Can You Have Gastric Sleeve Surgery Twice? Exploring Options

Vertical Sleeve Gastrectomy (VSG), commonly known as gastric sleeve surgery, is a powerful tool for weight loss, but sometimes you don’t get the results you expected. The thought of undergoing a second gastric sleeve surgery can be disheartening, but you may have more options than you think!

Some patients find themselves back at square one after a period of initial success, while others find themselves dealing with uncomfortable complications like gastric reflux. Fortunately, advances in bariatric medicine have made it possible to address these issues and regain control of your weight loss journey.

So, can you have gastric sleeve surgery twice, and is it the only option available? From a second surgery to non-surgical revisions, let’s explore your options so you can make an informed decision about the best path forward!

Can You Have a Second Gastric Sleeve Surgery?

Yes, it is possible to have a second gastric sleeve surgery, but it’s not always the first option recommended. A gastric sleeve revision surgery, known as “gastric sleeve revision surgery” and informally referred to as “re-sleeving,” involves removing additional portions of the stomach to further reduce its size. 

Revision surgeries are quite common, making up 10% of all bariatric procedures performed in the U.S. each year. Re-sleeving can help some patients achieve further weight loss, but it’s a more complex and advanced procedure that comes with increased risk, particularly if complications like gastric reflux are already present.

Before considering revision weight loss surgery, it’s important to explore all available options, including non-surgical gastric sleeve revision, which has emerged in recent years asmay be an equally effective and safer alternative. In the following sections, we’ll delve deeper into both approaches to help you understand your options.

Understanding Surgical Options for a Second Gastric Sleeve

When considering a second gastric sleeve surgery, there are typically two options available to you. While re-sleeving is one approach, your surgeon may also suggest converting your gastric sleeve to a gastric bypass as a second alternative. Each of these options has its own set of advantages and risks, which we’ll explore below.

Gastric Sleeve Revision Surgery (Surgical Re-Sleeving)

Surgical re-sleeving involves removing additional portions of the stomach to further reduce its size, helping to restrict food intake even more than the original procedure. This can be a highly effective option for achieving further weight loss, especially in patients who experienced initial success but have since regained weight due to overeating.

However, re-sleeving is a more complex surgery with heightened risks. Studies have shown that re-sleeving can lead to weight loss of 7-20% of their total body weight in the first year. But, the procedure comes with a 10% risk of complications, particularly for patients with pre-existing conditions like severe reflux. 

Patients with severe reflux are often advised against this procedure, as it could worsen their symptoms. Due to the complexity of re-sleeving, it’s crucial to work with a highly experienced bariatric surgeon who is skilled in advanced revision procedures. You may have to do some searching to find someone who is qualified, and your original surgeon may not be the best choice.

Conversion to Gastric Bypass

Another surgical option that may be available to you is converting your gastric sleeve into a gastric bypass. Gastric bypass surgery not only reduces the size of the stomach further but also reroutes part of the digestive system, which can enhance weight loss by limiting calorie absorption.

Converting to gastric bypass is sometimes recommended for patients who are struggling with severe gastric reflux or those who haven’t achieved the desired weight loss after their initial gastric sleeve surgery. It can be highly effective, with studies indicating an average of 41.5% of their excess body weight loss (EWL) within one year of the procedure.

However, it’s a more invasive surgical procedure that requires a longer recovery period and comes with an 7.2% risk of complications, such as nutritional deficiencies, dumping syndrome, and a higher potential for surgical complications. Like re-sleeving, this type of surgery should only be performed by a surgeon with extensive experience in bariatric revisions.

Exploring Non-Surgical Gastric Sleeve Revision (SIS)

For patients who are hesitant to undergo a second surgery, a non-surgical option like Endoscopic Gastric Sleeve Revision, also known as Sleeve-In-Sleeve (SIS), offers a safer, non-invasive alternative. This advanced procedure can be just as effective as surgical re-sleeving for many patients but with significantly less risk.

Here’s what SIS involves, its advantages, and the success rates you can expect.

What is Endoscopic Gastric Sleeve Revision?

Endoscopic Gastric Sleeve Revision, or SIS, is a non-surgical procedure that involves tightening or resizing the stomach using an endoscope - a flexible tube with a camera and tools attached. Endoscopic revision is done through the mouth, so there are no external incisions, significantly reducing the risk of complications and shortening recovery time. 

