Two reasons justify it: severe reflux and insufficient weight loss with a documented behavioural effort behind it.
A minority of sleeve patients develop reflux that medication cannot control, and continued acid exposure risks damage to the oesophagus. Conversion to bypass is the definitive treatment and usually resolves it.
Where a patient has genuinely followed the programme, attended follow-up and still not achieved meaningful loss, conversion can help. Where follow-up was never attended, revision surgery usually repeats the outcome — which is why we ask for the history honestly.
Longer operating time, higher complication rates than the primary operation, and a more demanding recovery. It is a bigger undertaking than the first surgery, not a simple adjustment.
Endoscopic assessment, dietitian re-engagement, GLP-1 therapy and behavioural support resolve a substantial proportion of cases without further surgery. We work through those before booking a theatre.
Yes, with the operative report and current endoscopy. Without documentation of the original procedure, we start with imaging.