Does the Gastric Sleeve Always Work?

Posted on: 19th Jun, 2020


If you’re investigating metabolic surgery, it’s likely that outcomes and efficacy are important to you. In the case of the gastric sleeve, a common question is whether it always works. The short answer is no, because nothing always works. But there is very encouraging data showing that it almost always works. And it works way better, and is much safer, than doing nothing or continuing to pursue diets and exercises, shots, pills, herbs and programs that most definitely do not work.

Successful Outcomes

Laparoscopic sleeve gastrectomy has become the number one weight-loss procedure, or metabolic surgery, because of its excellent success rate and low complication rate. Many studies show an equivalent weight loss success and nearly equivalent diabetes remission success rate as gastric bypass surgery, but with fewer complications of blockages, reoperations, and vitamin deficiencies. In 2019 U.S. hospital data, sleeve gastrectomy was safer than a gallbladder or an appendectomy, an astonishing track record of safety.

In my own hands, after two decades of experience with other bariatric surgeries, and many complex gastrointestinal surgical procedures, I have completed approximately 3000 sleeve gastrectomy procedures with 0.0% mortality and approximately 2000 consecutive procedures with 0.0% leak rate. Our team’s published paper describes many of the technical elements leading to illumination of leaks as a complication. Other experienced surgeons and centers have produced similar results. But does the sleeve always work?

The answer is that no surgery always works, and instead what we see is a bell-shaped curve of weight-loss results after the sleeve, like that after gastric bypass surgery. This means there are amazing successes in which the person loses every single extra pound, but it also means there are people who are very unsuccessful and who lose very little weight. Most people are in the middle somewhere, losing on average around 65-70% of their excess body weight, and keeping most of that off for more than 10 years.

Why Would it not be Successful?

There are numerous answers, and it is common to lay some of the blame on a lack of proper diet and discipline, lack of exercising, and failure to follow through with recommended behavior changes. But I think it is also clearly true that each individual has different genetics, age and health conditions, as well as some different biochemistry involved. So, some of us are more likely to succeed than others. Regardless of the causes, not everyone will achieve success with the sleeve procedure, so what are the next options? Our philosophy has been to get back to basics and first emphasize proper dieting that prioritizes vegetables and protein and minimizes carbohydrates, then emphasize the dedication to daily physical activity, with regular walking of an hour a day. For some people, their metabolism may require two hours a day, or 20,000 steps a day, crazy as that might sound. Then we give some consideration to weight-loss medications and see if that may help jumpstart the process, utilize protein shakes and a low-calorie diet. 

The key is not to lose hope. One of the great virtues of the sleeve (or a failed bypass) is that it is compatible with a wide variety of revisional minimally invasive procedures that may yield excellent weight-loss results. If that’s of interest, you can visit www.RevisionBariatric.com for a free report on 33 things you must know before revising a failed sleeve or bypass.

The options boil down to procedures to tighten the gastric sleeve itself, to convert to a gastric bypass, or to change to a duodenal switch procedure. Although more long-term data is needed, we have found limited success with “re-sleeve” in selected patients whose sleeve appears to have a generous volume. Conversion to gastric bypass is technically easy to perform and delivers great results for patients who have severe GERD. Laparoscopic duodenal switch yields the best results over time and is nicely compatible with the sleeve procedure. This can be performed with a laparoscopic technique, and recent technical advances and data have favored a loop or single anastomosis duodenal switch. It induces hormonal mechanisms that lead to greater weight loss success, while mitigating vitamin deficiencies. 

Don’t Give Up

The worst step you can take is giving up. Just because the sleeve “did not work” does not mean the battle against unhealthy excess weight or type 2 diabetes should be abandoned. On the contrary, revising the procedure and forging on with a plan will add years to your life and quality to those years in the form of improved health.

If you or a loved one have regained weight after a sleeve procedure done years ago, or simply failed to lose adequate weight after the sleeve, talk over the options with your bariatric surgeon by scheduling an informational consultation. Dr. Sasse is a certified expert in bariatric surgery, and he is currently accepting new weight loss patients in Reno, Nevada. There are multiple options and a high likelihood of success with further dedication and further intervention. Let our team tell you more.

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