Prof. Dr. Toygar Toydemir
He received the title of Professor of General Surgery in 2020. Dr. Toydemir, who has extensive experience in reflux and obesity surgery, continues his work in these fields. You can read the rest of our article about Gastric Sleeve Revision Surgery prices, treatment process, and post-treatment precautions.
Read More Make an AppointmentA sleeve gastrectomy revision surgery is an effective treatment option for individuals who have previously undergone sleeve gastrectomy but did not achieve the desired results for various reasons. This procedure targets issues such as weight regain after the initial surgery or complications like gastroesophageal reflux disease (GERD). The type of revision to be performed is customized according to the patient’s overall health status, weight loss goals, and existing problems. With options such as gastric bypass, re-sleeve (repeat sleeve gastrectomy), or duodenal switch, safe solutions can be provided for individuals.
| Objective | In patients who did not achieve sufficient weight loss or regained weight after the initial sleeve gastrectomy, restore weight loss and reduce complications. |
| Method of Application | Performed under general anesthesia using the laparoscopic method. The stomach, which was shaped during the first sleeve gastrectomy, can be converted to a gastric bypass, duodenal switch, or undergo a repeat sleeve gastrectomy. |
| Eligibility Criteria | – Insufficient weight loss after the first sleeve gastrectomy. |
| – Weight regain. | |
| – Emergence of reflux or other stomach issues. | |
| Duration of Surgery | 1–3 hours. |
| Length of Hospital Stay | 2–3 days. |
| Advantages | – Provides solutions to unexpected outcomes after the first surgery. |
| – Reactivates weight loss. | |
| – Can resolve complications such as reflux. | |
| Disadvantages | – A technically more complex surgery. |
| – Revision surgeries carry a higher risk of complications. | |
| – Possible vitamin and mineral deficiencies, long-term supplementation may be required. | |
| Possible Complications | – Bleeding. |
| – Leakage. | |
| – Infection. | |
| Postoperative Nutrition | – Starts with a liquid diet, then transitions to purée and soft foods. |
| – In the long term, healthy and balanced eating habits must be developed. | |
| Physical Activity | After surgery, start with slow walks; increase activity level gradually as you recover. |
| Follow-Up Process | – Regular doctor and dietitian check-ups are necessary. |
| – Vitamin and mineral levels should be monitored regularly through blood tests. | |
| Who Is Not Eligible? | – Patients not suitable for general anesthesia. |
| – Individuals with active stomach or intestinal diseases. |
Sleeve gastrectomy was initially described in 1993 as part of the biliopancreatic diversion with duodenal switch (BPD/DS) procedure. This method, noted for its successful weight loss and metabolic improvements, eventually evolved into an independent bariatric procedure. In the early 2000s, surgeons such as Michel Gagner began performing it laparoscopically, and it gained popularity because of its minimally invasive nature and rapid recovery. Today, sleeve gastrectomy has become one of the most frequently preferred methods in obesity surgery.
However, with the widespread adoption of sleeve gastrectomy, it has been observed that issues such as weight regain, insufficient weight loss over time, and gastroesophageal reflux disease (GERD) can appear. These complications have led to the development of revision surgeries following sleeve gastrectomy. The main goal of sleeve gastrectomy revision surgery is to manage these complications and help patients achieve their weight loss goals.
The concept of revision bariatric surgery dates back to the era before sleeve gastrectomy. In the 1980s and 1990s, the shortcomings of procedures like vertical banded gastroplasty (VBG) and non-adjustable gastric banding prompted surgeons to move toward more effective methods such as Roux-en-Y gastric bypass (RYGB). These experiences laid the foundation for sleeve gastrectomy revision surgery.
Revision options for sleeve gastrectomy include repeat sleeve gastrectomy, conversion to Roux-en-Y gastric bypass, and biliopancreatic diversion with duodenal switch. These innovative approaches are personalized according to patient needs, thereby increasing the effectiveness of revision surgery.
