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By Abdulaziz Ali - Medically reviewed by Prof. Cuneyt Kayaalp, on Apr 21, 2024

What is a Gastric Sleeve Revision?

Gastric sleeve revision is a surgical procedure intended for individuals who have previously undergone a gastric sleeve surgery (sleeve gastrectomy) but did not achieve the desired results or encountered complications over time. The procedure rectifies or improves the outcomes of the initial surgery.

During the initial gastric sleeve surgery, a significant portion of the stomach is removed, leaving a smaller, tube-shaped stomach (resembling a sleeve). This reduction in stomach size helps patients lose weight by limiting food intake and reducing hunger. However, in some cases, the stomach may stretch over time, or the initial surgery may not lead to sufficient weight loss or may cause complications.

Gastric Sleeve Revision Recovery Time

The recovery time for gastric sleeve revision can vary based on the individual's health, the specific nature of the surgery, and the patient's adherence to post-operative care guidelines. Generally, the hospital stay for a gastric sleeve revision may last a few days, with the total initial recovery period ranging from a few weeks to a few months.

Immediate Post-Operative Phase (First Few Days)

This phase involves close monitoring in the hospital. As the medical team advises, you will start with a liquid diet and gradually transition to pureed foods.

Early Recovery Phase (First Few Weeks)

After discharge, you must adhere strictly to dietary guidelines, engage in light activities, and attend follow-up appointments. Full recovery from the surgery, including the ability to return to normal activities and work, typically occurs within 3 to 5 weeks.

Extended Recovery Phase (Up to Several Months)

Complete healing and stabilization of weight loss patterns may take several months. During this period, you should maintain regular consultations with your healthcare providers, adhere to nutritional guidelines, and engage in regular physical activity.

Follow your surgeon's post-operative instructions, attend all follow-up appointments, and communicate any concerns or complications that arise during the recovery period. The focus should be on physical recovery and adapting to the lifestyle and dietary changes necessary for the long-term success of the gastric sleeve revision.

Gastric Sleeve Revision Requirements

Undergoing a gastric sleeve revision is a decision that requires careful consideration and an understanding of the specific requirements to determine if you are an eligible candidate. The requirements for gastric sleeve revision typically involve a combination of medical, psychological, and lifestyle criteria:

  1. Previous Gastric Sleeve Surgery: The most fundamental requirement is having previously undergone gastric sleeve surgery and not achieving the desired results, experiencing significant complications, or having issues such as weight regain after an initial period of success.
  2. BMI for Gastric Sleeve Revision: Body Mass Index (BMI) is a critical factor. Patients who haven't reached their weight loss goals and have a BMI that still categorizes them as overweight or obese qualify for revision.
  3. Consultation with a Gastric Sleeve Revision Doctor: A thorough evaluation by a qualified bariatric surgeon or gastric sleeve revision doctor is essential. The doctor will assess your medical history, the success or complications of the initial surgery, and your overall health to determine if a revision is the best course of action.

How Common is a Gastric Sleeve Revision?

Gastric sleeve revisions are not as common as the initial gastric sleeve surgeries but are becoming the new norm. This rise is partly due to the increasing number of primary gastric sleeve surgeries and a better understanding of the long-term outcomes and potential complications associated with the procedure. 

While the majority of patients achieve successful results with their initial surgery, a subset may require a revision for various reasons, including inadequate weight loss, weight regain, or complications such as GERD or sleeve dilation.

Gastric Sleeve Revision for GERD

Gastroesophageal Reflux Disease (GERD) can be a significant issue for some patients after a gastric sleeve surgery. Sometimes, altering the stomach's structure can exacerbate or lead to severe GERD. 

A gastric sleeve revision for GERD typically involves converting the sleeve gastrectomy to another type of bariatric surgery, such as gastric bypass. This conversion can help alleviate the symptoms of GERD by reducing acid reflux, improving the quality of life, and addressing the patient's weight loss needs. However, this decision should be made after a comprehensive evaluation by a specialist, considering all the potential risks and benefits.

Gastric Sleeve Revision Process

The gastric sleeve revision process is thorough and tailored to meet your needs. Understanding the steps involved, from the decision-making to surgery and healing, is essential for a successful outcome. Here's an overview of the gastric sleeve revision process:

Initial Consultation and Evaluation

The process begins with comprehensive consultations with a bariatric surgeon. The doctor will evaluate the reasons for the previous gastric sleeve's inadequacy or failure.

Determining the Method of Revision

The surgeon will discuss the gastric sleeve revision approach based on the initial consultation. The method chosen depends on individual factors such as the degree of weight regain, the presence of complications like GERD, or the anatomy of the existing gastric sleeve.

Pre-Operative Preparations

Before the surgery, you may undergo several tests and evaluations to ensure you're fit for the procedure. Nutritional counseling, psychological evaluation, and physical examinations are common at this stage.

The Surgery

The gastric sleeve revision surgery can be more complex than the initial sleeve gastrectomy. The surgeon may opt for different techniques, such as re-sleeving (making the stomach smaller again), converting to a gastric bypass (for better weight loss results or to address GERD), or other methods, depending on your specific situation.

