Patient A.S. sent us this question: “I had Bariatric Sleeve surgery in Houston, regained my weight back. I had watch a surgeon on you tube perform Endoscopic Sleeve Gastrolatry the advantages of minimal invasive weight loss. I am diabetic Type II, and Obese as of now. Can I qualify for these procedure for a second chance rather than DS-Duodenal Switch. Please Advise. Thank you.”

Dear A.S,

Gastric sleeve revision surgery may be indicated after weight regain. First, a thorough evaluation with a qualified bariatric surgeon is needed to determine the reasons of weight regain. Accordingly, several surgical options for gastric sleeve revision may be offered if you are deemed a good candidate for weight loss surgery. These include redo sleeve resection, conversion of gastric sleeve to gastric bypass or duodenal switch. Redo gastric sleeve surgery is typically offered if the initial sleeve gastrectomy was poorly performed. A retained gastric fundus in the setting of a hiatal hernia is in my experience, at Houston Weight Loss Surgery Center, a common cause for poor weight loss and weight regain. I have had great success in revising these cases by resecting the retained gastric fundus and repairing the hiatal hernia. Patients with gastric sleeve lumen narrowing following sleeve gastrectomy require revision to Roux-en-Y gastric bypass to alleviate the obstructive symptoms like heartburn, regurgitation and vomiting

Gastric sleeve conversion to duodenal switch, DS, is also a viable option especially for super morbidly obese patients with type 2 diabetes. DS is the most effective surgical solution for type 2 diabetes. DS, however, is a malabsorptive procedure and is associated with long-term complications including diarrhea, excessive flatus, vitamin and mineral deficiency, osteopenia, osteoporosis, and kidney stones. If you have advanced diabetes and your BMI is more than 50, DS may be a good option for you.

Endoscopic sleeve gastroplasty is a novel and experimental weight loss procedure. We have limited data on its effectiveness as a primary weight loss procedure. I am not aware of any studies examining the use of endoscopic suturing to revise a failed gastric sleeve. The concept is quite appealing due to its non-invasive nature. Effectiveness and durability must also be taken into consideration. There is no point of using a minimally invasive revision procedure that does not work.

I hope this brief review is of help to you. Warm Regards, Dr. Darido