In some patients, the gastric band (LAP-BAND®) may fail to provide adequate weight loss and the patient may be considered for band removal and revision surgery to the gastric sleeve.

After the band’s removal, the surgeon then 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.

After the removal of the band, the surgeon creates a small pouch at the top of the stomach, stapling it off from the rest of your stomach. Then, the surgeon cuts the small intestine and sews part of it directly to the new pouch. This limits food intake as well as decreases the secretion of the hunger hormones – gremlins – 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.

When revising the gastric sleeve to a gastric bypass, the surgeon first 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.

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. Because this procedure requires re-stapling, it may be associated with a higher complication rate.