Revision Weight Loss Surgery
Revision weight loss surgery modifies or changes a previous bariatric surgery. Most bariatric surgery patients have long-term success with their procedure. However, some people develop problems. Revision surgery can help resolve issues that develop following the first surgery. There are several types of revision surgeries. The one that is right for you will depend on what kind of bariatric surgery you originally had. Reoperative bariatric surgery and revision bariatric surgery are other names for these procedures.
What is gastric band revision surgery?
Gastric band revision is the most common type of revision surgery. In the past, gastric banding was very popular. The band restricts the amount of food you can eat. However, the band can slip or loosen over time. If this occurs, revision options include sleeve gastrectomy and gastric bypass.
What is gastric sleeve revision surgery?
Gastric sleeve revision is not as common. However, in some people, the stomach size can double over time after sleeve gastrectomy. This leads to increased food intake. Revision options include re-sleeving, gastric bypass, and duodenal switch surgery.
What is revision surgery for gastric bypass?
Gastric bypass revision is also relatively uncommon. Like sleeve gastrectomy, it is possible for the stomach to stretch over time. There are three main options to revise a gastric bypass. This includes placing a gastric band, reducing the stomach size with a sleeve procedure, and bypassing more of the small intestine. Some surgeons may also offer a procedure to reduce the opening between the stomach and small intestine.
Your doctor may recommend revision weight loss surgery for the following reasons:
Complications from the original procedure such as leaks
Inadequate weight loss
Intolerable digestive problems such as reflux
The goal of revision weight loss surgery depends on the reason you need it—to restore weight loss or resolve complications or side effects. The goal can influence your doctor’s choice of revision surgery.
Issues with weight are common reasons for weight loss revision surgery. Doctors and insurers generally use the same criteria for revision due to weight as they do for the original surgery. This means you must meet the following criteria:
BMI (body mass index) of 40 kg/m2 or greater
BMI of 35 kg/m2 or greater with obesity-related health problems
For revision surgery, you will need to work with your bariatric care team to uncover all the reasons for weight regain or failure to lose weight. Doctors can correct anatomic reasons with revision surgery. But you will need to address potential nutritional and behavioral reasons with your care team. It is necessary to rebalance lifestyle choices that may be interfering with your success before considering revision surgery.
The same doctors who perform bariatric surgery will complete your revision surgery. This includes bariatric surgeons and general surgeons. Bariatric surgeons are often general surgeons who specialize in bariatrics. Bariatrics is the field of medicine that deals with the causes, prevention and treatment of obesity.
Revision weight loss surgery will take place in a hospital under general anesthesia. Like the original procedure, revision surgery can be either traditional open surgery or minimally invasive laparoscopic surgery. In many cases, doctors can perform the revision laparoscopically. This generally results in fewer short-term risks after surgery, less pain, and a faster recovery. However, your doctor may opt for an open surgery with a large incision if you have extensive scarring from the original surgery.
Gastric band revision
Gastric band revisions include sleeve gastrectomy and gastric bypass. Sleeve gastrectomy involves removing a large portion of the stomach to create a tubular pouch. This drastically reduces the stomach size. Gastric bypass involves creating a small pouch out of the stomach. The surgeon divides the small intestine and connects this small pouch to the lower part of the small intestine, then connects the upper part of the small intestine further down on the lower part. This allows bile from the liver and enzymes from the pancreas to mix with food for digestion.
Gastric sleeve revision
Gastric sleeve revisions include gastric bypass, re-sleeving, and duodenal switch surgery. Re-sleeving repeats the sleeve procedure to reduce the stomach size and recreate the tubular pouch. Duodenal switch surgery is a combination of sleeve gastrectomy and gastric bypass. It bypasses more of the small intestine and results in more weight loss than other forms of bariatric surgery. However, it also carrier a higher risk of malnutrition and other problems.
Gastric bypass revision
The gastric bypass revisions include gastric banding, sleeving the bypass, and bypassing more of the small intestine. Gastric banding places an adjustable silicone band around the upper part of the stomach. Sleeving the bypass involves removing part of the bypass pouch. Bypassing more of the small intestine moves the pouch connection further down the small intestine. This reduces the amount of calories you can absorb.
What to expect the day of your revision weight loss surgery
Knowing what to expect can help set your mind at ease. You will meet with a preoperative nurse to go over any test results and check your vital signs. You’ll also meet with the surgeon one last time before surgery. The anesthesiologist or nurse anesthetist will talk with you about your medical history and the anesthesia you will have. They will give you a sedative to help you relax before the team takes you to the surgical suite. With general anesthesia, you won’t remember anything else until you wake up in the recovery room.
