Gastric sleeve surgery is a safe and effective procedure for weight loss. However, sometimes patients experience complications after bariatric surgery.
If your primary vertical sleeve gastrectomy has resulted in inadequate weight loss or failed to mitigate diabetes symptoms, your surgeon may recommend a sleeve revision. This can be done in several ways.
What is Gastric Sleeve Revision?
As the popularity of sleeve gastrectomy surgeries continues to grow, so do revisional bariatric operations. Now, what is gastric sleeve revision? Patients can experience complications after surgery or struggle to lose weight over time. In these cases, the best solution is often a surgical adjustment to get their journey back on track. Many perform several revisional procedures to help our patients regain control and reach their goals.
Sometimes, the stomach can become too large after a sleeve gastrectomy. In these cases, the sleeve may lose effectiveness, and a patient may start eating more, leading to weight gain. In other instances, patients who suffer from acid reflux find that their sleeve is causing them to eat more than they can comfortably handle. If this is the case, a revision can be performed to increase the restriction on the stomach or convert it to a bypass to improve acid and bile flow through the esophagus.
The surgeons revise sleeve gastrectomy using a minimally invasive technique called SIS (endoscopic plication). This procedure involves a small tube inserted into the stomach and a series of tiny sutures placed around the outside surface of your stomach. It takes less than an hour to complete and leaves no external scars. It can also re-sleeve your stomach to provide more effective portion control or convert to gastric bypass or duodenal switch, demonstrating better long-term weight loss results.
What Are the Revision Procedures?
Most revision surgeries are performed to address complications from the initial procedure. However, some patients choose to have revision surgery for aesthetic reasons or because they feel their previous surgical results are beginning to “age.”
Gastric sleeve revision is a non-surgical outpatient procedure involving suturing the stomach pouch created initially during a vertical sleeve gastrectomy (VSG). This is most commonly done in patients who experienced weight regain due to stomach stretching from overeating. It can also be done for patients with severe reflux that didn’t respond to medications.
Another joint bariatric surgery revision is for patients with a Lap Band (a silicone band placed around the top of the stomach to restrict food intake). It can be done in cases where there has been a loosening or slipping of the band, which causes the patient to lose weight less than desired.
Lastly, some patients who had stomach stapling surgery in the ’70s, ’80s, or early ’90s may need to have this procedure revised to a gastric bypass. This is a more complex and invasive procedure involving rearranging the gastrointestinal tract, and it carries the highest rate of success for weight loss, comorbid disease resolution, and maintenance of weight loss. Additionally, daily shapewear can assist in maintaining the desired body contours and enhancing their overall appearance.
What Are the Revision Complications?
Many patients need a revision because of complications from their original surgery. These can include weight regain, reflux, and difficulty swallowing. These conditions require different treatment plans than other revision surgeries, so you should discuss all your options with a specialist before you decide.
Revisions to help with comorbidities often involve converting your gastric sleeve to a gastric bypass. This can help improve reflux and makes swallowing easier by lowering the pressure in your stomach pouch. It can also make your stomach smaller, which increases satiety and aids in weight loss.
A dilated gastric pouch is another common reason for a revision. This is usually caused by overeating or eating foods high in fat or sugar. Revision surgery can correct this by reducing the size of your stomach pouch. This can be done laparoscopically by dividing the lateral aspect of your sleeve with a linear stapler to reduce pouch volume and form a new vertical line.
Sometimes, your doctor may convert your sleeve to a gastric bypass or duodenal switch. These step-up procedures offer more long-term weight loss results than a sleeve. They can also help solve comorbidities such as acid reflux and dysphagia.
What Are the Revision Options?
If you have a gastric sleeve surgery that hasn’t delivered on its promise of permanent weight loss, it may be time to consider a revision procedure. Revision surgery is a safe, minimally invasive option that can help you stop the cycle of weight gain and restore your satiety sensation to encourage long-term success.
Over time, even with a successful gastric bypass, your stomach pouch can stretch. This can cause the anti-reflux barrier to break down and allow acid reflux. This can also lead to poor weight loss results and a recurrence of comorbid conditions. Revision surgery involves modifying your anatomy to increase or restore gastric restriction to prevent this.
Revising a gastric sleeve is commonly done by re-sleeving the stomach pouch. Research has shown that this can be an effective and durable solution for people with sleeve gastrectomy who struggle to lose weight.
Another option is to convert your sleeve to a gastric bypass. Conversion to this method is usually more accessible, particularly if your sleeve has stretched. It is thought to be more effective for patients who struggle with a lack of weight loss, reflux, or malnutrition.
