Gastric Sleeve Revision Surgery

In this article, Dr Kuzinkovas explains what gastric sleeve revision surgery is. Dr Kuzinkovas also shares the information on why it may be a suitable option for patients who aren’t achieving their desired weight loss results or experiencing complications from previous Lap Band or gastric sleeve surgery.

What is gastric sleeve surgery?

Sleeve gastrectomy is a weight loss procedure that takes a metabolic and restrictive approach to weight loss. The procedure involves the removal of approximately 75% of the stomach. The procedure is performed using keyhole surgery. Compared to other weight loss procedures, sleeve gastrectomy retains stomach function and a normal digestive pathway. With the digestive tract unchanged, patients experience fewer complications compared to lap band surgery. Individuals who undergo gastric sleeve surgery are significantly less likely to develop anemia or nutrient deficiencies when compared to gastric bypass surgeries.

How does a gastric sleeve achieve weight loss?

Weight loss is achieved by restricting the amount of food an individual can consume. The individual’s metabolism is also altered due to hormonal changes in the body. The reduction in stomach size results in a lower production of the hormone Ghrelin, the hunger hormone. These two elements combine to offer an effective weight-loss treatment for patients with a high body mass index (BMI).

Is gastric sleeve an effective weight loss procedure?

Patients who undergo gastric sleeve surgery can expect to lose between 65-70% of excess weight. Gastric sleeve is known to cause very little sickness, vomiting and burping and is tolerated well by most patients. This is due to the preservation of stomach function. The sleeve gastrectomy is also known to positively affect associated conditions such as diabetes. The above factors make gastric sleeve surgery one of the most popular surgeries performed around the world.

What happens if gastric sleeve surgery is unsuccessful?

Insufficient weight loss following surgery

The success of any surgical weight loss treatment can be determined according to several factors. Total weight loss is often the first measure of success. Generally speaking, a target weight loss of approximately 65% of excess weight within 18 months is often considered a success. When the desired weight loss is not achieved and a patient’s BMI remains over 40 (or 30 with a related chronic disease), there may be grounds to consider revisional bariatric surgery.

Reduced quality of life following weight loss surgery

In addition to total weight loss, lifestyle factors such as food intolerance, difficulty eating solids and digestive discomfort can affect the overall quality of life. These factors alongside the total weight loss can also help determine the success of bariatric surgery. Where lifestyle impact factors are considered severe, revisional bariatric surgery may also be recommended.

Gastric sleeve revision surgery

Gastric sleeve to re-sleeve

Stretching of the gastric pouch can occur in some individuals. This is characterized by an increase in pouch size over and above the goal size of 100-150ml (normally the stomach is 1500ml). The increase in size means the restrictive component of the procedure is not performing as expected and can lead to a gradual increase in portion size and calorie consumption.

Patients who experience gastric pouch stretch following sleeve gastrectomy but otherwise have few complications may be suitable candidates for a gastric sleeve redo. As the name suggests, this procedure involves reshaping the gastric pouch using the same, laparoscopic procedure (keyhole surgery). 

Gastric sleeve to gastric bypass

The sleeve gastrectomy can be revised to gastric bypass. Patients experiencing complications or reduced quality of life factors such as food intolerance, acid reflux or slow weight loss may be suitable candidates for this procedure. 

Acid reflux following gastric bypass

Of all weight loss procedures, the gastric bypass is known to have the lowest rates of acid reflux. This is due to the procedure’s ability to keep intragastric pressure lower compared to the gastric sleeve. For patients who experience severe Gastro-oesophageal reflux disease (GORD), gastric bypass is the preferred treatment as it is considered to be the benchmark for managing GORD.

Resolution of related conditions

All weight loss procedures are known to have a positive effect on chronic health conditions related to obesity. Sleep apnea, hypertension and diabetes the most common are shown to improve with weight loss following the successful weight loss surgery. In cases where improvement of related conditions isn’t experienced by the patient and weight loss remains low, revision to gastric bypass may be recommended. 
Gastric bypass is known to demonstrate the most effective and rapid improvement in some chronic diseases. Patients with type 2 diabetes who have undergone gastric bypass have in some cases seen complete remission of type 2 diabetes symptoms.

Choosing revision surgery for gastric sleeve

For patients who have undergone gastric sleeve surgery and have not reached their desired weight loss, there are options to revise the procedure. It is important to remember that all cases are different and require a unique approach that is matched specifically to the individual’s needs. The process of determining the most appropriate approach to revision surgery for the gastric sleeve depends on the individual and their circumstances. 

Having performed more than 5,000 weight loss procedures and being actively involved in the training of surgical trainees, Dr Kuzinkovas can help you determine which weight loss revision surgery is best for you. If you would like more information on the revision of gastric bypass, please get in touch with our team and speak to Dr Kuzinkovas today by contacting our clinic on 1300 551 533.

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