Bariatric surgery can achieve major results, helping people lose weight and manage health problems associated with obesity. However, not all patients will achieve their desired results.
Over time, a patient’s stomach pouch can stretch out, making it harder for them to feel full or get desired results. This is when revision surgery may be needed.
What Is a Revision Surgery?
Whether it’s due to weight regain, poor health habits, or changes in life circumstances, patients can sometimes struggle to achieve the results they wanted from their initial bariatric surgery. In some cases, doctors may suggest a second procedure called revision surgery.
A surgeon specializing in revision surgeries will perform diagnostic imaging and tests to see what’s causing your symptoms. This could include a CT scan to look for a spinal fracture or lack of fusion, an MRI to locate the presence of a herniated disc, or an EMG to determine nerve functionality.
You’ve had discomfort, dumping syndrome, or other unwanted symptoms. Dumping syndrome occurs when food leaves your stomach and enters your small intestine too rapidly after you eat. The stomach pouch can then be made smaller to fix the issue. Additionally, the doctor can address issues like malabsorption or low blood sugar.
Revision surgery can also correct complications from previous gastric bypass surgery. This is often a more challenging operation because the scar tissue has formed around organs nearby, such as the spleen, liver, and pancreas. It’s important to choose a surgeon familiar with these issues and with a good track record of successful outcomes.
Revision surgery is often used to treat herniated discs, bone spurs, and stenosis in the spine. During this type of surgery, the doctor can remove excess scar tissue and use an Epiduroscopy to access herniated areas to relieve pain and pressure directly.
Can I Have a Revision Surgery?
Whether or not you need bariatric revision surgery depends on how well your initial weight loss surgery was performed and your progress. The best way to avoid requiring a revision is to choose a skilled bariatric surgeon to perform your initial surgery and to follow their instructions before and after your procedure.
Most bariatric revision procedures are designed to return the size of a patient’s stomach pouch to its intended post-surgery size. However, the surgical options will vary depending on what type of surgery you had originally and your specific weight loss goals. Like the original operation, assessing your needs will involve weighing the complication rate of your particular surgery, your weight loss results, and other factors like your base metabolic rate and physical condition.
Your doctor may be able to spot problems with your original surgery during regular follow-up appointments. Still, a more dramatic change in your weight or unpleasant complications can signal the need for a surgical revision. Revision surgery can address any issues that inhibit weight loss and make it more difficult to maintain long-term weight loss success.
Despite being a complex surgery, most bariatric revisions can be completed through laparoscopy, using small incisions rather than open surgical techniques. This allows for less pain and a shorter recovery time.
How Can I Know if I Need a Revision Surgery?
Bariatric surgery is a major life change and promises big results for people who need to lose weight. It is an effective tool to help them achieve this goal and improve the health complications of obesity, such as diabetes and sleep apnea. However, a person may experience significant weight regain or complications with their initial bariatric procedure, leading them to seek revision surgery.
The most common indication for revision bariatric surgery is inadequate weight loss following LAGB or SG. Other reasons include intolerable reflux symptoms, gastroesophageal stricture, uncontrolled diabetes, and psychosocial factors. Patients must undergo a thorough evaluation to determine whether they would benefit from the conversion of their original operation.
In some cases, the esophagus, stomach, and small intestine connection created by your previous bariatric surgery may become disconnected due to scar tissue. A surgical team can use a minimally invasive transoral gastric outlet reduction (TORe) to repair the connecting link using sutures through zero incisions.
In other cases, the stomach sleeve may stretch over time, making food stuck in the pouch and not being digested properly. In this case, a surgeon can perform a sleeve gastroplasty to reduce the size of the stomach, thus making it easier to lose weight.
Is a Revision Surgery Right for Me?
Revision surgery is a complex procedure and comes with potential risks. It is important to have a surgeon with experience in the technique who understands how to assess each patient’s unique situation and needs. It would help if you also considered the complication rates of different procedures and your specific weight loss goals and base metabolic rate.
The human body has an amazing ability to adapt. Over time, your stomach pouch can stretch out and be less effective at controlling calorie intake, especially if you have regained weight after surgery or suffer from a medical issue like gastroesophageal reflux disease (GERD). Revision surgery can return the size of the stomach pouch to its original state and help you continue losing weight.
A surgical revision can also be a solution for people who have regained weight after their initial bariatric surgery due to a lack of motivation or difficulty with adherence to diet and vitamin requirements. Ultimately, long-term success with any bariatric surgery depends on permanent lifestyle changes, and patients who choose to have this kind of surgery must be committed to those changes.
Whether your original procedure was a gastric bypass, laparoscopic adjustable band, sleeve gastrectomy, or Roux-en-Y gastric bypass, our team of experts at OHSU can help you find the right solution to achieve your desired results. We perform dozens of revision surgeries yearly with minimally invasive techniques, even when your first surgery requires a large incision.
