Revision after Bariatric Surgery
Revisional surgery after a bariatric procedure is possible. It is important to differentiate between a reversal and a revision. There are no truly reversible bariatric procedures, but they are all able to be revised. Your specialist bariatric surgeon will discuss the options available to you.
We know that successful outcomes require changes to your lifestyle. That includes what, how much, and how often you eat.
When is a revision after bariatric surgery needed?
A revision procedure may be required when:
- Significant complications or side effects related to the previous surgery
- Failure of an implanted device
- Failure to resolve co-morbidities
- Inadequate weight loss or weight regain
Further surgery where there has been any previous surgery on the stomach or intestines will be more complex than an original procedure. It will require more intense work up, planning and execution to obtain an optimal outcome.
The original surgery needs to be dissected back to as close to normal as possible, nerves need preserving as much as possible and any blown valves or hernias need fixing appropriately.
Before even contemplating revisional surgery it is imperative that the reasons for the suboptimal outcome from the initial surgical experience be understood.
Questions need to be answered. Such as:
- was the correct operation performed (applying current knowledge)
- was there a technical issue with the surgery or as a result of a post operative event.
- were appropriate instructions given and were they followed
- was there adequate follow up and support
Then there needs to be a solid plan in place as to how to avoid any non operative issue affecting outcome to be avoided in the future. Any nutritional deficiency needs correcting and a plan for ongoing testing and optimisation made. The revision and operative plan moving forward needs to be practical and defined.
All this should occur before a scalpel comes into the equation.
"Revision surgery is more difficult than the original surgery and so the potential for complications is higher. We need to try and figure out why the original surgery did not ever work or why it has ceased to work, what is causing side effects, or has gone wrong with a device.
This process will involve lifestyle and dietary analysis as well as endoscopic and possible specialised tests such as functional Barium x ray analysis and CT scans. We discourage rushing into any surgery as procedures are not wholly reversible and we definitely avoid quick fix decisions where revisional surgery is concerned. If a job is worth doing it is worth doing right. Your future health and quality of life may depend on it! "
Revision after Bariatric Surgery
Revision surgery for any primary bariatric or subsequent bariatric surgeries, is extremely complex and requires specialist attention. The failed surgery may be of no fault of your own, or lifestyle factors may have contributed. It is fundamental to the success of further surgery that we determine why the revision is needed and how we may counteract failings in the future.
What may lead to revision surgery?
There are several reasons why your previous bariatric procedure may not have worked as you hoped.
Your Upper GI West team will look at:
- Diet as the cause for weight regain.
- Steps include analysing what you eat and keeping a food diary
- There can also be emotional issues attached to overeating
- Stress itself can affect energy utilization by the body
( Working with a dietitian and psychologist can help to address these)
- Structural problems. If your pouch size is too large or not uniform it can cause problems with weight loss. Your bariatric surgeon will assess your pouch and the opening between your stomach and small intestine to see if there is a problem with an endoscope.
- The length of the bypassed intestine may also be relevant to weight loss failures or inadequate metabolic effects or complications. Endoscopy can be used to assess this, as can a functional barium or CT scan. We believe members of the Upper GI West surgical team are the best to assess your Upper GI tract as they are trained, skilled and experienced at performing the surgery so they will know what the pouches and anastomosis should look like and when they are not quite right. They are also fully trained, credentialled and experienced at endoscopy.
- Failed procedure. For example in the case of Gastric Banding. An endoscopy here is essential to assess for position of the band, pouch dilatation, oesophageal dilatation and function and possible erosion of the band etc. A functional barium may help assess contractility in the oesophagus. Manometry is a specific test of the contractility of the oesophagus.
- Hormonal or metabolic problems may be causing a failure to lose enough weight or weight regain. Or there may be hormonal problems occurring as a complication of surgery, eg Secondary Hyperparathyroidism, or there may be nutritional issues as a result of vomiting or bypasses or disuse of parts of the intestine.
(A bariatric physician or medical specialist can help diagnose and treat these)
What types of revisions are possible?
Many revision options can be considered depending on the previous procedure and a thorough analysis of the anatomy and function of the Upper GI tract (oesophagus, stomach and duodenum)Gastric Band as a primary procedure
- Remove gastric band
- Replace gastric band
- Sleeve gastrectomy
- Single anastomosis gastric bypass
- Roux en Y gastric bypass
- SIPS/SADI duodenal switch
- Gastric transit bipartition
Sleeve gastrectomy as a primary procedure
- Re sleeve gastrectomy
- Roux en Y gastric bypass
- Single anastomosis gastric bypass
- SIPS/SADI duodenal switch
- Gastric transit bipartition
Single anastomosis bypass as a primary procedure
- Anastomosis narrowing
- Roux en Y gastric bypass
- Reversal
- Other procedures probably possible but significantly more complex
Roux en Y bypass as a primary procedure
- Pouch tightening
- Anastomosis narrowing
- Intestinal limb adjustment
- Reversal
- SIPS/SADI duodenal switch
- Other procedures possible but significantly more complex
Other procedures or options may be possible upon careful and thorough assessment.
Patients considering revisional surgery should:
- Understand the surgery and risks involved
- Be prepared for the necessary dietary and lifestyle changes required
- Have NO alcohol or drug dependency problems
- Have NO uncontrolled psychiatric conditions
- Be non-smokers, or ex-smokers for at least 3 months
- Not be planning pregnancy within 12 months of surgery (Women)
- Be willing and able to partake in potential lifelong regular medical follow up
Why Upper GI West for revision surgery?
As we have mentioned, revisional surgery can be extremely complex and carries additional risks.
We believe these specific operations are best carried out by specialists who have undertaken the additional Upper Gastrointestinal Surgery training, making them leaders in their field.
The Bariatric Surgeons at Upper GI West, are all Upper Gastrointestinal Specialists and they have completed accredited Oesophago gastric subspecialty training.
We have a comprehensive and thorough understanding of the Upper Gastrointestinal tract and Bariatric Surgery, together with advanced technical surgical skills to ensure you receive the best quality of care.
As a group we are regularly attending and have presented at national and international meetings. We are in tune with global developments and innovations in revision surgery. Our aim is to make sure you receive the best possible information based on a thorough assessment to assist you in making the right decision for you.