Sleeve gastrectomy revision surgery is suitable for patients who did not achieve the expected results from the initial sleeve gastrectomy or who developed complications after the surgery. First, those who experience inadequate weight loss (less than 50% of excess weight) or weight regain (regaining more than 25% of lost weight) are among the candidates for this procedure. Patients struggling with weight control due to gastric sleeve dilation or hormonal adaptations may benefit from revision procedures such as repeat sleeve gastrectomy or Roux-en-Y gastric bypass.
Additionally, patients who develop severe gastroesophageal reflux disease (GERD) following sleeve gastrectomy should be evaluated for revision surgery if their symptoms cannot be controlled. Roux-en-Y gastric bypass is often preferred for managing GERD because it can alleviate reflux symptoms and support weight loss.
Mechanical complications of the gastric sleeve, such as stenosis, strictures, or twisting, can lead to symptoms like dysphagia and abdominal pain. In such cases, surgical intervention can restore normal stomach function.
Another important consideration is the development or persistence of obesity-related comorbidities. Revision surgery may improve metabolic outcomes for conditions such as type 2 diabetes, hypertension, or obstructive sleep apnea.
Finally, patients who underwent sleeve gastrectomy as part of a planned two-stage treatment may be considered for a second bariatric surgery. This approach can be used for high-risk or severely obese individuals to support further weight loss and improve comorbidities.
Sleeve gastrectomy revision surgery may be risky for individuals with certain medical conditions or circumstances, and it is generally not recommended in these situations. First, patients with severe cardiovascular diseases are not suitable candidates because the stress of surgery could exacerbate existing heart problems and pose life-threatening risks. Similarly, individuals with advanced lung diseases must be considered carefully due to potential complications from anesthesia and recovery difficulties.
Active gastrointestinal diseases, especially peptic ulcers, can complicate surgical intervention, so controlling these conditions first is a priority. Additionally, untreated psychiatric disorders may hinder the patient’s ability to adopt the necessary lifestyle changes after surgery. Active drug or alcohol addiction also jeopardizes the recovery and postoperative care process.
Coagulation disorders present a significant contraindication for surgery because they heighten the risk of bleeding. Women who are pregnant or plan to become pregnant in the near future are not considered suitable for revision surgery due to risks to both mother and fetus.
In patients with active cancer, cancer treatment takes precedence, and elective surgeries should be postponed. Severe liver diseases, particularly cirrhosis and portal hypertension, substantially increase surgical risks. Lastly, patients who cannot comply with postoperative instructions may jeopardize the success of the procedure and are not suitable candidates.
Sleeve gastrectomy revision surgeries are performed using various techniques to address weight regain, complications, or inadequate weight loss following the initial bariatric procedure. The type of surgery is determined by the patient’s anatomy, health status, and current problems.
Repeat Sleeve Gastrectomy (ReSG):
In this method, the enlarged gastric sleeve is resized to its original capacity. Preoperative imaging methods are used to assess the degree of dilation and the need for reshaping. This procedure is effective for correcting anatomical deformities.
Conversion to Roux-en-Y Gastric Bypass (RYGB):
Often chosen for patients with severe gastroesophageal reflux disease (GERD) after sleeve gastrectomy, this procedure restricts food intake and reduces nutrient absorption by bypassing part of the small intestine. Creating a gastric pouch and rearranging the intestines require surgical precision and expertise.
Conversion to Duodenal Switch (DS):
This approach combines the sleeve gastrectomy with a significant intestinal bypass procedure, supporting weight loss through both restriction and malabsorption. Preserving the pylorus and appropriately adjusting the length of the intestines helps achieve an optimal balance between nutritional stability and weight loss.
Single Anastomosis Duodeno-Ileal Bypass (SADI-S):
A variant of the duodenal switch, SADI-S includes only one anastomosis to reduce operative time and complications. It provides a less invasive solution, balancing weight loss effectiveness and nutritional complications.
Bleeding: Postoperative bleeding may occur at the suture lines or in the tissues of the surgical area. In some cases, a blood transfusion or a second surgical intervention may be needed.
