Bariatric Revision Surgery in New Jersey | Top Bariatric Surgeons | Advanced Surgical & Bariatrics of NJ

Revisional Bariatric Surgery in New Jersey

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After deciding to have bariatric surgery, it’s disappointing when you don’t get the results you hoped for or if you experience complications. At this point, don’t feel like all hope is lost.

For some people, a single bariatric procedure may not produce the desired results- either through insufficient weight loss, significant weight regain, or poor resolution of comorbidities. If an issue arises after bariatric surgery, a revisional procedure is also done to correct the problem.

Bariatric revision surgery may be the next step to help support you achieve your goals. After thorough testing, your doctor comes up with an effective plan to get you back on track. These operations are now exceedingly safe and oftentimes successful. You have more than one choice — and more than one chance — thanks to the revisional options available to you.

Talk to the highly trained surgical specialists at Advanced Surgical & Bariatrics to see how you may benefit from a bariatric revision. We have some of the best bariatric surgeons in the field.

Patients may inquire about revision weight loss surgery for several reasons. A single weight loss surgery procedure is sufficient for many patients, providing adequate long term weight loss. For others, a single weight loss surgery procedure may not cause the desired results, either through insufficient weight loss, poor resolution of co-morbidities, and/or due to medical complications resulting from the weight loss surgery itself. When performing revisional weight loss surgery, one needs to be able to utilize every tool available, and sometimes create new ones based on your particular problem.

Types of Bariatric Surgery that Require Revision

Since the 1980s, obese patients have benefited from bariatric surgeries, but over time, problems and complications emerged that required reevaluation. A couple of kinds of the procedure that were once popular, but now require bariatric revision include:

  • Vertical Banded Gastroplasty. An early form of gastric banding surgery, this procedure provided substantial weight loss for the majority of patients with few complications. Over time, however, many gained back much of the weight while others complained of increased appetite. Doctors usually traced these problems to an interruption in the staple line, although it was also possible that the scar tissue obstructed the stapled stomach or the plastic band eroded over time. Other side effects from this procedure include:
    • Heartburn
    • Upset stomach
    • Stomach pain
    • Vomiting
    • Excessive weight loss, often in conjunction with nausea
  • Jejunoileal bypass. Unfortunately, most of the patients who had this surgery require a reversal. Once an extremely popular type of gastric bypass surgery, the jejunoileal bypass has fallen out of favor due to some serious side effects, such as:
    • Severe diarrhea
    • Kidney and liver damage
    • Electrolyte abnormalities
    • Other gastrointestinal problems

A Common Bariatric Revision Surgery

If you lose 50 percent of your desired weight loss goal following a bariatric procedure without complications, your doctor considers the operation to be a success. With a very high starting body mass index, despite the amount of weight lost, obesity related medical problems may still persist. If you haven’t reached your weight loss goals, you may undergo testing to determine how we can help you get there. This process determines whether or not you would benefit from a revision. Additional procedures that address the original bariatric operation may be able to support you in achieving your goals.

The procedural options for people who have had or currently have a gastric band in place are broad. After the band is removed, one may elect to ultimately have either a gastric sleeve or gastric bypass performed. Doing so will not only drive the weight down further, but also tends to alleviate nausea and vomiting, as well as acid reflux, that may have resulted from placement of the silicone ring around the top of the stomach.

For people found to have an exceedingly large gastric sleeve, a “resleeving” of the excess stomach tissue may be an option- not only would this further reduce the volume of the sleeve, but may also decrease the hunger drive more effectively. An enlarged stomach after sleeve gastrectomy may also be folded in on itself and sutured to make it smaller. Finally, converting a gastric sleeve into a gastric bypass may allow people to more successfully continue on their bariatric journey.

There are also options for people who previously have had gastric bypass surgery. One revisional procedure is performed endoscopically, which doesn’t involve incisions or formal surgery. Using a small flexible camera inserted into the mouth and advanced until the stomach pouch is encountered, the connection between the pouch and small intestine can be narrowed down to appropriate dimensions. This thereby decreases the amount of food needed to fill up the pouch so that people do not “feel like a bottomless pit”- a comment that is repeatedly heard some years after the original bypass surgery. Most bariatric surgeons do not perform this type of revision. At Advanced Surgical and Bariatrics, we have the skill set, training, experience and expertise to effectively support you in regaining your health.

