Weight loss surgery often can improve an individual’s health so significantly that it changes their life. Many patients see major improvements after having gastric sleeve surgery, but some develop chronic side effects or do not lose as much weight as they expected. Sometimes, when this occurs, a bariatric doctor will suggest a gastric sleeve to gastric bypass revision to help resolve issues or improve weight loss results.
This article will explain why a sleeve-to-bypass revision may be recommended, how doctors decide if someone is a good candidate, and what patients should expect.
What Is Revision Bariatric Surgery?
A revision to bariatric surgery is when another procedure is done to increase weight loss results, stop weight gain, or fix issues the patient has been experiencing since the first surgery.
There are different types of revision procedures, but the most common is called a conversion, which means changing one bariatric procedure into another. For example, converting a gastric sleeve to a gastric bypass is one type of revision procedure.
Doctors may consider revision surgery when symptoms or weight loss results indicate that another procedure may work better for the patient’s needs.
Why People Choose a Sleeve-to-Bypass Revision
People choose to undergo a revision surgery for many different reasons. The most common reasons include:
Gastroesophageal Reflux Disease (GERD)
Some patients have chronic and severe acid reflux after gastric sleeve surgery, which is known as GERD. It can cause heartburn, vomiting, chest pain, and inflammation in the esophagus. A large registry study reported that GERD is the second most common reason for bariatric revision surgery.
Performing a sleeve to a gastric bypass often reduces reflux symptoms because the bypass changes how stomach acid flows through the digestive tract.
Research has shown that more than 75 percent of patients who had a sleeve converted to gastric bypass experienced resolution of their GERD symptoms after the revision.
Weight Regain
Weight regain can happen years after the original sleeve surgery. Sometimes the stomach gradually stretches or the patient reverts back to their previous eating habits. A sleeve-to-bypass revision can add restriction and promote metabolic changes that may support additional weight loss.
Inadequate Weight Loss
In some cases, patients lose less weight than expected after gastric sleeve surgery. When lifestyle changes and medical support are not enough, revision surgery may be considered.
Complications From Sleeve Surgery
Although less common, sometimes issues like strictures, anatomical changes, or severe and chronic digestive symptoms may lead the surgeon to recommend conversion to gastric bypass.
Who Is a Candidate For Gastric Sleeve To Gastric Bypass Revision?
Good candidates for a gastric sleeve to gastric bypass revision are normally individuals who have undergone a previous gastric sleeve surgery but are now experiencing severe gastroesophageal reflux disease (GERD), have experienced a significant amount of weight regain, or have not lost an adequate amount of weight since their surgery.
Research shows that approximately 12% to 20% of patients who undergo gastric sleeve surgery become candidates for surgical revision within 7 to 10 years.
Not everyone is a good fit for revision surgery, and bariatric surgeons carefully evaluate each patient before recommending an additional surgery.
What Do Doctors Look at To Determine if You Are a Good Candidate?
When doctors are considering a patient for a bariatric revision surgery, they consider a lot of different information related to the patient, which often is a multi-step process. A careful evaluation helps determine if a sleeve-to-bypass revision is the safest and most effective option.
Some of these steps include:
Review of Prior Surgical Records
Surgeons usually read and analyze the original operative report and review the patient’s medical history. This helps them understand how the original sleeve was performed and identify possible causes of symptoms.
Diagnostic Testing
Doctors may order imaging or tests to evaluate the stomach and esophagus. These tests often check for signs of reflux, hiatal hernias, or changes to the sleeve’s structure.
Nutrition Levels
Blood tests are often ordered to check vitamin and mineral levels.
A Medication Review
The medications that the patient is routinely taking are often assessed to determine if they are affecting digestion, blood sugar, or weight.
Discussion of Goals
The doctor will talk with you about the results you are looking for before they determine if a revision would be right for you.
What Changes With a Gastric Sleeve To Gastric Bypass Revision?
