Revision Bariatric Surgery

Background

Patients who have previously undergone weight loss surgery may require a repeat operation for several reasons:

  • Correction of a complication that occurred following the initial surgery. An example is the slippage of a gastric band causing erosion into the stomach. The gastric band may then need to be repositioned, replaced or even removed.
  • Intolerance of the original operation. Individual responses to each procedure vary. 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.
  • Ineffective weight loss. Over-eating can stretch the new small stomach and reduce its restriction on food intake, resulting in weight loss plateau or weight regain. In order to improve weight loss the operation may need to be redone or converted to an alternative procedure.

Surgery

The most common revision weight loss 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 and intestines created by the original operation.

This means that revision operations are much more complex and take longer to complete than an initial operation of the same kind. Consequently, the risk of complications is also greater. To maximise safety, it is sometimes necessary to perform these procedures in two stages. For example, patients undergoing gastric band conversion to gastric bypass may first have the band removed and after a period of recovery (approximately 3 months), the bypass will be performed.

Advantages

Following your initial surgery, any intolerable symptoms or stalled weight loss needs to be discussed with your treating surgeon, general practitioner, dietitian and physician to establish any cause and work towards improving your results. Although infrequently required, patients report better quality of life, improved weight loss, and improved control of obesity-related issues such as high blood pressure, diabetes and high cholesterol after revision surgery.

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

Disadvantages

As previously stated, revision surgery is more difficult to perform than primary surgery. The length of stay in hospital is longer, and the risk of complications is greater. It is important to discuss revision surgery at length with your treating team, as it can only be recommended after consideration of all other options.

Complications

The complication profile for revision surgery is essentially the same as for the primary procedure in question. The increased duration and difficulty of the surgery do, however, result in higher complication rates. These will be discussed specifically during your consultation if you are considering a revision operation.

Summary

Revision weight loss operations are a complex area of surgery. They are necessary for a small minority of patients and are advisable in certain other circumstances. If it is the right thing for you, a revision operation can improve both your quality of life and your obesity-related health issues.