Infection: Surgical site infections may develop, particularly at incision sites or as intra-abdominal abscesses. Such conditions typically require antibiotic therapy or surgical drainage.
Anastomotic Leaks: Leaks at surgical connection points can cause serious complications like peritonitis or sepsis. Urgent surgical intervention may be required.
Thromboembolic Events: Blood clots such as deep vein thrombosis (DVT) or pulmonary embolism can lead to severe outcomes. Anticoagulant medications and early mobilization are crucial to prevent these complications.
Respiratory Problems: Complications such as pneumonia or atelectasis can develop due to anesthesia and limited mobility. Respiratory therapy and early mobilization are important.
Nutrient Deficiencies: Vitamin and mineral absorption may decrease after surgery. Lifelong supplementation and regular monitoring are necessary.
Strictures and Stenosis: Narrowing at surgical connection points may require endoscopic dilation or surgical revision.
Dumping Syndrome: Rapid gastric emptying can usually be managed through dietary changes or medication.
Psychological Effects: Lifestyle changes and unmet expectations after surgery can lead to depression or anxiety.
Weight Regain: Weight regain may occur if dietary and lifestyle guidelines are not followed, or due to stomach dilation. Additional interventions may be required.
Sleeve gastrectomy revision surgery can provide an effective solution for patients who fail to achieve weight control or develop complications such as gastroesophageal reflux disease (GERD) after a sleeve gastrectomy. However, success rates depend on the type of procedure chosen, the patient’s overall health status, and adherence to lifestyle changes.
Repeat sleeve gastrectomy aims to restore the stomach’s original restrictive capacity, reinitiating weight loss. While it can result in significant weight reduction, it carries a higher risk of complications. Roux-en-Y gastric bypass may be more effective for patients with severe GERD or substantial weight regain, achieving an average of 41.5% excess weight loss.
Biliopancreatic diversion with duodenal switch (BPD/DS) is a more complex option for patients with serious metabolic problems or significant weight regain. However, due to the higher risk of complications, it must be carefully evaluated.
Preparing for sleeve gastrectomy revision surgery requires thorough planning and a multidisciplinary approach to improve the operation’s safety and success. The preparation process involves key steps such as medical evaluation, nutritional adjustments, psychological support, and patient education, tailored to individual health needs.
A detailed medical assessment before surgery is crucial for identifying comorbid health issues. Cardiovascular and pulmonary functions, as well as metabolic status, are evaluated to minimize perioperative risks. Standard laboratory tests are also essential for determining surgical suitability.
Another important aspect of surgical preparation is adopting proper dietary habits. Patients are advised to follow a low-calorie, high-protein diet before surgery to reduce liver size and intra-abdominal fat. Switching to a clear liquid diet one day before surgery helps facilitate the procedure. Nutrition specialists create individualized diet plans during this period.
Psychological evaluation helps patients prepare mentally for surgery and the lifestyle changes afterward. Addressing mental health is a vital factor in postoperative success.
Patients should be thoroughly informed about the surgical procedure, potential risks, and required lifestyle changes. This fosters realistic expectations and emphasizes the importance of a long-term commitment.
Physical activity is encouraged before surgery. An appropriate exercise plan can speed up recovery.
Postoperative care following sleeve gastrectomy revision is crucial for successful recovery and achieving long-term weight loss goals. During this period, dietary management, physical activity, psychological support, and regular medical follow-up must be addressed together.
Initially, patients start with a clear liquid diet to protect the stomach and digestive system. This phase includes water, broth, and sugar-free liquids. In subsequent weeks, patients progress through full liquids, puréed foods, soft solid foods, and finally regular foods. Consuming high-protein foods is important for preventing muscle loss and supporting recovery. Avoiding sugary and fatty foods helps prevent dumping syndrome and weight regain. Additionally, lifelong vitamin-mineral supplementation is necessary after surgeries similar to gastric bypass to prevent deficiencies of B12, vitamin D, calcium, and iron.