Monitoring Gastric Sleeve Revision Weight Loss

After the surgery, the doctor will monitor your weight loss progress. This involves regular check-ups with your healthcare provider, adhering to dietary guidelines, and engaging in recommended physical activities.

Gastric Sleeve Revision Options

Several options are available when revising a gastric sleeve, each tailored to address specific issues or goals. The most common gastric sleeve revision options include:

  1. Re-Sleeving: This involves reducing the size of the stomach again if it has stretched since the initial procedure, leading to weight regain.
  2. Conversion to Gastric Bypass: This option solves severe GERD or if you haven't achieved significant weight loss with the sleeve. Gastric bypass can offer better results regarding weight loss and resolving acid reflux.
  3. Adding a Gastric Band: In some cases, adding a gastric band to the existing sleeve can help enhance restriction and promote further weight loss.
  4. Duodenal Switch: Converting to a duodenal switch may be an option for significant weight regain or substantial weight loss. This procedure is more complex and involves stomach and small intestine changes.

Each option has its benefits, risks, and considerations. Discussing these in detail with your healthcare provider to determine the most suitable approach for your gastric sleeve revision is crucial.

How Do They Do Gastric Sleeve Revision to Bypass

Converting a gastric sleeve to a gastric bypass is a revision option for patients who have not achieved their desired weight loss goals or are experiencing complications such as severe GERD. The process involves the following steps:

  1. Surgical Approach: The revision is laparoscopic, meaning it's minimally invasive, involves small incisions, and uses a camera to guide the surgery.
  2. Creating a Small Pouch: The surgeon makes a small pouch at the top of the stomach, similar to the traditional gastric bypass procedure.
  3. Bypassing the Stomach: The small pouch is then directly connected to the small intestine, bypassing a large portion of the stomach and the first part of the small intestine (the duodenum).
  4. Reducing Absorption: This rerouting reduces the amount of food you eat at one time and decreases the absorption of calories and nutrients, leading to weight loss.
  5. Post-Operative Care: After the surgery, the doctor will place you on a specific diet and need to follow strict nutritional guidelines to ensure proper healing and maximize weight loss results.

How Do They Do Gastric Sleeve Revision to Duodenal Switch

A gastric sleeve revision to a duodenal switch is another option for individuals who require further weight loss or have specific metabolic conditions. 

  1. Maintaining the Sleeve: The existing gastric sleeve is preserved, maintaining the reduced stomach size.
  2. Intestinal Bypass: The next step involves rerouting a significant portion of the small intestine. The surgeon divides the duodenum just past the stomach and connects the end portion of the intestine (the ileum) to the new opening in the duodenum.
  3. Altering Digestion and Absorption: This rerouting changes digestion and limits the absorption of calories and nutrients, leading to weight loss.
  4. Comprehensive Follow-up Care: Patients need careful monitoring and possibly supplementation to prevent nutritional deficiencies due to the procedure's complexity and nutrient absorption changes.

Gastric Sleeve Revision After Pregnancy

Pregnancy after a gastric sleeve surgery can lead to various changes in the body that might necessitate a revision surgery, particularly if significant weight gain occurs or if nutritional issues arise. Here's what to consider for a gastric sleeve revision after pregnancy:

  1. Timing: It's crucial to wait until the body has fully recovered from childbirth and any potential breastfeeding period is complete. 
  2. Evaluation: A thorough evaluation is necessary to determine the reasons for the revision, whether it's due to weight regain, nutritional deficiencies, or changes in the stomach's structure post-pregnancy.
  3. Nutritional Support: Given the increased nutritional needs post-pregnancy, particularly if breastfeeding, the revision process should include comprehensive dietary counseling to meet the mother's and baby's health needs.

Gastric Sleeve Revision Success Rate

The success of gastric sleeve revision can be quite significant, but it's important to have realistic expectations and understand that outcomes can vary based on individual circumstances. 

You will experience substantial weight loss after a gastric sleeve revision, especially when the revision is due to weight regain or insufficient weight loss after the initial surgery. The amount of weight loss can vary, but many achieve results comparable to or exceed their initial weight loss.

Gastric Sleeve Revision Side Effects

While gastric sleeve revision can offer significant benefits, it's also associated with potential side effects and complications. Being aware of these is crucial for anyone considering the procedure:

  1. Nutritional Deficiencies: Due to changes in the absorption of nutrients, you may be at risk for deficiencies in vitamins and minerals and may require lifelong supplementation.
  2. Surgical Complications: As with any surgery, there are risks of complications such as infections, bleeding, or adverse reactions to anesthesia. There's also the potential for leaks from the staple lines in the stomach.
  3. Gastrointestinal Issues: Some patients may experience gastrointestinal symptoms post-surgery, including nausea, vomiting, acid reflux, or dumping syndrome, where food moves too quickly from the stomach to the small intestine.
  4. Weight Regain: Although the goal of the revision is to aid in weight loss, there's still the possibility of weight regain if lifestyle modifications are not adhered to.
  5. Psychological Effects: The physical changes after surgery can also have psychological impacts. Some individuals may experience mood swings, depression, or challenges in adapting to their new lifestyle and dietary habits.

