Revision Procedure

Weight loss surgery can and does fail at times for a variety of reasons. Patients who experience failure many times are reluctant to seek assistance because they feel that every attempt they have made to reach a healthy stable weight, has failed so they themselves are a failure. NOT TRUE!

How Revision Surgery Works

The first step in revision surgery is to have an endoscopy and upper GI series not only to determine the cause of failure, but also for the surgeon to be able to visualize and plan precisely how he will execute the revisional surgery. If your insurance will cover these two diagnostic procedures, you may elect to have them done in the U.S.. If your insurance does not cover, you may want to fly into your surgical destination of choice at least a day prior to your revisional surgery to complete the diagnostics and discuss with your surgeon the options available to you.

Lapband patients will want to remove their lapband and revise to a sleeve gastrectomy or bypass. Some surgeons can or will revise a sleeve pouch, others will not revise the pouch but revise the sleeve surgery to a RNY (gastric bypass) or a DS (duodenal switch). Gastric bypass patients can sometimes have the staple lines repaired and the pouch trimmed. If the stoma has failed, the least risk approach would be to apply a lapband over the gastric bypass. The bypass may also be revised to a distal bypass and some surgeons will attempt to revise the stoma. A failed gastric bypass typically can’t be revised to a DS by most surgeons.

If a patient has a hiatal hernia, we can also repair the hernia during the same surgery.

Review of Types of Revision Surgeries:

Gastric Bypass Revision Surgery

If roux-en-y gastric bypass fails to produce desirable weight loss, or if patients lose too much weight, revising to another surgery type could be ideal. Although, gastric bypass is considered to be semi-permanent, patients can convert to a variety of options including duodenal switch, and Lap-Band. In Lap-Band, the band is placed around the stomach to help induce weight loss. Other options include:

  • Shrink the stoma by injecting a sclerosant (“sclerotherapy”)
  • Reduce the Size of the Pouch
  • Add Lap-Band around the stomach (lap band surgery)
  • Lengthen the Roux limb

Gastric Bypass Failure can be caused by:

  • Pouch enlargement
  • Staple line disruption
  • Stoma enlargement or failure
  • Patient’s body adjusting to lowered caloric intake

Gastric Banding Revision Surgery

Increasing in consensus is dissatisfaction of gastric banding as a tool to treat obesity. More and more patients are experience insufficient weight loss, and undesirable complications. The most common revisional surgery, is Lap-Band to Gastric Sleeve. The gastric sleeve provides the restriction familiar to Lap-Band patients, but also includes a suppression of appetite. List of revisional surgeries include:

  • Re-Adjust Lap-Band Placement
  • Lap-Band to Gastric Sleeve
  • Lap-Band to Gastric Bypass

Statistically, 10 years post op 60% of all lapband patients no longer have their lapband. Lapband failure can be caused by:

  • Erosion
  • Slippage
  • Pouch enlargement
  • Poor access to adjustments
  • A certain percentage of patients simply do not lose weight with Lap-Band.

Gastric Sleeve Revision Surgery

If gastric sleeve surgery fails to produce adequate weight loss, many patients opt to go with the duodenal switch, or have a re-sleeve.  Both options should work to increase amount of expected weight loss. List of revisional surgeries:

  • Gastric Sleeve to Duodenal Switch
  • Re-Gastric Sleeve

Vertical Sleeve Gastrectomy failure can be caused by:

  • Pouch enlargement
  • Patient’s body adjusting to lower caloric intake

Vertical Banded Gastroplasty

Vertical Banded Gastroplasty, or stomach stapling, is an outdated weight-loss procedure that uses stitches and an implant to achieve weight loss. Developed by Dr. Edward E. Mason, the developer of the original Gastric Bypass in 1966, it was original developed in 1980. Since that time, long-term studies over 10 years show disappointing results.

Compared with other surgery options, Vertical Banded Gastroplasty doesn’t produce the necessary weight loss and can allow patients to regain their weight. Other possible reasons for weight loss failure is the lack of duplicate stitching (a practice which is now standard), which can tear or open. When this happens, patients must convert to another surgery time.

Surgeries VBG can be revised to:

  • Gastric Sleeve Surgery (Likely)
  • Gastric Bypass Surgery (Less Likely)

Patients of weight loss surgery must also factor in their personal genetics. Certain individuals are simply designed to store fat and several years after weight loss surgery, their bodies adapt to the malabsorption component and lowered caloric intake and patients begin to slowly gain weight again.