Bariatric Revision Surgery Near Baltimore, Maryland

Bariatric surgery is usually successful, both in terms of helping a patient achieve significant weight loss and minimizing complications. Unfortunately, some patients after primary bariatric procedures may experience side effects or fail to succeed in losing the expected amount of excess weight or experiencing weight regain. In these situations, a follow-up bariatric procedure, known as a bariatric surgery revision, may be necessary to alter or repair the initial bariatric surgery.

Bariatric revisions may also be necessary due to surgical complications from an earlier procedure or previous bariatric surgery.

Although it can be an emotional setback for obese patients when bariatric surgery does not lead to the expected amount of weight loss, the only failure is giving up. Obesity is a chronic disease and is prone to relapse if patients do not adhere to healthy eating and lifestyle modifications. As with any serious health condition, if the first treatment is not effective, then the doctor will recommend additional treatment options. With weight loss surgery, a bariatric revision surgery may be necessary as an additional treatment for obesity. Maintaining a healthy lifestyle after surgery is crucial for long-term success and overall well-being.

A gastric bypass revision is necessary in approximately 5 to 10% of patients over 5 years due to complications from previous weight loss surgery, unsatisfactory weight loss, or weight regain.

Complications that may occur after gastric bypass surgery, such as ulcers, chronic vomiting, hernia, and staple line failure, can often be improved through revisional bariatric surgery.

If gastric bypass fails, a patient has several options, including:

• If the problem is a lack of weight loss or weight regain, a non-surgical approach includes examining eating habits and exercise routines and participating in nutritional counseling, exercise programs, behavior modification therapy, psychological counseling, and support groups. In our practice, all candidates for revision surgery after initial gastric bypass are supposed to attend the STRIVE program, which includes nutritional education and behavioral modification. You may find further information on this program on the Bariatric Dietician and Psychologist pages
• If the problem is a lack of weight loss or weight regain, surgical options include full revision of the initial bypass with reduction of the proximal pouch and stoma size as well as lengthening of the Roux limb conversion to duodenal switch.
• It is important to understand that revision surgery is associated with a lower success rate compared to initial bypass because it is offered to a group of patients prone to recurrence of morbid obesity. Consequently, without successful preparation with the help of a bariatric dietician and behavioral psychologist, successful weight loss is difficult to achieve.
• Every revision surgery is also associated with a slightly higher risk of postoperative complications due to charged anatomy and postoperative scarring.

The revision rate for the LAP-BAND is required for over 50% of patients within 5 years due to either device-related problems, severe reflux, or unsatisfactory weight loss, often necessitating revisional weight loss surgery. One of the most common gastric banding complications is slippage of the gastric band, which requires a follow-up procedure to fix the problem. While some patients will have the band replaced, others choose to revise to another procedure, such as gastric sleeve or gastric bypass. The choice of procedure for conversion of failed Lap Band is based on the presence of reflux symptoms, other co-morbidities like diabetes, and degree of excess weight prior to revision surgery. Your surgeons, after appropriate workup, will help you choose what is best for you.

The gastric sleeve is one of the most frequently done primary weight loss procedures that involves reducing the size of the stomach to restrict food intake. In the past, it was used primarily as the first stage in a two-stage procedure or the gastric component of the duodenal switch procedure (gastric sleeve and intestinal rerouting). Although many people will lose sufficient weight with the gastric sleeve procedure, if further weight loss is needed, then conversion to a duodenal switch or gastric bypass may be an option.

With Gastric Sleeve being the dominant bariatric primary procedure in use today, it has become recognized that the most significant potential side-effect is severe reflux symptoms. About 24-40% of patients might experience reflux, and in 15-20% of Gastric Sleeve patients, symptoms of GERD may become so bothersome that surgery is required. There are several reasons for severe reflux/GERD (development or recurrence of hiatal hernia, stricture or deformity of the sleeve, bile reflux, etc.), but whatever the cause is, there is nearly 100% success rate with symptom resolution with conversion to Gastric Bypass with simultaneous Hiatal Hernia repair. Coupled with additional dietary education, this treatment usually results in additional weight loss if needed.

Before a revisional bariatric procedure is performed, the patient will be examined by Drs. Averbach, Hamdallah, & Swift to determine the cause of failure and to evaluate the appropriate treatment options. He will need to determine if post-operative weight loss failure is due to a problem with the original surgery or a result of the patient’s inability to follow the necessary dietary and lifestyle guidelines. The latter situation makes the STRIVE program mandatory prior to revision for weight loss failure.

Another consideration is whether the patient has unresolved co-morbidities that may improve with additional surgery. Drs. Averbach and Hamdallah will discuss the options with you and explain what to expect with the bariatric revision.

Besides that, there might be additional requirements for coverage of revision surgery based on your insurance plan.

A substantial proportion of morbidly obese patients suffer from reflux symptoms frequently associated with hiatal hernia that were not addressed during the initial bariatric procedure, recurred, or developed in later years.

It is an especially significant finding after sleeve gastrectomy but happens after gastric bypass and Duodenal Switch.

A hiatal hernia may be associated with significant bothersome reflux symptoms affecting a patient’s quality of life and does not always respond to medical therapy with antacids. Depending on the clinical situation, a hiatal hernia can be repaired as a separate procedure or in conjunction with other revision surgery.

The procedure consists of a reduction of the herniated junction of the esophagus and stomach into the abdomen with the closure of the diaphragm muscle defect to keep the stomach in the abdomen.

Marginal ulcer is a condition that can complicate gastric bypass in about 5% of patients at various time intervals after the procedure. It develops immediately below the stoma on the small bowel side. If detected early, it can be healed with medications. Delayed diagnosis or unresponsiveness to medications might result in the development of a deep, penetrating ulcer with a callous margin that will not heal.

In such circumstances, an ulcer excision with a revision of the stoma might be required.