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

Contact the Methodist Weight Management Program

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Take the first step toward better health today.

Contact the Methodist Weight Management Program at
(214) 947-3699 or
weightloss@mhd.com.

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Methodist Weight Management Program.