeling with meals, thus enabling quick weight loss.

#3: Gastric Sleeve Revision to Duodenal Switch

Gastric sleeve revision surgery to duodenal switch is another viable option, though aggressive. The benefit of revising gastric sleeve to duodenal switch is that the sleeve-shaped pouch is in place in the first surgery.

The surgeon only performs the second stage of the surgery, which is rerouting the small intestine to ensure it absorbs fewer calories when food is eaten and digested.

#4: Gastric Sleeve Revision with Adjustable Gastric Band

When a sleeve gastrectomy fails, an adjustable gastric band is an alternative, though not recommended. Though lap-band was a popular procedure, it has some complications, side effects, and risks. Thus, it is a failure. Adding a lap band to the gastric sleeve is definitely an option, though it is not performed by surgeons today.

Gastric Sleeve Surgery Revision Success Rate

Patients who needed a gastric sleeve revision because of complications or insufficient weight loss experienced a reduction in BMI (body mass index) and a significant percentage of weight loss. The outcome, however, depends entirely on the chosen procedure for revision and its effectiveness. Gastric sleeve surgery has many advantages. Especially when it comes to laparoscopic sleeve gastrectomy, it is one of the most preferred methods because it has fewer side effects and ensures greater weight loss. Moreover, it is less complicated than the gastric bypass procedure or duodenal switch. If a patient is not satisfied with the result, gastric sleeve can be corrected easily.

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