RE-SLEEVE STOMACH REDUCTION AGAIN

RE-SLEEVE STOMACH REDUCTION AGAIN

Re-sleeve is the name we give to making the growing stomach tube smaller again by re-cutting or folding and sewing it. It is a common and effective revision surgery. It has almost no malabsorption effect.

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RE-SLEEVE STOMACH REDUCTION AGAIN

Re-sleeve is the name we give to making the growing stomach tube smaller again by re-cutting or folding and sewing it. It is a common and effective revision surgery. It has almost no malabsorption effect.

It becomes more difficult for the re-sized stomach to grow again. This reduces the risk of weight gain after re-sleeve. After sleeve gastrectomy, the stomach tube can expand from the top and bottom. Since the expansion of the upper part will increase food intake, an unpreventable weight gain begins. In the re-sleeve operation, these enlarged upper and lower stomach parts are removed and sutured again.

 

 

WHY WEIGHT GAIN AFTER GASTRIC SLEEVE SURGERY?

Weight gain after sleeve gastrectomy is a problem that can be encountered at different rates depending on the time elapsed after surgery. We can examine this problem in three stages.

  • Those who cannot lose enough weight in the first 6 months after surgery
  • Those who lost weight after surgery but regained weight in less than 3 years
  • Weight gainers after 5 years after surgery.

The most common reason in the first group is that the stomach cannot be reduced sufficiently as standard in sleeve gastrectomy surgery. In this group, inadequate weight loss can rarely be seen in women over the age of 45 who live sedentary, even if the stomach is reduced standardly. In the second group, it can be thought that the stomach is reduced with a 36Fr spark plug and the plug is not approached very tightly with a stapler. We often use a thinner 32 Fr spark plug. Of course, even if there is no technical problem in this group, there may be weight gain because a proper lifestyle is not created. Again, women over the age of 45 who live sedentary can be in this group. In the third group, although sleeve gastrectomy surgery is performed in accordance with the technique, long-term weight gain is often due to lifestyle changes.

WHY DO WE GAIN WEIGHT AGAIN AFTER GASTRIC SLEEVE SURGERY?

  • Sleeve gastrectomy surgery is not performed according to the technique
  • Although sleeve gastrectomy surgery is performed in accordance with the technique, the person returns to inappropriate eating habits
  • Rarely, a clear cause of weight regain despite gastric sleeve surgery can be identified. It can be interpreted that the metabolic response of these people is different.

GASTRIC SLEEVE OR GASTRIC BYPASS, IN WHICH CASE IS WEIGHT REGAIN MORE COMMON?

Gastric sleeve gastrectomy surgery is as effective as gastric bypass surgery when performed according to standards. After gastric bypass, the connection between the gastric pouch and the intestine expands over time and the amount of food consumed by the patient at a time increases and weight gain begins. RNY gastric bypass surgery has very little malabsorption effect. In bypass operations such as mini bypass, duodenal switch or transit bipartition, the malabsorption effect is much higher. Even in bypass operations with a high malabsorptive effect, weight gain begins when the amount of food consumed at one time increases. In other words, in general, when the connection between the newly created small stomach pouch and the intestine expands in bypass surgeries, weight gain starts again. Therefore, the effect that keeps the person at the weight they have lost in obesity surgery methods is mainly the restrictive effect. When the restrictive effect on food intake decreases, weight gain begins despite the malabsorption effect. Sleeve gastrectomy or gastric bypass surgery carry the risk of weight regain at similar rates.

Based on our experience, we recommend gastric sleeve surgery first, and if weight gain occurs again, gastric bypass surgery should be performed in the second stage. In fact, most of the time, when there is weight gain after sleeve gastrectomy, we perform stomach reduction surgery, which we call resleeve, before performing gastric bypass surgery.

WHAT HAPPENS IF WEIGHT IS REGAINED AFTER GASTRIC SLEEVE SURGERY?

Regardless of the reason, weight gain after gastric sleeve surgery causes the person to seek to lose weight again. First of all, a change in diet and a more regular active life is recommended, but it is often not effective. First of all, it should be questioned whether there is an increase in the amount of solid food that the person can take at a time. Increased gastric capacity after sleeve gastrectomy can also be checked endoscopically or radiologically. The situation we frequently encounter is an increase in stomach capacity. In this case, we recommend that the stomach be reduced again with surgery. This method, which we call Re-Seeve, is actually the standard reconstruction of the sleeve gastrectomy. In this method, the same abdominal wall holes are used. The operation generally takes 1 hour and the risks are the same as the first sleeve gastrectomy.

