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If your previous vertical sleeve gastrectomy (gastric sleeve) did not help meet your weight-loss goals, it could be time to consider a revision surgery to help achieve your weight-loss goals. 

 

It has been well-documented that 2.5% of laparoscopic sleeve gastrectomies may require revisional surgeries(1). The need for a revisional procedure is caused by several factors, such as straying from necessary lifestyle changes, intolerance to side effects, and complications.

Top Surgeons for Gastric Sleeve Revision in Los Angeles

Revisional bariatric procedures performed by an experienced bariatric surgeon produce the most favorable outcomes. The Khalili Center’s bariatric surgeons are experts in bariatric revisions, such as gastric sleeve revisions, gastric bypass revisions, and Lap-Band (gastric band) revision to sleeve gastrectomy

Our founder, Dr. Theodore M. Khalili, MD, FACS, has performed more than 8,000 advanced laparoscopic bariatric surgeries, including the first robotic-assisted gastric bypass surgery in the United States. 

Like Dr. Khalili, all our bariatric surgeons specialize in advanced laparoscopic techniques and robotic-assisted surgeries that minimize complications and scarring risks. 

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My name is Dr. Theodore Khalili, surgeon and founder of Weight Loss Surgery of Southern California. I founded the Center because I have dedicated my life-long professional work to patient care. My approach to patient-centric partnerships and service-oriented facilities offer a comprehensive and holistic approach to bariatric treatment – all in one place.

I believe that patient care does not end right after surgery – it’s only the beginning. I founded the Center to give patients access to a supportive community that guides them through each step of the weight loss journey. We work with a team of registered dieticians, psychologists and general doctors to create tailored, best-in-class care available.

I have performed over 8,000 bariatric surgeries…

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Dr. Theodore M. Khalili,
Founder and Director of the Khalili Center for Bariatric Care


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Are You a Gastric Sleeve Revision Candidate?

Although a sleeve gastrectomy is an effective weight-loss surgery, complications such as insufficient weight loss, weight regain, hernias, and acid reflux may arise. Overeating and inactivity can cause the patients’ stomachs to restretch, resulting in inadequate weight loss or weight gain

Gastric sleeve surgery can also cause side effects, including gastroesophageal reflux disease (GERD) and hiatal hernia (stomach bulging into the diaphragm). Our surgeons will assess your body mass index (BMI) and perform examinations before considering the revisional procedure. You will also be provided with the necessary information, such as possible outcomes and risks, before making your final decision.


Understanding Bariatric Revision Surgery

Bariatric surgeries are an effective tool that can jumpstart your weight-loss journey. However, 5% to 15% of bariatric procedures may require revisional surgeries(2). Original procedures that may require revision are gastric banding and bariatric procedures that are no longer performed, such as gastroplasty and jejunoileal bypass.

Standard bariatric procedures, such as gastric bypass and sleeve gastrectomy, are considered the safest and most effective weight-loss surgeries(3). These procedures may also require revisions when the patient experiences weight regain or complications.


How Gastric Sleeve Revision Works

A vertical sleeve gastrectomy can be converted into three revision options: the roux-en-y gastric bypass, duodenal switch, or gastric re-sleeve surgery. The recommendation of the surgery type will come after careful assessment from our bariatric surgeons. The revision procedure is performed laparoscopically through small incisions on the abdomen. A laparoscope (camera) and special instruments are inserted through the incision sites. The surgeon watches the operation through a monitor.

Like the original surgery, the revisional surgery’s goal is to reduce the volume of food intake and absorption of calories and nutrients. During the conversion to gastric bypass, the surgeon creates a small gastric pouch and attaches this to the lower part of the small intestine. This procedure minimizes the calorie intake by bypassing a large section of the gastrointestinal (GI) tract. Since the stomach pouch can hold only a small amount of food, a significant weight loss results. 

A duodenal switch procedure detaches the lower part of the stomach and attaches it to the lower end of the small intestine. Like gastric bypass, duodenal switch causes malabsorption of calories by having the food skip a large portion of the GI tract.

A re-sleeve gastrectomy is performed on patients who previously received a gastric sleeve procedure. When the patient’s stomach has stretched, a re-sleeve gastrectomy will, once again, reduce the stomach size. This procedure can lead to long-term weight loss


Expectations from Gastric Sleeve Revision

Revisional weight-loss procedures can provide the same positive results as bariatric surgeries. Significant excess weight loss results have been documented among patients who underwent revisional procedures. Patients who went through a gastric bypass procedure resulted in 56.7% excess weight loss one year after gastric sleeve revision. Diabetic symptoms improvement was also documented. 

