Gastric Sleeve After Failed Gastric Bypass

Question Below Submitted By:  

Jo (a patient from Martinez, GA)

Can gastric sleeve surgery be done after a failed gastric bypass? My gastric bypass surgery was performed 9 years ago. I had decent weight loss but I am gaining again and do not want to regain all of my weight.

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01.

Expert Responses to the Question Above

Surgeon response to "Gastric Sleeve After Failed Gastric Bypass"

by: John Rabkin, MD

Jo,

A failed Roux-en-Y Gastric Bypass (RNY) can be reversed (taken down) and a vertical sleeve gastrectomy (VSG), also called gastric sleeve, constructed at the same time (RNY "converted" to VSG.)

This procedure is much more complicated from a technical perspective than either of the two procedures done initially (primary bariatric surgical procedures as opposed to revisional procedures). It involves reconstruction of the stomach which then has to be "sleeved" as well as taking down the roux-en-y limb of jejunum and either removing it entirely or placing it back into continuity with the remainder of the intestines.

In my experience this must be done as an open (not laparoscopic) procedure to properly reconstruct and safely sleeve the reconstructed stomach.

Furthermore, as the incidence of complications is high (as much as 25% to 30% or potentially as many as one in three) patients undergoing this procedure must be prepared for a longer recovery than they experienced during their
primary (initial) bariatric surgical procedure. This includes leaks from the gastric sleeve as well as mechanical and or functional obstructions at the gastro-gastrostomy (stomach reconstruction site), the pylorus (which has been defunctionalized for a protracted period of time due to the RNY anatomy), and/or the reconstructed intestine after putting the roux-en-y limb of jejunum back into continuity with the remainder of the intestines.

Frequently, I will prophylactically place a feeding jejunostomy tube at the time of the surgical procedure to utilize if the patient has one of these difficulties post-operatively.

When patients recover from the revisional bariatric surgery, my experience is that they have a very gratifying weight loss and are happy with the results.

However, remember that just as the RNY failed over time due to its lack of associated calorie malabsorption, the VSG is at the same risk of long term failure with the distinct possibility of weight regain necessitating yet a third bariatric surgical intervention. For that reason, many patients who fail the RNY consider the Duodenal Switch (DS) as an alternative revisional bariatric procedure where the risk of weight regain over time is very low compared with the VSG or the RNY.

Revisional bariatric surgery overall is a much more complicated intervention both from a prosepective patient's perspective in terms of their decision making of what procedure to undergo as well as from the bariatric surgeon's perspective of the nuances of the surgical procedure and subsequent patient management.

Anyone considering undergoing revisional bariatric surgery should do their 'due diligence' and carefully consider their options prior to moving forward. Once they do so, they will be happy that they did and with the outcome that they can enjoy!

John Rabkin, M.D.
Pacific Laparoscopy

(click here for Dr. Rabkin's full bio & contact info)

DISCLAIMER: This educational advice is based on the depth of your question and the details provided. The above should never replace the advice of your local physicians as they have the ability to evaluate you in person.

Related Pages:
- Gastric Bypass Revision: 5 Options

02.

Patient Responses to the Question Above

Side Effects to long term

by: Alice

Good afternoon: I have Gastric by pass since 2003.
Dr. Jorge Rabasa in Miami Fl.
I lost 125 pounds, pretty much kept it off, but through the years, I gained little by little but still 160 pounds after being so many years over weight at 252 pounds.

I belive it's my way of eating n that's why I have gain around 20 pounds.
I would love to loose those 15-20 pounds but it's been hard.
My question is: Gastric by-pass depletes you of all your nutrients that are essential for your health.

Also you develop neuropathy from vitamin depletion.
Is there is anything I can do to replace all the vitamins and minerals, food taken by mouth?
I started B-12 shots.

Thank you so much for listening.
Waiting for your respond.

Alice Aleman
305 283-2820

Had RNY Gastric Bypass 2003

by: Gina knight

Had my surgery 3/10/2003 I had great weight loss. In 2011 I was diagnosed with a Thyroid problem. My internal doctor over-dosed my medication high and low dosage. I went from hyperthyroidism to hypothyroidism off and on a year an a half. Before I was sent to the specialist.

Who took another 4 months and could not regulate it. I then went to another endocrinologist specialist. Who regulated my medication dosage and got my thyroid under control. Unfortunately 2 years later 2013 underwent a heart stent.

Then 2014 both legs bypassed I've regained 60 pounds and, cannot get the weight off. My endochronologist said my thyroid is now completely inactive. I feel horrible and cannot get the weight off.

Can I leave my surgery as is. But do the sleeve or lap band ??? PLEASE HELP😪

Trying to find out if the sleeve is an option

by: Tonya baines

I had gastric bypass in 2007 I did awesome I lost over 250 lbs! 7 yrs ago I developed a bone spur on my spine that restricted my mobility n I could not do nursing any more!

I gained back 100 in 3 yrs now I just gained 30 in 2 months! I would like to know if is an option for me! TY

Redue surgery

by: Analaura Avena

I would like to know if a gastric by pass can be changed to a sleeve?

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