“I had undergone gastric bypass surgery a few years prior, and I knew I had put quite a bit of weight back on, but something just clicked, and I knew I had to do something about it. Dr. Averbach said he could perform the surgery and give me a second chance, but only if I was really ready to make the changes necessary to be successful this time around.” – Nicole
Dr. Averbach, Dr. Hamdallah, and Dr. Swift combined have more than 20 years of experience performing bariatric surgery, which makes them uniquely qualified to treat patients who require revisional bariatric surgery.
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 procedure may experience side-effects or failed to succeed in losing the expected amount of excess weight or experience 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.
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 in giving up. Obesity is a chronic disease and is prone to relapse if patients do not adhere to healthy eating and life style 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.
A gastric bypass revision is necessary in approximately 5 to 10% of patients over 5 years due to complications, unsatisfactory weight loss, or weight regain.
Complications that may occur after gastric bypass surgery, such as ulcers, chronic vomiting, hernia, staple line failure, can often be improved through revisional bariatric surgery.
If gastric bypass fails a patient has several options, including:
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. 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. Choice of procedure for conversion of failed Lap Band is based on presence of reflux symptoms, other co-morbidities like diabetes and degree of excess weight prior to revision surgery. Your surgeons, after appropriate work up, will help you choose what is best for you.
The gastric sleeve is one of the most frequently done primary weight loss procedure 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 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 maybecome 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 and 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 for 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.
Substantial proportion of morbidly obese patients suffer from reflux symptoms frequently associated with hiatal hernia that was not addressed during initial bariatric procedure, recurred or developed in in later years.
It is especially significant finding after sleeve gastrectomy, but happens after gastric bypass and Duodenal Switch.
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, hiatal hernia can be repaired as a separate procedure or in conjunction with other revision surgery.
Procedure consists of reduction of the herniated junction of the esophagus and stomach into the abdomen with closure of 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 development of deep, penetrating ulcer with callous margin that will not heal.
In such circumstance ulcer excision with revision of the stoma might be required.
Yes. Gastric bypass revision surgery is a procedure that is done relatively often. The main reason people get gastric bypass revision surgery is to help improve weight loss results. If you want more information about gastric bypass revision surgery, simply schedule a consultation with us!
For more than 150 years, Ascension Saint Agnes Hospital has been dedicated to the art of healing by providing exceptional care to the greater Baltimore area. Built on a strong foundation of excellent medical care and compassion, Ascension Saint Agnes is committed to providing the best care for our patients for many years to come.