Sleeve Revision Surgery...
If a patient has not achieved the results they hoped for from a gastric sleeve, they may consider a sleeve revision procedure. There are two issues related to the lack of success from the initial gastric sleeve surgery.
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The stomach volume has expanded: This is concluded by evaluating the sleeve gastrectomy anatomy results through an endoscopy. Because the stomach is not as narrow as it could be, maximized food restriction is not achieved. And therefore, portion control and hunger control are not as effective.
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May be necessary to add malabsorption or a malabsorptive component
Restrictive Component Procedure...
Volume Reduction of Sleeve Procedure
A purely restrictive solution is the least aggressive of the three sleeve revision options.
This surgical technique is performed by tucking in and sewing the outer, lateral portion of the stomach in order to reduce its volume, therefore further limiting food intake.
Excess volume remains despite original Gastric Sleeve procedure
Before Sleeve Revision
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Reduced volume by Gastric Plication
After Sleeve Revision
Malabsorptive Component Added Procedures...
*more weight loss is necessary
1. Sleeve to Gastric Bypass: This is a more aggressive revision generally utilized when the sleeve has resulted in underperformance or if there are complications such as severe, chronic reflux . The stomach is divided into two unequal parts and the smaller part is connected to the top of the small intestine, in order to bypass the larger, distal portion of the stomach.
2. Duodenal Switch Surgery: This hybrid procedure combines both restrictive and malabsorptive components. Although one of the more aggressive procedures, it is statistically highly effective for patients who struggle with extreme cases of obesity to experience maximum weight loss.
The original sleeve gastrectomy, which is a restrictive procedure, adds a malobsorptive component with the duodenal switch by creating two separate pathways. First, the duodenum (top of the small intestine) is sealed off from the bottom of the stomach. It is then re-routed to connect to another portion approximately 9 feet down the small intestine tract (eliminating almost 75% of this part of the digestive process). As a result, food travels separately down the digestive tract from digestive juices, creating a smaller capacity for calorie intake and nutrient absorption. The duodenal switch is effective in treating the following obesity comorbidities:
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Type 2 Diabetes- the body’s need for insulin or oral hypoglycemic medicine is decreased
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Asthma
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Sleep Apnea
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Depression and Anxiety
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Heart Disease
Patients can expect to lose 60-85% of excess weight after 18 months. Because the duodenal switch procedure is malabsorptive, this comes with a higher risk of nutritional deficiencies over time if the patient does not maintain a consistent vitamin supplement or neglect getting blood work as necessary.
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