What to do if the Gastric Sleeve stops working? By Juan Hidalgo on June 05, 2020

gastric sleeve  As we all know Gastric Sleeve Surgery also called Vertical Sleeve Gastrectomy is a safe and effective procedure for weight loss and the Gastric Sleeve Surgery is one of the leading weight loss surgery options which involve the removal of 60 to 80% of the stomach allowing for the management of morbid obesity. The portion of the stomach that remains will take the shape of a shirt sleeve, and thus the name, but this technique helps reduce the amount of food the patient is able to consume. Recently many obese people make the decision to have this surgery because they have tried different diets with no long-term results. However, Gastric Sleeve Surgery is not a magic pill or a quick answer to their obesity problem.  It is definitely not the “easy way out” and this procedure requires commitment and hard work. It is actually a challenge for these patients to change their eating habits and lifestyle. This requires also that a patient adapts to a new level of physical activity and healthy food choices, something most are not used to.  That said even with a perfect surgery sometimes the gastric sleeve surgery stops working.  If this is the case we must look at why that is and see if it is either correctable through diet or revision surgery.

With all of the post-op surgery requirements, some patients get stressed out, and not everyone has the success they can and should have, and some patients have initial success and then fall off the wagon and start going back to their old ways, leading to a slippery slope where pounds and weight starts creeping back on.  As these patients have failed themselves, they end up tapping out or quitting and basically state that “My sleeve surgery just did not work”… something that is entirely untrue and usually something that can be remedied if caught in time.

There a number of factors that might contribute to the fact that some patients fail or regain weight some years later after having Gastric Sleeve Surgery but the truth of the matter is that Weight Loss Surgery’s success depends upon patient’s ability to stick to certain lifestyle and nutrition guidelines. Thin people, in general, are thin because of their habits while obese people are overweight for the same reason.  Weight regain years after Gastric Sleeve Surgery is mostly the result of personal changes, bad choices, and when most patients asked will tell you they deep down know what they are doing that is causing the weight to regain.   If this is the case in reality usually a revision surgery is not needed unless the patient has stretched out their pouch and as such damaged their sleeve.  For these patients, a new lifestyle adjustment may be sufficient and should be tried prior to any revision surgery.  First, they need to start with a pouch reset, and then get back on track with eating properly.  If after this nothing is working then they should consider revision surgery.

So, usually for a Bariatric Revision Surgery, it is also important to make sure that the original doctor did leave the stomach the right size from the beginning and make sure that the original surgery was done as planned.  Some patients go to surgery mills in Tijuana Mexico where the doctors are pumping out 10 surgeries or more a day, and when that is the case in a few instances the patient may end up with a defective surgery, and in these cases, the bariatric revision is needed to correct the errors of the first surgery.  First, you must look at whether the patient had success after their surgery, if the answer is no, then it is important to investigate the size of the pouch or the sleeve.  If the patient is able to eat too much food, this is also a sign that the stomach was left too large by the original surgery and needs to be corrected in revision surgery.  The only true way to figure out what is wrong is to troubleshoot through questions, and then actually go in and see what is going on.

Revision surgery is exactly that, the doctor goes into the body cavity and reviews what the prior surgeon has done.  Typically they can see if the doctor left the pouch or stomach too big, or was impatient and did not measure the sleeve correctly from the beginning.  Usually, the doctors in Tijuana are in a rush and leave the bottom portion of the stomach just a little too large as they don’t take the time to measure the sleeve correctly and as such even a small amount of error can allow a patient to eat more food then they need and over time this stretches out the sleeve even more.

Another factor is that in a few patients the Gastric Sleeve Surgery causes reflux disease. Obviously, these patients need to try to get the reflux under control prior to deciding to have further surgical intervention. If they are candidates for revision surgery after evaluating their particular situation, the most common revision suggested is Mini Bypass or Bypass Revision if they had a Gastric Sleeve procedure.  This usually will take care of the reflux problem.

With the Gastric Bypass, the stomach is divided into a small pouch that processes food and a much larger lower portion that is bypassed. Then, the small intestine is connected to the pouch. The stomach will be smaller and there will be also changes in hormones affecting appetite. A conversion to a Gastric Bypass is particularly effective for those who also have reflux disease.

Mini Bypass procedure is less technically challenging than Bypass and carries a lower percentage of complication risk. This is also a laparoscopic weight loss surgery, similar to Gastric Bypass but it only has one connection to the small intestine and thus restricts and impairs the absorption of food and nutrients across the gastrointestinal tract.

Mini Bypass or Bypass Revision will the revision of choice for most Gastric Sleeve patients due to their own particular situations. However, the surgeon must evaluate the general shape of their anatomy to see what options might be right for them.  In some instances, a Re-Sleeve can be done thus correcting the errors from the original surgery but usually, for best results, it is best to revise to a gastric bypass or mini bypass for best weight loss results.  That said, even with revision surgery, the weight loss is much slower than in the original surgery usually about 60 percent slower, and even with a revision, you may not have the desired results of weight loss especially if you do not follow your doctor's dietary guidelines.


Of course, Weight Loss Team, and its staff of experts will be more than ready to guide you through your journey to be successful after your Bariatric Revision Surgery you may need if you are not satisfied with your weight loss results. If you have any further questions, please feel free to contact us.


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The Weight Loss Team Staff

The Weight Loss Team

The Weight Loss Team in Puerto Vallarta is dedicated to the continued weight loss success of every patient. Through our state-of-the-art technology, advanced techniques, and easy access to online support, patients can expect successful weight loss surgery that creates lasting results. Patients travel from around the world to our practice to experience:

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If you're ready to lose weight and sustain a healthy, happy lifestyle, contact our Puerto Vallarta practice by filling out our online form or calling 800-404-9064.

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