For sleeve patients that didn’t find the success they were hoping for, options are available to renew weight loss.

Revisions for a complication like gastric reflux involves converting to a gastric bypass. This is a straightforward operation that results in a lower pressure pouch that improves reflux and makes swallowing easier.

Revisions for weight regain include two types that can be done simultaneously, if both are needed. The first is reducing the size of the sleeve to restore restriction. In some patients, the sleeve gets bigger over time, or was larger than was optimal, so more food is eaten before a sense of fullness is reached.

The most consistent way to restore restriction is to re-sleeve the stomach. We place a tube down the sleeve and staple along the tube the same way as we do during a primary sleeve gastrectomy. This works fairly well to restore restriction, but it will often not lead to as strong of a feeling as the first surgery did. This is partly because nerves become dulled, and restoring anatomy will not fully restore the restrictive feeling.

Another option is to convert to a duodenal switch. The duodenal switch is an operation we perform frequently, and it has the best weight loss of all the surgeries we perform. The duodenal switch begins with a sleeve gastrectomy and then involves a small bowel bypass. Converting an existing sleeve gastrectomy to a duodenal switch simply involves doing the small bowel bypass. This procedure is low risk and can be done as a single anastomosis, meaning with one connection, which minimizes the risk of the operation. This surgery is done laparoscopically, usually using all the same incisions from the sleeve gastrectomy.