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Revision Surgery: Gastric Sleeve and Gastric Bypass

By Ajay Goyal, MD, FACS | April 13, 2021

In the past six months, I’ve increasingly had patients ask me about gastric sleeve and gastric bypass revision surgery. 

One thing I tell patients is that obesity is a disease that weight loss surgery doesn’t cure.  Surgery is simply a tool, along with a healthy diet and exercise, to help you lose weight and get healthy. And sometimes, no matter how hard you work, life’s circumstances get in the way and you need a second chance. And a global pandemic certainly has made the past year tough for many of us.

For patients who have gained the weight back or who were not able to lose the amount of weight they wanted after bariatric surgery, New Jersey Bariatric Center® offers several weight loss surgery revision procedures for patients who qualify to help them reach their weight loss goals. 

In general, if you’re considering revision surgery insurance companies recommend that: 

  • You are at least one year out from weight loss surgery
  • You have gained back at least 50% of the excess weight lost, or have been unable to lose more than 50% of your excess weight (Clinical Reason)

OR

  • You are having problems with Gastric Band, Gastric Sleeve or Gastric Bypass such as moderate to severe heartburn or unable to tolerate your diet despite eating slowly (Technical Reason)

Revision Options:

Gastric Bypass Revised: The gastric bypass revision surgery involves making the gastric pouch a smaller size as well as narrowing the connection between the pouch and the small intestine. This leads to further limiting food intake. 

Gastric Sleeve to a Gastric Bypass: When revising the gastric sleeve to a gastric bypass, the surgeon shortens the sleeve to create a gastric pouch, then reroutes the small intestine to the bottom of the pouch.  A smaller stomach – the gastric pouch –  leads to decreased calorie absorption, a more limited food intake and a continued lowering of hunger hormones secreted. 

Gastric Band to Gastric Sleeve: After the band’s removal, the surgeon removes a portion of the stomach and narrows the remaining part to the size of a banana or a vertical “sleeve,” limiting food intake and reducing overall hunger. The procedure also causes the secretion of fewer hunger hormones – grehlins – resulting in less overall hunger leading to weight loss.  Visit the Gastric Sleeve page to learn more about gastric sleeve surgery.

Gastric Band to Gastric Bypass:  After removing the band, the surgeon creates a small pouch at the top of the stomach, then reroutes the small intestine directly to the new pouch.  This limits food intake as well as decreases the secretion of the hunger hormones – grehlins –  and the amount of calories absorbed by the body.  This dual approach – the restrictive [restricting the amount of food) and malabsorption (reduces the amount of calories absorbed) – leads to weight loss.  To learn more, visit the Gastric Bypass page.

Can you “re-sleeve” the stomach?

This question comes up often, and unfortunately no, re-sleeving is not an option. Re-sleeving is not an FDA approved procedure and it does not significantly decrease the size of the stomach. Further, it has not shown to demonstrate long-term weight loss results. Read more about Re-Sleeving here. 

Deciding if Revision Surgery is Right for You

If you’re thinking about gastric sleeve or gastric bypass revision surgery, schedule a visit with your NJBC surgeon to discuss your options to determine if revision surgery is right for you.  I also recommend talking to one of our NJBC RDs to review your options from nutritional support to medical weight loss to help kick start your weight loss again.  And check out our “Fall Back into Good Habits” blog post for some quick tips to get back on track.

Ajay Goyal, MD, FACS, is founder and director of the New Jersey Bariatric Center, a medical & surgical weight loss center with offices in Springfield, Somerville, Hoboken, East Brunswick, Hackettstown and Sparta, New Jersey. New Jersey Bariatric Center helps patients achieve long-term weight loss success through the most advanced bariatric surgery procedures, including gastric sleeve and gastric bypass procedures. New Jersey Bariatric Center’s approach to patient care has resulted in zero mortalities and a complication rate that is lower than the national average.
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