How Is a Gastric Sleeve-to-Sleeve Revision Done?

Gastric sleeve surgeries account for approximately 70% of obesity surgeries performed worldwide. For this reason, they are also the type of surgery that most commonly requires revision. Surgical experience is extremely important in sleeve gastrectomy. Surgeons all over the world perform this procedure; however, there is still no universal consensus. This means there is no single standardized technique, and each surgeon performs the operation based on their own experience.

For example

The calibration tube placed in the stomach (a tube inserted temporarily to measure the stomach size) can range from 1 cm to 3 cm in diameter. The size of the tube used is important. Another factor is the pylorus (the last part of the stomach). Some surgeons begin cutting immediately, while others start 10 cm away from the pylorus.

The fat pad (which contains the ghrelin hormone responsible for appetite) is another point of اختلاف. Some surgeons remove it, while others consider it risky and leave it in place.

The fundus (upper part of the stomach), which contains the highest concentration of ghrelin hormone, is also debated. Some surgeons remove it completely, while others partially remove it or preserve it due to concerns about ischemia (tissue damage).

Some surgeons fix the remaining stomach to the omentum (intra-abdominal fat) with sutures, while others do not. In short, unlike gallbladder surgery, there is no clear consensus among surgeons. Therefore, when patients regain weight, it is difficult to determine whether the cause is related to the patient or the surgical technique. The key factors evaluated in weight regain are stomach size and whether the fundus was adequately removed.

How Do We Decide on Gastric Sleeve-to-Sleeve Revision?

When a patient presents with weight regain, the first step is to perform an endoscopy to evaluate the size of the stomach. The second factor assessed is the presence of reflux. Another important diagnostic test is a contrast-enhanced esophagus-stomach-duodenum radiography (barium swallow), which helps visualize stomach size and measure gastric emptying.

How Is Gastric Sleeve-to-Sleeve Revision Performed?

The procedure is essentially similar to the initial surgery. The main challenge for the surgeon is to release adhesions and resect the enlarged portion of the stomach.