Bariatric revision surgery

Bariatric revision can refer to the surgical reversal of a procedure, reoperation of a previous surgical procedure, or conversion to another medically necessary procedure due to inadequate weight loss. Cases of reversal are necessary when the patient develops complications from the original procedure, such as stricture or obstruction.

As bariatric surgery advances, we must increasingly acknowledge the chronic, complex nature of obesity. Occasionally, a weight loss procedure doesn’t lead to as much weight loss as the surgeon or patient hoped for, or it can contribute to long-term complications. At St. Luke’s Health, we believe patients are entitled to revisional surgical therapy for either partial or lack of response to initial therapy, as well as for complications. This is similar to a person with high blood pressure needing two to three medications to manage their condition.

Benefits of bariatric revision surgery:

• Reinitiates weight loss to achieve desired weight goals
• Leads to improved overall health by reducing obesity-related health risks such as diabetes, hypertension, and sleep apnea.
• Addresses complications, such as pouch enlargement, strictures, ulcers, or nutritional deficiencies
• Enhances quality of life with increased mobility, energy, and self-confidence

Risks of bariatric revision surgery:

• Surgical risks, including infection, bleeding, anesthesia complications, and blood clots
• Complications such as leaks at surgical connections, strictures, or bowel obstructions.
• Nutritional deficiencies
• Recovery challenges
• Variable outcomes

Revisions may be available for patients who have previously had gastric band, gastric sleeve, or gastric bypass surgery. The type of revision you are able to receive depends on the surgery you had, your anatomy, overall health, and other considerations that your doctor will discuss with you.

Types of bariatric revision surgery

1. Gastric bypass revision

Gastric bypass revision is a surgical procedure performed to modify or correct a previous gastric bypass surgery. Gastric bypass surgery, also known as Roux-en-Y gastric bypass, is a weight loss procedure that reduces the size of the stomach and reroutes the digestive tract. It is effective in helping individuals lose weight by limiting the amount of food they can consume and absorb.

However, over time, some patients may experience complications or inadequate weight loss results after the initial gastric bypass surgery. Gastric bypass revision surgery is then considered to address these issues.

The primary goals of gastric bypass revision may include:

• Restoring weight loss: In cases where a patient regains weight after initial success, revision surgery can help reinitiate weight loss.
• Correcting complications: Revision surgery may be necessary to resolve complications like pouch enlargement, strictures, or ulcers that can develop after the initial procedure.
• Altering the anatomy: In some cases, surgeons may need to modify the anatomy of the digestive tract to improve the patient's health and outcomes.
• Improving nutrient absorption: Revision surgery can also be used to improve the absorption of essential nutrients if malabsorption issues arise.

2. Sleeve gastrectomy revision

A sleeve gastrectomy revision is a surgical procedure performed to modify or correct issues that may have arisen following an initial sleeve gastrectomy. Sleeve gastrectomy is a weight loss procedure that involves removing a portion of the stomach to create a smaller, sleeve-shaped stomach pouch. This reduced stomach size limits food intake and helps individuals lose weight by promoting early satiety.

However, some individuals may encounter challenges or complications after their initial sleeve gastrectomy, leading to the consideration of a revision surgery.

The reasons for sleeve gastrectomy revision may include:

• Weight regain: If a patient regains a significant amount of weight after the initial sleeve gastrectomy, a revision can be considered to help restart the weight loss process.
• Inadequate weight loss: In some cases, the initial sleeve gastrectomy may not have resulted in the desired weight loss, and revision surgery can be explored to enhance weight loss outcomes.
• Gastroesophageal Reflux Disease (GERD): Some individuals may develop or experience worsening of GERD symptoms after sleeve gastrectomy, and revision surgery may be performed to address this issue.
• Dilated stomach pouch: Over time, the stomach pouch created during the sleeve gastrectomy may stretch or dilate, leading to increased food intake. Revision surgery can help reduce the pouch size to promote satiety.
• Complications: Complications such as leaks, strictures, or ulcers can occur after sleeve gastrectomy. Revision surgery may be necessary to correct these issues.
• Nutritional deficiencies: Revision surgery can also be performed to address nutritional deficiencies that may arise due to the altered digestive system's reduced ability to absorb nutrients.

