2 years post VSG, haven't lost much weight. Should I revise my sleeve to bypass? Am I a candidate?

Question

I had VSG surgery 6/14/2016. I didn't lose much weight at all. I noticed a problem when I started eating solids. I was told to only eat 1/4 cup at a time. I did that and always felt hungry. Stomach growling hungry. I kept getting headaches my attitude changed I was miserable. I told the NP and she wrote me a script for phentermine and sent me on my way. I took it and lost another 20. I stopped taking it and gained the 20 pounds back. I don't know what to do now.

Ali Solmaz, MD · Answer

Thank you for sharing your experience. Based on the clinical history you’ve provided, it appears you may be a candidate for revisional bariatric surgery, specifically a conversion from vertical sleeve gastrectomy (VSG) to Roux-en-Y gastric bypass (RYGB). While the sleeve is a highly effective procedure for many, a subset of patients do not experience significant or sustained weight loss due to a variety of anatomical, physiological, or behavioral factors.
You underwent VSG in June 2016 and noticed minimal weight loss early on. The fact that hunger persisted even when adhering to portion recommendations&mdash;such as consuming only ¼ cup of food at a time&mdash;raises the possibility that the sleeve may not have produced the expected hormonal and restrictive effects in your case. Persistent hunger after VSG can suggest that a significant portion of the gastric fundus, which produces the hunger hormone ghrelin, may have been retained, or that the gastric pouch may have dilated over time. These issues are sometimes only identifiable through diagnostic imaging or endoscopy.
Additionally, the use of phentermine provided temporary relief, indicating that pharmacological appetite suppression was more effective than the mechanical or hormonal restriction offered by the sleeve. However, regaining the lost weight after stopping the medication further supports the idea that the current anatomical configuration may not be sufficient for long-term weight management.
Revision to gastric bypass is commonly considered in cases of inadequate weight loss, weight regain, severe gastroesophageal reflux, or persistent hunger. Gastric bypass not only reduces stomach capacity but also creates significant hormonal changes through intestinal rerouting, which enhances satiety and improves metabolic function. It is particularly effective in patients who have not responded well to sleeve gastrectomy and is often the revision of choice when other interventions have failed.
Before proceeding, a comprehensive evaluation is essential. This includes a nutritional and psychological assessment, anatomic imaging (typically an upper GI series or endoscopy), and laboratory testing to rule out nutritional deficiencies or metabolic barriers to weight loss. Revisional bariatric surgery is more technically complex than primary procedures and should be performed by a bariatric surgeon with expertise in revisions, ideally within a high-volume center.
In summary, your symptoms and weight loss trajectory strongly suggest that a revision from sleeve to bypass could be beneficial, particularly if anatomical or functional abnormalities are identified.

Pablo Garcia, MD · Answer

Hello, thank you for sharing your case. My recommendation for you is to have a consultation with the doctor who performed your surgery and seek guidance from a nutricionist. My Best Wishes,

Michael F. Sedrak, MD - Account Suspended · Answer

In adequate WeightLoss after sleeveFor somebody having this kind of problem immediately after surgery, that might suggest a technical or an anatomic issue with the sleeve such as retained fundus. The first step is to evaluate the anatomy that you currently have,  My prediction based on your own description of your problem, for example, is that if you get a barium swallow is that you’ll see a large round part of stomach at the very top. After that is diet evaluation. From there next steps can be decided.

2 years post VSG, haven't lost much weight. Should I revise my sleeve to bypass? Am I a candidate?

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2 years post VSG, haven't lost much weight. Should I revise my sleeve to bypass? Am I a candidate?

Answers (3)

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Recommended reading

Everything you need to know about Gastric Sleeve Surgery

Our mission is to create a world where every investment in modern beauty is Worth It.