Bariatric Revision Surgery
Bariatric revision surgeries can vary greatly based on the original operation, whether it was open or laparoscopic, the degree of weight loss achieved, and the current nutritional and physical state of the individual. Revision procedures are not one size fits all and not everyone is a candidate for a revision. The information below represents general information based on the original bariatric procedure performed.
Gastric Banding Revisions
Individuals who have undergone a gastric banding procedure may experience complications such as a slipped or eroded band. Symptoms of a slipped band include progressive intolerance to solid foods, new onset heartburn, or regurgitation of fluid in the back of the throat while sleeping. Patients experiencing issues such as these generally require removal of the band and can have a second procedure like a gastric sleeve or gastric bypass at the same time depending on insurance coverage.
An eroded gastric band may present with vague abdominal pain, fever, or a port site infection. However, most eroded bands present with only symptoms of a loss of restriction and the band is found eroded incidentally. An erosion requires removal of the band followed by healing of the hole formed in the stomach. A second procedure such as a gastric sleeve or gastric bypass may be attempted at a later time.
The band patient may also experience mechanical failures such as a flipped port or tubing issues resulting in inability to access the port for band adjustments. In this scenario, it is possible to replace the damaged component of the band and preserve the band as a weight loss procedure.
Gastric Bypass Revisions
Gastric bypass surgery can have mechanical failures as well. They are usually related to marginal ulcerations that lead to bleeding or obstructions at the anastomosis (connection between the stomach pouch and small intestines) with subsequent prolonged vomiting and malnutrition. These mechanical failures can usually be fixed by revising the original anastomosis.
Revision of a gastric bypass for inadequate weight loss or weight regain is a difficult scenario. In reality, most patients don’t need a revision. The most common complaint we see with patients who have gained weight back after gastric bypass surgery is "my pouch has stretched out”. There may be some patients in which that is true, however, most patients have reverted back to poor eating habits and our Aftercare Program can get these patients losing weight again.
The main function of gastric bypass surgery is to help patients control appetite and portion sizes. We know portion sizes may increase some over time, but it’s not usually due to a major stretching of the pouch. However, a pouch may have been made too big in the beginning but felt small at first due to swelling and newness of the surgery. After that wears off, then portion sizes can get bigger. This large pouch is the minority of the patients we see who may actually be candidates for a revision. They typically had their surgery many years ago or in an open fashion. Most current laparoscopic gastric bypasses are made with small pouches that don’t stretch much over time.
Another potential cause of weight gain after gastric bypass surgery is stretching of the anastomosis over time. This can lead to faster emptying of the pouch which allows you to eat more or be less full with a small meal. There are some newer non-surgical procedures which attempt to reduce the size of the anastomosis by going through the mouth and placing sutures in this area to narrow the connection. However, these procedures are not covered by insurance, and they aren't showing much long-term success. Unfortunately, there is only so much we can do surgically to maintain these small openings over time.
Gastric Sleeve Revisions
Mechanical failure of the gastric sleeve surgery may occur and will result in the development of severe gastroesophageal reflux disease (heartburn) or prolonged nausea and vomiting. When mechanical failure occurs, the gastric sleeve is usually converted to a gastric bypass procedure to alleviate these symptoms.
Revision of the gastric sleeve may also be considered for inadequate weight loss or weight regain. If the sleeve was made too big at the original operation, then it may be possible to re-sleeve and achieve adequate restriction with subsequent weight loss. If weight regain occurs in the face of normal anatomy, then the initial approach is to try and preserve the gastric sleeve through our Aftercare Program. If we are unable to achieve adequate weight loss with our Aftercare Program, then a revision to a duodenal switch is the procedure of choice.
Vertical Banded Gastroplasty and Stomach Staplings
Stomach stapling procedures were purely restrictive procedures originally developed in the early 1970’s and were once popular surgeries for managing obesity. However, today they are rarely performed due to the large number of patients who have experienced either poor long-term weight loss or mechanical failure. Due to the anatomy, most of these patients are only candidates for revision to a gastric bypass procedure.