Can You Have Gastric Sleeve Surgery Twice

Today gastric sleeve surgery is very popular, which makes up more than 50 percent of all bariatric surgeries in the United States. It often works successfully. If you’re getting ready to get this operation, you’re probably looking ahead to your weight loss results. However in a few cases, revision is required. But can you have it twice?

Yes, it’s possible to have gastric sleeve surgery twice

Gastric sleeve surgery removes a large, unnecessary part of the stomach so there will be smaller room for food. The stomach size can be reduced by about 80 percent, which is so significant to suppress your appetite and make you feel full faster.

The successful rate of the operation is quite awesome. But this doesn’t mean it works for anyone. About almost 20 percent of patients will have another sleeve procedure (also called re-sleeve surgery) several years after their initial operation.

There are a number of reasons to have re-sleeve procedure. The following are the most common ones.

Insufficient weight loss

In general, gastric sleeve surgery will provide weight loss at the following pace:

  1. About 1/3 of excess weight 3 months afterwards.
  2. About 1/2 of excess weight after 6 months.
  3. And after 1 year, it’s possible to have weight loss up to 70 percent of excess weight. Losing 50 percent of excess weight is very common.

If you lose weight much different than expected, it’d be better to see your surgeon. Several factors may cause this poor outcome.

It’s possible that your surgeon did the procedure improperly, causing slowly ‘inadequate’ weight loss. Gastric sleeve surgery makes you feel full more quickly and reduces the amount of hunger-triggering hormones. Surgeon errors can make one or both of these effects less likely, these may include:

  1. Undiagnosed and untreated hiatal hernia (when part of the stomach bulges through the diaphragm muscles). This hernia must be fixed during surgery so it doesn’t affect your weight loss goal.
  2. The gastric fundus, one of the first parts of the stomach, is not properly removed during operation.
  3. The removed part of the stomach is not large enough to drive adequate weight loss.

In many cases, the problem has to do with poor diet and lifestyle choices. In such cases, a few adjustments in diet and lifestyle are required.

Side effects after surgery

In rare cases, revision may be required if patients experience persistent side effects (e.g. chronic acid reflux and heartburn with hiatal hernia). This is particularly true if the side effects don’t relieve with lifestyle measures (dietary changes) or non-surgical medications.

Also, surgery may reduce the natural ability of the stomach to absorb vitamins, minerals, or other essential nutrients from foods. Sometimes this side effect is serious. But it’s usually treatable with non-surgical medications.

Weight regain problem

A significant weight regain after gastric sleeve surgery is not common, but it can occur. About 3 out of 10 patients eventually have weight regain. How long it takes for weight to creep back can vary widely, from several months to years after surgery.

The good news, the amount of this weight regain is usually tolerable (not significant). But it’s also possible to regain all of the weight lost. If your weight regain is significant, revision might be required.

Typically, the problem is triggered by the following factors /conditions:

  1. The follow-up support after surgery is not enough for the patient.
  2. The stomach stretching out, the most common reason for weight gain after gastric sleeve surgery. With more room for food, you can be hungrier while eating. As a result, you’re likely to eat more.
  3. Hunger-triggering hormones (such as ghrelin) are creeping back up.
  4. Recommended lifestyle measures are not followed as well. Surgery can drop pounds of excess weight more quickly. But appropriate lifestyle changes are still required afterwards to help keep the weight off in long term.

Are you qualified for revision?

You can’t get the result reversed later on. But the small banana-shaped stomach after surgery may change over time, causing weight gain. When weight gain is significant and if it doesn’t respond to lifestyle measures, ask your doctor /surgeon whether you’re qualified for revision!

A comprehensive evaluation is usually necessary before you get the answer. There are several factors to consider during this evaluation. The main ones are the size and anatomy of your stomach.

Also, your doctor may suggest you first try a few lifestyle changes before revision surgery. It’s quite common to find people after sleeve surgery with insufficient weight loss or weight regain due to inadequate physical activity (not exercising enough) and continuing their bad eating habits (diet high in fats and sugars).

Just like your first operation, sleeve revision costs money – which is also time consuming and it isn’t going without risks. So it should be your last option.

In addition, ask also about non-surgical medication. Although it’s usually not effective to cope with weight gain after gastric sleeve surgery, it’s worth a try. For instance, a medication called Topiramate might help lose your weight.

Pros and cons of gastric re-sleeve surgery

As with most surgeries, it’s important to completely understand pros and cons before getting this surgery twice! Whatever your choice, this may stress you out. So talk with your doctor or someone else who understands you most!

Re-sleeve surgery is one of several options. Depending on your situation, (if possible) your surgeon might recommend a different type of bariatric surgery (e.g. gastric bypass, duodenal switch, or lap-band bariatric surgery).

Pros

Going to any type of bariatric surgery for second time is challenging, since again revision is not going without risks. But technically, re-sleeve is relatively easier (less challenging to carry out than converting to duodenal switch or gastric bypass), making the revision successful more likely.

Re-sleeve should result a similar number of weight loss as the average initial sleeve surgery. Some patients also find that it is effective enough to help avoid ‘cheating’ on their meal plans.

Cons

As mentioned earlier, it costs money. Even with insurance, you could spend about $3,500. Without insurance, it costs around $23,750 to $28,500. See also ways to reduce cost for gastric sleeve surgery in here!

And there is no guarantee that it works long-term. It’s possible that the stomach stretch out again afterwards, this is especially true if you’re continuously going with bad behaviors and eating habits that provoke weight gain.

References:

  1. http://www.soard.org/article/S1550-7289(18)30123-0/fulltext
  2. http://www.sciencedirect.com/science/article/pii/S1550728916307742
  3. http://link.springer.com/article/10.1007/s11695-014-1332-9

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