Gastric sleeve surgery is one of the most common bariatric procedures performed today. It causes weight loss by reducing the size of the stomach and therefore, reducing the amount of food the patient can eat. Initially, the gastric sleeve procedure was carried out as the first stage of a duodenal switch procedure but it has proven to be highly effective on its own.
Patients may lose up to 78 percent of their excess weight in the first one to two years after surgery if they exercise and practice good dietary habits. In addition to reducing obesity, sleeve gastrectomy also results in the reversal of obesity-related conditions such as hypertension and diabetes.
Despite the typical success rates, there are situations where gastric sleeve revisions are necessary. Revision surgeries are other bariatric procedures that are carried out if gastric sleeve surgery does not achieve the desired results.
One way of revising a gastric sleeve procedure is to re-sleeve the stomach. This involves reducing the size of the pouch in much the same way as it was done originally. Research has shown that this can be an effective and efficient way to address postoperative weight gain.
Filip, Hutopila, and Copaescu carried out a retrospective evaluation of 27 patients who had laparoscopic gastric re-sleeve procedures after sleeve gastrectomy between January 2013 and December 2016.
They noted that there were statistically significant differences between BMI prior to re-sleeve and all the measurements at six months, one year, and three years following re-sleeve.
Furthermore, the six patients who had comorbidities prior to re-sleeve had those conditions go into remission at one year after re-sleeve. However, one patient had their hypertension return three years post-op.
Laparoscopic Roux-en-Y gastric bypass is another way to correct a failed gastric sleeve. Using staples, the surgeon creates an upper pouch in the stretched stomach.
The small intestine is divided at around 45cm from the stomach and the lower end is connected to the pouch. Meanwhile, the upper end is attached to the small intestine around 100cm below the point of the division.
The stomach pouch is then only able to hold about an ounce of food. The additional benefit is that the food bypasses the portion of the small intestine where most nutrient absorption occurs.
The mini gastric bypass surgery is considered the best option for many gastric sleeve patients.
This procedure also involves dividing the stomach to create a new tubular pouch. However, the new pouch is a little larger and holds two to five ounces.
Also, instead of dividing the small intestine, the surgeon attaches the new stomach pouch directly to the jejunum (the lower portion of the small intestine). Since only one new connection is required, the bypass procedure is simplified.
The duodenal switch also has significant weight loss potential but it is a more complicated and invasive procedure than gastric bypass. It limits eating and alters digestion by bypassing part of the intestine.
When carried out as a gastric sleeve revisional surgery, the surgeon may perform a type of re-sleeve and then refashion the intestine. The lower intestine is divided much further down than with gastric bypass so there’s a much smaller portion where food and digestive enzymes meet.
The procedure gets its name because the intestinal bypass starts at the duodenum – the first part of the intestine. The duodenum is divided and attached to the ileum or lower part of the small intestine.
Yilmaz, Ece, and Sahin carried out a retrospective study that included the outcomes of 32 patients who underwent revisional surgery. They were taken from a group of 500 patients who received primary laparoscopic sleeve gastrectomies.
The revisions were most commonly necessitated by weight gain, poor weight loss, and gastroesophageal reflux disease. Twenty-three patients received a revisional laparoscopic gastric sleeve procedure while nine underwent a revisional laparoscopic Roux-en-Y gastric bypass.
The researchers found that the average operation time, duration of hospital stay, and rate of complications were all significantly higher than in the total cohort. They determined that even though these revisional procedures appear to be safe and effective, they are associated with increased complications.
If you’ve received a gastric sleeve procedure and you didn’t lose the amount of weight expected or you regained lots of weight, the surgery may need to be revised. You may also need help if you’re experienced negative side effects.
As you can see, there are multiple options for people in your situation. The team at Renew Bariatrics will talk to you about your goals and challenges and help you to come up with a plan that supports your unique health and weight loss journey. Contact us today to learn more!
American Society for Metabolic and Bariatric Surgery, The Story of Obesity Surgery, Chapter 4, Biliopancreatic Diversion and Duodenal Switch. Accessed at http://asmbs.org.
Dijkhorst, P. J., Al Nawas, M., Heusschen, L., Hazebroek, E. J., Swank, D. J., Wiezer, R., & Aarts, E. O. (2021). Single Anastomosis Duodenoileal Bypass or Roux-en-Y Gastric Bypass After Failed Sleeve Gastrectomy: Medium-Term Outcomes. Obesity surgery, 31(11), 4708–4716. https://link.springer.com/article/10.1007/s11695-021-05609-1
Filip, S., Hutopila, I., & Copaescu, C. (2019). Re-sleeve Gastrectomy – An Efficient Revisional Bariatric Procedure – 3 Years Results. Chirurgia (Bucharest, Romania : 1990), 114(6), 809–823. https://doi.org/10.21614/chirurgia.114.6.809
Fischer, L., Hildebrandt, C., Bruckner, T., Kenngott, H., Linke, G. R., Gehrig, T., … Buchler, M. W. (2012, May). Excessive weight loss after sleeve gastrectomy: a systematic review. – PubMed – NCBI. Retrieved from https://pubmed.ncbi.nlm.nih.gov/22411568/
Mitchell BG, Gupta N. Roux-en-Y Gastric Bypass. [Updated 2021 Jul 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK553157/
Seeras K, Sankararaman S, Lopez PP. Sleeve Gastrectomy. [Updated 2022 Feb 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519035/
Yilmaz, H., Ece, I., & Sahin, M. (2017). Revisional Surgery After Failed Laparoscopic Sleeve Gastrectomy: Retrospective Analysis of Causes, Results, and Technical Considerations. Obesity surgery, 27(11), 2855–2860. https://doi.org/10.1007/s11695-017-2712-8
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