The stand-alone sleeve has been a popular bariatric surgery option for over 15 years now.  The sleeve, when done correctly is a very good option for good long-term results not only for weight loss but also for resolving associated comorbidities.

Unfortunately, as time goes by, the body changes, circumstances change, in short life happens and some patients find themselves regaining weight. When you have had a successful sleeve surgery that improved your quality of life it is natural that your first option would be to redo the sleeve. make it small once again so I can have the benefits I enjoyed when I first had surgery, this is a common request from patients.

Today we would like to address when a resleeve or sleeve reconstruction surgery is NOT a good option.  There are other scenarios where the resleeve is an excellent option for revision surgery, we will discuss these in another blog.

First, we would like to point out some important facts:

It is normal for the sleeve to not be the same size as it was right after surgery. The sleeve will stretch over time to reach its mature size. If you followed your surgeon’s post-op instructions and the sleeve was done adequately it should give you enough restriction to be able to maintain your weight loss long term.

The gastric sleeve is formed by making the stomach a narrow tube, hence the name “sleeve” which resembles the shape of the sleeve in a shirt. The stomach is not made shorter only narrower.

Below you will find the most common scenarios when a resleeve is not recommended because it will not offer you proper weight loss results or resolve comorbidities associated with obesity.


  • Grazing

In some cases, the sleeve is small and really cannot be made much smaller, but patients regain weight because they eat high-calorie foods all throughout the day. This is called grazing. The good news is that in these cases, the sleeve is still working properly, offering you restriction but what is required is a change in eating habits to start working with your sleeve to start losing weight again.

  • You have a medium to small sleeve

In this case, your sleeve is a bit larger than recommended, either because it stretched over time, or it was done a bit large at the original surgery. A barium swallow x-ray will let the doctor know just how much smaller a sleeve can be made. If the sleeve is small to medium in size it will be made a bit smaller, but it will most likely not make a significant difference in the amount of food it holds to help you reach your weight loss goals.  The revision surgery might reduce the amount of food your stomach holds by 1 to 1.5 ounces which might not be enough of a difference to yield good results.

  • Your stomach is long

As mentioned above the sleeve is made by making the stomach narrower. Some patients find that their sleeves can hold too much food, so they seek a resleeve or sleeve reconstruction surgery. After testing, images show that the sleeve is actually quite narrow and cannot be made smaller, the issue lies in that the stomach is longer than the average which permits the patient to eat more jeopardizing their weight loss.

  • You have already had a Re-sleeve

Stomach tissue that has already been worked on twice is not a good area to work on once more. There are adhesions and scar tissue that make the chance of a leak very high, stapling once again over this type of tissue is not recommended.

  • You have a lot of acid Reflux

The gastric sleeve is a high-pressure system.  A small percentage of patients may experience acid reflux that is not controlled by medication or that take a high amount of medication daily to control it. In these cases, making the sleeve smaller is not recommended as this will most likely cause more reflux making the issue worse.

So, what are my options if a resleeve is NOT an option and I have regained weight or am regaining weight?

Fortunately, all other weight loss surgery options may be open for you, converting to a gastric bypass is usually recommended in all the above cases. The gastric bypass will give you a smaller stomach offering more restriction and give you malabsorption which will permit you to lose weight in 2 ways, it will also address acid reflux problems successfully.  A Duodenal Switch is usually recommended in all the above cases except the last one involving acid reflux.  The DS is considered in some circumstances the best option for long-term weight loss results offering restriction plus malabsorption.

At Mexicali Bariatric Center we specialize in revision surgeries, each case is special and unique. It is especially important in revision surgeries to customize the surgery according to the patient’s needs to obtain the best results possible. For more information, please contact us at (888) 344 3916 US Toll-Free or www.mexicalibariatric.com