Bariatric Surgery Revisions
While most patients find that their primary bariatric surgery allows them exceptional excess body weight loss and disease improvement over the course of the rest of their lives, some patients will not receive the results they expect long term and have some weight regain. Other patients may experience rare complications from their weight loss surgery which may require surgical correction.
What Are Your Expectations?
First, it is important to adjust expectations, if necessary. Bariatric surgery is not a cure-all – rather it is a tool for patients to change their lifestyle and improve their chances of losing a significant amount of weight. But what is the appropriate measure of success? Objectively, losing 50-70% of excess body weight would be considered successful. Of course, this will fluctuate over time, which is perfectly normal. It is important to continue long term follow up with your physician as obesity is a lifetime disease process.
Could It Be A Lifestyle Issue?
We will then evaluate your diet and exercise program to ensure that the weight regain is not due to lifestyle issues. If lifestyle issues may be to blame, you will work with our staff and dietitian to get back on track. Often times, a small fix can help you get back on track without the need for additional surgery.
If the above fails to change the weight regain situation, we will begin to consider options for revising the primary bariatric procedure. The most common revisions include:
Revising the Gastric Band
Although once a very popular choice among patients seeking weight loss surgery, the gastric band surgery has shown a higher rate of long-term failure than stapled procedures, like the vertical sleeve gastrectomy and Roux-en-Y gastric bypass. Because of this, we perform many band removals and lap-band revisions. Fortunately, the band is fully reversible and the stomach remains completely intact after removal. The lap-band device is simply removed from the top of the stomach. A band can be revised to any other procedure that the patient desires, or simply be taken out returning to the original anatomy with no restriction. Because the anatomy is not changed, hunger hormones are still present meaning many patients still struggle with hunger despite frequent band fills. Band patients may also experience failed weight loss or a plateau with weight loss months or years after surgery, which halts their weight loss and leaves them unsatisfied. Typically, we will perform a gastric bypass or gastric sleeve to when a lap-band is removed to aid the patient in achieving the desired weight loss that lead them to choosing to have bariatric surgery in the first place.
There are many reasons for lap-band removal and conversion to another bariatric procedure. Some band patients are unable to find a “sweet spot” with the lap-band and are left feeling that it is always too tight, or too loose. If the gastric band is excessively tight, the patient may experience vomiting, reflux, or choking. If a lap-band is too loose, a patient is able to continue to over eat unrestricted and will not experience the desired weight loss. Others struggle with food texture after the gastric band. Eating foods that have more texture including meat and foods high in fiber can be difficult to get down or keep down. Outside of issues with weight loss, other complications can occur that require the band to be removed. These include lap-band slipping, the band eroding the stomach organ, or mechanical failure.
Revising the Gastric Sleeve
A gastric sleeve revision is performed for weight regain, below expected weight loss, or significant reflux or heartburn. The most commonly performed revision of sleeve gastrectomy is conversion to the gastric bypass. This can help with further weight loss as well as allowing for significant improvement in heartburn. Other options, including duodenal switch or redoing your sleeve, can be considered. Revising the sleeve gastrectomy can consist of “resleeving” where the sleeve pouch is slimmed to restore restriction when the original sleeve pouch was either created larger than is idea or has been stretched over time. In other cases, a more extensive revision of the sleeve is performed where a malabsorptive component is added by bypassing part of the small intestine with a gastric bypass or duodenal switch. Choosing to convert your sleeve to a gastric bypass would mean the stomach pouch is further decreased, from the size of a banana to the size of an egg, and the small bowel is rearranged to allow fewer calories to be absorbed during digestion. A duodenal switch would mean the sleeve pouch stays intact, or is slightly slimmed when appropriate, while a portion of the small bowel is bypassed.
Revising the Gastric Bypass
Gastric bypass revision can be more challenging, but is doable. The revision options will depend upon your particular issue or anatomy. There may be surgical changes made to the gastric pouch or the amount of small bowel that is being bypassed. A rare complication specific to the Roux-en-Y gastric bypass known as stoma dilation has been shown to contribute to inadequate weight loss and weight regain and can be surgically corrected when appropriate.
For a full discussion of possible bariatric surgery revision options and an physical evaluation specific to your circumstance, we invite you to schedule a consultation with Dr. Henke by contacting us.