Revision: Gastric Sleeve to Gastric Bypass*

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• Two steps
• Revision

Obesity rates and the number of super-obese patients (BMI >50 kg/m2) has risen dramatically across the world. It is almost impossible to treat severe obesity using only diet and exercise. This has led to the search for surgical techniques which would provide adequate weight loss. Surgery is the only and most effective treatment of severe obesity that provides effective long lasting weight loss. Currently performed laparoscopic surgeries are modern, technically easier, and effective and are safer than ever before. Newer laparoscopic options for obesity treatment include laparoscopic sleeve gastrectomy, gastric bypass surgery, gastric banding and some others operations. All these options differ in complexity, reversibility, complications and extent of excess weight loss. The choice of procedure depends on a patient and a surgeon factors.

Two steps

Still, obese and super-obese patients are classified as high-risk patients because of complications and negative impact of obesity on their health. Overweight and obesity are associated with a higher risk of cardiovascular disease, increased incidence of heart attack, hypertension, dyslipidemia and type II diabetes. The impact on health care is overwhelming. If a patient agrees to have a surgery it is strongly recommended to apply surgical treatment in two stages. Sleeve gastrectomy as bariatric procedure was introduced as the first step operation in a two-step approach in high-risk or super-obese patientsbefore performing a more complicated procedure such as the gastric bypass surgery. Sleeve gastrectomy is a relatively new operation with fewer surgical risks that are particularly suited to those patients at highest risk for surgery, either because of their medical co-morbidities or their weight.

Studies show that the sleeve gastrectomy in the super-obese patients can be a definitive treatment for an average loss of excess weight by 50% in one year. After the first surgery step patients loose enough weight in order to perform second step – gastric bypass surgery. During this procedure a small stomach pouch is constructed bypassing a small segment of intestines. Despite all advantages of this procedure the surgeon and the patient should keep in mind that it is quite new technology and there is not as much long-term follow-up data as for other procedures.


Sometimes when after sleeve gastrectomy in the long-run follow-up weight loss is insufficient, revision is needed. Also there is a possibility of complications such as severe symptoms of gastroesophageal reflux disease, strictures, fistulas, and malnutrition then revision is required. During the surgery gastric tube is formed, as a result the anti-reflux barrier between the stomach and the lower esophagus does not perform its function adequately. Sometimes even a high dosage therapy of proton pump inhibitor medications cannot relief the symptoms of reflux. Gastric bypass is considered to be the best option for revision procedure after sleeve gastrectomy surgery. Consequently gastric bypass revision surgery quickly solves these issues. Patient can stop medication immediately after revision and research shows that it has long-lasting effect.

Due to recent quality improvement laparoscopic conversion from sleeve gastrectomy to gastric bypass has become technically more simple, more safe, and effective for re-inducing weight loss and for treatment of severe reflux after sleeve gastrectomy.