The Answers to Gastric Sleeve Failures

The Answers to Gastric Sleeve Failures

The Gastric Sleeve is an open procedure, and is known as part of the Duodenal Switch since 1988.  The Laparoscopic Gastric Sleeve on high risk patients started in 2004 as the first stage of the Duodenal Switch (DS) and soon after that date, several teams started Laparoscopic Gastric Sleeve programs as primary or solitary surgical procedures for morbidly obese patients. In 2007 the Gastric Sleeve was proposed as a treatment for Metabolic Disease regardless of the excess weight of the patient. 

There are no long term follow-up results currently available for Gastric Sleeve Patients as a primary procedure. However, due to the increasing popularity of the Laparoscopic Sleeve, we are starting to see an increased number of failures. What we have observed in most of the Gastric Sleeve failures is the presence of large stomachs or large sleeves instead of a small volume sleeve. We have also observed a very poor nutritional and dietary change of habits in patients exhibiting gastric sleeve failure .

gastric-sleeve-proper-size   = CLICK VIDEO

When we started performing Lap Band Procedures we were creating 50 cc pouches; soon after started creating 15 cc pouches in order to give patients restriction and to avoid failures.  We are experiencing similar conditions with the Gastric Sleeve.  The remaining stomach is too large (large sleeve) so patients don’t have adequate restriction to lose weight as we expected. The use of a smaller bougie during surgery to calibrate the size of the sleeve is imperative to avoid such technical failures. The running suture reinforcement will also help to prevent a large stretching of the sleeve.

When we started performing Gastric Sleeves we didn’t have enough appropriate follow-up care for patients because we were assuming the sleeve will work and do its job (by creating enough restriction and decreasing the Ghrelin levels to lower  hunger). The truth is that patients need to be monitored closely and assisted on a regular basis with support groups and counseling in order to succeed.

We believe that the stretching of the Sleeve over time will also play a huge role in all of the cases of failure just as we learned from the lap band. Dilated pouches (large pouches) played a huge role in Lap Band failure in the past, and now in the case of the Gastric Sleeve, failure is due primarily to a large stomach pouch or sleeve.

Arturo Rodríguez, MD

http://www.thebariatric.com

http://www.bandstersforum.com

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15 Responses to “The Answers to Gastric Sleeve Failures”

  1. Lisa says:

    There is nothing here, what is the point of this video?

  2. Hello Lisa,
    What video are you talking about?

  3. Becky says:

    Dr. Rodriguez, I had a sleeve gastrectomy in January 2010. I have gained back the 20 pounds I lost prior to the surgery, plus another 15. Can a lap band be placed around the top of the sleeve? I am devastated that this procedure did not work for me. I was convinced that the sleeve gastrectomy was much superior to the lap band procedure by my surgeon.

  4. Hello Becky,
    I am sorry to hear about it.
    In some patients that the sleeve gastrectomy didn’t work was shown that the sleeve was too wide permitting the pass of all kind of foods and therefore not working as a restrictive procedure as intended.
    Placing a lapband in the upper pouch could be one of your options.
    I personally like the lapband as a first option for choosing a weight loss procedure either do I was the first surgeon in Mexico to do the gastric sleeve.
    I do like the gastric sleeve very much if you also are diabetic or have Metabolic syndrome.
    The sleeve is very good for not having appetite is this your case?

  5. roberta says:

    Ho fatto una sleeve 17 mesi fa non riesco a nutrirmi ho dolore quando mangio e a distanza di 1 anno ho sviluppato un esofagite importante, c’è un modo per correggere il problema????? Grazie e vi prego ho bisogno di suggerimenti veloci.

  6. Sandra Moncivais says:

    Hi i did the sleeve jan 2012 and i just lost 40 pounds and that it it didnt work for me im gainging it back
    Can i get it redone or should i just get bypass
    sansra

  7. The sleeve should be restrictive.
    In some cases the sleeve is “wide” and aloud food to go through easily. Those patients can have a re-do surgery.
    I would go for a GB if I see a “normal: sleeve during a barium swallow.

