Revisions to Bariatric Surgery

As is possible with any surgical procedure, bariatric surgery does not always turn out as planned. While complication and mortality rates have steadily decreased over the years, on average, it is important to remember that these procedures are complex and serious, and for one reason or another, may fail at some point in the future.

When a patient expresses to us that they are unsatisfied with the results of their past bariatric procedure, we begin by analyzing their diet and exercise regimen. Post-surgery lifestyle changes are a key component of success after bariatric surgery and some patients may not have been ready to undertake critical lifestyle changes such as modified eating and improved workout habits. If this is the case, then revision surgery will not be performed. Rather, we will work with the patient to analyze possible problem areas and develop a comprehensive plan to address them.

In some cases, the primary procedure may have failed due to gastrointestinal anatomical problems or a case where the surgery was not appropriate for that particular patient. In situations like these, the most important next step is to figure out why the procedure failed. Upon learning the underlying reason, and then approving a patient for revision surgery, we must then evaluate the options available to them.

When to Call Us

Just as in a patient’s pre-bariatric lifestyle, weight will fluctuate. These fluctuations may be caused by temporary dietary changes, menstrual cycles and a multitude of other factors. However, when the ups and downs become rapid and significant, this may warrant a call to our office. We suggest that all our patients keep a journal of their diet and exercise regimens. Another useful factor to journal is mood. Stress, anxiety, sadness and even happiness can all contribute to weight gain, as we often use food both to medicate and celebrate. The bottom line? Discuss your challenges in a support group or call our office if you believe something is not right. We’re here to help.

The Most Common Bariatric Surgery Revisions

Gastric bypass revisions are most often employed to correct stretching of the gastric pouch or stoma. This can happen slowly over time as the stomach is a very adaptable organ. There are several remedies to address this issue that can include minimally invasive and endoscopic (no incision) procedures. Patients should be aware that after they reach their goal weight, they may gain back 5-10% of their excess body weight loss – this is natural and does not require a revision.

The sleeve gastrectomy, or gastric sleeve, removes a significant portion of the stomach pouch, but can be revised by converting into a gastric bypass. In doing so, we add a malabsorptive (restriction of the absorption of nutrients in the intestine) component to the sleeve. This combination can offer the jump-start a patient needs to get back on track.

The gastric band can be revised to virtually any other procedure, assuming that the patient qualifies. Remember, some patients can qualify for a Lap-Band with a BMI of as low as 30 – it is important to remember that these patients may not qualify for a stapled procedure. Since the band does not permanently alter any part of the digestive tract, the original band can be replaced or the band can be removed and a stapled procedure such as a gastric bypass or gastric sleeve can be performed.

Revision surgery should not be taken lightly. These surgical procedures are still major surgery and come with all the risks associated with any other bariatric procedure. In fact, the risks of the revision procedure are actually heightened due to the fact that the patient will have already had abdominal surgery. Risks of complications may also be greater. While we do not encourage patients to revise their primary bariatric procedure in every case, we do understand that it is important and necessary in some. We will help you determine if your case qualifies for a revisional bariatric procedure and discuss solutions according to your specific need.

Learn more about revision choices by scheduling a consultation with our office.

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