Gastric Bypass Revision
There are two main reasons a revision may be appropriate after a Roux-en-Y Gastric Bypass. The first is a post operative complication. Second is inaequate weight loss after your initial procedure or weight regain beyond a nominal amount.
For gastric bypass patients, complications include conditions like ulcer disease, low blood sugar, and excessive weight loss, among others. There are some complications that can contribute to weight regain, but generally they are different. Revisions for complications vary significantly based on the complication. Solutions can include operating to reevaluate the stomach to intestine connection or reversal of the gastric bypass.
Reigniting Weight Loss
It is well recognized that not everyone achieves lasting weight loss success with a gastric bypass. Every patient responds to surgery differently, and every surgery is different. Initially, when a patient experiences weight regain, we investigate to identify if any behaviors can be modified to restart weight loss. In some circumstances, patient education offered at the time of surgery regarding required behavioral changes has changed with new information or recommendations. In some cases, many years have passed and lessons learned at the beginning of the weight loss surgery journey may have been forgotten. When behavior modifications fail to achieve the desired result, we explore revisional options.
Before we explore the different options, it is helpful to discuss why gastric bypass patients lose weight. There are 2 separate, but complementary, mechanisms. The first is restriction. Restriction is essentially the earlier sensation of fullness. The second mechanisms are the hormonal and metabolic effects which are the result of bypassing a portion of the small intestine.
First, we look at restriction. There is a gradual decrease in the feeling of restriction over time in every patient. Sometimes, this is minimal and conducive to weight maintenance. Occasionally, it is much more. Our work-up before a revisional surgery includes looking at the pouch and the connection with the small bowel to see if they are dilated– if they have grown significantly larger. If they have, this represents one method to revise the surgery back to the original state. It is important to note that the feeling of restriction will never be back to what it was immediately after the first surgery. However, the renewed restriction achieved can still be helpful for weight loss. Additionally, a hiatal hernia can contribute to the loss of restriction. Repairing this can help as well.
Second, we look to the small bowel’s metabolic and hormonal effect. When a gastric bypass is done, a variable amount of small bowel is bypassed. This is based mostly on the surgeon who performed the operation. When a surgeon creates a gastric bypass, 3 small bowel limbs are created. One connects to the pouch and is called the roux limb. One carries the bile and pancreatic enzymes and is called the BP limb. The third is the remainder of the small bowel where the food and enzymes are combined and is call the common channel. The most common technique involves creating a roux limb of 75 cm and a biliopancreatic limb of 50 cm. The average person has about 800 cm of small bowel, leaving 675 cm and the common channel. It should be noted that the actual amount varies significantly from patient to patient.
When we revise the small bowel anatomy on someone who has a gastric bypass, we typically shorten the common channel and lengthen the BP limb. This change increases the weight loss potential of the gastric bypass. Within limitations, different lengths can be used safely and achieve the desired results.
These techniques to revise a gastric bypass are typically associated with comparable risks to a primary gastric bypass. They are mostly done laparoscopically even if done as an open procedure originally with one long incision.
Pursuing a Secondary Procedure
Some insurance policies include revisional options while some do not. It is important that you familiarize yourself with the details of your policy. We do offer self pay pricing for all revisional procedures.
To be considered for a secondary bariatric surgery, our doctors will require a copy of your operative note from your first bariatric surgery to properly evaluate your anatomy and options moving forward.