Revisional Bariatric Surgery

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.

Failure after Gastric Bypass may be due to mechanical or metabolic reasons; the eating behaviors of a patient should be considered as well. In fact, the first step in assessing a patient who has failed to lose adequate weight after Gastric Bypass, is to look carefully at the patient’s food consumption. The best way to analyze food intake is to simply start a detailed food diary. Patients are often shocked at how many calories they do consume on a daily basis. While we may think we have a good idea of our food consumption, it only takes tracking food intake in a food diary to get a true picture of how much we consume. When patients are not eating how they should, getting back on track is the next step.

Options performed in our practice include band over bypass, revision of bypass or pouch (constriction).

The gastric bypass procedure can ultimately fail for several reasons, the most common of which is gastric pouch dilation, where the stomach increases in size over time. Since the gastric bypass affects both the stomach and small intestine, there are fewer options to definitively restore the previous function than the gastric band or sleeve. The most commonly performed revision to a gastric bypass is the duodenal switch, which itself is sometimes used as a primary procedure. The duodenal switch essentially reactivates the portion of the stomach that was cut away. The duodenal switch procedure maintains the bypass’s combination of restriction and malabsorption.

The gastric sleeve, also known as the sleeve gastrectomy is one of the most commonly performed bariatric surgeries in the United States. If the sleeve begins to lose its effectiveness and the patient’s weight starts to creep up, there are ways that it can be revised. The first revisional surgical option for the gastric sleeve is to convert it to a duodenal switch. This is a relatively straightforward procedure as the gastric sleeve is, in fact, the first (restrictive) part of every duodenal switch procedure. By adding the malabsorptive component of the duodenal switch, excess weight regain can be reversed. Another option to revise the gastric sleeve is called a re-sleeve. This is where the gastric sleeve is performed for a second time. A second cut along the greater curvature is created, much in the same way as the primary procedure. A re-sleeve works exactly the same way as the original surgery and simply re-shrinks the stomach to the size that it was immediately after surgery – or slightly smaller.

The gastric band, also known as Lap-Band® or Realize® Band is one of the simplest procedures to revise. Revising a gastric band can be achieved in different ways. First, the band can simply be replaced with a new band, making sure that the procedure offers its full potential. Replacing the band does not allow the patient to lose any more than the primary surgery. However, it can assist the patient in losing some of the regained weight, especially if the regain is due to a complication such as the band eroding into the esophagus or slipping from its original position. The band can also be revised by converting it to a stapled procedure such as the gastric sleeve or the gastric bypass. This simply involves removing the band and performing the sleeve or bypass as if it were a primary procedure. Since the gastrointestinal tract has not been modified in any way previously, the only limitation to these procedures involves surgical risk and the patient’s ability to heal effectively.

*Individual Results May Vary.

Location
Anish Nihalani, MD, FACS
98 James Street, Suite 103
Edison, NJ 08820
Phone: 732-204-6088
Fax: 732-218-9142
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732-204-6088