SLEEVE TO RYGB OR MGB/OAGB

Service Description

Sleeve to Gastric Bypass Revision (RYGB or MGB/OAGB) Revising a Gastric Sleeve (VSG or ESG) to a Gastric Bypass—either Roux-en-Y (RYGB) or Mini Gastric Bypass (MGB/OAGB)—is a well-established and increasingly common revisional bariatric procedure. It's typically performed when a patient experiences weight regain, inadequate weight loss, or severe gastroesophageal reflux (GERD) after a primary sleeve procedure. Why Revise a Sleeve? - Severe GERD: Sleeve increases intragastric pressure and weakens LES - Weight regain: Stomach can stretch over time or initial restriction was insufficient - Inadequate weight loss: Particularly in high-BMI patients or poor responders - Persistent metabolic disease: Type 2 diabetes or dyslipidemia not resolved - Dilated sleeve: Anatomical failure due to sleeve expansion This applies to both: - Laparoscopic Sleeve Gastrectomy (VSG) - Endoscopic Sleeve Gastroplasty (ESG) (converted to bypass via laparoscopy) What Does the Revision Involve? 🛠️ Surgical Steps: - Assessment of sleeve anatomy (dilation, scarring, adhesions) - Creation of small gastric pouch - Bypass of small intestine: - RYGB: Roux limb with two anastomoses (food + biliopancreatic) - MGB/OAGB: Loop gastrojejunostomy with single anastomosis This conversion requires a highly skilled bariatric team, especially if dense scar tissue or sleeve dilation is present. Benefits of Sleeve to Bypass Revision - Excellent GERD resolution: RYGB is considered the gold standard for post-sleeve reflux - Additional malabsorptive effect: Improves weight loss and metabolic outcomes - High T2DM remission rates: Especially with bypass physiology - Durable long-term results: Reduces hunger via hormonal modulation - Safe, effective revision in expert hands: Well-studied in high-volume centers 🧠 Summary - Converting a sleeve to a gastric bypass is a highly effective revision when patients experience reflux, weight regain, or metabolic failure. - RYGB is preferred for GERD and more precise bypassing. - MGB offers a simpler, faster alternative with strong metabolic effects, but may not resolve reflux and has higher malabsorption risk.