Conversion/Revision to Gastric Bypass Surgery After Gastric Sleeve Surgery
A procedure to revise a gastric sleeve to a gastric bypass is an option for patients experiencing inadequate weight-loss following a primary bariatric surgery. In some cases, a re-sleeving procedure may be possible. But for others, the most effective treatment is a conversion to a gastric bypass. And, it’s not only poor weight-loss results that can warrant the change. Patients reporting uncomfortable digestive side-effects such as gastroesophageal reflux can also benefit.
There are now many options for patients looking to drastically lose weight. As well as the gastric sleeve and gastric bypass, patients can opt for laparoscopic banding or the gastric balloon, depending on their circumstances. Undergoing weight-loss surgery is a lifestyle commitment that requires considerable resilience. And when it doesn’t go as planned, the resulting weight-gain and discomfort can cause distress.
At Southern Nevada Bariatrics, board-certified bariatric surgeon Mustafa Ahmed, MD, addresses the needs of his patients with the utmost standard of care. Prior to gastric sleeve revision, many patients are deeply disappointed with their initial weight-loss procedure. Dr. Ahmed will set things right. At a personal consultation, he will assess your individual needs and ensure the best course of action for your circumstances. Call our Las Vegas office at (702) 626-0499 or send an inquiry online to discuss your options.
- 1 Gastric Sleeve Issues
- 2 Benefits of Conversion to Gastric Bypass
- 3 Candidates
- 4 Personal Consultation
- 5 Procedure
- 6 After Your Sleeve-Bypass Surgery
- 7 Cost of Sleeve-Bypass Revision Surgery in Las Vegas, NV
- 8 FAQ
- 9 References
Gastric Sleeve Issues
As a primary surgery, sleeve gastrectomy is considered the best choice in patients with less severe weight gain and fewer inhibitory medical conditions. (1) It removes a large portion of the stomach, creating a sleeve-shaped tube between the esophagus and the small intestine. This significant change means that your appetite is suppressed, and you cannot physically eat more than a certain amount of food in one meal. When the alteration works as planned, the gastric sleeve also causes solid food to empty quicker and induces a beneficial change in gut hormone activity. (2)
Gastric sleeves are proven to be a safe and efficient weight-loss method. (3) Many people experience dramatic weight loss in a short timeframe. But there will be some for whom gastric sleeving does not go as planned. In these cases, patients should consider a conversion procedure from gastric sleeve to gastric bypass.
What Can Go Wrong with a Gastric Sleeve?
Post-operative issues such as bloating, and other digestive problems usually resolve in the early stages after a sleeve gastrectomy. However, long-term problems can present and persist in the month that follow. These can include the following.
Inadequate Weight Loss
In one study, after 18 months with a gastric sleeve, 23% of patients reported insufficient weight loss. (3) Other studies show that a certain number of patients struggle to continue to lose weight, and may regain weight over time. Although scientists don’t know the exact reason why, the following factors are thought to be involved.
- The gastric tube has become dilated, so food restriction is limited.
- Not enough of the stomach was removed in the original surgery.
- Hormonal changes, particularly the hunger hormone ghrelin has become more active. (3)
Gastroesophageal Reflux Disease (GERD)
Reflux usually improves over time following a sleeve gastrectomy, but for some patients it remains after the initial stages of recovery. When bile flows up into the esophagus, patients can experience intense discomfort in the form of a burning sensation in the chest. Other symptoms include belching, nausea, and food regurgitation, making the digestive process both frustrating and painful.
Metabolic complications can occur after a sleeve gastrectomy. This means patients may experience nutritional deficiencies. Of all micronutrients, the most commonly deficient are vitamin B12, iron, calcium, and vitamin D in gastric sleeve patients. (1)
Benefits of Conversion to Gastric Bypass
A gastric bypass is a more involved bariatric procedure than a gastric sleeve, but it is an efficient way to lose weight safely and effectively.
Benefits include the following.
- Resolution of digestive discomfort
- Resumption of weight loss toward your goal weight
- Regained control over food intake
- Better overall comfort when eating
- Reduced risk of obesity-related disease
- Small incision sites in the abdomen
- Improved quality of life
As well as reducing symptoms of GERD, some research studies have indicated that sleeve-to-bypass surgeries improve diabetes symptoms. (4)
Patients who have experienced a plateau in their weight loss, or an increase in weight are good candidates for conversion of their gastric sleeve to a gastric bypass. Additionally, patients who experience other negative physical side-effects, such as GERD and micronutrient deficiencies may benefit. A revision surgery can be the solution to the frustration felt following an unsuccessful primary bariatric procedure, and Dr. Ahmed will steadfastly work to create a personalized treatment plan that will get you to your desired weight-loss objectives.