  8. Wendy says:

    I had the lap band done in June 2012, since that time before the surgery I had lost 8 lbs on my own plus the lbs I had to lose in order for this surgery.

    Later on in 2013 I was suffering from a lot of pain and couldn’t figure out what this pain was from, it is located where the lap band is. I figure something is going with this band, and since the band can hold up to 4cc, I had 3.0 cc of saline in the band ring, could this amount of 3 cc be the cause of the pain, and or could it be that it has slipped?

    I’m worried that if I need to go back to have this taken care of, my surgery was done in Tijuana, Mexico, that I ate more than I should of that it caused this?

  9. Hi Wendy,
    Sorry to tell you that you have an old Lapband model.
    Pain can be related to the fill you have or slippage.
    You need a barium swallow to rule out slippage and if normal remove some fluid until you feel better.

  10. Tonya says:

    Can you tell me what it is you are seeing as far as success when it comes to lapband to sleeve revisions. I revised in September and though I was told I would only be able to eat a few bites and would lose my feeling of hunger neither has been the case. I truly feel that this is because my history of dialations with the band left the top part of my stomach too stretched out for the sleeve to work for me. What are your thoughts ?

  11. Hi Tonya,
    I’ve seen some patients that are just like you.
    Most of the ones I’ve seen are eating everything and when I take a fluoro control I can see that the sleeve has stretched.
    My thoughts are that patients should be committed with any kind of weight loss procedure, with the diet and the exercise, and most of them want the procedure to work alone and that is just one third of the road to weight loss.
    There is a fact that hunger goes away with the sleeve but there is very little to do when you eat by anxiety or that you are just too long sited or in bed.
    When the sleeve has gotten stretched the patients can have a re-do or switch to a Gastric Bypass with medication and very close follow up.

  12. Tonya says:

    Thank you for your response, I guess I should have also mentioned that I lost 100 lbs with my band and kept it off for six years. On my day of sleeve surgery I was only 15 lbs from my goal weight which is great, but six months post op I’m still the same weight. I also run 2-3 miles 2-3x a week and watch my protein and water. My leak test the day after surgery showed a very distorted picture almost blob like where by band had been removed and I just can’t imagine this hasn’t effected my success post sleeve.

  13. Hello again Tonya,
    You did great with the Lapband and need just a small push to get to your goal with the gastric sleeve.
    In some patients that we de-band and do the sleeve at the same time we can see a bigger pouch above the sleeve than when gastric sleeves are done at first, this pouches can hold more food if they stretched so having a second X-ray control would be wise.
    In case you have pictures of your first X ray contra you can send them to me at md@thebariatric.com and I can take a look of them if you want and give you my opinion.

  14. Linda Browning says:

    Dr. Rodriguez,
    It has been a long time. You did both mine and my daughter’s, Heather, band back in 2003. I had to have mine removed due to erosion. If it hadn’t been for you and your wonderful skill and knowledge, I don’t think I would be writing you here today. You said someone above was watching over me and I agree. He also guided your hand. Anyway, all these years later, Heather is now 25 and still overweight. You also removed her lapband soon after you removed mine. We feared the same would happen to her. She had Graves disease and has gained over the years but doctors finally have her medicine where it needs to be. She is 5’2″ and close to 300 now. Do you do gastric bypass or sleeve and if so..how much do these surgeries cost? I am contacting you because my trust in you is 100%+++. Thank you, Linda

  15. Hi Linda,
    It has been a long time but I remember You and Heather very well.
    Sorry to know about Heathers health, She can have either the sleeve or the Gastric Bypass.
    Can you contact me through my email? md@thebariatric.com
    I need 5 nights with me with either the Gastric Sleeve or The Gastric Bypass.
    Do to forget to leave me you new phone number.

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