Secondary or Revisional Bariatric Surgery

When a patient chooses bariatric surgery to fight their obesity problem, there are certain expectations that they and their surgeon set – measures of success. Generally, patients lose a significant amount of weight in the first year or two after surgery.* However, it is just as hard to maintain that weight loss as it is to lose the weight in the first place. Most often, weight regain is a result of less than ideal dietary and exercise choices and can be corrected with a series of consultations with our nutritionist. With that said, if we have ruled out the possibility of lifestyle deficiencies causing lack of weight loss or significant weight regain, we can begin to consider a follow-up surgical procedure to correct it.

It is important to note that gastric sleeve and gastric bypass patients should expect some weight regain over the longer term. This is due to the natural stretching of the stomach pouch over time.

Revising the Gastric Bypass

The gastric bypass is the most complex of the three major bariatric surgeries as it combines both restriction and malabsorption. However there is still the opportunity for a follow-up procedure to enhance its effectiveness if needed. If there is any weight gain due to the enlargement of the stoma (the valve separating the esophagus and the stomach) a minor endoscopic procedure may be all that’s needed to correct it. If the stomach pouch has stretched, the restrictive portion of the procedure can be revised, or a gastric band can be placed over the top of the stomach pouch to regain restriction.

Revising a Gastric Sleeve

The gastric sleeve procedure was once commonly performed as the first part of a two stage procedure. The goal was to have the patient lose weight and reduce their surgical risk with this straightforward restrictive procedure, before adding a malabsorptive component. Even though the sleeve is now performed as a standalone procedure, revising it to a gastric bypass or duodenal switch is a proven solution. A procedure known as a re-sleeve can also be performed. This is essentially a second sleeve procedure that cuts away any excess stomach tissue.

Revising a Gastric Band

Because of the nature of the gastric band, it can be revised very easily. If the band has shifted or eroded into the esophagus, it can be replaced to regain the former restriction. Should the band not offer the degree of weight loss that the patient and surgeon expect, it can be removed and a gastric sleeve or gastric bypass can be performed to replace the primary procedure.

Considerations of a Secondary or Revisional Bariatric Procedure

It is important to note that there are added risks associated with follow-up procedures, especially if you are in less than ideal general health. Before considering a follow-up bariatric procedure, it is important that we rule out lifestyle causes such as overeating or under-exercising as a reason for weight regain.

If you are considering a follow-up bariatric procedure, you do not need to attend bariatric seminar. Please schedule a consultation with our office. We will evaluate your particular situation and offer the best solution for your circumstance.

*Results will vary between patients

2016, Bariatric Specialists of North Carolina, a part of the EmergeOrtho network
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