Can old gastric sleeve scars be opened again for another surgery?

by Clint
(Columbus, Ohio)



I had the gastric sleeve done in 2013. I got bad gastric sleeve scars and still have them. I gained back all 85 pounds of weight I lost after surgery. Bariatric surgery before and after made my stomach change. The size of my stomach after gastric sleeve increased, that’s why my doctor said I gained back so much weight. I didn’t follow a gastric sleeve diet anymore after a year when I lost a lot of weight. I’m thinking about getting surgery again.

I have good health insurance that might pay and I’m way overweight again. Talked with my main doctor who says I should get a duodenal switch now because it’ll work better than the sleeve. Doctor told me duodenal switch after the sleeve is a good way to lose weight, but how bad are those scars?

I’m nervous about getting more scars as bad as my vsg scars. My gastric sleeve stomach scars really bother me. I know someone with a lap band scar and hers isn’t as bad.

Can they re-open the scars I already have from the gastric sleeve when they do the duodenal switch? How bad are the duodenal switch scars? Is there any ideas how to make scarring not as bad?


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by: John Rabkin, M.D., Pacific Laparoscopy

Dear Clint,

The Sleeve Gastrectomy (SG) Weight Loss Surgical (WLS) procedure which you underwent was originally conceived as the initial part of a 'staged' (two part) Duodenal Switch (DS) WLS procedure. After finding that many of the patients who underwent the SG didn't return to complete the DS because they were satisfied with the weight loss after the SG, many bariatric surgeons began to offer the SG as a 'standalone' WLS procedure and it has now become the most commonly performed WLS procedure in the United States.

The SG is a purely 'restrictive' WLS procedure as it doesn't create any malabsorption of calories consumed. The DS, on the other hand, does have associated calorie malabsorption as part of how it leads to durable weight loss: as the 'restricted capacity' of the sleeved stomach lessens over time, the 'duodenal switch' component of the procedure ensures that not all of the ingested calories are absorbed by the body, predominantly calories from consumed fat. Consequently, the long term weight loss achieved by patients who undergo the DS is superior to that of patients who undergo the SG.

Many patients who don't lose enough weight or regain substantial amounts of the weight they lost as in your experience after a 'failed' SG elect to 'complete' the DS. The results are similar to patients who undergo the DS initially. In most cases, however, this involves 're-sleeving' the stomach in addition to creating the 'switch.' To safely and properly 're-sleeve' the stomach, most bariatric surgeons performing this more complex revisional bariatric procedure do it 'open' as opposed to laparscopically. Consequently, the scarring to which you refer in your question undoubtedly will be more substantial than from your original procedure (which I presume was done as a laparoscopic procedure.) The surgical approach is routinely through a 'midline' incision: any of your prior scars in the midline can be incorporated in the incision for the revisional surgery.

Most patients in my experience, however, do not find that the associated scarring from any of these procedures is significant enough to dissuade them from having the WLS procedure(s) which offers them tremendous health benefits and lifestyle improvement. I am unsure as to the difficulties that you've faced from the scarring from your prior procedure that creates the significant concern that you outline in your question. I recommend that you discuss your concerns thoroughly with your bariatric surgeon to (hopefully) allay any residual hesitation you may have to proceed with the DS.

John M. Rabkin, M.D.
Pacific Laparoscopy


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DISCLAIMER: This educational advice is based on the depth of your question and the details provided. The above should never replace the advice of your local physicians as they have the ability to evaluate you in person.

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