Can you change your previous gastric sleeve to gastric bypass? Yes, and many patients do it, but it is not a simple redo of the first surgery. It is more complicated and complex than that.
A “gastric sleeve to gastric bypass” conversion means changing the type of bariatric surgery you had before to a different one called Roux-en-Y gastric bypass. This is a kind of revisional bariatric surgery that may help if the first procedure is no longer working as well, has not worked enough for you, or you have developed chronic side effects that you cannot live comfortably with.
This article explains what that conversion means, why it is done, who might be a candidate, what to expect from surgery and recovery, and what you can expect in results.
What a Gastric Sleeve To Gastric Bypass Conversion Means
A gastric sleeve is a type of bariatric surgery that makes your stomach smaller by removing about 75 to 85 percent of it, so you feel full sooner and eat less. If you start to regain weight or develop ongoing issues like acid reflux (heartburn) or other complications, your bariatric surgeon might suggest converting your sleeve into a gastric bypass.
In a gastric bypass, a much smaller stomach pouch is created and connected to the small intestine in a way that skips much of the digestive process, so the body does not absorb all the calories. This often helps with weight loss and can reduce the symptoms of reflux.
Is A Revision Surgery Just Redo Of The First Surgery?
No. Some patients think that bariatric revision surgery is just doing the original operation again, but it is not. Converting a sleeve to a bypass is more complex than a first-time surgery, and the surgeon has to work around scar tissue and changes from the first surgery, and also reroute part of the intestine, which takes careful planning, skill, and precision.
Why a Surgeon May Suggest a Conversion
A bariatric surgeon may recommend converting from a gastric sleeve to bypass for several reasons, which may include:
- You have regained weight or you never lost an adequate amount after your gastric sleeve surgery.
- You developed ongoing or severe acid reflux (GERD) after your sleeve surgery that medication is unable to control.
- The restriction created by the gastric sleeve has become ineffective due to stretching or dilation of the sleeve.
- Other functional issues or complications related to digestion.
Each person is different, so conversions are looked at on a case-by-case basis and depend on your symptoms, how long it has been since your sleeve surgery, and your current health.
How Does a Bariatric Team Decide If You Are a Candidate?
Your surgeon and team of bariatric professionals will perform a complete evaluation of your health, medical history, and current circumstances. This may include the following:
- A review of your progress since your gastric sleeve surgery.
- A physical exam and some diagnostic tests.
- A discussion about your weight history, current symptoms, and the results you would like to see.
- Nutrition and psychological assessment to make sure you are ready for another surgery
- A review of any non-surgical steps you have tried, such as diet changes or medical treatments.
Your bariatric team looks at the full picture before recommending a conversion. Bariatric surgeons such as Dr. Michael Williams and Dr. Brendon Curtis at the Laparoscopic & Endoscopic Surgery Institute regularly evaluate patients to determine if a revision surgery may help.
Surgery is normally only considered when the potential benefits outweigh the risks for your specific situation.
What Changes With Your Conversion To Roux-en-Y Gastric Bypass?
During a gastric sleeve to gastric bypass conversion, a smaller stomach pouch is created, and part of the small intestine is rerouted to skip a substantial portion of the normal digestive process, limiting the number of calories you can eat and your body can absorb.
These changes are usually done laparoscopically, which uses small incisions and tools with cameras. Because the surgeon is making additional anatomy changes beyond what was done during the initial gastric sleeve, the surgery often takes longer and is more technical.
Why Converting To Gastric Bypass From Sleeve Often Helps Reflux
After sleeve surgery, some patients develop acid reflux, or the mild symptoms they had previously get worse. A gastric bypass reroutes food lower into your digestive tract, so the acid from your stomach is less likely to travel up into your esophagus.
A large study of around two thousand patients who converted from gastric sleeve to gastric bypass experienced significant improvements in their acid reflux symptoms. Some of the results of that study showed the following:
- The scores recorded for GERD symptoms dropped from 24.6 to 6.6 one year after surgery.
- 74% of patients needed reflux medication before their surgery, and only 27% still needed medication one year after their conversion.
Benefits and Tradeoffs
Converting a gastric sleeve to a gastric bypass may help some patients, but when making a decision about this surgery, there are some benefits and tradeoffs to consider.