All surgeries involve risks and the possibility of developing complications. Surgical risks are generally higher with revision surgery compared to the original surgery. The risk is increased if you have extensive scarring. Because of this, doctors recommend trying other strategies first to resolve issues from the original surgery.
General risks of surgery
The general risks of surgery include:
Anesthesia reaction, which can include breathing problems
Potential complications of revision weight loss surgery
Most revision weight loss surgeries are successful, but potential complications include:
Damage to organs or blood vessels
Dumping syndrome, which occurs when food moves too quickly from the stomach into the small intestine
Internal hernias, which can lead to bowel blockages
Leakage of digestive juices and intestinal contents at the connection sites
Peritonitis, which is inflammation and infection of the lining of the abdominal cavity
Severe malnutrition, food intolerances, and dehydration
Reducing your risk of complications
You can reduce your risk of certain complications by:
Following your doctor’s instructions on activity and diet before and after the procedure
Informing your doctor if there is any possibility of pregnancy
Taking the medications your doctor prescribes or recommends
Telling all members of your care team if you have allergies
Telling your doctor if you have unexpected symptoms or signs of complications, such as bleeding, fever, or increase in pain
You can prepare for revision weight loss surgery by:
Following a healthy diet and exercise plan. Ask your doctor about the benefits of physical therapy prior to (and after) surgery.
Fully explaining your medical history, allergies, and medications you take. This includes prescriptions, over-the-counter drugs, supplements, and vitamins. To make this easier, keep with you a current list of your medical conditions (including drug allergies) and medications.
Getting the preoperative medical tests your doctor orders. Possible tests include blood tests and X-rays.
Not eating or drinking before surgery. Your team may postpone your surgery if you eat or drink too close to the start of surgery because you can choke on stomach contents during anesthesia.
Stopping smoking as soon as possible (if you smoke). Even quitting for just a few days can help the healing process.
Taking or stopping medications as directed. Your doctor will give you instructions for taking your specific medications and supplements.
Questions to ask your doctor
Making a list of questions can help you remember everything you want to ask about your procedure. Questions you may want to ask the doctor include:
Why are you recommending this type of revision surgery for me? How do the outcomes compare with other revision techniques?
How many of these procedures have you performed? How often do you see complications?
What is involved in this revision surgery? What other treatments will I need?
How long does the surgery take? When can I go home?
What restrictions will I have after surgery? What kind of assistance will I need at home?
When can I return to my regular activities?
How will you manage my pain?
What changes, if any, to my medication plan do I need to make?
When should I follow up with you?
How should I contact you after hours if I have a problem?
Knowing what to expect makes it easier to plan and prepare for a successful recovery.
How long will it take to recover?
Like your original bariatric surgery, you will spend a few days in the hospital. In general, revision surgeries usually result in a slightly longer stay compared to the first surgery. The recovery can take longer as well. This is especially true if you have significant scar tissue from the original surgery.
Recovery time once you are home depends on your age, overall health, and the type of revision surgery. You will probably begin to feel like yourself again within a few weeks. Physical therapy can help with your recovery by increasing strength and stamina and minimizing pain. It can also help to work with a physical therapist before surgery to prepare your body for the process. Full recovery can take a few months.
Will I feel pain?
There will be pain and discomfort after revision weight loss surgery. Pain management is important for your recovery. Don’t wait until you feel significant pain before taking medicine; stay on a schedule to keep pain at a minimum. Controlling pain lets you complete physical therapy and other rehabilitation activities. Tell your doctor if your pain gets worse or changes in any way. It could be a sign of a complication.
When should I call my doctor?
Call your doctor right away or seek immediate medical care if you have:
Breathing problems such as trouble catching your breath
Confusion or changes in level of alertness
Chest pain, pressure or tightness
Drainage of pus, redness or swelling around your incision
It’s common to have a fever right after surgery. Your doctor will give you instructions about when to call for a fever.
Inability to urinate or move your bowels
How might revision weight loss surgery affect my everyday life?
Revision weight loss surgery can get you back on track and give you a second start at taking control of your health. Your revision surgery is much more likely to be successful when you address the issues that led to the initial problem.
After revision surgery, you will need to continue the diet changes from your first surgery. This includes reducing portion size, eating smaller more frequent meals, and stopping at the first sign of fullness. You also need to meet your fluid requirements each day to avoid dehydration. Vitamin supplementation will continue as well. Your dietitian is a good resource as you recover and begin your new journey.
Maintain your relationships with your care team members. They can help you keep working on lifestyle habits and manage stress and emotions. Your goal is to reclaim your health and reap the benefits of weight loss surgery.