6 January, 2024

When Should I Consider Revision of Gastric Sleeve Surgery?

Some individuals choose to undergo a surgical procedure to help them lose weight. Out of the percentage of obese individuals who qualify for bariatric surgery, only about 1% of them actually go through with it. Many of these patients choose gastric sleeve surgery because it is typically done laparoscopically and is less invasive than gastric bypass.

Unfortunately, research has shown that 50% of these patients end up gaining back a substantial amount of the weight they lost. In fact, a prospective analysis involving 782 obese male and female patients found that roughly half of the patients regained weight after having bariatric surgery. Patients with extreme obesity had a considerably higher rate of surgical failure and weight regain. One of the ways to correct this weight gain and promote further weight loss is through a revision surgery for the gastric sleeve.

In today’s article, we are going to talk about some of the factors that can contribute to weight gain after bariatric surgery and when you might consider gastric sleeve revision surgery.

Why Would A Patient Need Weight Loss Revision Surgery After Gastric Sleeve?

Gastric sleeve surgery, also known as sleeve gastrectomy, is a popular and effective weight loss surgery that involves the removal of a large portion of the stomach to create a smaller, sleeve-shaped stomach pouch. This procedure restricts the amount of food that can be consumed, resulting in reduced calorie intake and weight loss. However, like any surgical procedure, gastric sleeve surgery may not always yield the desired outcomes or may require revision in certain cases.

What Factors Can Contribute To Weight Gain Requiring A Revision Of Sleeve Surgery?

Bariatric surgery typically helps patients lose a substantial amount of weight, but there are instances when the restrictive nature of the initial procedure may become ineffective. This can cause the patient’s weight loss to plateau, or worse, they may begin to gain weight.

Here are some of the most common reasons patients consider a revision of gastric sleeve surgery:

Insufficient Weight Loss
While gastric sleeve surgery is known to be effective in helping patients achieve significant weight loss, there may be instances where the desired weight loss goals are not achieved. If patients have not lost enough weight or have hit a plateau in their weight loss journey despite following a healthy diet and lifestyle, they may consider revision surgery for the gastric sleeve.
Weight Regain
Weight regain is another common issue that some patients may experience after gastric sleeve surgery. Initially, patients may lose a significant amount of weight, but over time, due to factors such as poor diet choices, a lack of physical activity, hormonal changes, or emotional eating, weight regain can occur. If you have regained a substantial amount of weight after your initial weight loss following gastric sleeve surgery, a revision may be necessary to help you get back on track with your weight loss goals.
Restrictive Changes Are Or Have Become Ineffective
Sometimes the patient’s stomach is not reduced enough to make a significant difference in implementing portion control, or they overeat, constantly stretching their stomach pouch over time. It is also possible for the connection between the stomach and the small intestine to widen and allow quicker digestion. This removes the benefits of prolonged satiety and can result in insufficient weight loss.
Complications or Side Effects
While gastric sleeve surgery is generally safe, like any surgical procedure, it carries some risks. In some cases, complications or side effects, such as acid reflux, persistent nausea or vomiting, leaks from the staple line, or strictures (narrowing) of the stomach, may occur. Patients may desire gastric sleeve revision surgery if they are experiencing persistent or worsening complications or side effects that are affecting their quality of life.
Other Medical Conditions
In some cases, patients may develop new medical conditions after gastric sleeve surgery that may require a revision. For example, they may develop a medical condition such as gastroesophageal reflux disease (GERD) after undergoing gastric sleeve surgery, and a revision may be necessary to manage or treat this type of condition effectively.
Personal Goals
Weight loss revision surgery after the gastric sleeve may also be considered if you have achieved part of your initial weight loss goal and are now looking for additional weight loss or maintenance.

What Is Involved In Revision Surgery For Gastric Sleeve?

Undergoing a revision surgery after gastric sleeve surgery can bring with it increased complications and risks. Sometimes, patients convert their gastric sleeve surgery to a more restrictive gastric bypass, which involves further alterations to their digestive system.

Patients may also have their stomachs further reduced through laparoscopic surgery similar to their initial gastric sleeve procedure. Undergoing another surgical procedure will also require another long recovery time. With the advancements in the field of endobariatrics, some of these revisions can now be accomplished without surgery.

How Can Revision For Sleeve Surgery Be Done Without Incisions?

Endoscopic revision of gastric sleeve surgery is a minimally invasive procedure that may be considered as an option for revision of gastric sleeve surgery without making additional incisions.

Gastric sleeve revision

During an endoscopic revision of gastric sleeve surgery, the endoscope is inserted through the mouth and into the stomach, eliminating the need for any external incisions. The endoscope allows the surgeon to visualize the stomach pouch and perform various procedures to revise the gastric sleeve. Using this technique has many advantages, including a very low risk of complications and a very quick recovery time.

Some common techniques used in endoscopic revision of gastric sleeve surgery include the following:

1. Place Sutures To Reduce The Stomach Size
If the patient’s stomach was not adequately reduced initially or if it has stretched, it can be further reduced or corrected without surgery. The surgeon uses an endoscope to place sutures or create folds in the stomach pouch to reduce its size or reshape it, which can help restrict food intake and promote weight loss.
2. Staple Line Reinforcement
The surgeon may use the endoscope to place sutures to reinforce the staple line along the original sleeve gastrectomy, which can help reduce or inhibit further stretching of the stomach pouch.
3. Stoma Reduction
The surgeon can use an endoscope to perform the TORe procedure and narrow the size of the stoma, which is the opening between the stomach pouch and the intestine, to restrict the passage of food and promote weight loss. The surgeon uses specialized instruments passed through the endoscope to place sutures in the tissue around the outlet, or stoma, effectively reducing its size.

Patients typically recover relatively quickly after TORe, with most being able to resume regular activities within a few days.

Gastric sleeve surgery can be an effective weight loss surgery for many patients; however, there may be instances where a revision of surgery is necessary due to insufficient weight loss, weight regain, complications, etc. If you are experiencing any of these issues, you may be a good candidate for a non-surgical revision to your previous sleeve surgery.

Contact Simmons Advanced Weight Loss Solutions and set up an appointment today to speak with Dr. Simmons and determine if you may benefit from non-surgical gastric sleeve revision surgery.

Even if your initial surgery was years ago, if you are experiencing weight gain or have been unsuccessful in losing enough weight to reach your goals, Simmons Advanced Weight Loss Solutions may be able to help you through a revision of bariatric surgery. Get in touch with us today and learn about your options for weight loss without incisions or surgery.

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