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Preventing Gastric Sleeve Failure After Surgery

Preventing Gastric Sleeve Failure After Surgery

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      If you’ve had bariatric surgery, one of your biggest concerns may be that you’ll regain some of the weight. It’s not uncommon for people to start gaining some weight back at 12-18 months after surgery. There are a variety of reasons why a patient gains weight after gastric sleeve surgery. These could be related to surgery, eating habits, or other things such as medications and other medical issues.

      Definition of a Failed Gastric Sleeve

      There are a few different ways that patients may experience gastric sleeve failure. Most commonly, a gastric sleeve failure is one that fails to maintain a patient’s weight loss of 50% or higher. Another simple way to define gastric sleeve failure is failing to lose enough weight to bring a person’s BMI into a healthy range.

      Sometimes, patients are told they are experiencing a gastric sleeve failure when they have ongoing complications.

      Woman standing by a pool in a swimsuit smiling.
      Weight regain is possible and may happen for several reasons.

      Why the Gastric Sleeve Fails?

      The goal of weight loss surgery is to achieve weight loss so that patients can live a healthier, longer life. However, some people do experience failure after gastric sleeve.

      It is important to keep in mind that obesity is a chronic disease that is not cured after bariatric surgery. Gastric sleeve provides patients with a powerful tool for weight loss. Without the right care, this tool can’t be effective and may lead to weight gain.

      There are a few different reasons why patients may not lose as much weight as expected after gastric sleeve surgery.

      The top reasons for gastric sleeve failure include:

      • Resuming unhealthy eating habits after surgery
      • Lack of physical activity
      • Medications
      • Surgical complications
      Woman standing up against a wall holding a cup.
      Obesity is a chronic disease that requires ongoing treatment with a team of healthcare providers.

      Gastric Sleeve Failure and Behavior Changes

      Often, weight regain or slow weight loss is related to behavior and nutrition choices. After weight loss surgery, it’s essential to know that behavior change is necessary to lose and maintain weight loss successfully. While most diets are temporary solutions, bariatric surgery requires a lifelong commitment to habit changes.

      Gastric sleeve failure can happen in patients who are eating too many calories, eating too often, and choosing the wrong foods. It’s important to recognize a gradual increase in the volume of food consumed at meals. Weight gain is also typical in patients who are consuming too many liquid calories, like those found in juice and soda.

      It may be helpful to document your intake and share it with your dietitian. You may be surprised to see the choices and quantity of food that you’ve eaten.

      Medical complications

      Sometimes, the gastric sleeve may fail to provide adequate weight loss because of the enlargement of the stomach pouch. Patients can overeat and cause some stretching or expansion of the stomach after surgery. This is referred to as a dilated gastric pouch. Pouch stretching might be related to lifestyle and dietary choices, as mentioned above. This stretching can lead to increased appetite and decreased feelings of fullness.

      Other medical reasons for weight regain or inadequate weight loss can include pregnancy, thyroid issues, medication side effects, and kidney or heart problems.

      Gastric Sleeve Revision

      In rare cases, a gastric sleeve failure may be related to the surgery itself. A gastric sleeve may fail to provide a large amount of weight loss because not enough of the stomach was removed during the first surgery or stomach pouch dilated after the surgery. In certain situations it is possible to re-sleeve. Additionally, gastric sleeve surgery can be converted to a gastric bypass or duodenal switch.

      Medical supplies laid out on a table.
      Revision surgery may be recommended for patients who have a failed gastric sleeve after other interventions have failed.

      How to Prevent Adding to the Gastric Sleeve Failure Rate

      A very useful tool for preventing weight regain is a nutrition education and follow up with healthcare providers. Before and after bariatric surgery, patients are encouraged to make healthy habit changes. The best education includes information about nutrition, behavior change, and physical activity. Here are some tips to prevent weight regain after gastric sleeve:

      • Rely on your bariatric team. Obesity is a chronic, lifelong disease. Your bariatric healthcare team can help identify and address any issues. Schedule regular visits with your bariatric team to keep your goals on track.
      • Follow your nutrition plan. It is important to follow a plan to ensure you have adequate nutrition and maintain muscle mass.
      • Avoid snacking and grazing. Eating a little bit all day long can make the calories add up. Grazing also prevents you from feeling full.
      • Join a support group. If you are having trouble following recommendations and changing your lifestyle, bariatric support groups can be an excellent place to keep you on track.
      People sitting around a table talking.
      It’s important to have a dynamic support team to learn from peers and share stories of triumph and struggles.

      Gastric Sleeve Surgery: Only a Tool

      Bariatric surgery is just one part of a treatment plan for obesity. Patients must follow nutrition and exercise recommendations, or complications can occur.

      In most cases, the safest and most effective way to combat weight regain is by changing nutrition and lifestyle habits. Reviewing post-surgery diet and exercise recommendations is often helpful for patients down the road.

      It’s important to remember that even the most dedicated patients often experience highs and lows after bariatric surgery. Difficulties are not always a sign of failure. The patient’s success depends on several things.

      Woman sitting with a book open.
      By tracking your intake, you can get a big picture of your eating habits. Your dietitian can help review your recent meals and help you come up with a plan of action.

      Patients are often encouraged to talk with their physician and dietitian about getting back on track with healthy habits before considering revision surgery. Other members of your support team may include a personal trainer, psychologist, and local support group.

      The most important way to be successful long term is to make lifelong habit changes and maintain those habits even years after surgery.

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        Morgyn Clair, MS, RDN


        Morgyn is an RD specializing in weight management and surgical weight loss. She has a master's in clinical nutrition and dietetics, and currently works as a clinical dietitian in a physician’s office.

        Gintas Antanavicius, MD, FACS, FASMBS

        Medical Reviewer

        Dr. G is a co-founder of BariBuilder. A US-based expert surgeon with over 10 years of bariatric experience, he regularly publishes research in medical journals like SOARD, Obesity Surgery, etc.