All About Gastric Sleeve Revision to Mini Gastric Bypass

Vertical sleeve gastrectomy (VSG), also commonly called gastric sleeve surgery, is the most performed bariatric surgery in the United States and worldwide. Each year, approximately 150,000 patients in the U.S. undergo VSG surgery, and 380,000 worldwide.

During gastric sleeve surgery, a portion of the patient’s stomach is removed and the remainder is stapled together to resemble a smaller sleeve-like pouch. The new stomach capacity is about 25% of its original size, limiting the amount of food the patient can consume in one meal.

Most patients lose a significant amount of weight immediately following the surgery, which can be a result of the special diet that must be followed while the stomach is healing. Patients can only consume clear liquids for a week, followed by thicker liquids during week two, until they work their way up to more solid food choices after four to six weeks. They are to strictly avoid foods that are processed or have added sugar.

Sometimes, patients begin to gain back the weight they lost, and in some cases, the weight they gain can surpass their original weight. What causes this to happen? Can anything be done to stop the weight gain? Today we will discuss weight regain after gastric sleeve surgery and what can be done to stop it.

Consequences Of Not Following Recommended Diet After Gastric Sleeve Surgery

After gastric sleeve surgery, it takes between a month and six weeks before the patient can begin to eat solid foods. The reduced stomach is much smaller, so it is important that they strictly adhere to the dietary guidelines they were provided with by their surgeon.

Failure to follow these guidelines can result in various negative consequences, including:

Poor Nutrition
If they do not properly follow the dietary directives, they will not consume the proper amount of vitamins, nutrients, protein, etc. their body needs to function properly.
Dumping Syndrome
Although not as common as with gastric bypass patients, about 25% of gastric sleeve patients can become ill if they eat sugar-laden, fried, or processed foods. If they eat the wrong types of foods, they are at risk for dumping syndrome, which causes nausea, cold sweats, diarrhea, fatigue, flushing, heart palpitations, sweating, low blood pressure, etc.
Weight gain
The stomach sleeve can stretch out gradually in response to the patient lacking portion control and continually overeating until it reaches almost its original size. This removes the restrictive nature of gastric sleeve surgery, and the patient will begin to gain weight.

What Causes Weight Regain After Gastric Sleeve Surgery?

Weight Regain After Bariatric Surgery Explained - IBI Healthcare Insitute

Dr. Chris discusses the reasons behind weight regain after bariatric surgery and successful weight loss and how to prevent it.Learn more about weight regain ...

Obesity is a complex disease, and there are many factors that can influence a patient’s ability to lose weight and maintain that loss. Some of the factors that can influence a patient’s ability to lose or maintain weight include:

Patient Compliance
Patients must change their lifestyle habits after undergoing bariatric surgery if they desire to lose weight and keep it off. Bariatric surgery is just a tool that can help them manage some of the challenges of weight loss, but the patient needs to do their part to achieve successful and sustainable weight loss.
Genetics
Although not as common or well understood, a rare gene or a combination of genes can affect the appetite or the rate at which food is metabolized.
Medical Conditions
Sometimes obesity is linked to a medical condition such as Cushing syndrome or medical issues that inhibit physical activity, such as arthritis.
Medications
Some medications inhibit weight loss, such as prescription antihistamines, antidepressants, antipsychotics, beta-blocking medications for type 2 diabetes, corticosteroids, etc.
Hormones
Hormones play a role in the appetite, metabolism, and the way body fat is distributed. Obese individuals usually have an imbalance of hormones that promote fat accumulation. It is a vicious cycle because hormone imbalance and obesity feed off each other.
Stress
Our bodies produce a hormone in response to stress called cortisol, which promotes the accumulation of fat and inhibits its use for energy.

How Is Weight Gain Handled After Gastric Sleeve Surgery?

After undergoing gastric sleeve surgery, if the patient stops losing weight or, even worse, begins to gain weight, a revision surgery from sleeve to mini gastric bypass can be performed. Revision surgery can be done to convert VSG to any other form of bariatric surgery that may be more effective for the patient.

The best revision surgery for each patient is determined depending on the underlying cause of the weight gain. If patient compliance is an issue and the stomach pouch has stretched out, it can be tightened through a sleeve revision to a mini gastric bypass, which also adds malabsorptive measures and can restart weight loss.

