Revision Bariatric Surgery

Many people experience positive and lasting results from weight loss surgery. Even so, there are times when the desired results aren’t achieved or when weight gain occurs without a clear explanation.

When weight loss surgery doesn’t accomplish the intended goals, revision bariatric surgery may be a solution. The reason for unsuccessful weight loss surgery can be:

• The inability to make appropriate lifestyle choices
• Internal issues

Ruling Out Diet and Exercise Issues

Determining the reason why bariatric surgery hasn’t worked is often a process of elimination of potential causes. Diet and exercise issues are usually ruled out first by discussing a patient’s daily eating and fitness habits. A psychologist may provide assistance with the evaluation process to identify or rule out possible emotional reasons for not achieving weight loss goals. Patients with a low basal metabolic rate (BMR), or those who burn less energy while resting, may have difficulty losing weight—although issues with low BMR can usually be solved with adjustments to fitness routines.

Checking Stomach Pouch Size

If diet and exercise isn’t the problem, the next step before recommending revision surgery is to check the size of the stomach pouch that was created with the first bariatric surgery. When the opening between the stomach and small intestines (stoma) isn’t the right size, weight issues may be experienced after surgery. An evaluation of the stomach pouch may be done with an upper gastrointestinal (upper GI) tract radiography that involves a special dye and an X-ray to observe the upper GI tract in real time. A special tube with a camera (endoscopy) may be inserted into the mouth and into the stomach to view the pouch and stoma. Some patients may have an eating test to determine when they feel full.

Correcting Pouch and/or Stoma Size Issues

If the problem with weight loss is due to an issue with the newly created pouch or stoma, revision surgery is often recommended to perform the necessary adjustments. A smaller pouch will make your stomach hold less food and a stoma that’s made smaller will drain slower and make you feel fuller longer. The stoma may be reduced with the injection of a sclerosant, referred to as sclerotherapy, into the stoma. Injections are typically administered during more than one procedure to create scarring to naturally reduce the size of the stoma. Studies on the effectiveness of these injections show that more than half of all patients who have sclerotherapy lose a significant portion of their regained weight.

Revision with Gastric Banding

Some patients who need revision bariatric surgery benefit from a revision to a gastric band. With this type of revision, an adjustable and inflatable silicone band is placed around the upper portion of the stomach. Adding a band to modifications that have already been made to the stomach may create a stronger feeling of fullness. The advantage with this is option is that the band itself can be adjusted so that it’s tighter or loosened if it reduces food intake too much.

Conversion to a Duodenal Switch

Patients who were excessively obese prior to their initial weight loss surgery may benefit from a conversion to a duodenal switch. It’s a secondary procedure that reduces the stomach size to about 30 percent of its original size. During a duodenal switch, the intestine is cut and reattached lower so the digestive process starts at a later point to further reduce absorption of calories from food that’s consumed. It’s a more restrictive option that’s often highly effective even when a previous weight loss surgery fails. Another conversion option is to lengthen the part of the intestine where food intake takes place following weight loss surgery, referred to as the roux limb. It is usually reserved for patients with a very low BMR.

The decision to opt for a revision procedure will be based on the reason why your first surgery didn’t work and your goals going forward. Ideally, you want to do everything possible to make your first weight loss surgery as successful as possible. Maintain ongoing communication with your surgeon to discuss any concerns you may have anytime after your procedure. If there is no physical or structural cause for your lack of satisfactory results, you may be referred to a dietician, nutritionist, or other specialist to see if lifestyle changes can be made before a revision is considered.

To learn more about revision bariatric surgery, contact our office today.