Revision Bariatric Surgery Types
While bariatric surgery is a highly successful, evidence-based solution to the management of severe obesity, on average 20% of patients will fail to lose adequate weight or regain weight.
A very small number of patients may have complications from a previous procedure that could include a failure to resolve comorbid medical conditions such as diabetes, and anatomic changes that cause symptoms.
What is revision surgery?
Revision surgery involves a modification of your original procedure and may involve conversion to another procedure. The choice of revision or conversion is determined on a case by case basis. Each patient is evaluated to assess causes of failure and the likelihood that they will succeed with revision or conversion surgery.
What are my options?
Your options for revision surgery depend on many different things including the type of initial weight loss surgery you had and your success with that procedure, your individual circumstances, and potential causes for weight regain and failure to achieve weight loss goals.
Laparoscopic Lap Band Revision or Conversion
Laparoscopic adjustable gastric banding is the only bariatric procedure that does not alter the anatomy. This results in lower than average weight loss. In some cases, the patient has achieved successful weight loss but the band has slipped or eroded. Replacing the band or repositioning it can help maintain weight loss.
When weight loss has not been successful or maintained, conversion to either a gastric bypass or sleeve procedure is preferred for satisfactory additional weight loss and a reduction of comorbid medical conditions. The choice will depend on complications experienced from the band including acid reflux, weight regain, failure to achieve weight goals, and the presence of scar tissue which may preclude conversion to a sleeve procedure. In that case a bypass may be the better option.
Laparoscopic Gastric Sleeve Revision or Conversion
20-30% of sleeve patients develop acid reflux (GERD). Sleeve revision may be an option to minimize reflux. Also, patients with a sleeve may experience an increase in stomach size after a few years. Options may include sleeve revision or conversion to a bypass which will address reflux issues and failure to achieve weight loss goals.
Revision Laparoscopic Gastric Bypass
Even with a gastric bypass the stomach will stretch. Corrective surgery is intended to modify the anatomy to increase or restore gastric restriction to stop weight regain and restore satiety sensation and/or recurrence of weight related co-morbid conditions. This approach will reduce the size of the pouch and the size of the juncture between the stomach and the intestines.
Options may include inserting a lap band around the pouch to restrict food intake and removing part of the pouch to reduce the size of the passage to the intestines. Another option is to bypass more of the intestines to reduce the ability to absorb calories. Finally, minimally invasive repair using endoscopy can allow us to tighten the connection between the stomach and intestines to restrict food intake and reduce the absorption of calories.
Bariatric surgery is highly successful, and most patients meet their goals and regain a healthy quality of life. Still there are patients who may need corrections to achieve their goals, even though the original surgery was correctly performed.
Dr. Ragui Sadek is an international recognized authority in minimally invasive bariatric surgery. He and his team perform more than 1,200 complex procedures every year, with few post-surgery complications. Our surgical and bariatric center has received the Bariatric and Metabolic Center of Excellence from the American Society for Metabolic and Bariatric Surgery.