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What Is Bariatric Revision Surgery?

I have been asked this question a number of times. So where do I begin. Firstly, Weight loss or Bariatric surgery has repeatedly…

Reconstructive surgery after weight loss

I have been asked this question a number of times. So where do I begin. Firstly, Weight loss or Bariatric surgery has repeatedly been shown to be a safe, effective and long-term treatment of obesity and its associated complications. However, like all procedures it may be necessary to re-operate, possibly due to inadequate weight loss or a complication may need correcting. Any subsequent surgeries after the first procedure are known as revision surgeries.

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Types of Bariatric Revision

Bariatric revision surgery is divided into three types:

  • Conversion procedures: where the original surgery is converted into a different type. Such as performing a gastric bypass after removing an adjustable gastric band
    Corrective procedures: where the original procedure is modified to improve its effectiveness or fix a complication associated with it. For example, changing the limb lengths on a gastric bypass
    Reversal procedures: to revert your stomach back to its original design, such as removing a gastric band
Why are Bariatric Revision Surgeries performed?
The indications for procedures to be revised are varied and can depend on the procedure performed, patients’ weight loss goals or if complications arise.
Gastric bypass procedures may be revised if there is:
  • Bleeding from one of the joins
  • A fistula develops: which is an abnormal connection between the new stomach pouch and bypassed stomach
  • Inadequate weight loss
  • Leakage from the joins
  • Obstruction or blockage of the bowel
  • Ulceration of the join between your bowel and stomach pouch
  • Re-emergence of obesity associated conditions like type 2 diabetes
  • Weight regains
 
Most gastric bypass revisions are corrective, rather than a conversion or a reversal.
Gastric band revisions may be needed if there:

  • Band slip and blocks the stomach

  • Band erodes into the stomach

  • Patients develop reflux symptoms

  • Port or tubing problems

  • Pouch dilation above the band

  • Weight gain

  • Weight-related conditions develop

 

One of the main advantages of adjustable gastric banding is that it is relatively easy to reverse. However, one major disadvantage is the high complication rate associate with them. Gastric bands can also be converted to gastric bypass or a gastric sleeve.
Gastric sleeve revisions may be needed if there is a:

  • Leakage from the long staple line used to form the sleeve

  • Fistula due to a chronic leak from the staple line

  • Reflux disease that can’t be managed with medication

  • Difficulty eating due to twists or narrowing of the sleeve

  • Weight regains

Patients who develop worsening gastric reflux or heartburn from their sleeve gastrectomy may be candidates for conversion to gastric bypass. This conversion usually eases these symptoms by rerouting the acid and bile streams to an area of the intestines that is further down from the oesophagus.

 

Recovery from Revision Surgery
Compared to initial surgery recovery from revision surgery similar to that of the initial procedure. Though post-operative hospital stays are slightly longer after a revision surgery. Despite that the hospital stays were still short and weight loss good, making revision surgery an effective and viable option for certain patients who are unhappy with the results of their initial weight loss procedure.
Risks of Revision Surgery

Revision surgery, while very safe, is associated with a slightly higher rate of complications than initial surgery when performed in experienced units.