How do I reset my sleeve after almost 4 years out? How soon can another gatric sleeve surgery be considered?

Question

had gastric sleeve surgery July 2014. My starting weight was 252 lbs and I lost down to 152 lbs, 100 lbs total. But now it's 2019 and I'm gaining weigh, yet I still feel the restriction. I don't understand why I am gaining weight when I don't eat much, yet too I feel as though I am always hungry. What is going on and what must I do because now I am weighing 205 lbs and counting. I am so nervous and don't want to fail my sleeve and surgery efforts.

Babak Moeinolmolki, MD, FACS · Answer

Hello,
Thank you for your question. I am sorry to hear the surgery has failed to fully treat your obesity. It is essential that you work closely with your surgeon’s weight loss team. In my clinic, patients are followed by myself, as well as our dietician and therapist. Many patients also attend a support group. A team is necessary to support you in maintaining your post-surgery lifestyle changes.
In addition to challenges with lifestyle changes, weight regain can be due to the initial sleeve being too large, and/or stretching over time. When this is the case, surgical options include a re-sleeve, gastric bypass, or duodenal switch. 
Consultation with a bariatric surgeon will help you determine the best treatment based on your experience with the first surgery, your anatomy, your other health conditions, and your health goals.
Please do not give up and know that many patients, regardless of their experience with their initial surgery, find long term results with persistence and expert care.
Best wishes,
Dr. Moein

Ali Solmaz, MD · Answer

It sounds like you're experiencing gastric sleeve weight regain, which can happen even years after surgery. Since you still feel restriction but are always hungry, several factors could be contributing to this. Over time, your sleeve may have slightly stretched, but more importantly, ghrelin (the hunger hormone) can increase again, making you feel hungry more often. Even if you're not eating much, frequent snacking, liquid calories, or carb-heavy meals can lead to weight regain. Your metabolism may have slowed down after a long period of weight loss, requiring fewer calories than before. Additionally, conditions like insulin resistance, thyroid issues, or vitamin deficiencies can impact weight regain.
To reset your sleeve and get back on track, you can try a pouch reset, which is a structured diet that mimics post-op eating by starting with liquids and slowly reintroducing solids. This helps with portion control and mindful eating. Tracking your intake can also be helpful, as even small amounts of high-calorie foods can add up. Using apps like MyFitnessPal or Baritastic to monitor protein, carbs, and fat might give you insight into hidden culprits. Increasing protein intake to around 60-100 grams daily while ensuring you drink at least 64 ounces of water can help manage hunger and promote satiety. Cutting out slider foods and liquid calories, such as sugary drinks, alcohol, and high-carb snacks, is also key. Since muscle loss from weight loss can slow metabolism, incorporating strength training three to four times a week can help rebuild lean mass and improve metabolic function.
Checking your hormones and lab levels may provide additional insight, as thyroid imbalances, insulin resistance, or vitamin deficiencies could be making weight loss harder. If lifestyle changes don’t help, revision surgery may be an option, though a resleeve is not commonly recommended unless your stomach is significantly stretched. In cases where restriction remains but weight regain is due to metabolic or hormonal factors, procedures like gastric bypass or duodenal switch may be more effective.
Right now, the best approach would be to attempt a pouch reset, track intake for a few weeks, and schedule an appointment with a bariatric dietitian or surgeon to discuss your options. Weight regain is common, and you have not failed your sleeve. You can absolutely turn this around before considering revision surgery.

Ariel Ortiz, MD, FACS · Answer

Hi there, I’m sorry to hear you are gaining back some weight. The first thing I recommend doing is to contact your bariatric nutritionist and to improve your physical activity program. If you still feel the restriction in your stomach, it can be suggestive that your surgery is still functional and with a good adjusted dietary plan you can be back on track, remember that a good diet not only consists of how much do you eat, the quality of your food intake is a big deal to the success of these type of surgeries. Of course, if your diet adjustments are not working as well as you wish, I suggest you having a consult with a certified Bariatric Surgeon, so we can recommend the surgery that best suits your needs, like a Re-sleeve, a Gastric Bypass, or a Gastric Plication. I hope you can find the results you are looking for. - A.L

K. Todd Foreman, MD · Answer

When patients have good initial weight loss followed by some gain, it often can be controlled by working with a dietitian who truly understands Bariatric Surgery, along with at least 150 minutes per week of exercise. Consider getting an appointment with your surgeon's dietitian and ask about getting back on track.

Pablo Garcia, MD - Account Suspended · Answer

Hello, I hope you're well. There is a percentage of patients who regain the weight or significant weight following bariatric surgery. My recommedation is you are evaluated by a certified bariatric surgeon in order to determine the cause of your eight gain, as well as a right solution for you. There are other interventions to consider before revision surgery, like being followed closely by a specialized nutritionist and psychologist.

How do I reset my sleeve after almost 4 years out? How soon can another gatric sleeve surgery be considered?

Answers (5)

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