What is Revisional Bariatric Surgery?
Revisional bariatric surgeries can sometimes be performed to help reduce a stretched initial bariatric operation back to an effective weight loss size or to convert patients who have previously had another bariatric operation to a different bariatric surgery to treat some problem. If a patient has a malfunctioning LAP-BAND®, for instance, we can offer LAP-BAND® removal with simultaneous conversion to a different, more effective bariatric surgery at that time. If a patient’s operation were merely reversed, without revising to another operation, nearly all patients would regain all of their weight within a year of reversal.
Why would you need revisional bariatric surgery? Here are the most common reasons:
- Gastric band intolerance (this is common and usually not preventable)
- Severe persistent reflux
- Food intolerance
- Band slips
- Band prolapse
- Band erosions
- Hardware failures
- Weight regain or Inadequate weight loss
- Usually gastric band
- Stretched gastric sleeve or gastric bypass pouch (this is rare and preventable)
- Historic bariatric operations that are no longer performed and may need to be reversed or revised
- Jejunoileal bypass
- Vertical banded gastroplasty (sometimes)
If you’re experiencing complications, these revisional bariatric surgeries may help*:
|Primary Surgery||Ideally revise to|
|Gastric Band without effective weight loss (and/or unresolved diabetes)||Intestinal Bypass (Gastric Bypass or Loop Duodenal Switch)|
|Gastric Band intolerance||Sleeve or Gastric Bypass|
|Sleeve with reflux problems||Gastric Bypass|
|Sleeve without reflux problems||Add loop to complete Loop Duodenal Switch (SADI-S)|
|Gastric Bypass with weight regain||1. Surgical revision of pouch, stoma or limb length
2. Conversion to Loop Duodenal Switch (SADI-S)
3. Investigative endoscopic revision of pouch or stoma only (ROSE or APC procedure)
|Loop Duodenal Switch with severe reflux||Gastric Bypass|
It is very important to understand that when weight regain or ineffective weight loss is the reason for revision, making appropriate changes to the behaviors that have resulted in weight regain will be absolutely necessary before the revision can be considered. Otherwise the revision will not be any more effective than the first operation.
Up to half of all LAP-BAND® patients eventually need to have their band removed. This can happen for a variety of reasons. At least 40% of patients don’t see the weight loss they were hoping to achieve with the band: they only lose about 25% of their excess weight. Other patients suffer from band infections, band erosions (when the band grows into the stomach), or band slippage. LAP-BAND® patients may also experience difficulty swallowing or keeping their food down, or develop severe and worsening reflux.
Often these problems can be fixed with a LAP-BAND® removal*. At the BMCC we can replace your LAP-BAND® with a safer and more effective procedure such as a gastric sleeve*.
Gastric Bypass Revision
The gastric bypass is usually a successful surgery, and when patients receive strong support, very few need a gastric bypass revision*.
When patients do, many times this is because the patient hasn’t followed their diet and exercise regime, or their plans may have been flawed. If you have weight loss issues, we’ll work with you to make sure that your diet and exercise plans are effective and tailored to you, and that you’re able to follow through with them.
However, sometimes the problem is that the gastric pouch has become stretched, which means you have to eat more in order to feel full, leading to weight regain. If this is the case, we can use a variety of procedures to revise your gastric bypass so that you can lose weight and keep it off*.
Do I Need Revisional Bariatric Surgery?
Revisional bariatric surgery can often help, but you do need to know that most studies indicate that the scarring present after the first surgery increases the risk of a revisional operation.
What Is a Hiatal Hernia?
The diaphragm is a muscle that separates the chest from the abdomen. Normally there is a small key hole for the esophagus (your swallowing tube) to pass through down to your stomach. In some patients this small key hole can stretch, allowing a portion of the stomach to slide upward into the chest. This forms a hiatal hernia.
While hiatal hernias do not always produce symptoms, they can cause severe reflux or swallowing problems that may not respond well to medical therapy. In these settings anti-reflux surgery or a hiatal hernia repair can be an effective way to treat these problems*.
How Is Reflux (GERD) Diagnosed?
Reflux is definitively diagnosed by using a test called a pH study. Sometimes, your doctor may also diagnose mild to moderate reflux by looking at your symptoms and by placing you on an antacid medication to see if symptoms improve. In cases of severe reflux, an upper endoscopy (EGD) may be necessary to look for damage to the esophagus and to test for an ulcer-producing bacteria in the stomach known as H. Pylori. A swallow study (UGI) may also be performed if you or your doctor suspects that you have a hiatal hernia.
How Is Reflux (GERD) Treated?
Reflux is usually treated by your primary care doctor, using one or more of the following:
- Dietary modifications
- Histamine 2 blockers (e.g. Zantac)
- Proton pump inhibitors (e.g. Prilosec)
When these measures fail to adequately control symptoms, or when a large hiatal hernia is present, anti-reflux surgery may be needed*.
What Is Anti-Reflux Surgery?
Anti-reflux surgery is an option for severe reflux or heartburn (also known as GERD) when antacid medications fail or (sometimes) when a significant hiatal hernia is present. Anti-reflux surgery is called fundoplication. Fundoplication involves wrapping a portion of the upper stomach around the valve between the esophagus and the stomach to reinforce this valve-controlling reflux.
If a hiatal hernia is present, it will need to be repaired to control reflux or other symptoms caused by the hernia, such as difficulty swallowing or chest pain. The hernia can be repaired by pulling normal abdominal contents (including the stomach) out of the chest down below the diaphragm into the abdomen where they belong, and then repairing the enlarged hole in the diaphragm to restore the normal-sized key hole. This prevents the stomach and valve from slipping back up into the chest and can help to restore normal external pressure on the valve, which resolves reflux*.
In some cases a mesh may be used to further reinforce the diaphragm and keyhole. Usually a fundoplication will also be performed with the hiatal hernia repair.
When patients suffer from reflux and from morbid obesity, the best surgical treatment is a laparoscopic gastric bypass. This cures more than 90% of reflux and also effectively treats morbid obesity*.
Bariatric Revision Surgery and Emerging Bariatric Technology
Bariatric surgery is evolving as we discover new procedures that are safer and less invasive. At the BMCC, we’re committed to incorporating cutting-edge treatments and technologies when they are both safe and effective and can provide additional benefit for you. Some of these therapies are being used in revisional bariatric surgery. The ROSE (Restorative Obesity Surgery, Endolumenal) and the APC (Argon Plasma Coagulation), for instance, are endoscopic procedures that can shrink down your gastric pouch if it’s become stretched out*.To learn more about emerging bariatric technology, see our full page on emerging bariatric technology.
If you’re experiencing pain, vomiting, weight regain, or other complications after your initial bariatric surgery, let us know. We can generally help.