Gastric Sleeve Conversion to Gastric Bypass

This article will discuss everything you need to know about this revisional weight loss surgery. From understanding the procedure and its benefits to learning about the potential risks and complications, we’ll provide you with the information you need to make an informed decision. 

If you’re ready to take the next step in your weight loss journey, Detroit Weight Loss Center, with locations in Commerce Charter Twp and Southfield, Michigan, is here to help. Schedule an appointment today to discuss your options with our experienced team of bariatric experts!

What is a Gastric Sleeve Procedure?

A gastric sleeve procedure (also known as sleeve gastrectomy) is a type of bariatric surgery aimed at helping people lose weight. During this surgery, a large portion of the stomach is removed, leaving a smaller, sleeve-shaped stomach.

This smaller stomach restricts the amount of food a person can eat, helping them feel full sooner and consume fewer calories. It also results in hormonal changes that impact hunger, fullness, appetite, cravings, and greatly affect metabolism. As a result, significant weight loss can occur.

The gastric sleeve procedure is usually recommended for individuals who are severely overweight and have struggled to lose weight through other methods. It can help improve or resolve obesity-related health issues such as diabetes, high blood pressure, and sleep apnea.

However, in some cases, patients may not achieve the desired weight loss or may experience weight regain or acid reflux after a gastric sleeve procedure. In such situations, a conversion to a gastric bypass, duodenal switch, or SADI surgery may be recommended to further aid in weight loss and help maintain a healthier weight.

What is a Gastric Bypass Procedure?

A gastric bypass procedure is a type of weight loss surgery that helps people who struggle with severe obesity. During this surgery, the stomach is made smaller, and part of the small intestine is bypassed.

The smaller stomach limits the amount of food a person can eat, making them feel full sooner. By bypassing part of the small intestine, fewer calories and nutrients are absorbed from the food you eat. The new route decreases the hunger and increases the fullness sensation. 

In addition, effects on hormones and metabolism improve high blood pressure, diabetes, sleep apnea, high cholesterol, and other metabolic conditions. These changes usually lead to significant weight loss.

Some people consider gastric bypass if they’ve had inadequate weight loss or regained weight after previous bariatric surgery, like a laparoscopic adjustable gastric band (lap band) or sleeve gastrectomy. In addition, people may opt for a gastric bypass to help treat acid reflux, gastroesophageal reflux, or GERD. 

Gastric bypass surgery can also improve or resolve obesity-related health issues like diabetes, high blood pressure, and sleep apnea. It’s a powerful tool for those struggling with weight gain and its associated health problems.

Who Can Benefit from a Bariatric Revision Procedure?

Bariatric revision surgery can benefit people who have had inadequate weight loss or regained weight after a previous weight loss surgery or people who are experiencing complaints that could be improved with additional revision.

Individuals who have undergone gastric sleeve surgery may find that they haven’t lost enough weight or that they’ve regained weight over time. In such cases, a bariatric revision procedure, like converting to a gastric bypass or SADI, can help them achieve further weight loss and sustain it.

Several factors may lead to insufficient weight loss or weight regain after gastric sleeve surgery, including:

  1. Limited Success: Some people may not achieve the desired weight loss after gastric sleeve surgery.
  2. Weight Regain: Others may initially lose weight but later regain it due to various reasons, such as overeating or stretching of the stomach.
  3. Health Concerns: Weight regain can also lead to the return of health issues like diabetes, high blood pressure, or sleep apnea.

Bariatric revision surgery aims to address these issues by providing patients with a new opportunity to achieve significant and sustained weight loss.

Is it Safe to Go from a Gastric Sleeve to a Gastric Bypass or Duodenal Switch?

Converting from a gastric sleeve to a gastric bypass or SADI is generally safe and effective for those who haven’t achieved sufficient weight loss or who have experienced weight regain after the initial surgery. The decision to undergo a conversion procedure is usually made after careful consideration by both the patient and their healthcare team.

While all surgeries carry some risks, the benefits of converting to gastric bypass or SADI, such as the potential to achieve weight loss and sustain it, often outweigh the risks. Patients who undergo this conversion procedure typically experience significant improvements in their weight loss journey and overall health.

It’s important for individuals considering this option to discuss the potential risks and benefits with their healthcare provider to make an informed decision.

How is a Gastric Sleeve Conversion Surgery Performed?

During a gastric sleeve conversion to gastric bypass surgery, the surgeon modifies the existing gastric sleeve by rearranging the digestive system. Here’s an overview of how the procedure is performed:

  1. Anesthesia: The patient is given general anesthesia to ensure they are comfortable and pain-free during the surgery.
  2. Incisions: The surgeon makes several small incisions in the abdomen.
  3. Gastric Sleeve Modification: The surgeon accesses the existing gastric sleeve and carefully converts and makes adjustments to the stomach and/or intestines by attaching it directly to the small intestine, bypassing a portion of the GI tract.
  4. Closure: Once the bypass is created, the surgeon closes the incisions with stitches.