During the SIS procedure, the endoscope is used to place sutures inside the stomach, creating a smaller, tighter sleeve. This reduces the stomach’s capacity once again, similar to what was achieved during the original surgery. 

The procedure is particularly beneficial for patients who have experienced weight regain due to overeating, have developed complications like severe gastric reflux, or are concerned about the potential risks and long recovery time associated with additional surgery.

The Advantages of Endoscopic Gastric Sleeve Revision (SIS)

SIS offers several advantages over traditional surgical re-sleeving:

• Non-Invasive: Since SIS is performed endoscopically, there are no external incisions, which means no scars, a lower risk of infection, reduced pain, and a quicker recovery period.

• Lower Complication Rates: As with any medical procedure, SIS comes with potential risks, including anesthesia reactions, bleeding, and infection. Some patients may experience temporary symptoms like mild pain, nausea, and vomiting, which usually resolve quickly after the procedure.
  However, the overall complication rate is fewer than 5%, with severe complications occurring in less than 1% of patients, which is 4.5 times lower than the risks associated with a second bariatric surgery.

• Shorter Recovery Time: Most patients can go home the same day of the procedure and return to normal activities within 1-3 days, compared to the extended hospital stay and weeks or months of recovery that a second bariatric surgery may require.

• Comparable Weight Loss: SIS can result in similar weight loss outcomes to surgical re-sleeving, with patients typically experiencing a 15% weight loss within the first year of the procedure.

When to Consider a Second Gastric Sleeve Surgery or Non-Surgical Revision

Deciding when to consider a second gastric sleeve surgery or revision procedure is a major decision that depends on various factors. Below are some common situations that suggest a revision may be necessary.

Weight Regain

Weight gain is one of the most common reasons for considering a second gastric sleeve surgery or revision. If you’ve regained a substantial portion of the weight you originally lost, it may be time to explore options like re-sleeving or SIS to help you get back on track.

Post-Surgery Complications

Post-surgical complications, such as severe gastric reflux, persistent nausea, or other digestive issues that have developed since your first surgery, may indicate the need for intervention. Often, these complications can be addressed with a non-surgical procedure like SIS.

Unsatisfactory Results

If you didn’t achieve the weight loss results you were hoping for after your initial gastric sleeve surgery, a revision might be worth considering. A second procedure could set you on the path to success.

Worsening Comorbidities

Conditions like diabetes, hypertension, or sleep apnea that worsen after your initial surgery could be a sign that your procedure needs to be revisited. Revising your gastric sleeve could help manage these comorbidities more effectively, making a significant difference in your overall health and longevity.

Increased Appetite

A noticeable increase in appetite or the ability to eat larger portions than you could originally may suggest that your stomach has stretched over time due to overeating. A revision procedure can help reduce your stomach’s capacity again, helping you regain control over your eating habits.

Making the Right Choice for You

Choosing whether to undergo a second gastric sleeve surgery or non-surgical revision is a personal decision that should be made with the help of your medical team. Here’s how to make the right choice for you.

Weighing the Risks and Benefits

Weighing the potential risks and benefits can help you make the right decision. Surgical options like re-sleeving or converting to gastric bypass can be highly effective for weight loss, but they come with higher risks and longer recovery times.

Non-surgical options like endoscopic gastric sleeve revision offer similar results to re-sleeving and a safer, non-invasive alternative but may not be the best option for those with certain comorbidities or extensive weight regain. Understanding these factors and weighing them with your doctor is key to making an informed decision.

The Role of Lifestyle and Post-Revision Care

No matter which option you choose, your long-term success will depend heavily on your commitment to healthy lifestyle changes. Adopting a healthy diet, engaging in regular physical activity, and following the guidelines provided by your medical team will play a direct role in achieving and maintaining your weight loss goals. 

Take the Next Step with Bariendo

If you’re considering a gastric sleeve revision, understanding the risks, benefits, and available options is crucial for making an informed decision. While you can undergo gastric sleeve surgery twice, non-surgical procedures like Endoscopic Gastric Sleeve Revision (SIS) offer a safer, non-invasive alternative that can be just as effective for many patients. 

Ready to explore your options? Our team is here to help you achieve long-lasting weight loss success with personalized care and the latest advancements in non-surgical weight loss procedures. 

Schedule a free consultation with the bariatric endoscopy experts at Bariendo to discuss the best path forward!