Gastric sleeve revision to bypass: procedure, risks, and benefits

Some patients who had their sleeve gastrectomy procedure relapse years later. If it happens in your case, you may benefit from a revision surgery that can help you lose weight again. Revision from sleeve to gastric bypass or mini-bypass can also treat some specific symptoms of other gastric problems that you might be facing as a sleeve gastrectomy patient.

Remember that your weight regain isn’t a sign of a lack of willpower or neglect. It might, but there can be certain reasons behind your gastric sleeve surgery needing another operation to help you achieve your weight loss goal.

It’s always best to remember that you should make your decision about a revision surgery when you get all the necessary information on your possible best results. Always discuss all the potential options with your doctor before you decide to undergo a gastric sleeve revision to bypass surgery.

Why would you need a revision to bypass?

The possible positive outcome of your sleeve gastrectomy revision is a chance to lose the weight you expected to get rid of and prevent potential weight regain. A gastric bypass might additionally solve your problem of gastric reflux. Revision to gastric bypass can also cure complications from your first surgery, such as leakage, ulcers, and more.

There are two main reasons behind a revision after sleeve gastrectomy. After your weight loss surgery, the results might be unsatisfying despite the fact that the operation was successful and you followed all the instructions and recommendations.

As a sleeve gastrectomy patient, you may need a gastric sleeve revision to bypass to treat reflux. Gastric sleeve revision to gastric bypass due to GERD is useful when you develop reflux or suffered from it before your initial surgery. One of the studies shows that the percentage of patients after sleeve gastrectomy who are dealing with a recent or worsened reflux is about 35%. 

This sort of gastric revision can also be helpful in case you don’t lose enough weight after your sleeve gastrectomy procedure or if you regained most of your excess weight. When you don’t lose the expected weight after your gastric sleeve surgery, you might get confused and demotivated to continue your healthy lifestyle.

Another reason for your second gastric surgery can be the stretching of your sleeve. There is one study showing that more than 50% of gastric sleeve patients experienced sleeve stretching, which is an increase in the size of the stomach. It may happen one to two years after your surgery. If it’s your case, then the vertical sleeve revision to gastric bypass procedure may be a good solution to this problem.

How is the gastric sleeve converted to bypass?

Your surgeon will create a detour around the bottom part through the small intestine in the remaining part of your stomach. Gastric sleeve converted to bypass allows for a combination of both stomach restriction and diminished nutrient absorption. By doing this the esophagus becomes separated from the part of the stomach.

Benefits of revision to bypass

There are several benefits of revision to bypass if you had a previous sleeve gastrectomy procedure that didn’t bring the expected results. Here are the possible positive outcomes of your gastric sleeve revision to bypass:

  1. The surgery gives you an opportunity to lose the expected weight and prevents potential weight regain of your excess kilograms
  2. If you suffer from reflux after your sleeve gastrectomy, a gastric bypass may also solve the problem of your GERD
  3. This procedure solves medical complications related to your first gastric surgery, including ulcers, scar tissues, or inability to absorb required nutrients

Are there any potential risks to getting a revision to bypass?

Gastric bypass is the most successful revision procedure after sleeve gastrectomy and there is no more significant risk of performing a gastric bypass revision surgery following your first operation. (3) Possible risks include:

  1. Immediate risks: reaction to anesthesia, infections, bleeding, blood clots 
  2. Short-term risks: dumping syndrome, constipation, bowel obstruction
  3. Long-term risks: malabsorption, gallstones, strictures, hiatal hernia

Gastric bypass revision surgery is more demanding because it requires reconnecting a part of your stomach with the small intestine and the created pouch, to achieve the functionality of the digestive system. It’s worth noticing that the mini bypass procedure is a less complicated surgery compared to a regular gastric bypass and therefore results in fewer potential post-op risks.

Will my post-op life be different?

Your healing experience is going to be similar to your previous procedure. After your gastric sleeve to gastric bypass revision, you can expect to go home two-three days after the procedure. It will take you some weeks to return to your daily activities. You will need to stay active without overdoing it and follow dietary instructions given to you by your doctor and/or dietitian.

However, gastric bypass surgery is more complex and therefore has a longer recovery process overall. It might last from 4 to 6 weeks to recover from it, while only 2-3 weeks on average in the case of sleeve gastrectomy. Of course, the recovery time varies from person to person, depending on each patient’s health condition and age. You will also need a lifelong intake of your supplements since malabsorption is more common with this type of surgery.

Recovery period

The healing period will most probably last from 4 to 6 weeks. The good news is that recovery time after gastric bypass surgery is usually the same as in the case of your previous gastric sleeve procedure. Staying in the hospital might take a day or two longer than in the case of your initial sleeve gastrectomy because another operation involves scar tissue as well. When you are discharged and come back home to rest, your healing process is going to look more or less the same as after your gastric sleeve surgery.

Dietary changes

Gastric bypass not only reshapes your stomach, like gastric sleeve surgery but also rearranges the digestive system’s anatomy. For this reason, the absorption of vitamins and supplements is lower in the case of this weight loss procedure. You will need to add twice as much protein to your diet after that kind of gastric revision and take your prescribed vitamins and supplements for life. When it comes to gastric bypass, the most common deficiencies include vitamin B12, vitamin D, iron, and copper.

Similar to your initial sleeve gastrectomy, your diet will mostly consist of clear fluids in the first weeks following the procedure. Keep in mind that your liquid diet will last longer than your previous surgery. When you start including solid foods in your meals after some time, you need to follow your recommended diet that is low in calories, and high in healthy fats, protein, and fiber. Focus on balanced meals served in small portions, rich in proteins. You should also avoid rice, bread, raw vegetables, and fresh fruits, as well as meats that are difficult to chew. Here are some suggestions listed for your diet after gastric sleeve revision surgery:

  • Take vitamins and minerals prescribed by your doctor
  • Eat and drink slowly to avoid dumping syndrome
  • Drink 2 liters of water a day, between meals
  • Focus on high-protein food
  • Avoid meals high in fat and sugar

Aili A, Maimaitiming M, Maimaitiyusufu P, Tusuntuoheti Y, Li X, Cui J, Abudureyimu K. Gastroesophageal reflux related changes after sleeve gastrectomy and sleeve gastrectomy with fundoplication: A retrospective single center study. Front Endocrinol (Lausanne). 2022 Nov 18;13:1041889. doi: 10.3389/fendo.2022.1041889. PMID: 36465617; PMCID: PMC9716307.

Disse E, Pasquer A, Pelascini E, Valette PJ, Betry C, Laville M, Gouillat C, Robert M. Dilatation of Sleeve Gastrectomy: Myth or Reality? Obes Surg. 2017 Jan;27(1):30-37. doi: 10.1007/s11695-016-2261-6. PMID: 27334645.

Nevo N, Abu-Abeid S, Lahat G, Klausner J, Eldar SM. Converting a Sleeve Gastrectomy to a Gastric Bypass for Weight Loss Failure-Is It Worth It? Obes Surg. 2018 Feb;28(2):364-368. doi: 10.1007/s11695-017-2856-6. PMID: 28891022. 

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