Furthermore, gastric bypass after sleeve gastrectomy has resolved GERD symptoms and hiatal hernia in 100% of patients(5)It is also well-documented that duodenal switch after gastric sleeve surgery failure resulted in BMI reduction at around 12.8 to 31.9 kg after a two-year follow-up. Duodenal switch patients also no longer complained of side effects caused by their initial surgeries(6). 

Revisional procedures can also reduce comorbidities associated with obesity, such as high blood pressure and diabetes. Laparoscopic re-sleeve gastrectomy has been documented to produce 31% excess weight loss and reduce the need for anti-hypertensive and antiglycemic medication after one year(7).


Recovery Guidelines

The total recovery period after laparoscopic revision weight-loss surgery is around six to eight weeks. You will be required to stay in the hospital for two days. During this time, your diet will consist of clear liquids, such as water, clear soups or broths, and sugar-free gelatin. Upon discharge, you can start and maintain a full liquid diet for two weeks. This diet allows you to heal and adjust to the new size of the stomach. 

You will feel pain for a few days following the procedure. You must avoid driving a vehicle during the first week after surgery or while you are on pain medication. You must also take it easy during the first two weeks. Time off from work is ideal two weeks after the surgery. 

If you have a labor-intensive job, you will need to take six weeks to recover before going back to work. Heavy lifting and strenuous activities must be avoided six to eight weeks after gastric sleeve revision surgery. Around the third week after the revisional surgery, you can transition to pureed foods. Our dietitian will provide a menu to help you with your food options. Four to five weeks after the surgery, you can gradually start taking soft foods, such as yogurt, cottage cheese, and mashed potatoes. You can go back to a regular diet around six to eight weeks after the procedure. Due to malabsorption of nutrients, our dietitian will advise you to take multivitamins and mineral supplements.

Pre-SurgeryPreparation

Before the surgical procedure, you will undergo a series of examinations, blood tests, and X-rays. You will also be interviewed regarding your ability to make lifestyle changes and stick to healthy food choices. Our dietitian will ask you to undergo a restrictive diet program, similar to the one before your original surgery. It is well-documented that weight management or weight loss before bariatric surgery can lower complication risks(4)

Diet restrictions can contribute to a low glycemic state among diabetic patients and reduced liver volume. These results provide surgical advantages during the operation. Your energy will be low and moving around will be difficult after the procedure. Thus, you have to make arrangements with friends or loved ones to assist you with hospital discharge and daily tasks or chores at home.

The Khalili Center Aftercare Program

We have created a comprehensive program designed to provide support through your weight-loss journey. Our team of experts will help you achieve significant weight-loss, prevent weight regain, and reduce complication risks.

The aftercare program consists of follow-up appointments, monthly walks with the doctors, consultations with our dietitian, and counselling sessions with our psychologist. You can also participate in our community activities, education seminars, and support groups.

Our aftercare program is also specifically designed to help patients who underwent revisional procedures. Our coaching staff will ensure that you avoid the recurrence of the undesired results from the previous surgery.

FAQs

What is Gastric Sleeve Surgery?

Laparoscopic sleeve gastrectomy is one of the safest and most commonly performed bariatric procedures. In 2018, 61.4% of bariatric procedures performed in the United States were sleeve gastrectomies(8). This procedure has less than a 1% complication rate (0.96%). 

Gastric sleeve surgery is performed by reducing the size of the stomach into a tube. This tube can hold a small amount of food, resulting in eventual weight loss. Pain from a gastric sleeve surgery will subside after a few days. 

Gastric sleeve surgery is a permanent procedure. However, patients who do not follow diet restrictions can cause their stomachs to stretch, making the procedure ineffective.

What are the Risks and Side Effects of Gastric Sleeve Revision?

The complication rate for bariatric revisional procedures varies depending on the patient’s complexity and existing health condition. It is well-documented that revisional surgeries can lead to a longer operating time, higher blood loss, longer hospital stay, and higher risk for intensive care unit (ICU) stay(9)

Moreover, risks and side effects may also present depending on the type of revisional surgery performed, including the following(10):

  • Infection
  • Excessive bleeding
  • Reactions to anesthesia
  • Lung or breathing problems
  • Blood clots
  • Leaks in your gastrointestinal system
  • Death (rare)
Does Insurance Cover Gastric Sleeve Revision?

