What Is Revisional Bariatric Surgery?
Bariatric surgery is a successful, safe and long-term tool to combat obesity and weight gain. However, there are times when it becomes necessary to re-operate, whether because the original surgery was unsuccessful, or a problem needs to be corrected. Second and subsequent surgeries after an initial bariatric procedure are known as revision surgeries.
Who Is A Candidate For Revisional Bariatric Surgery?
Our providers will review your case thoroughly to identify the reason for failure. Successful bariatric surgery requires patient compliance in terms of diet and lifestyle changes. If you need help in these areas, an exercise program or appropriate therapy will be recommended. If the original procedure was inadequate or complicated, your doctor will discuss treatment options best suited to your specific condition. You might also benefit if you experience complications like:
- Bleeding
- Malnutrition
- Fistula
- Vomiting
- Leakage
- Hiatal Hernia
- Obstruction
- Ulcers
- Re-emergence of weight-related conditions
- GERD
Types Of Revisional Bariatric Surgery:
The American Society for Metabolic and Bariatric Surgery (ASMBS) classifies revision surgery into three types:
- Conversion procedures are aimed at changing the original surgery into a different type. An example of a conversion procedure is removing an adjustable gastric band and performing a sleeve gastrectomy.
- Corrective procedures modify the original surgery to make it more effective or to eliminate a problem with it. For example, modifications to a Roux-en-Y gastric bypass are considered corrective.
- Reversal procedures restore the original gastric anatomy, such as removing an adjustable gastric band.
Gastric Bypass revisions are mostly corrective, rather than a conversion or a reversal. May be performed due to:
- Bleeding
- Fistula
- Inadequate weight loss
- Leakage
- Obstruction
- Ulcer
- Re-emergence of weight-related conditions like type 2 diabetes or heart disease
- Weight gain
Adjustable Gastric Band revisions are relatively easy to reverse. The surgery can also be converted to gastric bypass, gastric sleeve or biliopancreatic diversion with duodenal switch (BPD/DS). May be performed because of:
- Band migration
- Band slippage
- Erosion
- GERD
- Port or tubing problems
- Pouch dilation
- Weight gain
- Weight-related comorbidities
Sleeve Gastrectomy revisions are rarely revised due to insufficient weight loss, subsequent weight gain or the reappearance of weight-related health problems. Sleeve gastrectomy’s that led to severe fistulas can be converted into various types of jejunostomies, which involve opening a hole in the stomach through the surface skin of the abdomen and the wall of the small intestines (jejunum). Patients who develop worsening gastric reflux or heartburn from their sleeve gastrectomy may be candidates for conversion to gastric bypass. This conversion usually eases these symptoms by rerouting the acid and bile streams to an area of the intestines that is further down from the esophagus. Revisions may be necessary due to:
- Fistula
- GERD
- Leakage
- Obstructions or strictures
BPD/DS may be revised to correct the following problems:
- Bleeding
- GERD
- Leaks
- Malnutrition
- Obstructions or strictures
What To Expect
How Is Revisional Surgery Performed?
Most are done with a laparoscope. This uses small incisions to insert a tiny camera and instruments. You have less pain and quicker recovery. In relatively few cases, surgery is open and uses a larger incision.
Assessment For Revisional Bariatric Surgery
Assessment for revision weight loss surgery may include a review of symptoms, performing an x-ray, endoscopy, or CT scan to evaluate the anatomy of the initial operation, assessment of eating behavior, and physiology of the gastrointestinal system.
Preparing For Surgery
Specific instructions will be provided by your surgeon. In general, you should:
- Stop smoking as it can slow down the healing process.
- Inform your surgeon about any health conditions, allergies, and regular medications.
- Avoid eating 8-12 hours prior to the surgery.
Risks And Complications
Revisional bariatric surgery, like any surgical procedure, can be extensive and may be associated with certain risks such as blood loss, the need to convert to open surgery with a large incision, infection and gastric leakage. The risk of complications is also higher in revisional surgery.
Recovery
The recovery from revisional bariatric surgery is quick and may require 1-2 nights in the hospital. Typically, you will have to return to your post-gastric surgery diet of liquid and pureed foods for a few weeks. It is crucial to follow your surgeon’s recovery instructions carefully, take your medication as prescribed, and attend each of your subsequent checkups.
Summary
Bariatric Revision surgery is recommended to promote further weight loss or resolve complications from prior bariatric surgery. The initial weight loss you experience following revision surgery may not be as dramatic as your initial surgery, but with patience and resolve, the effects of revision surgery will become apparent.
Schedule a Consultation
To learn more about revisional bariatric surgery contact us today to schedule a consultation with our team and begin your weight loss journey. Together, we’ll create a plan that’s right for you.
