Gastric Bypass Surgery, also called Roux-en-Y, is a gold standard weight loss surgery to manage obesity. Patients undergoing this procedure usually lose excess weight gradually within a span of 12 to 18 months. By 2 years, a person loses maximum excess body weight.
Although the Roux-en-Y procedure is well-tolerated, with a high success rate, many patients do not lose weight as expected or develop some complications. Many studies have revealed that some morbidly obese patients who chose to undergo gastric bypass surgery regained up to 50% of their weight in less than 10 years.
So, before you make this life-altering decision, understand whether you need it or not.
When is Revision Surgery Needed?
If you have not achieved the desired result from a procedure, it does not mean that you should undergo revision surgery. Your surgeon would rule out some of the common reasons for weight regain or no weight loss after the surgery, such as poor food habits, lack of exercise, and improper lifestyle.
Diet is the first and most obvious reason your surgeon would like to rule out. Journal your meals, and be honest. Write down everything that you bite and drink on a particular day. The food journal can help your doctor choose the best path. If food habits are not right, making minor changes can help. You may not even need a revision procedure.
Exercise is equally important after gastric bypass surgery. Once you recover, start exercising regularly and increase the pace of your activity.
If none of these reasons are found, your surgeon would detect the cause of failure.
Gastric Bypass Failure – Causes
Failing to lose adequate weight or get side effects or complications is a sign of failed surgery. There are some causes of a failed gastric bypass surgery:
- Insufficient Weight Loss: Not losing enough weight is a serious concern for patients. However, it is one of the primary reasons to opt for revision surgery.
- Weight Regain: Although patients lose weight gradually after the surgery, they may start regaining weight after some time. There may be many causes of weight regain including dietary changes, stomach pouch dilation, and genetic factors.
- Complications: Gastric bypass surgery can cause some complications. Post-operative complications are very common like diarrhea, dumping syndrome, solid intolerance, severe constipation, anemia, GERD, nausea, vomiting, and ulcers.
Benefits of Gastric Bypass Revision
Patients who underwent gastric bypass surgery but remain unsatisfied with the result can opt for revision surgery. Some of the well-known benefits of gastric bypass revision surgery are:
- Reduced Size of the Pouch: When gastric bypass is revised, it reduces the size of the stomach pouch. After the first surgery, the pouch starts increasing in size and holds more food. This is mainly the result of overeating and a poor lifestyle. The pouch size is reduced to reduce food capacity and hunger hormones.
- Intestinal Bypass: The next step gets into the bypassed part. An average human being has a six feet long intestine that is rerouted or bypassed. If the previous surgery was done 10 years ago, surgeons can bypass only 3 feet. The procedure is also called the short bypass. The bypass is revised by a laparoscopic limb distalization. As a result, the length of the biliopancreatic limb increases, thus bypassing the intestine even more and absorbing very little food.
- Distal Gastric Bypass: The intestine is distalized to lengthen the bypassed portion. Rather than bypassing 3 to 4 feet of the intestines, the portion is lengthened, and the patient would be left with just 6-8 feet. To distalize is to lengthen the rerouted intestines, or increase their length.
Gastric Bypass Revision Options
Gastric bypass revision is performed only when the previous gastric bypass has failed.
The conversion is a more complicated and riskier procedure than any other bariatric procedure. However, if an experienced surgeon performs the revision, it reduces the risk factors.
Here are your options:
- Stoma Shrink: Shrinking the stoma is the first option when it comes to the revision of gastric bypass. The procedure involves injecting sclerosant, also called sclerotherapy. The main ingredient, sclerosant contains sodium correlate, which is injected right into the patient’s stoma, or the space that lies between the small intestine and the stomach. If the stoma is dilated, the infection helps. Generally, it takes 2 to 3 injections to heal.
- Lap Band Surgery: Adding the lap band to gastric bypass is an alternative revision. Adjustable gastric banding or salvage banding is extremely beneficial in patients with dilated gastric pouches. A lap band is a small and adjustable band, which is placed in the stomach, the upper portion, to reduce the size of the stomach. The procedure is carried out laparoscopically, which ensures the abdomen heals quickly.
- Reduced Pouch Size: The pouch size can be reduced with StomaphyX – a suturing system performed endoscopically to decrease the size of the stomach outlet, or stoma, and the stomach pouch. If the surgeon detects an enlarged stomach pouch, they may perform a StomaphyX or ROSE procedure. Either of these procedures tightens the stomach endoscopically. The ROSE (Revision Obesity Surgery Endoscopic) is a simple method that narrows the stoma.
- Roux Limb Lengthening: This procedure involves the original gastric bypass system and covers it into a Distal procedure, which includes a longer limb. This method is only used for patients showing a very low BMR and failed weight loss, irrespective of their diet and exercise routine. This is a risky procedure.
- Duodenal Switch: It is, by far, the best revision procedure for any bariatric surgery failure. In the process, a small stomach in the shape of a banana is created, with two small parallel limbs attached to the small intestine also formed. Food, then, passes through separate channels, whereas juices from the pancreas and liver are drained from another channel. The process also prevents mixing the food they eat with the digestive juices. As a result, ingested food is not absorbed much and the patient experiences quick weight loss.
Roux-en-Y Bypass revision is a popular procedure with advanced laparoscopy techniques. However, there are risks involved depending on various factors. Consult your surgeon and discuss all the options closely before going for the surgery.
