Revisional Surgery from RNY to Sleeve — When Hunger Never Switches Off

rachelkibble7
Sep 7
2 min read

For most people, gastric bypass (Roux-en-Y, or RNY) is a powerful surgery. It restricts food intake, changes gut hormones, and for many years it was considered the gold standard. But for some patients who had older RNY surgery, there’s a specific problem that won’t go away: constant, gnawing hunger.

Why Does Hunger Persist After RNY?

Unlike gastric sleeve surgery, bypass operations leave the upper part of the stomach — the fundus — intact. The fundus is where most of the hunger hormone ghrelin is made.

That means even with a small pouch and rerouted intestine, ghrelin can still flood the system. The result?

Patients feel hungry almost all the time.
They may need to snack frequently.
Even with good restriction, the urge to eat never settles.

The Problem with Testing for Ghrelin

In theory, ghrelin can be measured in the blood. In reality, these tests are only available in research settings — not in routine clinical care. That makes it hard to “prove” ghrelin is the issue.

So instead, diagnosis is symptom-based. When patients describe constant hunger, never feeling satisfied, and struggling even with strict adherence, it strongly points to a ghrelin-driven problem.

Why Revision to Sleeve Helps

Unlike bypass, sleeve gastrectomy removes the fundus entirely. This means the main source of ghrelin is taken away. For patients tormented by constant hunger, the difference can be dramatic:

Hunger is reduced or eliminated.
Eating patterns become easier to control.
Quality of life improves, not just weight loss.

Risks and Considerations

Revision from RNY to sleeve is not straightforward. It’s complex, carries more risks than primary surgery, and is only appropriate for carefully selected patients. But when hunger is the main driver of failure, it offers a targeted solution.

Conclusion

For patients who’ve lived with years of relentless hunger after gastric bypass, revision to sleeve can feel like the “missing piece” of their journey. By removing the ghrelin-producing stomach, it tackles the root of the problem head-on.