About Bariatric Surgical Revisions
Due to the increasing popularity of weight loss surgery, more and more patients are undergoing operations to lose weight. Weight loss surgery, however, is not a miracle cure, and while most patients are successful after weight loss surgery, some patients may experience problems with the surgery or not succeed in losing the expected amount of excess weight.
In these situations, a follow-up bariatric procedure, known as a bariatric surgery revision, may be necessary to alter or repair the initial surgery. Revision weight loss surgery is a procedure that repairs or revises a prior weight loss surgery. Even the most successful operations may require a revision from time to time. Common revision cases include:
- Complications from prior vertical banded gastroplasty (VBG) or “stomach stapling”
- Complications from a previous open gastric bypass surgery
- Failure to lose adequate weight after a LAP-BAND surgery
- Inadequate weight loss or tendency to regain weight after gastric bypass
- Unresolved co-morbidities after surgery
Although it can be an emotional setback when weight loss surgery does not lead to the expected amount of weight loss, the only failure is in giving up. Obesity is a chronic disease and not easily treated. As with any serious health condition, if the first treatment is not effective, then the doctor will recommend additional treatment options. With weight loss surgery, a revision surgery may be necessary as an additional treatment for obesity.
Most revision surgeries can be done laparoscopically and are covered by medical insurance. You will be discharged from the hospital within one to two days. It is important to understand that while revision surgery is slightly higher-risk than a first-time operation, it is still lower-risk than remaining morbidly obese.
Revisions after LAP-BAND®
The revision rate for the LAP-BAND System is approximately 10% during the first two years. Revisions are due to either device-related problems, slippage or unsatisfactory weight loss. A complication specific to this type of procedure is slippage of the gastric band, which requires a follow-up procedure to fix the problem. While some patients will have the band replaced, others choose to revise to another procedure.
Revisions after Gastric Bypass
A gastric bypass revision is necessary in approximately 5 to 10% of patients over 5 years due to complications, unsatisfactory weight loss, or weight regain. Complications that may occur after gastric bypass surgery, such as ulcers, chronic vomiting, hernia, staple line failure, can often be improved through revisional surgery.
If gastric bypass fails, a patient has several options:
|If the problem is
|| Non surgical approach
|| Surgical approach
|Lack of weight loss or weight regain
- Examine eating habits and exercise routines
- Participate in nutritional counseling,exercise program, behavior modification therapy, psychological counseling, and support groups
- Placement of a LAP-BAND on the stomach pouch or conversion to other bariatric procedure.
|Stomach pouch or stomach opening has enlarged
- A LAP-BAND may be added to reduce amount of food that can be eaten and slow the movement of food from the stomach to the small intestines
- Either remove more stomach and re-stapling the stomach line or stitching up the stomach opening. This may only be a temporary fix and stretching may happen again
- StomaphyX, an incisionless revision that reduces stomach size
|Surgical complication, such as popped staple line, ulcers, or hernia
- Operate to surgically repair the problem
Patient Criteria for Revisional Bariatric Surgery
Before a revisional procedure is performed, you will need to attend a consultation to determine the cause of failure as well as evaluate your case for the appropriate treatment options. Bariatric surgery is a very specialized and complicated treatment process. Great care is given to maximizing weight loss success while minimizing risks and complications.
During the consultation, we will need to determine if post operative weight loss failure is due to a problem with the original surgery or the patient’s inability to follow the necessary lifestyle changes. We will want to discuss the options and what you should expect with the revision.
Results with a Bariatric Revision
Although the results can vary widely depending on the original procedure and the reason for the revision, these surgeries are usually successful in resolving the associated problems and promoting further weight loss. Weight loss following a revision is usually not as dramatic as the initial bariatric procedure, but it can be substantial over time. As revision surgery can be more complex and involve more risks than general weight loss surgery, it is important to choose a bariatric surgeon that is experienced and skilled in performing revision surgery.
As with all bariatric procedures, the best weight loss results are achieved by patients who are able to comply with the diet and exercise recommendations of their surgeon. The post operative process can be a struggle and you will benefit in your weight loss efforts by attending support groups, talking to a nutritionist for dietary advice, working out with a exercise program, and, if needed, talking to a psychologist to help deal with emotional aspect of obesity and weight loss surgery.
If you think that revisional surgery may be for you, please call us today for more information and set up a consultation with Dr. St. Laurent.