3. Adjustable gastric banding revision

Adjustable gastric banding revision, also known as revision surgery after adjustable gastric banding or laparoscopic adjustable gastric band (LAGB), is a surgical procedure performed to address issues that may have arisen following the initial placement of an adjustable gastric band. Adjustable gastric banding is a weight loss procedure that involves placing an inflatable silicone band around the upper part of the stomach, creating a small pouch. The band can be tightened or loosened by injecting or removing saline through a port under the skin, which controls the rate of food passage from the pouch into the lower stomach.

However, some individuals may experience complications, inadequate weight loss, or other issues after their initial adjustable gastric banding surgery, leading to the consideration of revision surgery.

The reasons for adjustable gastric banding revision may include:

• Inadequate weight loss: Some patients may not achieve the desired weight loss results with the adjustable gastric band. Revision surgery can be considered to explore alternative weight loss options, such as converting to another bariatric procedure.
• Band erosion: In rare cases, the gastric band can erode into the stomach tissue, leading to discomfort, infection, or other complications. Revision surgery is necessary to remove the eroded band and address any associated problems.
• Band slippage: The band can occasionally slip out of its optimal position, leading to reduced effectiveness and potential digestive issues. Revision surgery can reposition the band properly.
• Port complications: Problems with the port used to adjust the band, such as infection, displacement, or leakage, may require revision surgery to address.
• Persistent or severe reflux: Some individuals may experience ongoing or severe acid reflux (gastroesophageal reflux disease, or GERD) after adjustable gastric banding. Revision surgery can be considered to alleviate this issue.
• Intolerance to the band: In some cases, patients may find that they cannot tolerate the presence of the band, leading to discomfort or difficulties with eating. Revision surgery may involve band removal.

What is the recovery process from weight loss revision surgery like?

1. Hospital stay: The length of the hospital stay may vary, but most patients can expect to stay in the hospital for one to three days following bariatric revision surgery. During this time, medical staff will monitor your condition, manage pain, and ensure you are tolerating liquids and, later, soft foods.

2. Dietary progression: The diet progression after bariatric revision surgery typically follows a staged approach:

   • Clear liquids: In the initial days after surgery, you'll be limited to clear liquids, such as water, broth, and sugar-free beverages.
   • Full liquids: After a few days, you'll progress to full liquids, including protein shakes and pureed soups.
   • Soft foods: Once you can tolerate liquids, you'll transition to soft, easily digestible foods, such as yogurt, mashed potatoes, and scrambled eggs.
   • Solid foods: Over time, you'll gradually reintroduce solid foods, starting with soft, protein-rich options.

3. Pain management: Pain and discomfort are common after surgery. Your healthcare team will provide pain management strategies, which may include medications or local anesthesia at the surgical site.

4. Activity level: Initially, you'll need to limit physical activity and avoid heavy lifting. Gentle walking is encouraged to prevent blood clots and promote circulation.

5. Follow-up appointments: Regular follow-up appointments with your surgeon and healthcare team are crucial. These appointments allow for monitoring of your progress, adjustment of any medications, and assessment of nutritional status.

6. Nutritional supplements: Bariatric revision patients often require nutritional supplements to ensure they receive essential vitamins and minerals. Your healthcare provider will recommend appropriate supplements based on your specific needs.

7. Hydration: Staying hydrated is essential. You'll be advised to drink water and other approved fluids between meals to prevent dehydration.

8. Lifestyle changes: To maximize the benefits of the revision surgery, you'll need to adhere to dietary and lifestyle changes recommended by your healthcare team. This may include adopting a more balanced diet, regular exercise, and behavior modification strategies.

9. Potential complications: Be aware of potential complications, such as infection, bleeding, or leaks, and contact your healthcare provider immediately if you experience any concerning symptoms.

10. Psychological support: Bariatric revision surgery can have a significant impact on mental and emotional well-being. Many individuals find it helpful to seek support from a therapist, support groups, or counseling to address the psychological aspects of weight loss and surgery.