Bariatric revision surgery procedures can vary greatly based on the original operation, i.e. how long ago it was performed, 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.
Adjustable Gastric Band Revisions
Individuals who have undergone a gastric banding procedure may experience complications such as a slipped band or erosion of the gastric band. Patients experiencing issues such as these generally require removal of the band to allow healing followed by a second procedure later to either replace the band or to have a gastric sleeve or gastric bypass procedure
The band patient may experience mechanical failure such as a flipped port, or injury to the tubing resulting in a leakage of the fluid used to create restriction. In this scenario, it may be possible to replace the damaged component of the band; however, it is also likely the entire band and all components may need to be removed and a new procedure such as sleeve gastrectomy or gastric bypass performed.
Gastric Sleeve Revisions
Having the need for bariatric revision surgery is due to mechanical failure of the initial procedure, such as the development of severe reflux, prolonged nausea and vomiting, or too large of a sleeve may result in the need for a revision. When mechanical failure occurs, the gastric sleeve is usually converted to a gastric bypass procedure.
Inadequate weight loss may occur after the sleeve procedure. The first step to address inadequate weight loss or a substantial amount of regain is to confirm you are properly instructed on how to optimize usage of the sleeve as a weight loss tool. Can you answer yes to each of the following statements?
If you answered no to any of the statements above, please make an appointment with our dietitian, exercise physiologist and make plans to attend our back on track support group on the 4th Monday of each month at 6:00 PM. If you answered yes to all of the statements above and have experienced weight regain or inadequate weight loss, you may be a candidate for conversion to a gastric bypass or duodenal switch procedure.
Gastric Bypass Revisions
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 to an extent and we’ll discuss that in a minute. However, most patients have reverted back to poor eating habits. When asked how much chicken and veggies they can eat at one time, the answer is invariably, “I don’t know”. Well, there is your answer!
It falls back to these surgeries are tools to help you deal with your body’s slow metabolism and poor eating habits. Their main function is to help control appetite and portion sizes. We know portion sizes will increase some over time but it’s not usually due to 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 get bigger. This set of patients are the minority of the patients we see who may actually be candidates for a revision. They typically had their surgery either many years ago or in an open fashion. Most 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 opening between the pouch and small bowel connection (termed anastomosis) over time. This can lead to faster emptying of the pouch which allows you to eat more or be less full with a meal. However, there is only so much we can do surgically to maintain that small opening over time.
Vertical Banded Gastroplasty, Stomach Stapling, Other procedures
Vertical banded gastroplasty (VBG), most commonly known as stomach stapling or gastric stapling, is a restrictive procedure originally developed in the early 1970’s. VBG was once a popular surgery for managing obesity, however today it is performed far less frequently due to the large number of patients who have experienced very poor long-term weight loss. VBG patients may be a candidate for a gastric bypass procedure.
