Weight Regain One Year After Gastric Sleeve Surgery

by Sarah
(Lebanon)

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About a year and a half ago I had gastric sleeve surgery and lost about 30 kgs (66 lbs) which is perfect. However, my stomach stretched and I started to have irregular periods which was caused by PCOS.

I have put some weight again and it’s making me very scared because I eat well and exercise so much but get nothing in return.

Should I consider having another gastric sleeve surgery?

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Surgeon response to "Weight Regain One Year After Gastric Sleeve Surgery"

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

Sarah,

The weight regain that you're experiencing after undergoing the Verticle Sleeve Gastrectomy (VSG) is not uncommon.

Unfortunately, the physiologic principle by which the procedure affects the weight loss is confined to purely restriction. Since the capacity of the sleeve increases as the sleeve enlarges over time, weight regain is often the consequence.

Treatment approaches at this point include:

1. Caloric restriction (dieting) which you indicate you've attempted with little success
2. Pharmacologic agents (drugs) which offer little long-term durable weight loss benefit in my opinion, or
3. Reversional weight loss surgery

Whether or not you should undergo reversional weight loss surgery (as well as which procedure) depends on the extent of your weight regain and associated re-development of obesity related co-morbidities.

In terms of the options for additional surgery, one option would be to 're-sleeve' your gastric tube.

This procedure entails significantly greater risk than your original VSG and, I believe, can only be accomplished safely as an open (not laparoscopic) procedure; several surgical studies in the literature have confirmed that the risk of a leak from a laparoscopic revision is excessive.

Furthermore, I would expect that you would face weight regain again over time.

Other options would be to have an adjustable gastric band (AGB or "LapBand") placed around your gastric sleeve or to undergo a conversion to a Roux-en-Y Gastric Bypass (RNY).

However, my recommendation would be for you to consider undergoing a conversion to a Duodenal Switch (DS) which is actually just the completion of a 'staged' (two-part) DS. The VSG as originally described and utilized in weight loss surgery was simply the initial gastric portion of the DS: patients who subsequently failed to lose an adequate amount of their excess weight or who regained weight over time (as in your case) would simply undergo the 'switch' part of the DS as the second part of the 'staged' or two-part DS.

This approach has the advantage of incorporating the weight loss surgical principle of controlled caloric absorption in addition to the restriction of the sleeved stomach to not only assist with the weight loss but, even more importantly, prevent weight regain over time. The DS has, by an order of magnitude, much better weight loss durability compared to the other three standard surgical weight loss procedures.

As with any of these procedures, adverse effects are also a consideration. Therefore, you'll want to discuss the potential risks and benefits of any of these potential treatment options with your Bariatric surgeon.

Best regards,

John 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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