Bariatric (obesity) revision surgery is a general term that refers to repeated bariatric surgical procedures in patients who have previously had any type of bariatric surgery.
A revision procedure can improve the effectiveness of the original surgery and the patient’s quality of life (if the first surgery caused unwanted side effects).
Bariatric revision surgical procedures occur in approximately 7% to 15% of bariatric surgery patients. To determine if surgery is necessary, doctors will evaluate the patient’s overall health, weight loss progress, and quality of life issues (that have occurred since the first surgery).
Who is a candidate for revision bariatric surgery?
A patient may be a candidate for revisional bariatric surgery for one or more of the following reasons:
- Sometimes a patient fails to lose the expected amount of excess weight within a certain period of time after surgery, such as 18 months or two years. Although there are no formal weight loss guidelines that determine the treatment effect of the initial bariatric procedure, many studies suggest that patients may be candidates for bariatric revision surgery if they lose less than 15% of their total body weight.
- Sometimes, complications can occur with the initial bariatric procedure. For example, in a patient who has gastric band surgery, the band may slip around the stomach or wear into the inner lining of the stomach. In some cases, salt water may leak from the tube in the gastric band.
- Gastric bypass (RYGB), a small number of patients who undergo surgery may develop a gastric fistula (an unwanted connection of the small stomach pouch to the part of the bypassed stomach).
- The patient may develop a hiatal hernia, which is a small section of the stomach that is pushed upwards (from the abdomen into the chest cavity) and causes heartburn and/or discomfort.
- Patients may also develop ulcers (sores) or strictures (narrowing of the stomach pouch or the connection between the stomach pouch and the small intestine).
- Some sleeve gastrectomy (sleeve patients who have had a gastrectomy (gastrectomy) develop acid reflux or gastroesophageal reflux disease (GERD). Another symptom that may occur is difficulty swallowing.
- Some patients gain weight. For example, a patient who has had their first sleeve gastrectomy may gain weight and develop symptoms of GERD. After gastric bypass surgery, the point where the small intestine connects to the base of the stomach pouch (gastrojejunal anastomosis) may widen, reducing the output of satiety or “fullness” hormones and causing weight gain.
- Sometimes, the initial bariatric procedure can prevent too much of the nutrients from being absorbed from food, leading to malnutrition, vitamin deficiencies, or having too little calcium in the blood (hypocalcemia).
How are revision surgeries performed in obesity surgery?
There are many ways surgeons can revise an initial bariatric surgery. What happens during bariatric revision surgery depends on the problems that arose after the initial surgery and whether the surgeons plan to repair, convert, or reverse the procedure. Revision surgery is usually performed for the three most common types of bariatric revision surgery:
Sleeve gastrectomy:In this procedure, the surgeon surgically removes a significant portion of a person’s stomach, which reduces the volume the stomach can hold by 80%. As a result, the stomach becomes more like a tube through which food passes, rather than a pouch that can hold food and aid in digestion. Sleeve gastrectomy is irreversible.
After a patient initially undergoes sleeve gastrectomy, the stomach may retract or enlarge, which can lead to weight gain. Instead of creating a smaller stomach tube, surgeons often convert a sleeve gastrectomy into a gastric bypass or duodenal switch procedure. Converting to a gastric bypass is also an effective treatment for managing symptoms of gastroesophageal reflux disease (GERD) that may occur as a result of sleeve gastrectomy.
Gastric Bypass: During the procedure, also known as Roux-en-Y gastric bypass (RYGB), surgeons cut a small pouch from a patient’s upper stomach (near the esophagus) to hold food. Surgeons then reroute a portion of the small intestine and attach it to the bottom of the newly created stomach pouch. When a patient eats, food enters the small stomach pouch, then moves into the small intestine, bypassing most of the stomach and part of the small intestine.
Over time, the small stomach pouch can stretch or enlarge. This can be corrected surgically or endoscopically, or anti-obesity medications can be used.
A gastric bypass can also be converted to a single anastomosis sleeve ileal bypass (SSI).
Gastric Band Surgery: Also called lap-band surgery, this surgery involves placing an adjustable silicone belt (or band) over the patient’s upper stomach, dividing the stomach into two sections. Patients feel full sooner.
If the band slips after the surgery, surgeons can put the band back in place. In some cases, surgeons wait for inflammation or scarring to subside before removing the band and reattaching it. It is also possible for surgeons to convert the gastric band surgery into a gastric sleeve, gastric bypass, or SASI procedure.
What condition is revisional bariatric surgery used to treat?
Bariatric revision surgery is used to replace, correct or reverse a previous bariatric surgical procedure. Various conditions can arise after the initial bariatric procedure and a new operation may be required to address these issues.
What are the benefits of revisional obesity surgery?
Revisional bariatric surgery is performed to improve a patient’s health or quality of life. The procedure can promote greater weight loss in patients whose initial surgery did not result in the expected excess body weight loss. It can reduce or eliminate unwanted side effects that occur after the initial bariatric procedure, such as GERD or difficulty swallowing. It can also address complications such as ulcers or stenosis. It can also completely reverse the initial bariatric procedure if it is no longer desired or effective.
What are the risks associated with revisional bariatric surgery?
Some bariatric revision surgeries are performed as open surgery, which can pose a higher risk of bleeding, more pain at the incision site, and a longer recovery time than minimally invasive laparoscopic surgery.
Revisional surgery can carry more risks than initial bariatric surgery. It has higher complication and mortality rates.
Sometimes revisional surgery does not resolve problems that occurred after the initial surgery. However, for many patients, revisional bariatric surgery helps promote weight loss and improve their quality of life.
- Yale Medicine
- American Society for Metabolic and Bariatric Surgery (ASMBS)
- National Institutes of Health (NIH)
- Annals of Laparoscopic and Endoscopic Surgery (ALES)