Revision Sleeve to Duodenal Switch

Conveniently located to serve the areas of Houston and Katy

Weight loss surgery is not always successful. If you have previously undergone a sleeve surgery but are not achieving the desired weight loss or experiencing complications, a revision sleeve to duodenal switch surgery may be the solution for you. This advanced surgical procedure combines elements of both an intestinal bypass and sleeve surgery to help patients achieve their weight loss goals and improve overall health.

Dr. Ricardo Bonnor, MD, FACS, FASMBS, a board-certified surgeon, offers a comprehensive approach to revision surgeries. For more information, and to inquire about a personal consultation, call  (281) 579-5638 or complete this form.

Fellow of the American College of Surgeons FACS
ASMBS Ricardo Bonnor

Issues or Complications with a Primary Sleeve?

While this revision surgery can be highly effective in improving outcomes and resolving previous concerns, it is important to understand the potential risks and complications that can arise. Some complications include the following:

  • Acid reflux: Some individuals may experience an increase in acid reflux (GERD) symptoms after a revision sleeve. This can manifest as heartburn or regurgitation and may require lifestyle modifications or medication to manage effectively.
  • Sleeve leakage: In some cases, the newly created sleeve may not heal adequately resulting in a  leak, leading to digestive juices leaking into the abdomen. Prompt diagnosis and treatment are essential to manage this issue effectively.
  • Stomach stretch: Over time, the stomach sleeve may stretch, reducing its effectiveness in limiting food intake. This can potentially lead to weight regain. Adherence to dietary guidelines is necessary to prevent stretching of the stomach sleeve.
  • Stricture formation: Strictures or narrowing of the newly formed stomach sleeve can occur, making it difficult for food to pass through. This can cause discomfort and vomiting. 

Correction or Revision Following a Primary Sleeve?

A revision sleeve, also known as weight loss surgery revision, is a surgical procedure performed to modify or correct a previous gastric sleeve surgery. The revision rate for the gastric sleeve is between 9-11%. (1) It is typically recommended for individuals who have undergone a gastric sleeve but haven’t achieved their desired weight loss goals or have experienced weight regain or even complications related to the primary operation.

During a revision sleeve procedure, the surgeon makes adjustments to the existing gastric sleeve by either resizing or reshaping the stomach pouch(4). This may involve removing a portion of the stomach to reduce its size further or tightening the sleeve to enhance restriction and promote better weight loss outcomes. This is a re-sleeve or re-calibration of a previous sleeve. Another option for revision is converting a sleeve to a duodenal switch. This revision involves not only recalibrating the gastric sleeve but also revising to a duodenal switch.

What is Duodenal Switch Surgery?

Duodenal switch surgery, also known as biliopancreatic diversion with duodenal switch (BPD/DS), is a highly effective and complex surgical procedure that can address issues from a prior bariatric procedure. It has two components: restrictive and malabsorptive. The restrictive component involves reducing the size of the stomach by creating a   gastric sleeve surgery. This limits the amount of food that can be consumed, leading to feelings of fullness with smaller meals. Additionally, the malabsorptive component involves rerouting and rearranging the small intestine to decrease the absorption of calories and nutrients from the food consumed.

Revision Sleeve to Duodenal Switch Surgery

If you have previously undergone gastric sleeve surgery but are not experiencing the desired weight loss or weight regain, further revision may be necessary.   The revision procedure may involve converting the gastric sleeve to a duodenal switch.

Stages of Duodenal Switch Surgery

  • Incision and Access to the Abdominal Cavity: Dr. Bonnor will make small incisions in the abdomen to gain access to the abdominal cavity. These incisions are strategically placed to minimize scarring and optimize surgical outcomes.
  • Division and Rerouting of the Small Intestine: A portion of the small intestine is divided to create two separate channels. One channel carries food from the stomach sleeve to the remaining section of the small intestine, while the other carries digestive juices from the liver and pancreas to meet the food further down the intestine.
  • Connection of the Rerouted Intestine to the Stomach Pouch: The rerouted small intestine is then connected to the existing stomach pouch, allowing food to bypass a significant portion of the intestines, resulting in reduced calorie absorption.

Cost of Revision Sleeve to Duodenal Switch Surgery in Houston

We look forward to helping you by calling us at  (281) 579-5638 to further answer your questions and schedule your consultation with Dr. Bonnor.

Commonly-Asked Questions (FAQ)

Who is a candidate for revision sleeve to duodenal switch?

Revision sleeve to duodenal switch surgery is suitable for certain patients for whom their first revision weight loss surgery was unsuccessful. This procedure is typically recommended for individuals with a body mass index (BMI) of 40 or higher, or those with a BMI of 35 or higher who also suffer from obesity-related health conditions.

How do I know if duodenal switch surgery is right for me after getting a  sleeve?

The decision to undergo duodenal switch surgery following a sleeve should be made in consultation with a qualified bariatric surgeon. During a thorough evaluation, your surgeon will assess your medical history, current health status, and weight loss goals to determine if this procedure is suitable for you. It is important to have realistic expectations and be committed to making lifestyle changes to support your long-term success after surgery.

What are the benefits of robotic weight loss surgery?

Robotic weight loss surgery, which includes procedures like revision sleeve surgery and the duodenal switch procedure, is performed using minimally invasive techniques. This approach offers several benefits, including smaller incisions, reduced postoperative pain, faster recovery times, and less scarring compared to traditional open surgery.

Will I have to make lifestyle changes after revision to duodenal switch surgery?

Long-term success after revision sleeve to duodenal switch surgery often requires significant lifestyle changes.  


  1. Park JY, Song D, Kim YJ. Causes and outcomes of revisional bariatric surgery: initial experience at a single center. Annals of Surgical Treatment and Research. 2014;86(6):295. doi: 
  2. Hui C, Dhakal A, Bauza GJ. Dumping Syndrome. PubMed. Published 2020.
  3.  Tabibian N, Swehli E, Boyd A, Umbreen A, Tabibian JH. Abdominal adhesions: A practical review of an often overlooked entity. Annals of Medicine and Surgery. 2017;15:9-13. doi: 
  4. Li S, Jiao S, Zhang S, Zhou J. Revisional Surgeries of Laparoscopic Sleeve Gastrectomy. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy. 2021;14:575-588. doi: