Approximately 2 years after a sleeve gastrectomy or gastric sleeve, the volume of the stomach can expand. As the stomach expands, some patients begin to eat more. These patients may benefit from a bariatric revision surgery.
As the number of sleeve gastrectomies continues to rise in the United States and worldwide, so do the number of revisional bariatric operations. Candidates for revision surgery usually fall into two broad categories. One is for patients that have developed anatomic or medical issues over time following the primary bariatric operation. Another condition is weight regain after a primary procedure. Dr. Bonnor is here to answer your questions and see if you are a candidate for revision surgery.
Approximately two years after a sleeve gastrectomy or gastric sleeve, the volume of the stomach can expand. As the stomach grows, some patients begin to eat more. These patients may benefit from revision surgery . In addition, patients may experience acid reflux as a result of a hiatal hernia that has developed over time or due to dilatation of the upper portion of the sleeve. Texas Endosurgery is proud to serve the needs of Houston, Katy, Sugarland, Cypress and beyond. Contact our office at your earliest convenience and schedule a consultation with Dr. Bonnor. He also offers virtual consultations. Dr. Bonnor wants to connect with you.
Before and After Photos
Gastric Restrictive Revision
In a previous gastric restrictive procedure or gastric sleeve, approximately 70 to 80 percent of the stomach is removed resulting in an elongated and streamlined “tube like” new stomach, hence the name “sleeve” gastrectomy. Contrary to popular belief, there is no implant placed in the stomach. When a sleeved stomach increases its compliance over the years, weight regain may result as portions start to increase. Dr. Bonnor can revise or change a previous gastric sleeve to either a gastric bypass or duodenal switch procedure to help you with this weight regain.
There are several options for revision that could arise depending on the results of the preoperative work up:
- Re-sleeve – Dr. Bonnor can re-resect a portion of the stomach for better portion control. However, this occurs in rare circumstances since few patients meet these criteria.
- Sleeve to Bypass – Another option would be to revise the sleeve to a bypass with or without hiatal hernia repair. Several reasons include patient preference, acid reflux that is severe and not responsive to medical therapy.
- Sleeve to Duodenal Switch – Dr. Bonnor can also perform a revision to a duodenal switch for patients that have insulin dependent diabetes and are highly committed to lifelong follow-up. The duodenal switch can be performed either as a single anastomosis or a double anastomosis procedure. Briefly, the single anastomosis duodenal switch (DS) has comparable weight loss results to the standard or double anastomosis DS without the risk of bowel obstruction. Ultimately the success of the procedure weighs heavily with the commitment of the patient to lifelong lifestyle modification which includes proper nutrition and exercise. Dr. Bonnor brings the expertise of one of Texas’s top bariatric surgeons in Houston.
Before proceeding with a revision operation, it is imperative to perform an adequate evaluation of the existing anatomy. An upper endoscopy and an upper gastrointestinal study (where the patient drinks a contrast liquid) is typically required. Taking into consideration the anatomic findings as well as your current symptoms will typically determine what type of revision operation is best for you. For example, a conversion of a sleeve gastrectomy to a gastric bypass is particularly effective for those who also have an element of reflux. The bypass would treat both the reflux and address the weight gain. Schedule a consultation with us and see if you are a candidate for revision bariatric surgery.
Private Consultation in Houston
Research and questions about surgery have led you to Texas Endosurgery, and our professional and courteous staff is ready to help. During a consultation with Dr. Bonnor be prepared to discuss your medical history, future goals, and current issues with your gastric sleeve procedure. To answer these questions and many more, please Contact Texas Endosurgery.
Preparation and Procedure
Depending on the nature of your upcoming surgery, you may be advised to quit taking blood thinners such as aspirin, ibuprofen, plavix or eliquis. A consultation with the nutritionist will provide a review of nutrition instructions and long term recommendations.
On the day of your revision procedure, you will see Dr. Bonnor prior to your surgery and address any last minute questions. For revision cases you will usually spend one night at the hospital. For most cases no drains are used. Dr. Bonnor places a tremendous emphasis on not just the technical aspects of the case but also on patient-centered care such as prophylactic plain and nausea control to help you recover swiftly.
Healthy Recovery and Aftercare
In approximately three weeks from the day of surgery, you can expect to return to physical activity.
The recovery process varies depending on the extent and type of operation. With the advent of robotic-assisted surgery, recovery takes days rather than weeks. In addition, during your procedure, Dr. Bonnor has developed a technique to inject a non-opioid analgesic named Exparel in the abdominal wall which provides additional pain relief for 72 hours post surgery. This will facilitate a faster recovery and return to baseline function. As with any bariatric operation and more so with revision cases patients should be taking vitamins regularly. Here at Texas Endosurgery, we are Houston’s leading provider of bariatric surgery and weight loss surgery revision with an emphasis on patient safety and outstanding outcomes.