Sometimes we also encounter cases where the previous sleeve gastrectomy did not expand in volume but there is still weight gain. Since the gastric tube does not enlarge, there is no possibility of re-sleeve and in this case we apply omega gastric bypass. Omega gastric bypass is the standard bypass of 2 meters of thin glass, but if the patient's intestinal length is longer than normal, we bypass 2.5 or even 3 meters of intestine. The most common problem with omega gastric bypass is that bile reaches the stomach and causes complaints. To prevent this, we can direct the bile before it reaches the stomach by applying the 'Braun Anastomosis' technique. Braun anastomosis corrects reflux very effectively, especially in patients with reflux after sleeve gastrectomy.

We do not perform RNY Gastric Bypass surgery in weight gain after sleeve gastrectomy. The reason for this is that in RNY bypass surgery, only 60 cm of the first small intestine is bypassed and this is not very effective in weight loss. Although it is said that it can be preferred in patients with reflux complaints, since the patient needs to lose the weight gained other than reflux, omega bypass with Braun anastomosis is a more effective solution in our opinion.

After sleeve gastrectomy surgery, the person is expected to lose 70% of the excess body weight. Losing less than 50% is considered a failure. There is a problem of weight regain in all obesity surgeries and this rate is around 20% in 5-year follow-ups. For this reason, it would be very rational to start the bariatric surgery adventure with sleeve gastrectomy surgery, which is easy to revise, that is, to be converted to other surgery. In this way, bypass surgeries will be left to the second stage. Although revisions of bypass surgeries are also possible, it is technically much more difficult than the revision of the sleeve gastrectomy.

If you are experiencing weight gain after sleeve gastrectomy surgery, you can call us at +90 532 7281484 if you want to discuss this issue in detail and get information.

We wish you a healthy day.

Why weight gain after sleeve gastrectomy?

The most common cause of weight regain is the regrowth of the stomach volume or the fact that the sleeve gastrectomy was initially made larger than standard. Especially when the upper part of the stomach is not completely removed, it is easy to expand because it has thin walls. When this area expands, the amount of food taken at one time increases and weight gain occurs.
 

How much weight do I need to be to have sleeve gastrectomy?

For gastric sleeve surgery, you need to be at least 25 kilograms above your normal weight. Body mass index should be above 35. Diabetics between 30-35 can also undergo surgery.

YOUR SURGERY PROCESS

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Our clinic is in Nişantaşı district of Istanbul. If you would like to meet face to face before surgery, contact us for an appointment. You have decided to have your surgery and if you are coming from out of town and have limited time, you can contact our doctor Koray via phone or WhatsApp. After your surgery day is determined, our dietitian Mr. Efe will give you information about your pre-operative diet verbally or in writing. With this diet, your liver will shrink and your surgery will be more comfortable. Share with us the medications you used before surgery and let us determine which ones to discontinue.

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On the day of surgery, unless you are told otherwise, please come to the hospital at 08:00 on an empty stomach. Mr. Samet will meet you at the hospital and accompany you during your pre-operative tests. These tests take approximately 2 hours. You will settle into your hospital room while you wait for the test results. Approximately 30 minutes before your surgery, our teacher Koray will come and visit you in your room. You will be given a sedative before the surgery and taken to the operating room on your bed. Your surgery will be performed under general anesthesia, so your hour-long surgery will feel like 1 second. You will stay in the recovery room for 30 minutes after the surgery. When you go to your room, the nurse will give you painkillers and anti-nausea for any pain or nausea you may have. There will be no drain catheter in your body. You will be able to get up and walk on your own 2 hours after arriving in the room. 1 companion can stay with you in the hospital. There is no harm in being alone. The morning after your surgery, you will undergo an x-ray and a stomach x-ray will be taken. Here you will be given a drink mixed with cherry juice. After the scope, you will start drinking water and apple juice. When you are discharged after staying in the hospital for 2 or 3 nights, you can drive or travel by plane.

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When you go home, both our dietitian and nurse will continue to support you on what to do. You will be able to return to your daily life. Thanks to the closed surgery technique, there will be no problem in heavy lifting and daily movements. Post-operative showering starts in the hospital, but you should cover your stitches with waterproof bandages during the shower for the first 5 days when you go home. Your stitches are hidden and there is no need to remove them. You will start using your prescribed medications at home. Nutrition will be explained to you by your dietitian in the hospital, and on the 15th day, you will meet with our dietitian face to face again and your measurements will be taken. Online meetings will be available for those out of town. You can come for monthly check-ups throughout your weight loss process. You will have your blood tests done every 3 months and send them to us.

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