Light walks or low-intensity exercises in the early period improve blood circulation and reduce the risk of blood clots. As healing progresses, the intensity of exercise can be increased, and cardiovascular and resistance training can be incorporated. Physical activity not only boosts weight loss but also contributes positively to overall health and quality of life.
Patients may face psychological and emotional challenges after surgery. Counseling services or support groups can help maintain emotional balance during this period. Behavioral therapies play an important role in regulating eating habits and achieving long-term success.
Regular check-ups are essential for assessing nutritional status, vitamin and mineral levels, and metabolic conditions. Close collaboration with the healthcare team allows for early detection and timely intervention in potential problems.
Why might revision be necessary after a sleeve gastrectomy?
Sleeve gastrectomy revision may be needed due to insufficient weight loss, weight regain, or complications such as heartburn (GERD). Research indicates that revision rates following sleeve gastrectomy are about 4.7% at 5 years, 7.5% at 7 years, and 12.2% at 10 years. Revisions are typically performed to improve weight loss outcomes or alleviate complications by converting the sleeve gastrectomy to another bariatric procedure like re-sleeve, gastric bypass, or duodenal switch.
Which methods are used for revision surgery?
Revision surgeries following sleeve gastrectomy (SG) are performed at a rate of about 10.4%, increasing up to 22.6% at 10 years. The primary reasons for requiring revision are inadequate weight loss and complications such as gastroesophageal reflux disease (GERD). Common revision methods include Roux-en-Y gastric bypass (RYGB), biliopancreatic diversion with duodenal switch (BPD/DS), and repeat sleeve gastrectomy. RYGB is frequently chosen because it effectively addresses weight regain and GERD. Although BPD/DS provides significant weight loss, it has a higher risk of nutritional deficiencies. Repeat sleeve gastrectomy is performed for patients with stomach dilation, but may result in less weight loss compared to other revisions. The choice of revision method is tailored to the patient’s clinical status, surgical history, and the potential risks associated with each procedure.
Does this procedure accelerate weight loss again?
Sleeve gastrectomy revision surgery can accelerate weight loss again, but results vary depending on the type of revision. For instance, patients who undergo a Sleeve-In-Sleeve (SIS) revision experience an average of 15% weight loss, with 82% losing at least 10% of their body weight. Additionally, patients who convert from sleeve gastrectomy to Roux-en-Y gastric bypass (RYGB) can see 30–70% excess weight loss (EWL) in the first year, with some studies reporting 31% EWL at the end of the second year. The rate of revision after sleeve gastrectomy ranges from 10.4% to 22.6%. While revision surgeries may provide additional weight loss, individual outcomes vary and these procedures carry certain risks. It is therefore important to discuss all treatment options thoroughly with healthcare professionals to determine the most appropriate approach.
Does the risk of complications increase during revision surgery?
Compared to primary sleeve gastrectomy, revision surgery carries a higher risk of complications. Studies have shown that patients undergoing revision surgery experience more frequent perioperative complications, particularly anastomotic leaks (2.5% vs. 0.9%) and hospital readmissions (4.3% vs. 2.4%), as well as a higher long-term need for further surgical interventions (7.3% vs. 3.2%). Additionally, GERD rates in patients undergoing sleeve revision can reach up to 50%, compared to about 37.5% in those who only had a primary sleeve gastrectomy. These findings suggest that while revision surgery can be effective, it presents a higher risk profile.
Which dietary regimen should be followed after revision surgery?
After sleeve gastrectomy revision surgery, a structured diet is typically implemented to aid healing and help the digestive system adapt. Initially, a clear liquid diet consisting of water, broth, and sugar-free gelatin is recommended for about a week. This is followed by a full liquid diet that includes protein-rich drinks and puréed soups. Starting the third week, puréed foods such as soups containing meat and soft vegetables are introduced. During the fourth and fifth weeks, soft foods, including finely chopped lean meats and cooked vegetables, are consumed to facilitate digestion. Between the sixth and eighth weeks, normal-textured foods are reintroduced, focusing on balanced eating and mindful chewing. At each stage, it is important to eat slowly, chew thoroughly, and avoid foods high in sugar and fat.
References
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