Revision after gastric - how common is it?

Hi, I was sleeved in 2011. I lost 140,but regained 40. I'm still obese and considering revision. So as I've been reading up on revision and sleeve research that's happened since I was sleeved, I was shocked to find a JAMA article (November 2015 "Long-term Metabolic Effects of Laparoscopic Sleeve Gastrectomy") and saw that nearly HALF of sleeve patients regain "significant" weight by 5 years post surgery. Excess weight loss is at 77% 1 year out, but drops to 56% 5 years out.

So this made me realize there must be a lot of sleeve patients like me that were "early adopters" and are now realizing the sleeve wasn't quite what we had hoped. There were no long-term studies back when I did my surgery. I'm still really really glad I did it. I've kept off 100 lbs, which is awesome. I'm very grateful.

I've been struggling with weight loss these past few years. I've been on back-on-track, HMR, and other commercial and medical diets. I've finally called my surgery to discuss revision options.

Is the gastric bypass the most common revision option for sleeve patients? I'm sure my sleeve has stretched a bit over the years, so perhaps re-sleeving will be sufficient? Is it possible to have too much scar tissue and not be able to have a revision? I've had a lot of surgeries... (gallbladder out, ovary out, thyroid out... just slowly removing parts, haha)

I want to study up and be ready with good questions when I see my surgeon in a couple of weeks.

Thanks for your input.

50% of EWL is typically regarded as long term success medically, since it still beats the pants off dieting (typically 5% or less of dieters without surgery maintain significant weight loss of any sort, forget 50% of their excess weight). The most common cause of regain is habit and, frankly, carb creep back into the diet.

Sleeves tend not to stretch very much. More often if we overeat with any surgery, the food backs up into the esophagus...that is one of many reasons overeating close to surgery is dangerous.

Having said that, I actually am not sure of the most common revision. I suspect it is RNY just because more surgeons do that. DS is also a very valid and decent option for weight maintenance, though it requires a strong commitment to vitamins and high protein/fat for life.

It is weird thinking that I am considered a "success"... haha! But I am very grateful to still be down 100 lbs from my starting weight.

Thanks for your response! Yes, while the DS seems like a logical next surgery it does seem like RNY revision would be a more common approach. So few surgeons do DS - but most do RNY and VSG. DS isn't probably a great option for me because I'd struggle with a high fat diet as I'm vegetarian. (Part of the reason why I choose VSG in the first place.)

I'm meeting my surgeon next week. I was looking at his website and it looks like he (or his hospital) offers endoscopic revision. I've searched here on OH but haven't seen a lot about sleeve patients revising with endoscopic revision. But if my sleeve has enlarged, maybe that would be all I would need to kick weight loss back into gear. I'd love to be able to be successful with just restrictive only procedures, but I might need the metabolic boost of something more.

Thanks again for your response!

I just assumed if I wanted a DS from my rny that they would let me have it considering I regained all my lost weight

Converting to a DS from VSG is pretty straightforward. Going from RNY to DS is extremely complicated and risky. You can count on one hand the number of doctors in North America with much experience in doing that revision.

Update: Met with my surgeon and he is recommending I do the "loop duodenal switch"... so now I've got to research this option. It sounds great to be able to keep the sleeve stomach but add malabsorption. So far, though, it doesn't seem like there is a TON of long-term research on it. And I might have to self-pay because I don't think my insurance would cover this type of revision... but it would be worth the $$ if I could keep my sleeve. I have less restriction than when I started, but still definitely have restriction.

Hi MSTieMom, just curious....did your surgeon give you a reason why he/she recommended the DS instead of gastric bypass?

I'm in the same boat as you....sleeve in 2013, lost 140, gained 35. I saw a new WLS doc *****commended a revision to bypass. I've been approved with insurance, so now just nervous to pull the trigger and confirm the surgery. I keep hearing horror stories from people about complications, and scared to make a decision I regret.