Narrowing this connection between the stomach and small intestine can also be accomplished laparoscopically, during which the stomach pouch can also be made to be smaller.

Another surgical alternative to revising a gastric bypass involves bypassing more of the small intestine so that there is even less surface area involved in absorbing calories when eating. This results in an even less efficient digestive system so that weight loss goals may be more effectively accomplished.

5.0 ★ ★ ★ ★ ★ The doctors are very supportive

The office staff is great and there is never a long wait. The doctors are very supportive in this new change in your life. Everyone I tell about my upcoming surgery, says that this practice is the best. It’s very comforting to hear others confirm that I made the right choice.

Erik R.

Risks and Results of Revisional Bariatric Surgery

Revisional weight loss surgery is a big decision that should weigh the risks and the benefits of each type of option. Although still safe, bariatric revisions are slightly riskier than the first time a procedure is done.

Revisional bariatric surgery slightly more challenging because:

  • These procedures may take longer to perform
  • There may be additional scar tissue from the original procedure or any other abdominal/ pelvis surgeries.
  • There is a slightly increased, although still low, chance of blood loss, leak and infection.

The results of revisional weight loss surgery are relatively predictable when it comes to the treatment of medical conditions. That being said, predicting the impact of revision weight loss surgery on weight loss itself, is less accurate.

Since every person is different, each revisional weight loss surgery is approached in a tailored manner. In addition to more weight loss, revisional bariatric surgery can help cure reflux and improve medical comorbidities like diabetes, high blood pressure, and sleep apnea.

There are options available even if you have had bariatric surgery. Your doctor can help you decide your ideal revisional procedure. If you’re looking for a bariatric surgery revision, you can find it at Advanced Surgical & Bariatrics. Your team of specialists has some of the most recognized and best rated bariatric doctors in the Northeast at different locations throughout New Jersey. Contact the practice today to find out if bariatric revision gastric bypass surgery is right for you.

Reasons for Revisional Bariatric Surgery

Bariatric surgery is a well-established, safe and effective means for people with morbid obesity to reclaim their lives and get healthy again. But these procedures are not 100% effective for 100% of patients. It is important to remember that obesity is a chronic disease and weight loss surgery, in itself, is not a cure. Continued success after bariatric surgery requires ongoing hard work and lifestyle change.

What are the reasons for revision surgery?

The most common reasons for revision surgery are weight regain, inadequate weight loss, failure of the original surgery to resolve diseases associated with obesity, or complications related to the first bariatric procedure. 

Sometimes people:

  • Gravitate to “slider foods”, which have no nutritional value and can contribute to weight regain, but tend to be more easily consumed as compared to healthier alternatives.
  • Do not get the expected results. Each type of bariatric procedure has its own success rate- inadequate results can be related to the kind of weight loss surgery chosen, rather than something a person is or is not doing.
  • Can stretch out their stomachs years after surgery. With a sleeve or bypass, this expansion allows people to eat more before feeling full.
  • Undergo personal changes in behavior or attitudes. New life stresses (like having children, leaving a relationship, financial hardships, or a new job) make it challenging to commit to and stick with a health promoting lifestyle. Maintaining appropriate eating habits, incorporating a regular exercise routine, and effectively managing stress is important.
  • Have children after bariatric surgery. While this is often the goal of many women suffering from infertility or PCOS, with each subsequent pregnancy it becomes even more difficult to shed the baby weight.
  • Enter menopause.  With all the hormonal changes that occur during this time period, sometimes the metabolism slows down even more.

When you are regaining weight, or have inadequate weight loss, the very first thing to do is talk to your surgeon to evaluate the possible causes. When you feel you are losing control, speak with our surgeons who can provide you with the resources to refresh your lifestyle, make better food choices, exercise more, and become recommitted. When a revision is indicated, it can put you back on track to achieve your weight loss goals.

Advanced Surgical and Bariatrics of NJ has one of the lowest complication rates in the Northeast due to our emphasis on quality care, cutting-edge surgical techniques, and superior safety standards.

Dr. Ragui Sadek is an internationally recognized authority in minimally invasive bariatric surgery. He and his team perform more than 1,000 complex operations every year with few post-surgery complications. Surgeons who perform a lot of bariatric surgeries have lower complication rates, and higher success rates. Our team of multispecialty physicians will help you get back on track and take charge of your life.

