As bariatric surgeons, our goal is to improve the long-term outcomes for our post-bariatric surgery patients, including decreasing the need for a weight loss surgery revision. Bariatric surgery results in a physiologic reset within the body that helps patients lose weight and maintain that weight loss long term.
However, in some circumstances, a patient may regain a lot of their weight or have other complications that require a revision after bariatric surgery.
The surgery creates a metabolic response in your body to help with extreme weight loss. “Metabolic” refers to the biochemical processes involved in the body’s ability to convert food into energy, ultimately involved in the body’s normal functioning. The metabolic response that leads to weight loss will unfortunately not last without an overall lifestyle change.
A lot of patients are not educated on this pre-operatively, and they may start to slip into bad habits after their surgery if they assume the surgery itself will “fix” their weight. That is when we start talking about a weight loss surgery revision.
In our program, when patients are interested in a revision after weight loss surgery, we will put them on a 6-month weight regain program. This involves visits with a dietitian to get their diet back on track and visits with the bariatric psychologist to help them see through any emotional reasons why they might have gained too much weight.
We will also do some imaging, such as an endoscopy and radiographic imaging, to make sure the anatomy of your bariatric surgery is still intact.
Ultimately, we will try to do everything we can to help the patient lose the regained weight without surgery.
Depending on how much weight the patient has regained, this is not always possible. If we are not able to see a substantial jump in their weight loss, then we will begin to start talking about the various types of revisions you can have.
The most popular operation that we have seen over the last ten years is the gastric sleeve. The gastric sleeve is a bariatric procedure in which the surgeon will remove about 70 to 80% of the stomach, resulting in a smaller, banana-shaped stomach. Patients who have the gastric sleeve can expect to lose 65 to 75% of their excess weight, yet studies have found that patients 10+ years post-op will regain for an average excess weight loss of 50%.
The gastric sleeve is popular because it is an effective, fairly quick operation and, in some places, is being done as an outpatient procedure. The gastric sleeve will remain an effective operation as long as the patient’s diet stays in check. But unfortunately, that doesn’t always happen. With this particular operation, because we are not doing any small bowel bypass, patients will absorb everything they eat; therefore, they are more likely to experience regain after the gastric sleeve.
When a revision after the gastric sleeve is necessary, it can be done relatively quickly and safely. We can easily convert a gastric sleeve to a gastric bypass, a mini gastric bypass, a duodenal switch, a single anastomosis, or a SADI duodenal switch.
Bariatric revisions are a bit more complex when patients have had the gastric bypass or duodenal switch. Although weight regain is not as common with these procedures, it does happen, and revisions need to be considered in some cases.
A study found that the rate of revisions for patients who were 10+ years out from surgery were 26% for the band, 9.8% for the sleeve, and 4.9% for the gastric bypass.
There have been a number of different procedures that have come along to try and squeeze a little bit more weight loss. Yet, none of them are great options or very easy to do. The types of procedures for a revision of the gastric bypass are the transoral outlet reduction, lengthening of the roux limb, the addition of a gastric band, or conversion to a duodenal switch.
We try to do everything we can with our patients pre-operatively to help them avoid going back to the operating room, but when those things don’t work, we can reverse the gastric bypass. In our practice, we do a fair number of gastric bypass reversals to a duodenal switch for patients who have had significant weight regain.
Follow-up is one of the most influential factors in a patient’s long-term weight loss success. Patients who regularly follow up with the bariatric surgery and care team are two times more likely to experience better results and more sustained weight loss. Similarly, several studies show that ongoing interaction with your bariatric surgeon or support groups significantly improves weight maintenance and long-term success.
Yet when they need to have a revision after weight loss surgery, you want to visit a surgeon who is experienced in performing bariatric revisions. Schedule your appointment today and get started on your weight loss journey.
This article was originally published on the Bariatric Centers of America website.