Coverage for the procedure will depend on your insurance provider. Although the Khalili Center is accredited by several insurance groups, revisional procedures will still undergo an assessment. 

Before you call your insurance provider to assess the procedure, the surgeon must first recommend the procedure and provide an authorization request. This document provided by the surgeon will answer all the probable questions from the insurance company.  

What Alternatives Should I Consider Before Gastric Sleeve Revision?

Failing to maintain necessary lifestyle changes is the primary cause of gastric sleeve surgery ineffectiveness. Some patients achieve weight loss for the first few years and regain them after their inability to follow dietary guidelines. 

Gastric sleeve patients who feel that they did not lose enough weight can revisit the food and beverage guidelines provided to them by dietitians. Also, enrolling in an exercise program or regular physical activities, such as biking, hiking, running, and swimming can help achieve weight loss

References

  1. Hoyuela C. (2017). Five-year outcomes of laparoscopic sleeve gastrectomy as a primary procedure for morbid obesity: A prospective study. World journal of gastrointestinal surgery, 9(4), 109–117. https://doi.org/10.4240/wjgs.v9.i4.109
  2. Park, J. Y., Song, D., & Kim, Y. J. (2014). Causes and outcomes of revisional bariatric surgery: initial experience at a single center. Annals of surgical treatment and research, 86(6), 295–301. https://doi.org/10.4174/astr.2014.86.6.295
  3. Dogan, K., Gadiot, R. P., Aarts, E. O., Betzel, B., van Laarhoven, C. J., Biter, L. U., Mannaerts, G. H., Aufenacker, T. J., Janssen, I. M., & Berends, F. J. (2015). Effectiveness and Safety of Sleeve Gastrectomy, Gastric Bypass, and Adjustable Gastric Banding in Morbidly Obese Patients: a Multicenter, Retrospective, Matched Cohort Study. Obesity surgery, 25(7), 1110–1118. https://doi.org/10.1007/s11695-014-1503-8
  4. Roman, M., Monaghan, A., Serraino, G.F., Miller, D., Pathak, S., Lai, F., Zaccardi, F., Ghanchi, A., Khunti, K., Davies, M.J. and Murphy, G.J. (2019), Meta‐analysis of the influence of lifestyle changes for preoperative weight loss on surgical outcomes. Br J Surg, 106: 181-189. DOI:10.1002/bjs.11001
  5. Revision of Primary Sleeve Gastrectomy outcomes. Retrieved from https://www.sages.org/meetings/annual-meeting/abstracts-archive/revision-of-primary-sleeve-gastrectomy-to-roux-en-y-gastric-bypass-indications-and-outcomes-from-a-high-volume-center/
  6. Shimon, O., Keidar, A., Orgad, R., Yemini, R., & Carmeli, I. (2018). Long-Term Effectiveness of Laparoscopic Conversion of Sleeve Gastrectomy to a Biliopancreatic Diversion with a Duodenal Switch or a Roux-en-Y Gastric Bypass due to Weight Loss Failure. Obesity surgery, 28(6), 1724–1730. https://doi.org/10.1007/s11695-017-3086-7
  7. Cesana, G., Uccelli, M., Ciccarese, F., Carrieri, D., Castello, G., & Olmi, S. (2014). Laparoscopic re-sleeve gastrectomy as a treatment of weight regain after sleeve gastrectomy. World journal of gastrointestinal surgery, 6(6), 101–106. https://doi.org/10.4240/wjgs.v6.i6.101
  8. American Society for Metabolic and Bariatric Surgery. Bariatric Surgery Statistics. Retrieved from https://asmbs.org/resources/estimate-of-bariatric-surgery-numbers
  9. Zhang, L., Tan, W. H., Chang, R., & Eagon, J. C. (2015). Perioperative risk and complications of revisional bariatric surgery compared to primary Roux-en-Y gastric bypass. Surgical endoscopy, 29(6), 1316–1320. https://doi.org/10.1007/s00464-014-3848-4
  10. The Mayo Clinic. Side effects of Bariatric Procedures. Retrieved from https://www.mayoclinic.org/tests-procedures/bariatric-surgery/about/pac-20394258

The Best Weight Loss Surgery, Lap Band (Band Over) Bypass Surgeons
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