Frequently Asked Questions (FAQs)

What qualifies you for a gastric sleeve revision?

Qualifications include inadequate weight loss or weight regain after the initial surgery, complications like GERD or stomach dilation, or medical issues worsened by obesity.

What is the best revision surgery for gastric sleeve?

The best revision surgery depends on individual needs but can include re-sleeving, conversion to gastric bypass, or duodenal switch.

Does insurance cover gastric sleeve revision?

Coverage varies by provider and plan. It often requires proof of medical necessity, so check with your insurance for specifics.

Can a gastric sleeve be revised?

Yes, a gastric sleeve can be revised if the initial surgery didn't yield the desired results or if complications occurred.

How much is a gastric sleeve revision?

Costs vary widely based on location, facility, and specific procedure but can range from $20,000 to $30,000 without insurance.

Is a gastric sleeve revision worth it?

It can be worth it for individuals who didn't achieve the desired results from the initial surgery and are experiencing health issues or insufficient weight loss.

How to get approved for gastric sleeve revision?

Approval generally requires documentation of the necessity for revision, such as insufficient weight loss, medical complications, or nutritional issues.

Why would you need a revision after gastric sleeve?

Reasons include inadequate weight loss, weight regain, complications like acid reflux or stomach stretching, or worsened obesity-related health conditions.

Can you do a revision on a gastric sleeve?

Yes, revisions are possible and involve procedures like re-sleeving, conversion to gastric bypass, or duodenal switch.

Can you have gastric sleeve surgery twice?

A direct repeat of a gastric sleeve is uncommon, but you can have a second surgery as a revision or conversion to another type of bariatric surgery.

Can I shrink my gastric sleeve again?

Directly shrinking the sleeve again (re-sleeving) is a form of revision surgery, typically done if the stomach has stretched or if the initial surgery didn't result in sufficient weight loss.

Will I lose weight with a revision from sleeve to bypass?

Many patients lose weight after converting to gastric bypass, especially if the revision addresses issues from the initial sleeve surgery.

Do you lose weight after sleeve revision?

Weight loss is a common outcome after sleeve revision, especially if the revision addresses the specific reasons the initial surgery was not fully successful.

What are the risks of gastric sleeve revision?

Risks include bleeding, infection, leaks from staple lines, nutritional deficiencies, and the general risks associated with anesthesia and surgery.

How much weight can you lose with a revision?

Weight loss varies but can be substantial, especially if the revision effectively addresses the issues from the initial surgery and is accompanied by lifestyle changes.

What is the recovery time for gastric sleeve revision?

Recovery can take several weeks to a few months, depending on the individual and the specific type of revision performed.

Why didn't my gastric sleeve work?

Reasons may include inadequate diet and lifestyle changes, anatomical changes like stomach stretching, or metabolic factors.

What are the options for a failed gastric sleeve?

Options include re-sleeving, conversion to gastric bypass or duodenal switch, or addressing specific complications through medical or surgical interventions.

How do I know if I need a gastric sleeve revision?

Indicators include insufficient weight loss, significant weight regain, or the development of complications like severe GERD or a stretched stomach.

Why did my gastric sleeve fail?

Failure can be due to anatomical changes, inadequate lifestyle modifications, or individual metabolic factors.

Can a gastric sleeve be tightened?

The stomach can be made smaller again through a procedure known as re-sleeving, but this depends on individual circumstances.

How much weight can I lose after a revision?

Weight loss varies widely but can be significant if the revision effectively addresses the initial surgery's shortcomings and is supported by lifestyle changes.

What is the best revision surgery for gastric sleeve?

The best revision surgery depends on individual needs but often includes conversion to gastric bypass, duodenal switch, or re-sleeving.

How do you tell if you stretched your pouch?

Symptoms may include not feeling full, significant increases in the amount of food you can eat, or rapid weight regain.

How much weight can you lose after bariatric revision?

Weight loss varies but can be substantial, particularly if the revision addresses the specific reasons for the failure of the initial surgery.

What happens during a gastric sleeve revision?

The procedure varies but may involve re-sleeving, converting to another bariatric surgery, or addressing specific complications.

What is the hardest thing about gastric sleeve surgery?

Challenges often include adhering to a strict diet post-surgery, managing potential side effects, and making permanent lifestyle changes.

What to do after failed gastric sleeve?

Consult with a bariatric specialist to understand the reasons for failure and discuss potential revision options or other interventions.

Which bariatric surgery has the highest failure rate?

Failure rates vary by individual circumstances, but gastric banding generally has higher rates of failure or complication.

What are the different types of gastric sleeve revisions?

Types include re-sleeving, conversion to gastric bypass or duodenal switch, or other interventions to address specific complications.

How do you reset a pouch after gastric sleeve?

A pouch reset involves following a structured diet plan for a few days to weeks to shrink your stomach slightly and return to the post-surgery diet progression.