Gastric bypass surgery works a bit differently than gastric sleeve, which just makes changes to the stomach size. Gastric bypass involves the surgeon making a small pouch that will become your new stomach and connecting it to a lower portion of your small intestine. This causes the food you eat to travel past most of your original stomach and skip a large majority of the digestion process that normally takes place in your upper intestines.
These changes affect your digestive process in two ways:
- First, the smaller stomach pouch limits how much food you can eat at one time.
- Second, rerouting part of your intestine reduces the amount of calories your body can absorb and triggers changes to your hormones that influence appetite and metabolism.
Another thing that changes for many patients is it reduces acid reflux because the stomach acid is diverted away from the esophagus. Studies have found that gastric bypass often leads to lower use of reflux medications compared with sleeve surgery.
Risks Of Revision Surgery
Gastric sleeve-to-bypass revision surgery can be done and may correct the issues you are experiencing, but it is important to understand that this second surgery is often more complex than your first. Scar tissue from the original operation and changes in your anatomy can make the procedure much more technically challenging.
As with any surgery, it comes with risks, which may include bleeding, infection, or complications related to anesthesia.
Digestive Changes After a Sleeve-to-Bypass Revision
Gastric bypass surgery can help improve weight loss potential and reduce reflux for many individuals, but it also changes how your body digests food.
Because part of the small intestine is bypassed, your body absorbs fewer nutrients from food. To prevent nutritional deficiencies, patients usually need to take vitamin and mineral supplements for life. Your doctors will usually recommend routine blood tests to make sure your body is getting the vitamins and nutrients it needs.
Some people notice new food sensitivities, dumping syndrome after eating sugary or greasy foods, or changes in their bowel habits. Some of these issues get better with time, but others will require long term dietary changes to control, and patients will need to learn which foods work best for their bodies and choices to avoid.
Recovery
Recovery after a gastric sleeve to gastric bypass revision usually takes about four to six weeks before you can resume normal activities.
Most revision surgeries are done laparoscopically, so smaller incisions are used and patients normally only spend one or two days in the hospital and can return to their light activities at around three weeks.
As with the original surgery, the stomach needs time to adjust, so patients usually begin with liquids, move to soft foods, and work their way back to eating small portions of bariatric meals.
It is important to attend all of your follow-up appointments and utilize the support from your weight loss team when you need it. This will help your recovery go smoother and will go a long way to meeting your goals.
Where Can I Learn More About A Gastric Sleeve To Gastric Bypass Revision?
The knowledgeable team of professionals at Newvue Medical can help if you are experiencing weight regain, persistent reflux, or have other issues after gastric sleeve surgery.
Brian Sung, MD, is a board-certified bariatric surgeon with over two decades of experience specializing in primary and revisional weight loss surgery. He and his team can review your surgical history, discuss your symptoms and goals, and determine if a sleeve-to-bypass revision may help improve your results.
If you would like to learn more about a gastric sleeve to gastric bypass conversion or learn about your options for getting back on track after gastric sleeve surgery, the team at Newvue Medical can guide you through the evaluation process and help you decide what makes the most sense for your circumstances. Set up your consultation today.
FAQs
Is Sleeve-To-Bypass Considered Revision Surgery?
Yes. Converting a sleeve gastrectomy into a gastric bypass is a type of revision bariatric surgery because it changes a previous weight loss procedure.
Does This Revision Help GERD?
Yes, revising a gastric sleeve to a gastric bypass often helps reduce or eliminate acid reflux and GERD.
Will I Lose More Weight After Bariatric Revision?
Yes, most likely. Many patients lose additional weight after a sleeve-to-bypass revision, especially if the revision was performed due to weight regain or inadequate weight loss. A study that followed patients for two years after a revision reported that most patients lost 40% of their excess weight one year after their revision.
Is a Bariatric Revision Riskier than the First Surgery?
Yes. Revision procedures are often more complex because surgeons are operating on tissue that has already been altered and also has scar tissue present. An experienced bariatric surgeon can evaluate the risks and determine the safest option.