Nobody understands your body better than you do. If your past weight loss efforts are being undermined by a stretched gastric sleeve, you deserve a revision that suits your anatomical needs. Texas Endosurgery is founded on the principles of safety and satisfaction. One look at our rave reviews illustrates how seriously we take our role in your journey down the road to rejuvenation. We are humbled by our patients’ kind words, and we are committed to providing 5-star service.
Revising a Sleeve to a Duodenal Switch
A sleeve gastrectomy can also be revised to a duodenal switch procedure. The duodenal switch is a combination of a gastric sleeve and an intestinal bypass. Years ago, the duodenal switch was routinely performed for patients with a high body mass index (BMI). The sleeve gastrectomy was done first, and then after initial weight loss, the surgeon completed the intestinal bypass.
Many patients had such great results with a sleeve gastrectomy alone and therefore did not need a second step.
In a patient with a previous sleeve gastrectomy that requires more weight loss, surgeons can perform a completion, or so-called second stage duodenal switch. Overall, the duodenal switch has demonstrated better overall weight loss results as compared to a sleeve gastrectomy or gastric bypass. Therefore, a patient who does not experience adequate weight loss results with the primary sleeve gastrectomy may be a good candidate for revising to a duodenal switch.
Frequently Asked Questions (FAQ)
Gastric sleeve is not a reversible procedure. Part of the stomach is permanently removed. Though a gastric sleeve is not reversible, it can be changed to a gastric bypass or duodenal switch. In some cases a sleeve can be corrected or re-sleeved to improve the contour and decrease compliance. On the other hand, it is much harder to revise a bypass compared to a gastric sleeve.
There are two main reasons for performing a revision of a gastric sleeve. One is poor weight loss or weight regain and the other is complications from the original sleeve gastrectomy such as acid reflux disease, pouch stretching leading to increased compliance and overeating and strictures ( narrowing) leading to dysphagia or difficulty eating.
Generally, the coverage of revisional bariatric surgery is like the coverage of the primary bariatric operation. If you suffer from complications from the original operation you are more likely to get approved faster due to the medical necessity.
Please obtain a previous operative record, reports of any imaging study and record of recent endoscopy. The preoperative work up includes at least an upper endoscopy and an upper GI x-ray study (drinking contrast and obtaining x rays)
Without question, all surgery risks are exaggerated by smoking. Smoking leads to increased blood clotting, infections, leaks, as well as complications of anesthesia such as pneumonia. You will need to stop smoking 6 weeks prior to surgery. A nicotine test will be administered prior to surgery. A positive test will result in the cancellation of your surgery.
Although revision cases have a higher overall complication rate than primary procedures, revisional bariatric procedures have a low complication rate. There are variables that can be modified prior to the operation that can decrease the overall complication rate in all procedures which include: optimally controlling your diabetes prior to surgery, stop smoking prior to surgery, follow a proper nutrition prior to surgery, engage in exercise to increase your pulmonary function and improve your post op recovery.
Our practice has extensive experience in revisional procedures including revision of a failed gastric sleeve procedure. The primary goal of the procedure is to restore a normal eating pattern without experiencing unwanted symptoms such as pain, vomiting, acid reflux. When proper nutrition and exercise is combined with a well planned revisional baritricatic operation, weight loss is achieved. Patients need to realize that after a bariatric revision including a sleeve gastrectomy revision, weight loss is slower and the percentage of weight loss is lower compared to primary weight loss procedures.
- A Lazzatti, S Bechet, S Jourma, L Paolino, C Jung.Revision surgery after Sleeve gastrectomy: a nationwide study with 10 year follow up. Surgery for Obesity and Related Diseases.May 28, 2020. https://doi.org/10.1016/j.soard.2020.05.021
- Yeung, K Tai, P Nicholas, A Leanne. Does Sleeve gastrectomy Expose the Distal Esophagus to Severe Reflux? A Systematic review and Meta Analysis . Annals of Surgery. 271(2)257-265, February of 2020. https://doi.org/10.1097/sla.0000000000003275
- R Casillas, S Um, J Zelada, S Sachs, B Kim. Revision of primary sleeve gastrectomy to Roux en Y Gastric Bypass: indications and outcomes from a high volume center. Surgery for Obesity and Related Diseases. Vol 12 Issue 10 p 1817-1825. October 2016. https://doi.org/10.1016/j.soard.2016.09.038