Why Would A Patient Need Gastric Sleeve Revision Surgery?

Gastric sleeve surgery carries low risks and can be an effective means of weight loss, but sometimes it can yield unexpected results. In response to these unexpected results, a patient may desire a sleeve gastrectomy revision to a mini gastric bypass or another type of bariatric surgery.

The patient did not lose an adequate amount of weight
A year after gastric sleeve surgery, the patient should have lost a significant amount of their excess body weight.
Patient loses weight at first, then begins to gain significant weight
Sometimes, the stomach pouch stretches out despite their best efforts, and they need additional help that goes beyond portion control. A gastric sleeve revision to a mini gastric bypass can assist them in losing those extra pounds and getting back on track.
Unforeseen Complications
Sometimes patients experience side effects that inhibit their quality of life, such as chronic, severe acid reflux or a hiatal hernia.

The cause of acid reflux is normally attributed to the narrowing of the new, smaller stomach’s midsection, which can cause extra pressure and push the acid up through the esophagus. Also, there can be a defect in the valve that separates the stomach from the esophagus, which can let more of the unwanted acid in, resulting in heartburn and significant acid reflux.

A sleeve gastrectomy revision to a mini gastric bypass or a gastric bypass may alleviate the side effects of acid reflux and prevent more damage.

What Are The Benefits Of A Gastric Sleeve Revision To A Mini Gastric Bypass?

VSG surgery is a very popular form of bariatric surgery, but sometimes it does not deliver the significant weight loss the patient hoped for. When this happens, their previous gastric sleeve surgery can be converted into another form of bariatric surgery that will be more effective for them.

  1. Suitable for patients with less weight to lose. If the patient is within 100 pounds of their target weight, a gastric sleeve revision to a mini gastric bypass may be an excellent option. If they have more than 100 pounds of excess weight to lose, a traditional gastric bypass would be the better solution.
  2. Shorter Surgery. One of the benefits of a revision to a mini gastric bypass is that the procedure takes a shorter amount of time (about an hour less time) than traditional gastric bypass surgery and carries a lower risk factor.
  3. The first step is already done. During a mini gastric bypass or gastric bypass surgery, the first step is to make the patient’s stomach smaller by performing gastric sleeve surgery. When seeking a sleeve revision for a mini gastric bypass, some of the work is already done. The surgeon creates a malabsorptive situation by rerouting part of the intestine so the body can not absorb as many of the calories from the ingested food. The surgeon does not resect the intestine like in a traditional gastric bypass; he just pulls a length of it up and connects it to the stomach pouch.
  4. Stops weight regain and promotes weight loss. Adding the malabsorption technique of the mini gastric bypass will help stop the weight regain and promote additional weight loss.
Patient Testimonial - Gastric Sleeve Revision - IBI Healthcare Institute

Alicia tells her heartbreaking story of what motivated her to get additional help with her weight. She had bariatric surgery many years ago and her weight wa...

What Are The Drawbacks Of A Gastric Sleeve Revision To A Mini Gastric Bypass?

While the mini gastric bypass is a less complicated surgery to perform and will be sufficient for some patients, it also has a few cons when compared to traditional gastric bypass surgery.

  • It does not offer the same opportunity for weight loss as a gastric bypass because the malabsorptive capabilities of the mini gastric bypass are not as great;
  • The mini gastric bypass does not usually offer as much relief from severe acid reflux as a traditional gastric bypass.

Is Revision Surgery From Sleeve To Mini Gastric Bypass Right For You?

If you have previously had gastric sleeve surgery and you are unhappy with your weight loss results or are suffering from intolerable side effects, you may be a good candidate for revision surgery.

Depending on your circumstances and how much weight you have to lose, a gastric sleeve revision to a mini gastric bypass may work best for you, or you may be better served by a revision from a gastric sleeve to a gastric bypass or duodenal switch.

A consultation with a qualified bariatric surgeon like Dr. Chris Ibikunle of the IBI Healthcare Institute can help determine the best option for you.

The experts at IBI Healthcare Institute will help you understand all the options that are available to you and weigh the pros and cons of different bariatric revision surgeries. To learn more about sleeve gastrectomy revision to mini gastric bypass, contact us today!

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