Bariatric Surgery Revisions

Weight-loss surgery is typically very effective when patients follow their dietary and exercise plans, but in 20-30% of cases, these procedures may also simply fail to produce lasting weight loss results and weight regain can occur. This is not necessarily the patient’s fault; sometimes the body simply does not respond well to a particular obesity treatment. When an ineffective procedure results in weight regain, a revision procedure may be the best solution.

At AspireLife Bariatrics we offer several revisional bariatric surgery options.

Who requires Revision Bariatric Surgery ?

Not all patients will be good candidates for revision surgery. At AspirelifeBariatrics we will review each case individually to determine whether a candidate is eligible.

  •  Patients should be 2-years post-op
  •  Have gained back at least 50% of excess weight lost or have been unable to lose more than 50% of their excess weight
  •  We will review your case, including medical records and weight loss history, and decide on a case-by-case basis whether you are a good candidate for a revision procedure.
Appointment with Dr. Ashish Vashistha

Pre requirements before Revision Surgery -

The first step in revision surgery is to have an endoscopy. This not only help to determine the cause of failure, but also for the surgeon to be able to visualize and plan precisely how he will execute the revision surgery

Review of Types of Revision Surgeries:

1 Gastric Bypass Revision Surgery

If roux –en gastric bypass fails to produce desirable weight loss, or if patients lose too much weight, revising to another surgery type could be ideal. Although, gastric bypass is considered to be semi-permanent, patients can convert to a variety of options includingduodenal switch, and lap band. In Lap-Band, the band is placed around the stomach to help induce weight loss. Other options include: 

  •  Shrink the stoma by injecting a sclerosant (“sclerotherapy”)
  •  Reduce the Size of the Pouch
  •  Add Lap-Band around the stomach (lap band surgery)
  •  Lengthen the Roux limb

Gastric Bypass Failure can be caused by: 

  •  Pouch enlargement
  •  Staple line disruption
  •  Stoma enlargement or failure
  •  Patient’s body adjusting to lowered caloric intake

2 Gastric Banding Revision Surgery

More and more patients are experiencing insufficient weight loss, and undesirable complications with Lap Band . The most common revisionalsurgery, is Lap-Band to Gastric Sleeve. The gastric sleeve provides the restriction familiar to Lap-Band patients, but also includes a suppression of appetite.

List of revisional surgeries include:

  •  Re-Adjust Lap-Band Placement
  •  Lap-Band to Gastric Sleeve
  •  Lap-Band to Gastric Bypass

Statistically, 10 years post op 70% of all lapband patients no longer have their lapband.

Lapband failure can be caused by:

  •  Erosion
  •  Slippage
  •  Pouch enlargement
  •  Poor access to adjustments
  •  A certain percentage of patients simply do not lose weight with Lap-Band.

3 Gastric Sleeve Revision Surgery

If gastric sleeve surgery fails to produce adequate weight loss, many patients opt to go with the duodenal switch, or have a re-sleeve. Both options should work to increase amount of expected weight loss. List of revisional3 surgeries:

  •  Gastric Sleeve to Duodenal switch
  •  Re-Gastric Sleeve

Vertical Sleeve Gastrectomy failure can be caused by:

  •  Pouch enlargement
  •  Patient’s body adjusting to lower caloric intake

Risks of Revision Surgery

Patients considering revision must also be aware that revision surgery has almost a 50% higher rate of complications than a first time surgery. Human tissue does form adhesions after the first surgery. Adhesions vary from person to person and have no bearing on the external scars on the skin

Risks common with revisional surgeries are leakage, necessity to revise a laparoscopic surgery to open surgery, incisional hernia (from open surgeries), bleeding etc. With all surgeries there is always risk with anesthesia, this can be minimized by using a surgical team with an anesthesiologist well versed in bariatrics.