Recovery from gastric sleeve conversion to gastric bypass or SADI surgery typically involves:

  • Hospital Stay: Patients usually stay in the hospital overnight following the procedure to be monitored.
  • Dietary Changes: Patients will need to follow a specific diet plan as advised by their healthcare team, starting with clear liquids and gradually progressing to solid foods.
  • Physical Activity: Light physical activity is encouraged after surgery to promote healing, but strenuous activities should be avoided for a few weeks.
  • Follow-up Appointments: Patients will have regular follow-up appointments with their healthcare team to monitor their progress and ensure a smooth recovery.

Overall, while recovery times can vary, most patients can return to normal activities within a few weeks following gastric sleeve conversion to gastric bypass surgery. However, it’s essential to follow the post-operative instructions provided by the healthcare team to ensure a successful recovery and optimal results.

Risks and Complications for Gastric Sleeve Conversion Surgery

While gastric sleeve conversion to gastric bypass surgery is generally safe, like any surgical procedure, it carries certain risks and potential complications. Some of these include:

  1. Leak: A postoperative gastrointestinal leak is a rare but serious complication of gastric bypass.
  2. Stomal Stenosis: A stomal (anastomotic) stenosis is defined clinically as the inability to swallow liquids and usually occurs if the anastomosis narrows to a diameter of less than 10 mm. This is usually treated with endoscopic balloon dilation. 
  3. Marginal Ulcers: Marginal ulcers are areas of inflammation that can lead to pain and difficulty eating. In rare circumstances, marginal ulcers can cause bleeding, perforation, or blockage.
  4. Gastrogastric Fistula: A gastrogastric (GG) fistula is a channel that develops between the gastric pouch and the excluded stomach remnant, allowing ingested food to enter the bypassed foregut. 
  5. Diarrhea: Due to changes in your intestinal absorption, people can experience more frequent, greasy, or foul-smelling stools.  
  6. Dumping Syndrome: After RYGB, approximately 50 percent of patients will experience symptoms of flushing, crampy diarrhea, palpitations, and diaphoresis after ingesting a meal rich in simple carbohydrates.
  7. Hypoglycemia: More severe forms of low blood glucose can also occur independent of recent food ingestion. 
  8. Internal Hernia, Small Bowel Obstruction: Small bowel obstructions can occur at any time after RYGB, with a lifetime incidence of approximately 3 to 5 percent. 
  9. Psychosocial Impairment: Some patients experience psychosocial impairments following bariatric surgery, leading to alcoholism, substance abuse, and even self-injurious behaviors or suicide.
  10. Mortality: The 30-day mortality risk is usually less than 0.1%. 
  11. Infection: There is a risk of infection at the site of incisions or within the abdomen.
  12. Bleeding: Bleeding can occur during or after the surgery, which may require further medical intervention.
  13. Blood Clots: Blood clots can form in the legs (deep vein thrombosis) or lungs (pulmonary embolism) after surgery.
  14. Anesthesia Complications: Adverse reactions to anesthesia can occur, although they are rare.
  15. Nutritional Deficiencies: Bypassing a portion of the small intestine can lead to deficiencies in certain vitamins and minerals, such as iron, calcium, and vitamin B12.
  16. Severe Acid Reflux: In some cases, patients may experience severe acid reflux after gastric bypass surgery.
  17. Failure to Achieve Weight Loss: While rare, some patients may not achieve the desired weight loss following the conversion surgery.

It’s important for patients considering gastric sleeve conversion to gastric bypass surgery to discuss these risks and potential complications with their healthcare provider. 

Considering Gastric Sleeve Conversion to Gastric Bypass or SADI?

Gastric sleeve conversion to gastric bypass or SADI surgery can be an effective option for individuals who have not achieved sufficient weight loss or who have experienced weight regain after their initial bariatric surgery.

If you’re considering revisional weight loss surgery, it’s essential to consult with an experienced bariatric surgeon to discuss your options and determine the best course of action for your individual needs. Schedule an appointment with Detroit Weight Loss Center, with locations in Commerce Charter Township and Southfield, Michigan, today to explore your options and get started on the path to a healthier you!

Medically reviewed by Dr. Blake Movitz, MD,  FACS

Dr. Blake Movitz

Dr. Blake Movitz

Fellowship trained from the Mayo Clinic in Minimally Invasive Advanced GI Surgery, Complex Endoscopy and Bariatric Surgery.