Revision Bariatric Surgery

What to Consider Before Revision Surgery

There are many factors to consider when determining whether or not a revision procedure is the right option based on your experience with the first operation. If you followed all dietary and nutritional recommendations, there may be an internal issue. If weight loss never occurred after the surgery, it’s also likely that you are experiencing a mechanical issue, which is a common reason to consider a revision procedure.

When you suspect that the surgery wasn’t successful, schedule an appointment with your surgeon to discuss your concerns and get the information you’ll need to make a decision that’s right for you. Revision bariatric surgery may also be appropriate if had initial success with the procedure and other possible reasons for your results with the first procedure have been ruled out, including:

• Not sticking to dietary guidelines
• An exercise routine that didn’t address your needs
• Nutritional deficiencies within your diet

Testing Prior to Revision Surgery

Prior to proceeding with revision surgery, you’ll likely be given a series of tests if an internal issue is suspected. An upper gastrointestinal tract (upper GI tract) radiography is a test where you drink a special liquid before an x-ray is taken of your stomach area. The purpose of tests like this is to observe your digestive system in motion.

A tube with a tiny camera will be used to look at your stomach and small intestines with a test called an endoscopy. The endoscope will also take a closer look at your pouch to determine if there’s a problem there. Another test you may have is an eating test where you’ll be given some food to eat to see how much you can consume before feeling full. These tests also check for:

• Staple line problems
• Esophageal abnormalities
• Roux limb abnormalities
• Gastrogastric fistula

Revision Surgery Options

Revision surgery doesn’t have to be the same type of stomach surgery you had the first time. There are four common revision bariatric surgery options:

• Injecting a sclerosant: This procedure involves the injection of a sclerosant into an opening between the “stoma,” a term for the stomach and small intestines. The purpose of the injections, often done during 2-3 procedures, is to create scarring to reduce the size of your stomach.
• Addition of a gastric band: It may be recommended that your revision be a conversion to an adjustable band rather than another surgical adjustment to your stoma.
• Lengthen Roux limb: Only an option if you have an extremely low base metabolic rate, this procedure changes a conventional Roux-en-Y gastric bypass to a distal version of the same procedure.
• Duodenal switch conversion: Sometimes recommended for patients with a body mass index of 50 or more, this bariatric surgery procedure combines restriction with malabsorption of fat.

What Happens After Revision Surgery?

Regardless of the type of revision surgery involved, you’ll need time to recovery after the surgery. During this period, you may once again be restricted to a liquid diet before switching to soft foods. When you can tolerate soft foods without any issues, you should be able to safely return to regular foods.

Once again, you will receive dietary and fitness guidelines and education to increase your odds of success after revision surgery. You’ll have follow-up appointments where your weight loss will be tracked to determine if you’re having more success after the revision procedure.

Increasing Your Odds of Success with Revision Surgery

In a 2010 study, patients who had revision bariatric surgery due to insufficient weight loss lost an average of nearly 70 percent of their body weight from what it was prior to the revision procedure. An improvement in weight loss surgery techniques has also increased success rates with both first-time procedures and revision surgeries.

If you feel you didn’t receive clear instructions during your first procedure, don’t be afraid to ask questions to ensure your understanding of what you’ll need to do to sustain your results. Further increase your odds of post-revision surgery success by:

• Developing a strong, consistent support system
• Keeping a food journal to identify dietary choices that work for you
• Realizing an eventual slow-down in weight loss is normal
• Working with a dietitian and fitness counselor or trainer

Instances of patients gaining back weight after bariatric surgery are relatively low based on available data on the procedure. When weight gain does occur, it’s often due to an unforeseen internal issue, inappropriate dietary choices, or lack of regular exercise following the procedure. However, everyone is different and the likely reason for your surgery not living up to your expectations will determine the most appropriate options to achieve your desired weight loss and maintenance goals.