Resleeve After Failed Sleeve Surgery — When Is It Really Worth Considering?

(Part 3 of 5 in our Revisional Operations Series: Which Surgery for Which Patient?)

Sleeve gastrectomy is one of the most popular bariatric procedures worldwide. It’s effective, it’s relatively straightforward compared to bypass, and for many patients, it delivers excellent long-term results. But sometimes, patients who’ve had a sleeve find themselves regaining weight and ask about a “resleeve.”

The idea sounds simple: if the first sleeve isn’t working anymore, why not tighten it again? Unfortunately, the reality is not that straightforward.

Why Most Resleeves Don’t Work

In a properly performed sleeve, the entire stomach fundus (the upper part where ghrelin — the hunger hormone — is made) is removed. Once this has been done, the anatomy can’t simply be “re-shrunk.” Stretching of the sleeve over time does occur, but usually only to a limited extent.

If the original sleeve was technically sound, a second sleeve rarely adds much benefit. Patients often end up with the same problems again: weight regain, grazing, or persistent hunger.

When Resleeve

Is

Considered

There is one situation where resleeve can make sense:

• If the first sleeve was poorly performed — meaning a significant portion of the fundus was left behind.

• This residual fundus can keep producing ghrelin, contributing to hunger and weight regain.

• In these cases, a resleeve that properly removes the remaining stomach can be effective.

But this is rare. It requires clear surgical evidence (usually from imaging or endoscopy) that a large fundus remains.

Better Alternatives for Most Patients

For patients who regain weight after a well-performed sleeve, the issue is usually metabolic rather than anatomical. That’s why metabolic procedures such as Mini Gastric Bypass (MGB) or Roux-en-Y Gastric Bypass (RNY) are often better revision options. They don’t just reduce capacity — they change hormones, reduce insulin resistance, and address the deeper drivers of weight regain.

The Bottom Line

Resleeve has a very narrow role. Unless there’s clear proof of a technical problem with the original operation, it’s unlikely to succeed. For most patients, moving to a bypass procedure gives far greater long-term benefits.