Possible Benefits May Include:
- Additional weight loss if your sleeve stopped working as well as expected.
- Improvements or elimination of acid reflux symptoms for some patients.
- Changes to your digestive process can help you eat smaller portions and feel full sooner.
Possible Tradeoffs Include:
- Revision surgery is more complex than the first operation and may carry a higher risk of complications such as bleeding, infection, or leaks.
- After conversion, continuous follow-up care is necessary, which includes regular checkups with your bariatric team.
- Gastric bypass changes how your body absorbs nutrients, so daily vitamins and supplements are required forever.
How Long After a Gastric Sleeve Can You Convert To Gastric Bypass?
Some patients convert within a few years if they develop complications like severe acid reflux. Other people undergo a conversion many years later due to weight gain or inadequate weight loss.
How Much Weight Will I Lose After A Gastric Sleeve To Gastric Bypass Conversion?
A few different studies reported that patients lost anywhere between 43% and 58.5% of their excess body weight in 12 months after their conversion.
Each patient’s situation is different, so results vary and can depend on diet and lifestyle choices as well as any medical conditions present.
After a Conversion To Bypass Will I Need Lifelong Nutrition Follow-up?
Yes. Because gastric bypass conversion permanently changes how your body handles food, it increases the risk of experiencing severe nutritional deficiencies, so you will need to work closely with a dietitian and a bariatric medical team forever. This normally includes:
- Daily vitamins and minerals to prevent deficiencies.
- Regular lab tests to check nutrient levels.
- To focus on protein and hydration to support overall health.
Recovery After Conversion
Your recovery after your conversion is similar to that of first-time bariatric surgery and can take up to six weeks or a little longer. Most patients must follow a staged diet to allow their bodies to adjust to the changes that were made. This normally includes:
- Clear liquids for the first few days.
- Full liquids and then transitioning to soft foods as guided by your team.
- Gradually introducing regular solid foods.
When to Call Your Surgeon
Contact your surgeon right away if you notice:
- Severe abdominal pain
- Persistent vomiting or inability to keep fluids down
- Signs of infection, like fever
- Rapid heart rate or dizziness
These symptoms could signal complications that need prompt care.
Where Can You Get a Gastric Sleeve To Gastric Bypass Conversion?
Dr. Michael Williams and Dr. Brendon Curtis specialize in bariatric surgery, including revisional procedures, at the Laparoscopic & Endoscopic Surgery Institute in Alpharetta, Georgia.
The team of experts can evaluate your circumstances and symptoms and thoroughly explain all of your options and provide you with the support you need from before your surgery through your procedure and beyond.
If you are considering a gastric sleeve to gastric bypass conversion, the first step is to set up a consultation with one of our qualified board-certified bariatric surgeons who can help determine if a conversion surgery makes sense for you and your circumstances.
FAQs
Can a Gastric Sleeve Be Converted to Gastric Bypass?
Yes. A gastric sleeve can be converted to a Roux-en-Y gastric bypass through revisional bariatric surgery.
Why Do People Convert a Gastric Sleeve to Gastric Bypass?
Common reasons include weight regain, inadequate weight loss after the sleeve, severe acid reflux that does not improve with medication, or stretching of the sleeve that reduces restriction and leads to weight gain.
Is Gastric Sleeve to Gastric Bypass Conversion Riskier than Having a Gastric Bypass Originally?
Revision surgery usually comes with more risks than the first bariatric procedure because the surgeon must work around scar tissue and previous anatomical changes. Qualified candidates who choose a surgeon with extensive experience like Dr. Michael Williams or Dr. Brendon Curtis can help reduce risks and improve results.
How Much Weight Can You Lose After Converting Sleeve to Bypass?
Studies show patients may lose up to 58% of their excess body weight within the first year after converting from sleeve to gastric bypass. Results vary by person and are tied to permanent lifestyle choices.
Does Converting a Sleeve to Gastric Bypass Help Acid Reflux?
Yes, many patients experience improvement in reflux symptoms. Research shows the number of patients needing reflux medication dropped from 74% before surgery to 27% one year after conversion in a large study.
