Studies reveal that some bariatric surgery patients would require revision surgery to ease their complications. There may be many factors contributing to postoperative complications. Revision surgery is performed only when patients experience complications or fail to achieve the desired results after the surgery.

The revision procedure involves revising the failed lap band and unsuccessful methods like gastric bypass, mini gastric bypass, duodenal switch, or gastric sleeve.

What is Bariatric Revision Surgery?

Patients who choose to undergo bariatric surgery for weight loss want to achieve the best outcomes. However, there are times when patients do not achieve the desired satisfactory result even after several months of the surgery.

Moreover, some patients may start regaining weight that was lost after a bariatric procedure. Patients may also experience some medical complications like lap-band displacement or erosion, which requires revision surgery.

Why is Revision Surgery Needed?

A bariatric procedure is successful if a patient loses 50% of his/her excess weight and maintains the same for at least 5 years. However, approximately 20% to 30% of cases do not achieve similar results despite following the prescribed diet and exercising regularly. Some patients do not respond to obesity treatments as expected.

Sine of the common reasons for revision surgery include:

  • Insufficient weight loss
  • Weight regain
  • Medical complications
  • Comorbidities

Before going for revision surgery, know your options in detail.

Types of Bariatric Revision Surgery

Gastric Sleeve Revision Surgery

Although gastric sleeve surgery is designed to deliver rapid weight loss and long-term results, some patients may regain the weight. Now, there could be many reasons for that – not following the diet and nutrition, not adhering to lifestyle changes, and not exercising regularly. The new sleeve-shaped stomach gets stretched out and might even weaken the procedure, thus leading to weight regain.

When a gastric sleeve surgery fails to deliver expected weight loss results, patients opt for a Duodenal Switch, RNY Bypass, or a re-sleeve surgery. All these three options are known to promote weight loss results:

  • Gastric Bypass: From gastric sleeve surgery to the gastric bypass procedure is the safest and most effective revision. Patients also start getting results almost immediately after the revision.
  • Re-Sleeve Surgery: Although this is not an effective option, many patients want to take a chance. However, it is only effective on extremely dilated stomachs or stretched stomachs of patients who underwent gastric sleeve. Only the clinical history of a patient can say if the current gastric sleeve is effective or not.

Gastric Bypass Revision

There are times when gastric bypass patients start experiencing trouble maintaining their weight loss results in the long run. For them, there are some other bariatric procedures to continue to lose weight and manage.

Although the procedure is claimed to be long-lasting, though not permanent, patients can switch to convert to various options like Lap-BAND and duodenal switch. In a Lap-BAND surgery, a band would be placed around their stomach, which induces weight loss. However, there are some other options too like sclerotherapy that shrinks the stomach with a sclerosant injection, reduces the pouch size, and make the Roux limb longer.

Gastric bypass fails due to pouch enlargement, stoma enlargement, stoma failure, staple-line disruption, and when the patient’s body is adjusting to the reduced calorie intake.

Gastric Banding/LAP-BAND Revision Surgery

Gastric banding or LAP-BAND surgery is increasingly becoming an ineffective tool for obesity treatment. Patients undergoing this surgery often complain about inadequate weight loss with some undesirable complications. So, patients having complications can opt for any of the following revision procedures:

  • LAP-BAND readjustment
  • LAP-BAND revision to Gastric Sleeve
  • LAP-BAND revision to Gastric Bypass

Statistically, 60% of LAP-BAND surgery patients have the band removed after 10 years. There may be many reasons to opt for a revision surgery, which include slippage, erosion, enlargement of the pouch, no access to the adjustments, and insufficient weight loss.

VBG (Vertical Band Gastroplasty) Revision

Vertical Banded Gastroplasty, also called stomach stapling, is a relatively outdated method of weight loss. It uses an implant and stitches for weight loss. Long-term studies show that this procedure has disappointing results.

Compared to other bariatric procedures, VBG does not produce weight loss results. Rather, it allows patients to gain more weight. Other reasons for this failure could be the lack of additional stitching, which tears and opens. As a result, patients should immediately convert to an advanced bariatric procedure.

VBG surgery can be revised to gastric sleeve surgery, which is most likely. However, in some cases, it may be converted to gastric bypass as well.

Benefits of Revision Surgery for Weight Loss

If any bariatric procedure has failed because of the complications involved or due to inadequate weight loss, a revision or alteration surgery is recommended. Some patients may develop other associated problems including staple line leakage, gastric band slippage, and fistula. Likewise, others may develop medical complications such as ulcers, poor nutrient absorption, and scar tissue stricture.

With revision surgery, patients can instantly get relief from their complications and have a fresh breath of life. Once again, before you choose to go for a revision surgery, known more about the risks and challenges you may have to face:

Risks of Revision Surgery

It is important to understand that revision surgery has a 50% risk of complications compared to the first surgery. It is a reality and quite challenging.

Human tissues tend to form adhesions in response to disturbances like surgery. There are varying levels of adhesions varying from one person to another. It also does not have anything to do with external skin scars.

Bariatric revision surgeries also take more time in the operating room because it involves careful dissections of these adhesion layers.

Leakage is one of the most common risks involved in correctional surgery. Other challenges include incisional hernia, bleeding, and the need to revise laparoscopic surgery to open surgery. With all types of revision surgeries, the risk of anesthesia always persists. However, it can be reduced by involving an experienced surgical team having extensive knowledge in weight loss surgery. There is some hope in the field of newly suggested trans-oral surgery via endoscopy, though at a very nascent stage. Nevertheless, if this surgery is successful, it may be a way to perform low-risk procedures to repair enlarged stomas as well as other revision procedures.

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