*Altieri MD, et al. Rate of revisions or conversion after bariatric surgery over 10 years in the state of New York. Surg Obes Relat Dis. 2018 Apr;14(4):500-507. Epub 2017 Dec 29.

Revision Bariatric Surgery Types

While bariatric surgery is a highly successful, evidence-based solution to the management of severe obesity, some patients will fail to lose adequate weight or experience weight regain.

A very small number of patients may have complications from a previous procedure that could include a failure to resolve obesity related medical conditions, and anatomic changes that cause symptoms.

What is revision surgery?

Revision surgery involves a modification of your original operation and may involve conversion to another procedure. The choice of revision or conversion is determined on a case by case basis. Each patient is individually evaluated to assess the causes of their results and the likelihood that they will succeed with revision or conversion surgery.

What are my options?

Your options for revisional procedures depend on many different things- including the type of initial bariatric surgery and results with that operation, your individual circumstances, as well as potential causes for weight regain and inability to achieve or maintain weight loss goals.

Laparoscopic Gastric Band Revision or Conversion

Laparoscopic adjustable gastric banding is the only bariatric procedure that does not alter the anatomy. This, on average, may result in a lower weight loss. In some cases, the patient has achieved success but the band has slipped or eroded. Replacing or repositioning, the band can help maintain outcomes.

When weight loss has been less than successful, conversion to either a gastric bypass or sleeve procedure will provide for additional weight loss and a reduction of comorbid medical conditions. The choice will depend on complications experienced from the band that include 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

For people found to have an exceedingly large gastric sleeve, a “resleeving” of the excess stomach tissue may be an option- not only would this further reduce the volume of the sleeve, but may also decrease the hunger drive more effectively.  An enlarged stomach after sleeve gastrectomy may also be folded in on itself and sutured to make it smaller.  Finally, converting a gastric sleeve into a gastric bypass may allow people to more successfully continue on their bariatric journey.

Depending on the type of revision, acid reflux or GERD that arises after the initial gastric sleeve can be alleviated.

Laparoscopic Gastric Bypass Revision

There are also options for people who previously have had gastric bypass surgery. Even with a gastric bypass, the stomach will stretch. 

One corrective procedure is performed endoscopically, which doesn’t involve incisions or formal surgery.  Using a small flexible camera inserted into the mouth and advanced until the stomach pouch is encountered, the connection between the pouch and small intestine can be narrowed down to appropriate dimensions.  This thereby decreases the amount of food needed to fill up the pouch so that people do not “feel like a bottomless pit”- a comment that is repeatedly heard some years after the original bypass surgery. Most bariatric surgeons do not perform this type of revision.  At Advanced Surgical and Bariatrics, we have the skill set, training, experience and expertise to effectively support you in regaining your health.

Narrowing this connection between the stomach and small intestine can also be accomplished laparoscopically, during which the stomach pouch can also be made to be smaller.  

Another surgical alternative to revising a gastric bypass involves bypassing more of the small intestine so that there is even less surface area involved in absorbing calories when eating. This results in an even less efficient digestive system so that weight loss goals may be more effectively accomplished.

Bariatric surgery is highly successful with most patients meeting their goals and regaining a healthy quality of life. Still there are patients who may need revisional procedures to achieve their goals, even though the original surgery was correctly performed.

Dr. Ragui Sadek is an internationally 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.

Dr. Sadek

Dr. Ragui Sadek is a premier surgeon who established a state-of-the-art and one of the safest bariatric surgery programs in the state. Dr. Sadek has fellowship training in both laparoscopic/bariatric surgery and surgical trauma/critical care, allowing him to safely perform complex surgeries on patients who have been turned down by other practices. As a Clinical Assistant Professor of surgery at RWJ Medical School & the Director of bariatric surgery program at RWJ University Hospital, Dr. Sadek offers a cutting-edge range of laparoscopic, robotic, & bariatric surgical procedures with a complication rate substantially below the national average.

Dr. Sadek is a Clinical Assistant Professor of Surgery at Rutgers-Robert Wood Johnson Medical School and a Fellow of the American College of Surgeons. Having performed more than three thousand advanced surgical procedures, Dr. Sadek has established a strong patient satisfaction rate and a solid reputation among the surgical community and is renowned as a top physician in his field by International Association of Healthcare Professionals. As a board-certified surgeon, he holds affiliations with the American Society of Metabolic and Bariatric Surgery and the Society of American Gastro Endoscopic Surgeons. More about Dr. Sadek

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