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Revisional bariatric surgery

 

While bariatric surgery is often successful and associated with multiple health benefits, some patients find that their bodies eventually adjust to the changes brought on by weight-loss surgery, and are able to eat larger portion sizes and absorb more calories. Revisional surgery often involves going in to further reduce the size of your stoma, or stomach pouch.

Prior to performing revisional weight-loss surgery, your bariatric surgeon will consult with you to identify why the original surgery was not more successful. Revisional surgery may not be an option for some patients if they failed to lose weight due to lifestyle factors such as lack of exercise or poor nutrition. However, if other problems are identified -- such as the body adapting to absorb more calories or the stomach stretching -- then revisional surgery may be a viable next step.

Depending on the type of your original surgery, there are different approaches available for revisional surgery. Your bariatric surgeon will choose the right method of revisional surgery based on the nature of your individual needs or type of surgical complication.

Revision surgery for adjustable gastric banding patients (LAP-BAND, REALIZE Band)

Since adjustable gastric banding does not require any cutting or stapling of the stomach, LAP-BAND and REALIZE Band are often the easiest procedures to revise. Revising gastric band surgery can be achieved using one of two different methods.

First, your bariatric surgeon can replace your current band with a new band. In some cases, the original band can slip from its original position or become eroded into your esophagus -- requiring the need for a new band that works more efficiently.

The second option consists of converting your original band procedure into sleeve gastrectomy or Roux-en-Y gastric bypass. For this revisional procedure, your bariatric surgeon removes the band from your stomach, and performs either gastric sleeve surgery or gastric bypass as if it were the primary procedure. This type of revisional surgery is often associated with more downtime, and a slightly longer healing period.

Revision surgery for sleeve gastrectomy patients (gastric sleeve)

If you’ve had gastric sleeve surgery and realize that you’re starting to regain the excess weight you already lost, you may qualify for revisional gastric sleeve surgery.

Your first option for revisional surgery with sleeve gastrectomy is called a re-sleeve, which is often performed on patients whose stomachs have stretched following the first procedure. During a re-sleeve, your bariatric surgeon performs sleeve gastrectomy a second time, and makes a second cut to return your stomach to the size it was after the first surgery. In some cases, your bariatric surgeon may make your stomach slightly smaller to promote more effective weight loss the second time. Since re-sleeve surgery is nearly identical to the original gastric sleeve procedure, patients should expect to experience the same amount of downtime and recovery following surgery.

The second option for revisional sleeve gastrectomy involves converting the gastric sleeve to a duodenal switch, in which the small intestine is rerouted in a fashion that allows the patient to absorb fewer calories in a manner similar to that of gastric bypass surgery. The duodenal switch procedure is considered malabsorptive, which means that patients will be required to adhere to strict nutritional guidelines to avoid malnourishment and further complications.

Revision surgery for Roux-en-Y gastric bypass patients

Revisional surgery may be necessary for gastric bypass patients when their stomachs grow enough in size to retain larger portion sizes. During the original gastric bypass surgery, your stomach is reduced to about 20 percent of its original size, but can flex and dilate if you consistently overeat. In rare cases, gastric bypass patients may need revision to remove scar tissue that partially blocks the opening to the small intestine to resolve severe problems with dumping syndrome.

Roux-en-Y gastric bypass surgery is often revised through duodenal switch surgery.Some bariatric surgeons may add LAP-BAND or REALIZE Band to an existing gastric bypass surgery to further restrict portion sizes without requiring patients to undergo more invasive forms of revisional surgery.

Other forms of revisional surgery

In the event your stomach pouch has dilated to allow for consumption of larger portion sizes, your bariatric surgeon may suggest that your stomach be shrinked through administration of a sclerosant injection, which is known as sclerotherapy. The injection is made into your stoma, which is the opening between your stomach and small intestine, and results in a special type of scarring that reduces the size of your stoma. Studies have shown that this revisional procedure can help as many as 64 percent of patients lose at least 75 percent of their weight regain following treatment.

Alternately, your bariatric surgeon may suggest that you undergo either the StomaphyX or ROSE procedures, in which your stomach is tightened through the use of tubes instead of staples or incisions. During StomaphyX or ROSE surgery, your surgeon inserts special tubes into your mouth that extend from your esophagus into your stomach pouch to create permanent folds known as plications. As a result, your stomach pouch is made smaller to better restrict your portion sizes.

If at any time you feel that your weight-loss surgery is ineffective, or you suffer from one or more major symptoms related to digestion problems, make an appointment with your bariatric surgeon as soon as possible. Your surgeon can then perform a full examination, and determine whether revisional weight-loss surgery is required.

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