Revision Bariatric Surgery

Background

Patients who have had bariatric surgery previously may have to undergo a repeat operation for several reasons:

  • If there is a complication of the initial surgery this may have to be fixed with a second operation. Examples of this are a gastric band, which moves or slips out of position or erodes into the stomach. The gastric band may then need to be repositioned, replaced or even removed.
  • Intolerance of the original operation. It is impossible to predict with accuracy how successful an individual patient will be with any bariatric surgery. In rare circumstances, patients can find living with a band too difficult, or weight loss inadequate and elect to convert to an alternative procedure such as gastric bypass.
  • After any bariatric surgery, if the patient eats too much at once and stretches the remnant/upper part of the stomach then the patient may stop losing weight or regain the lost weight as the restriction on the amount eaten is less. To try and improve the weight loss again the operation may need to be redone or changed to another operation.

Surgery

The most common revision bariatric procedures are repositioning or replacement of a gastric band, or conversion of an existing procedure to a gastric bypass. In principle, these procedures follow the same steps as the original surgery. The difficulty with revision surgery stems from the scar tissue, which has grown from the primary operation, and the distortion (or alteration in shape) of the stomach anatomy from the original operation.

This means that these operations are much more difficult and take a lot longer than the first operation. Consequently the risk of complications is higher. For this reason, in certain circumstances these procedures are performed in two stages. For example some patients having gastric band conversion to gastric bypass will have the band removed and then wait three months for the bypass to be performed. This can improve the safety of the operation in some circumstances.

Advantages

If you are not doing well with your original operation, then it is important to work with your treating surgeon, general practitioner, dietician and physician to establish the reasons for this and how to get a better result. Only infrequently do people require a revision operation.

If this is the case, then a revision surgery can usually improve intolerable symptoms from the primary surgery, add to weight loss and improve control of obesity related problems such as high blood pressure, diabetes and high cholesterol.

Patients are much happier after successful revision surgery and report better diet related quality of life and improved weight loss.

Disadvantages

As mentioned, revision surgery is more difficult than primary surgery. The length of stay is longer and the risk of complications is greater.

It is important to discuss revision surgery at length with the treating team, as it can only be recommended after considering all your options.

Complications

The complication profile for revision surgery is essentially the same as for the original operation. The increased duration of surgery, the increased dissection and difficulty do however result in higher complication rates. These will be discussed specifically with you if you are considering this operation.

Summary

Revision bariatric operations are a complex area of surgery. They are necessary for a small minority of patients, and are advisable for certain others. If it is the right thing for you, an operation can improve both your quality of life and your obesity related health problems.