Gastric sleeve revisions
The sleeve gastrectomy is used to achieve weight loss in patients with severe obesity. Some patients lose less than expected despite the surgery; others develop complications. In either case, revision surgery can restore the weight loss or correct the problem.
These symptoms usually get worse rather than better on their own. If any of what follows sounds like your experience, it's worth being seen sooner rather than later.
Symptoms worth acting on
Most people adapt to these gradually, and stop noticing them. If you're doing any of the following, it's worth getting looked at.
Heartburn or reflux getting progressively worse, with medication no longer controlling it.
Difficulty swallowing that makes you choke or vomit when you eat, lie down or try to sleep.
Chest pain after eating.
A diet that has quietly narrowed — living mostly on liquids, soft foods, sauces and light crunchy things, while avoiding anything solid, dry, dense or doughy.
Weight loss significantly below what was predicted, or weight that has come back.
Weight loss significantly above what was predicted. Losing faster than expected is also worth investigating, not just celebrating.
What might be happening
Those symptoms point to one of a handful of complications. Which one it is determines what can be done about it.
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Heartburn, reflux or hiatal hernia
The most common reason patients come back after a sleeve. Several different things can cause it, and they're treated differently.
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Incarcerated or herniated sleeve
The sleeve has become trapped or herniated up into the chest.
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Stricture or torsion of the sleeve
The sleeve has narrowed or twisted, causing obstruction.
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Biliary reflux, gastritis or esophagitis
Bile irritating the stomach and esophagus. It can feel identical to ordinary acid reflux, which is why it often goes untreated for a long time.
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A large sleeve
The sleeve has more capacity than intended, which limits the weight loss it can produce.
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An incomplete sleeve
The original operation didn't achieve the intended anatomy.
How we diagnose it
Two studies, done by a bariatric surgeon who performs revision work, will usually show what has changed since your original operation.
Upper GI swallowing study
A live X-ray of you swallowing, showing how the sleeve is functioning and whether anything is narrowed, twisted or displaced.
Upper endoscopy
A camera passed into the stomach to look directly at the sleeve and the esophagus, and to find inflammation an X-ray can't show.
The conversation
After both studies it's usually clear what's causing the problem. Your surgeon will then go through what can and cannot be corrected, and what each option would mean for you.
Your options
Which of these applies depends entirely on what the studies show. Not every problem needs another operation.
- Changing your medication regimen
- Starting a new medication
- Endoscopic stent placement
- Re-sleeving the sleeve
- Converting the sleeve to a gastric bypass
- Hiatal hernia reduction, with repair of a sleeve trapped in the chest
Let's find out what happened
Make an appointment to talk through your symptoms and arrange the studies. Only once we know what's changed can we tell you how to fix it.
Had a different operation? See all revision options.