Revision Bariatric Surgery for Failed Vertical Sleeve Gastrectomy (VSG)

Vertical sleeve gastrectomy is among commonly performed Bariatric surgery procedures for management of moderate to severe obesity. In this bariatric procedure, the stomach is stapled vertically to reduce its size by 85%. After this procedure, the capacity of the stomach is reduced to 30-150 ml. The patient consumes less quantity of food and loses weight over months following the procedure. The nerve supply to the stomach and pylorus is left intact in order to keep normal motility of the stomach intact. It is a very effective procedure in losing weight and is used in place of gastric bypass or laparoscopic gastric banding. Around 80% of patients who undergo gastric sleeve lose excessive weight successfully but near 20% patients fail to do so. This failure to lose sufficient weight after vertical sleeve gastrectomy is called VSG-failure. Vertical sleeve gastrectomy failure can be corrected by revision Bariatric surgery. Following options are there to lose weight after vertical sleeve gastrectomy failure occurs:

  1. Re-sleeving of stomach
  2. Duodenal switch surgery
  3. Illeal transposition

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RE-SLEEVING OF STOMACH

This revision surgery procedure is suitable for those patients in which stretching of the stomach becomes the reason for vertical sleeve gastrectomy. Re-sleeving involves stapling the stretched stomach to reduce its volume again. Re-sleeving the stomach is successful in patients who lose some weight after VSG. If the patient fails to lose any weight after VSG then other revisional surgeries procedure should be performed for better results.

DUODENAL SWITCH SURGERY

Patient who fail to lose weight after vertical sleeve gastrectomy can be benefited by revision of VSG to duodenal switch. This revision Bariatric surgery procedure proves successful at losing weight in most of the patients. The other advantage of this revision is going from vertical sleeve gastrectomy to the duodenal switch carries little risk.

This is because performing duodenal switch for the first time can be really damaging to the body. The reason for low surgical risk for revising VSG to duodenal switch is that one part of reducing the size of the stomach is already done in VSG. Duodenal switch is probably the most effective revision Bariatric surgery after failure of VSG, gastric bypass, and laparoscopic gastric banding.

ILLEAL TRANSPOSITION

Illeal transposition is another revision Bariatric surgery procedure that can be performed on patients who fail to lose weight after VSG. In this procedure, changes in the position of terminal ileum are done but the total length of the intestine is preserved. This procedure has fewer long-term side effects.

Revision Bariatric surgery procedures are a little riskier than Bariatric surgery procedures performed in the first instance. For revision Bariatric surgery only dedicated Bariatric surgery hospital should be selected where the

Experienced bariatric surgeon performs these procedures with the utmost safety and care.

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