Understanding Gastric Sleeve Revision

The sleeve gastrectomy is an effective bariatric surgery for many patients. However, some patients experience a problem with their surgery that can cause weight regain and other issues.

One such issue is a stretched sleeve that causes difficulty swallowing. A revision is an outpatient procedure that tightens the sleeve without incisions.

What is a Gastric Sleeve Revision?

What is gastric sleeve revision? A gastric sleeve revision, also known as a vertical sleeve gastrectomy (VSG) revision, is an outpatient procedure that uses sutures to tighten a sleeve gastrectomy so it can promote weight loss. Sometimes, a patient’s stomach can stretch out after a VSG, making it more challenging to lose weight or leading to painful symptoms such as acid reflux and difficulty swallowing.

This treatment is often performed for patients who had a sleeve gastrectomy surgery and suffered from complications that interfered with their weight loss success. This treatment is typically performed with an endoscopic suturing system, allowing doctors to work inside the stomach without making external incisions. During this outpatient procedure, they use the endoscopic suturing system to fold and fuse stomach sections into smaller areas called plications. It decreases the size of your stomach, limits food intake, and prolongs satiety to help you reach your weight loss goals once again.

They also routinely perform a gastric sleeve revision for patients who previously underwent lap band surgery, which uses an adjustable silicone band placed around the top of the stomach to restrict food intake. A common reason for needing a gastric sleeve procedure is that the lap band has loosened over time and no longer helps with weight loss. In these cases, they can convert your lap band to a sleeve gastrectomy or duodenal switch to add the malabsorption component of those bariatric procedures and encourage long-term weight loss results.

What are the Benefits of a Gastric Sleeve Revision?

A gastric sleeve revision, or re-sleeve surgery, is a non-surgical procedure that helps patients with their weight loss goals. It is ideal for those who have experienced a lack of success with their original bariatric procedure. It can also address comorbidities such as acid reflux or dysphagia. A sleeve revision is most effective when paired with a lifestyle change that promotes healthy eating habits and exercise.

Sometimes, the connection between a patient’s stomach pouch and small intestines (called the stoma) can stretch over time. It may cause weight gain or a slowdown in weight loss results. During a gastric sleeve revision, the surgeon can tighten this connection and reduce stomach pouch size, allowing for increased weight loss.

Other times, the sleeve pouch can become too large due to a lack of adhesion or scar tissue buildup. In this case, a revision can be performed to add an adjustable band or to lengthen the Roux limb of a previous gastric bypass to a duodenal switch.

In addition to a lifestyle change, a gastric sleeve procedure can be converted to other types of bariatric surgery if it no longer offers the desired results. It is called a step-up surgical pathway and can include a conversion to a gastric bypass or a duodenal switch, which both offer improved results by adding malabsorption components to restriction surgery.

What are the Risks of a Gastric Sleeve Revision?

Sometimes a patient’s stomach can stretch after gastric sleeve surgery, leading to weight regain. In this situation, a gastric sleeve revision may be necessary to tighten the stomach pouch to its original size.

A sleeve revision is also an option for patients who have developed acid reflux / GERD and find it difficult to manage with diet and medication alone. Conversion to a gastric bypass will help divert the acid and bile flow away from the stomach.

Many patients who underwent lap band surgery (a silicone band placed around the top part of the stomach) now require additional surgery to lose more weight. It is usually due to a loosening or “slipping” of the band down the stomach, resulting in food intolerance and vomiting. A sleeve or gastric bypass procedure can correct this problem by attaching a loop of the small intestine to the stomach pouch, creating a new path for food to travel.

Sometimes the connection between a patient’s stomach pouch and the small intestines, the stoma, can enlarge after a sleeve revision. A sleeve or gastric bypass operation can tighten this connection to reduce the amount of food the stomach can hold, helping the patient to feel full after smaller meals. An endoscopic sleeve revision is a minimally invasive procedure performed through the mouth using a tube with a light and camera on its tip, called an endoscope.

How Can I Know if I’m a Good Candidate for a Gastric Sleeve Revision?

If you had bariatric surgery and lost a large amount of weight but then regained some of that weight or are suffering from a surgical or medical complication afterward, you may be a good candidate for gastric sleeve revision. This procedure aims to help you get back on track with your weight loss goals.

A gastric sleeve revision is typically done laparoscopically, meaning your surgeon will use tiny incisions rather than larger openings. Allows for a less invasive and faster recovery. A gastric sleeve revision can be performed in a few different ways. One option is to remove the stomach pouch entirely and then re-shrink it, which can be effective in cases where the stomach pouch has stretched out due to a change in diet or other complications like acid reflux.

Another option is to convert the sleeve to a bypass, which can be helpful for patients who are experiencing dumping syndrome or other stomach ulcers or want to see better long-term results than they would have achieved with a sleeve alone. Converting to a bypass can also help relieve symptoms of acid reflux, such as GERD (gastroesophageal reflux disease), by diverting the flow of food from the stomach.

If you have a BMI above 30 and have serious health problems related to your weight, such as severe diabetes or sleep apnea, you may be a good candidate for a gastric sleeve. The best way to know if you’re a good candidate for gastric surgery is to contact our practice and speak with an experienced bariatric surgeon.