Bariatric Surgery Revision
Revision bariatric surgery in Turkiye is performed on patients who have already undergone a form of bariatric surgery, and have either had complications from such surgery, have not achieved significant weight loss results from the initial surgery, or in the form of a sleeve to bypass revision. Bariatric revision surgery is usually performed laparoscopically, though open surgery may be required if prior bariatric surgery has resulted in extensive scarring.
With the increase in bariatric surgeries performed every year, the number of individuals who do not get satisfactory results from bariatric procedures is also increasing. Some weight loss surgery options may limit later revision bariatric surgery options.
Before considering bariatric revision surgery, detailed history of weight loss, appetite control, eating patterns, and adverse outcomes after primary surgery are mandatory to understand what has gone wrong. Additionally, investigations like upper gastrointestinal, endoscopy, and radiography are always used before elaborating a definite treatment plan.
Weight Loss Revision Surgery
If you have previously had bariatric surgery and have regained weight, diet and exercise are ineffective, you may be a candidate for bariatric revision surgery. Bariatric revision surgery would help correct any issues that have occurred since the initial surgery which are inhibiting further weight loss.
After undergoing weight loss surgery, patients generally remain under the care of their surgeon for several years. If the surgeon thinks that your weight loss is insufficient, the surgeon may take an X-ray to see the size of your stomach and determine your need for bariatric revision surgery.
It may have been years since the initial bariatric surgery and you may have gained weight for a variety of reasons. The bariatric revision surgery options that would work best for you are going to depend upon your weight loss goals and the type of surgery you had previously, so, there will be differences such as gastric sleeve revision, and gastric bypass revision.
Weight loss after revision bariatric surgery is usually slower and smaller than after primary bariatric surgery. Usually, a loss of 50% of excess weight a patient is having at the moment of revision surgery can be expected and considered satisfactory.
Bariatric Surgery Revision Diagnostic Testing
Doctors use a range of diagnostic tests to accurately diagnose and inform patients about revision surgery decisions. They include the following:
Clinic reviews: This is where diagnosis generally begins, and in all cases for gastric band patients. If a patient has a suspected leak from their band the diagnostic procedure will involve several regular clinic visits for volume checks.
Barium x-ray: This will always be needed for patients who have a failing bypass or sleeve surgery procedure. On occasion, surgeons will use it to band patients too. This is in cases where a slippage or leak from the band is suspected.
Gastroscopy: This is a more invasive method that involved placing a camera into the esophagus and stomach through the mouth. This procedure is done under sedation so is painless. A gastroscopy would rarely be needed.
Weight Loss Surgery Revision Reasons
Causes of bariatric revision surgery vary from ulcer to gastric band slippage. However, most reasons for a second bariatric procedure fall into five categories:
Research on a small number of patients in 2014 put the rates of bariatric revision surgery as:
For patients originally given gastric band surgery: 20%-60%
For patients originally given gastric bypass surgery: 9%-17%
For patients originally given gastric sleeve surgery: 9%-11%
Type of Bariatric Surgery Revision
Every patient will present with a unique circumstance, and therefore, the revision plan should be customized to their situation. Situations such as bariatric revision surgery, gastric sleeve revision, gastric bypass revision, or sleeve to bypass revision are individual.
Options for Revision of a Gastric Bypass
Present options include placing a gastric band over the top of the bypass, converting the bypass to a long limb bypass (lengthening the amount of intestine bypassed), or sleeve to bypass revision. Gastric bypass patients can also regain weight because of the stretching of the joint between the stomach pouch and the small intestine. This case allows too much food to empty into the small intestine. The result can be weight gain and discomfort when eating many foods.
Options for Revision of a Gastric Sleeve
The stomach tube may stretch over time with liberalized eating habits, even after a gastric sleeve. Alternately, the primary weight loss surgery may not have cut away enough of the stomach, allowing the patient to overeat. In both cases, if weight loss is not achievable through lifestyle change, a gastric sleeve revision procedure can be indicated.
The most common revision to a gastric sleeve is conversion to a gastric bypass or a mini gastric bypass, so sleeve to bypass revision. Other sleeve to bypass revision options include a re-sleeve, which involves cutting away extra stomach tissue to once again shrink the gastric tube and create additional restrictions. Weight regain is not the only reason why a gastric sleeve might be revised, however. In some patients, the gastric sleeve brings about new or worsened gastroesophageal reflux disease. These patients can benefit from a conversion to a gastric bypass.
Options for Revision of a Gastric Band
If the band fails, band patients may opt to remove the device. However, removing the band will, likely, accelerate the weight regain. Others, who have experienced a complication such as erosion or slipping of the band, will require corrective surgery.
Gastric band doesn’t change the anatomy of the patient’s stomach, so once it is removed, the patient has all other bariatric procedures to choose from. When revising a band, it is very much like having a primary procedure all over again. The revision can take place in one stage (removing the band and performing the revision to a different procedure) or in two stages (removing the band waiting a few months then returning for the revision procedure).
Recovery Time for Bariatric Revision Surgery
Actually, not all revisions need traditional surgery. Occasionally some can be done endoscopically via a tube placed down the throat.
Due to thickening and scarring, however, revision surgery are always more difficult than the initial surgery, regardless of how it is done. For this reason recovery time for bariatric revision surgery tends to be longer than for the first procedure. Sometimes it is not possible to do the revision bariatric surgery laparoscopically and the stomach will need to be assessed in the traditional way by cutting it open. This can extend the recovery time as the wound may take longer to heal.
Usually, patients can expect to spend a day or two longer in the hospital than for the original surgery, but the ‘home’ recovery time will be about the same. Similar precautions should be taken as those for the original surgery. These include caring for the wound, and moving around as soon as possible to prevent blood clotting but at the same time getting plenty of rest to ensure that the body can recover from the trauma. Additionally, patients will only be allowed a liquid diet for the first few days.
Gastric Band Revision: With this type of revision bariatric surgery, you will spend the least amount of time in the hospital, usually only staying overnight and recovering from the surgery within 10-14 days.
Gastric Bypass Revision: After a gastric bypass revision, you will spend around 3-5 days in the hospital, and after you have been discharged you will take a few weeks to return to normal activities, such as returning to work.
Duodenal Switch Revision: With this surgery, you will spend between 4 and 5 days in the hospital, where your recovery will be monitored. Once you are discharged it will take between 3 and 4 weeks for you to get back to normal.
The Study of Bariatric Revision Surgery
A recent study published in the Journal of Bariatric Surgery, involving a cohort of patients who underwent bariatric surgery revisions, found that revision surgeries can be effective in addressing complications and regaining weight. The study highlighted that in cases where the primary procedure had resulted in complications or insufficient weight loss, revision surgeries were crucial for improving patient outcomes. The study also emphasized the importance of personalized revision plans tailored to each patient’s unique circumstances and weight loss goals.
Good Candidate for Bariatric Revision Surgery
You have a body mass index in excess of 35, you have attempted your primary weight loss procedure and you are gaining weight.
You have a body mass index above 30 and you are experiencing a complication with your primary procedure that necessitates surgical revision for safety reasons.b
After your bariatric revision surgery, Healthy Türkiye help your diet and exercise plan to help you stay on track. Learn more about safe forms of bariatric surgery revision and which procedure may be right for you. If you want to learn more about bariatric revision surgery and explore the options for your individual situation, contact Healthy Türkiye and schedule a personal consultation with bariatric experts.