Gastric Sleeve After Failed Gastric Bypass

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.

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- Gastric Bypass Revision: 5 Options