Dr. Ahmed meets with every patient to find out what brought them to Southern Nevada Bariatrics. Where you have indicated an interest in a sleeve-to-bypass conversion, he will want to know your reasons for doing so. We will take a full account of your prior surgical experience, and note any slowing or ceasing of weight loss. We may also review the details of your first procedure from your medical history.
At your consultation, please be frank in telling us how your day-to-day life is affected by an inadequate gastric sleeve, and about your eating habits. Do not shy away from giving us the whole picture. If there are no reasons not to operate (such as illness) Dr. Ahmed will discuss surgery to rectify your problems and help you achieve successful weight loss. After he reviews your information, he will draw up a treatment plan for your conversion surgery.
As with your prior surgery, we may need to obtain information about your body via tests. Testing before your surgery may include an upper endoscopy, barium swallow, CT scan, and microbial testing.
A gastric sleeve to gastric bypass conversion procedure uses a technique called laparoscopy. This is usually the same method employed in sleeve gastrectomy. Dr. Ahmed uses specialized tools placed through small incision points in the abdomen to make the necessary adjustments to revise the sleeve into a bypass.
The bypass conversion circumvents an area of the small intestine called the duodenum. By doing so, Dr. Ahmed connects the remaining stomach to a point further down the digestive tract. This secondary area of the small intestine is called the jejunum. Once the precise adjustments to the area are complete, Dr. Ahmed will close the incisions and prepare you for your recovery.
After Your Sleeve-Bypass Surgery
Following your conversion procedure, Dr. Ahmed and his staff will monitor your progress closely. This includes tracking your recovery and weight-loss progress in the weeks that follow. He will provide specific instructions for you to achieve a successful recovery, and give you specific guidance regarding food intake and restrictions. Please follow these instructions precisely as written to ensure the success of your surgery.
Cost of Sleeve-Bypass Revision Surgery in Las Vegas, NV
We will calculate the cost of your revision surgery after your consultation with Dr. Ahmed. Each patients’ circumstances differ, and we’ll ensure you receive personalized care. We offer cash pay and financing options to qualified candidates. If your initial bariatric surgery has not been successful, there is hope with a conversion from a gastric sleeve to a gastric bypass. To arrange your first meeting with Dr. Ahmed, please call Southern Nevada Bariatrics at (702) 626-0499. To ask questions, use our free insurance verification, or to book your appointment, you can also fill out a convenient form on our website.
What options do I have if my gastric sleeve isn’t working?
Patients who have regained lost weight or whose weight has remained the same and desire more weight loss, there are conversion surgeries available. A gastric sleeve can be converted to a gastric bypass, or another variation, the duodenal switch. Patients who receive a secondary surgery can experience a resumption of healthy weight loss and renewed comfort.
How much additional scarring will there be for a revision bariatric surgery?
Surgeons minimize abdominal scarring through the use of laparoscopic surgery techniques. Where scars from a previous bariatric surgery are present, they will aim to access the internal organs through the same locations to reduce additional scarring.
- Kheirvari M, Dadkhah Nikroo N, Jaafarinejad H, et al. The advantages and disadvantages of sleeve gastrectomy; clinical laboratory to bedside review. Heliyon. 2020;6(2). doi:10.1016/j.heliyon.2020.e03496 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7052082/
- Catheline JM ., Fysekidis M, Dbouk R, et al. Weight Loss after Sleeve Gastrectomy in Super Superobesity. Journal of Obesity. 2012;2012:1-4. doi:10.1155/2012/959260 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3409558/?report=reader
- Hoyuela C. Five-year outcomes of laparoscopic sleeve gastrectomy as a primary procedure for morbid obesity: A prospective study. World Journal of Gastrointestinal Surgery. 2017;9(4):109-117. doi:10.4240/wjgs.v9.i4.109 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5406732/
- Landreneau, J. P., Strong, A. T., Rodriguez, J. H., Aleassa, E. M., Aminian, A., Brethauer, S., Schauer, P. R., & Kroh, M. D. (2018). Conversion of Sleeve Gastrectomy to Roux-en-Y Gastric Bypass. Obesity Surgery, 28(12), 3843–3850. https://doi.org/10.1007/s11695-018-3435-1