Revision surgery could give you a second or even a third chance
Most weight loss surgery goes smoothly and gives great results. Some patients, however, may have inadequate weight loss or have weight regain; or may have heartburn or acid reflux or difficulty swallowing, or even persistent vomiting after meals.
Revision surgery is designed to repair flaws in the prior surgery or convert it to a different type of procedure in order to improve weight loss or correct acid reflux or swallowing difficulty.
Before undergoing a revisional procedure, you will be carefully evaluated with a number of studies.
Sleeve to Gastric Bypass conversion
Converting a sleeve gastrectomy to a Roux-en-Y gastric bypass is the most common bariatric revision procedure. The common reasons for such a conversion are severe acid reflux and poor weight loss. This conversion has an excellent track record of curing acid reflux and results in excellent weight loss.
Sleeve to Loop duodenal switch conversion
This is a well established conversion procedure that is especially useful for patients who have excessive weight regain or have poorly controlled diabetes despite a sleeve gastrectomy. The loop duodenal switch is a robust procedure that can better withstand the injury caused by smoking or the use of non-steroidal anti-inflammatory medications, making it a useful option for those who may not be able to stop smoking or give up NSAIDs. This conversion is not helpful if acid reflux is also a problem.
Re-sleeve gastrectomy
There are some situations where it would be appropriate to ‘re-sleeve’ a prior sleeve gastrectomy. This is relatively uncommon. In situations where there is weight regain or poor weight loss and the original sleeve is significantly large or stretched, re-doing the sleeve gastrectomy to reduce the gastric pouch is a reasonable option providing there is no acid reflux. This is especially the case when the patient’s options are limited by a history of smoking or use of NSAIDs or there is a risk of poor compliance with taking vitamin supplements.
Lap band to sleeve or gastric bypass conversion
The lap band was a common procedure 10 to 15 years ago. About one out of three lap bands develop complications that require their removal. Simply removing the lap band alone invariably results in weight regain to levels prior to placing the lap band. For this reason, it is recommended that removal of the lap band be accompanied by the creation of either a sleeve gastrectomy or Roux-en-Y gastric bypass. In most circumstances, this conversion can be done at the same operation to remove the lap band.
Revsions of gastric bypass
Revisions of a gastric bypass could be challenging and without commensurate weight loss, Such revisions may be indicated where the gastric pouch is particularly dilated and or the Roux limb is short or where there is an abnormal communication with the ‘old’ remnant stomach (gastro-gastric fistula). The standard gastric pouch is 3-4cm long and excludes the gastric fundus, while the Roux limb is 150cm long.
In the absence of clearly identified anatomical deficiency of the gastric bypass, a revision will bring little value to the patient.