Abstract

Long-term weight regain is a fearedcomplicationof restrictive bariatric operation. The Sleeve Gastrectomy (SG)

is still in its early stages as a primary bariatric surgery and long-term data about its efficacy remains limited. From the

long term studies available it seems that approximately one-fifth of SG patients might be at risk for long-term weight

regain and about 5-10% of total SG patients will require surgical management forit. The possible mechanism behind

this weight regain is slowly being addressed. Patient noncompliance with dietary and lifestyle regimens is the most

practical factor that needs to be considered and can be prevented with a multidisciplinary team. Long-term gastric

pouch dilatation and gut hormone modulation are other theories that have been proposed to explain this weight regain.

Successful management strategies to combat weight recidivism include revisional bariatric surgery, performing a resleeve

gastrectomy or the addition of an adjustable band in the primary banded sleeve gastrectomy. However, the

safety of revisional bariatric surgery is a concern and should be performed only by an experienced bariatric surgeon.

It remains that as the SG continues to grow as a popular choice for the management of morbid obesity, more concrete

long term information will become available to address the how and why weight regain occurs.

http://omicsonline.org/open-access/the-sleeve-gastrectomy-and-how-and-why-it-can-fail-2161-1076-4-180.pdf

Thanks for posting this article. It's the most recently published research I've seen on VSG.

The sleeve is a tool and we must use it wisely, the sleeve is amazing. I know someone who has failed it and it's because they eat around it. I'm so afraid of regain and have a comprehensive follow up plan and plan on attending regular support groups I know I won't fail.

thank you for posting.

Interesting indeed but I was told by my surgeon in the very beginning, this requires a lifestyle change. Not a temporary one but forever to be successful. And I whole heatedly believe this to be true.

Bottom line, IMO, is that if I were to gain 30 pounds, it will be due to my "cheating" the sleeve, not the failure of the procedure. I also believe that if I were to return to rigorously following the guidelines, I would drop that 30 pounds. Does this point to a failure of the procedure?

Another thing about a small weight gain like that....are they counting those that became pregnant after the sleeve? Because that's definitely a 22 lb or more gain....

Bottom line, IMO, is that if I were to gain 30 pounds, it will be due to my "cheating" the sleeve, not the failure of the procedure. I also believe that if I were to return to rigorously following the guidelines, I would drop that 30 pounds. Does this point to a failure of the procedure?

Another thing about a small weight gain like that....are they counting those that became pregnant after the sleeve? Because that's definitely a 22 lb or more gain....

I can only imagine they are smart enough not to attribute pregnancy to weight gain as it is being referenced here. This is about gaining weight, ie fat. Not another human.

Like most, the fear of regain lives inside me but it doesn't slap tortilla chips out of my hand for me. I have never been as active as I am now. I log my food everyday and synch my Fitbit. I wonder if most regain is fatigue of the vigilance required to be successful.

Interesting

Based on a recent study that gut metabolism changes, not sleeve size, causes weight loss after surgery and another study that shows mice injected with bacteria from thin mice lose weight when exposed to healthy foods but not when they eat fatty foods (and mice not injected don't lose weight even when exposed to fatty foods) my take is:

• Restriction does play a part no matter what any else says. I can't eat as much at once.
• I wonder if the early "failures" did not experience the gut metabolism reset to the full degree because of their particular metabolism or because they ate fatty foods early out.
• I wonder if later "failures" accidentally undid the gut metabolism reset by eating too much fatty foods.

My fear is that if I eat too much fatty foods, my gut metabolism reset will go away. For whatever reason, I had no problem maintaining a very slim weight until I was in my early 30s. After that, I never got my weight under control again till surgery. I was raving hungry and even though I am a very controlling person, I couldn't control it. My heart goes out to those who don't get where they want with this surgery or those that suffer regain. How many of us heard "Just don't eat so much!" before we had the operation. Sometimes it's not that easy.

And yes, I do know I am responsible for what I eat, but for those who don't think body chemicals control more than we think, take some peyote and tell me all about it.

Just my two cents.

Cited studies:

http://www.sciencedaily.com/releases/2014/03/140326142209.htm

http://www.nytimes.com/2013/09/06/health/gut-bacteria-from-thin-humans-can-slim-mice-down.html?pagewanted=all&_r=0

I SOOOOO agree with you! I DID regain 27 pounds - 3 years out. Why? Cookies, candy, carbs, no exercise, yadayadayada. AND I DID lose thos 27 and an additional 10 with work and exercise and I'll tell you what - it would have been extremely difficult if I didn't have my sleeve. I Still Have the restriction and if eating properly, can only eat a small amount still. I DO get hungry sooner than Before and have to guard very carefully my calorie count per day because if I go over a certain amount I WILL and do gain.

Was my sleeve a failure? No. I feel truly successful almost four years out and 110 pounds lighter, normal BMI and size 8!

I can't tell you how much this post means to me. Right now, I'm up 30 from my all time post-surgery low, and about 20 from where I should be. I'm also about five above what my goal was going into the whole thing.

Since January, I've had six straight months of average weight gain, and don't truly understand why. I'm exercising more than ever. My eating is poorer, but not to the level that I would think would cause that. I simply don't understand what's happening, and it's heartening to hear you had and beat that same type of situation.

I can't tell you how much this post means to me. Right now, I'm up 30 from my all time post-surgery low, and about 20 from where I should be. I'm also about five above what my goal was going into the whole thing. Since January, I've had six straight months of average weight gain, and don't truly understand why. I'm exercising more than ever. My eating is poorer, but not to the level that I would think would cause that. I simply don't understand what's happening, and it's heartening to hear you had and beat that same type of situation.

Best thing I can tell you is to get real with yourself about your overall diet, when and what is going into your mouth. We can consume a LOT of calories with little effort if they are junk. I know. If you are not tracking your eats, I advise you to do so with my fitness pal or similar. I think you will be surprised. I know it can be difficult and it is never ending. Truly. But stop

It now and get back on track. Much easier when we are not overwhelmed. Good luck. You CAN do this!

Thank you. Really appreciate that!

Even if one gained back 30 lbs dumping the high BP and type 2 makes it a win.

Oh, it's still a win. No regrets about having it done.

Weight gain is the nightmare we all fear and live with. I am not cured of obesity, I'm simply in remission. There is no doubt in my mind I could gain back every pound I lost. There have been a few key statements people have made in this thread that resonate with me. Paraphrasing here:

• Success requires vigilance
• Success requires self-honesty about what we eat
• Success requires tracking as a way of accomplishing both of those

When I'm vigilant about my diet by weighing, measuring, tracking, and recording, I do best. I can do a WHOLE lot of damage in a just an hour or two. I don't have a normal body or metabolism, and I know deep down there is very little wiggle room for me. Don't get me wrong, I do let my guard down from time to time, I do get weary of the constant struggle, but I have to keep my eye on the prize. I love the way I feel and look, and I am grateful for what I consider to be a gift of being thin. I remember that, and it helps me to continue to do the things that have led to success. In the end, I have way more control over my success or failure as a result of having the sleeve than I did before surgery. I hope the "reset" stays reset!