Revisional Bariatric Surgery

Whilst bariatric surgery is a proven weight loss solution that has been successfully employed for decades, there are occasions when patients do not achieve the weight loss that they expect (or begin to regain weight several years after their procedure). Lack of weight loss or weight regain may be caused by one or more of many factors and need to be evaluated by a surgeon with extensive experience in revising primary bariatric procedures together with his multidisciplinary team.

Before considering revision to a primary bariatric procedure, it is important to understand that most patients will regain a little bit of weight in the future. This is perfectly normal and is not considered a complication requiring a revision.

The most common cause of insufficient weight loss is straying from the postoperative diet and exercise regimen. Over the years, it can get harder to maintain a strict diet and exercise program, and small lapses can compound over time. If a lifestyle issue is the primary cause of weight regain, our team of dieticians and psychologists will work with our patients to get back on track. Often, with renewed dedication to their health and new lifestyle, patients can begin to lose weight again. We can also add medications to help promote further weight loss.

If the stomach pouch or sleeve has stretched to such a degree that the patient is gaining a significant amount of weight and the restriction provided is no longer effective, there are both surgical and nonsurgical (endoscopic) techniques to restore restriction. Every patient will present with a unique circumstance, and therefore, the revision plan is customised to their situation.

Options for Revising a Gastric Bypass

Possible options include placing a gastric band over the top of the bypass or converting the bypass to a long limb bypass (lengthening the amount of intestine bypassed).

Gastric bypass patients can also regain weight because of the stretching of the join between the stomach pouch and the small intestine. This allows too much food to empty into the small intestine. The result can be weight gain and discomfort when eating certain foods. Mr. Ahmed offers minimally invasive or non-surgical, endoscopic options for this condition so called endoscopic stoma reduction surgery using Overstitch.

Options for Revising a Gastric Sleeve

The stomach tube may stretch over time with liberalised eating habits, even after a gastric sleeve. Alternately, the primary bariatric surgery may not have cut away enough of the stomach, allowing the patient to overeat. In both cases, if weight loss is not achievable through lifestyle change, a revision procedure may be indicated. The most common revision to a gastric sleeve is conversion to a gastric bypass or a mini gastric bypass. Other options include a re-sleeve, which involves cutting away additional stomach tissue to once again shrink the gastric tube and create additional restriction. Weight regain is not the only reason why a gastric sleeve might be revised, however. In some patients, the gastric sleeve brings about new or worsened gastroesophageal reflux disease or regurgitation of food. These patients may benefit from a conversion to a gastric bypass.

Options for Revising a Gastric Band

If the band fails, patients may opt for removal of the device. However, simply removing the band will, likely, accelerate the weight regain. Others, who have experienced a complication such as erosion or slipping of the band, will require a corrective surgical procedure.

The band does not change the anatomy of the stomach, so once it is removed, the patient has all other bariatric procedures to choose from. When revising a band, it is very much like the having a primary procedure all over again. The revision can take place as a single stage (removing band and performing the revision to a different procedure) or in two stages (removing the band waiting a few months then returning for a the revision procedure). Mr Ahmed will evaluate each person individually and decide with each patient what the best course is for them, namely 1 stage or 2 stage revision as well as optimal choice of revision procedure. Patients typically opt for revision to mini gastric bypass.

Are There Any Additional Risks to a Revision of a Bariatric Procedure?

Any surgical procedure comes with inherent risk, however when performing surgery on the same organ, there are always additional risks and considerations that are taken into account. For example, scar tissue around the surgical field poses a challenge during the second procedure, especially when performed laparoscopically. For this reason and others, revision bariatric procedures should be performed by surgeons, such as Mr. Ahmed, highly experienced in revisional techniques.

Based on a patient’s general health, pre-operative testing and more, Mr. Ahmed will offer guidance on the risks and considerations of a revision procedure.

Prognosis After a Revision Bariatric Surgery

The goal of revising a primary bariatric procedure is to create an environment where the patient can lose and maintain the degree of weight loss expected after their primary procedure. Lifestyle changes will remain a significant part of success. Many patients who may not have been vigilant in their lifestyle change after their primary procedure learn where they went wrong and modify accordingly, creating the potential for long-term success. The degree of weight loss success, even after a revision procedure, depends largely on the patient’s dedication to change.