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Revision Surgeries

Revision Bariatric Surgery at the Methodist Weight Management Program

In some cases, follow-up bariatric surgery may be necessary due to less-than-expected weight loss, or to alter or repair the initial surgery. Revision surgery may involve revising or reversing a bypass, adjusting a LapBand, or converting to another bariatric method due to anatomy changes or complications.

Revision surgery is more complex with greater risks than initial surgery. It is important to have the procedure performed by an experienced bariatric surgeon at a Bariatric Surgery Center of Excellence.

What is Bariatric Revision Surgery?

A bariatric “revisional” surgery is a procedure correcting a complication of a prior bariatric weight loss surgery and/or modifying a prior bariatric surgery to reestablish its effectiveness as a metabolic and weight loss tool.

Revision bariatric surgery is a procedure performed on individuals who have already undergone another form of weight-loss surgery that has lead to complications or has not resulted in significant weight loss. A revisional bariatric surgery is generally laparoscopic or robotically, unless there is extensive scarring from the previous surgery.

  • Failure in achieving weight loss goals
  • Weight regain after a weight loss surgery
  • Prominent heartburn or acid reflux
  • Frequent nausea and vomiting
  • Trouble swallowing

Gastric Bypass Revision Surgery
Patients who have previous gastric bypass surgery occasionally require revision.* This may be required if the stomach pouch has stretched. The stomach’s capacity may increase over time and slow down weight loss; some patients may regain some of the weight they have lost. We also offer a non-surgical option for revision of gastric bypass called endoscopic gastro jejunal outlet reduction (revisional procedure for gastric bypass patients).

Revision surgery: What is it and why would I need it after bariatric surgery? Revision surgery can help patients get back on track with their weight loss goals.

When bariatric surgery doesn’t result in long-term weight loss, many patients can get a second chance via bariatric revision.

But for some patients, the results are fleeting. After several years, the scales start to creep upward again and with that, the health concerns associated with obesity return. Others may have no problem maintaining weight loss, but instead suffer from acid reflux. The reasons initial bariatric procedures fail to produce lasting results vary. Each surgeon’s technique varies.

In the case of sleeve gastrectomies, sometimes the sleeve created to take the place of the stomach is simply too big after a sleeve gastrectomy.

Even in the Roux-en-Y gastric bypass, “how much small bowel bypassed varies from surgeon to surgeon But about half the time, bariatric surgery failure comes back to the patient.

“Over time food choices get a little worse” “You fall off the exercise wagon.”

It’s easy to understand. While bariatric surgery can seem like a quick fix, the long-term success requires permanent lifestyle changes.

Revising to Duodenal Switch

The decision to undergo a revision of a previous weight loss surgical procedure will depend on the number of variables. These include:

  1. Patients net weight loss (weight before surgery less stable weight after surgery)
  2. Patient age and overall functional status
  3. Co-morbidities (diabetes, polycystic ovarian syndrome, etc.)
  4. Complications of the previous weight loss surgical procedure.
  5. Adherence to Vitamin and diet requirements.

The answers to these questions will dictate the choice of the surgery. The goal of revising a weight loss surgery is to balance the potential risks of the operation against the benefits.

Gastric Bypass RNY to Duodenal Switch

Revision surgery of patients, who have had Gastric Bypass and after a few years of maintaining weight loss are experiencing weight regain, is common in our practice. Dilated pouch or dilated stomach to the small bowel anastomosis and poor diet have all possible explanation some patient gaining weight after Gastric Bypass. It has been demonstrated many years ago that the size of the pouch or the anastomosis was not a factor in determining which patient would experience weight regain and which would not.

We now know that revision of the pouch or the gastrojejunostomy anastomosis does not result in any significant additional maintained weight loss. Conversion off the proximal Gastric Bypass to the distal Gastric Bypass can have dire nutritional consequences.

Sleeve Gastrectomy to Duodenal Switch

Sleeve Gastrectomy procedures are also revised to the Duodenal Switch operation frequently. The weight loss with the Sleeve is less than that of the Duodenal Switch, and an addition of a malabsorption component, done correctly with Hess method, can deliver health benefits as well as additional weight loss. The addition of the Duodenal Switch component is a rather straightforward proposition following the failure of a Sleeve Gastrectomy procedure

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